Key Republican in Health Law's Fate Hails From a State That Embraced It - New York Times
As a former chairman of the committee responsible for electing Republicans to the House, Mr. Walden knows the politics of health care as well as anyone. But in his new role, he must reconcile the political goals of his party, which is committed to repealing the 2010 health law, and the interests of his state, where officials say the law has been a big success. In 2010, nearly one in five Oregonians lacked health coverage. Today, state officials say, 95 percent of Oregonians have coverage.
Since Oregon expanded eligibility for Medicaid under the health law in 2014, enrollment has increased more than 65 percent. Nearly one-fourth of the state’s four million residents are now on Medicaid.
In Mr. Walden’s district, the percentages are even higher. In some of his rural counties, more than one-third of the people are on Medicaid. President Trump easily carried those counties. Mr. Walden won a 10th term in the fall with 72 percent of the vote and was victorious in every one of the 20 counties in his district, which is about the size of New York, New Jersey and Connecticut combined.
But that does not guarantee that voters here endorse all the policies of his party. Hospitals are among the leading supporters and beneficiaries of Affordable Care Act. Mr. Walden was a trustee of a 25-bed hospital in his hometown, Hood River.
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Todd Meier for The New York Times
“We are very worried about what ‘repeal and replace’ might look like,” said David Underriner, who supervises the hospital, Providence Hood River Memorial, as Oregon’s regional chief executive for Providence Health and Services, the large Roman Catholic system that owns it.
Mr. Walden grew up on a cherry orchard, worked at radio stations owned by his family, and followed his father into the State Legislature. The political shifts that have turned all three Pacific Coast states reliably Democratic have begun to creep into a few of the conservative inland parts of Oregon. Hood River County, long known for fruit farming, windsurfing and the spectacular scenery of the Columbia River Gorge, has lately become a center for the production of surveillance drones, leading to an influx of software engineers, technology entrepreneurs and other young professionals.
Mr. Walden’s margin of victory in November in the county where he lives was just five votes — out of more than 10,590 cast.
“It’s just a little left-leaning,” Mr. Walden allowed. “It didn’t used to be that way.”
Unlike many Republicans in Congress, Mr. Walden has worked productively with Democrats. “I’m a problem solver,” he said in an interview after a town hall-style meeting here near the Idaho border. “I’m not an ideologue. I want to fix things.”
And in Oregon, some Democrats and health-law supporters are glad Mr. Walden is in his position.
“I’ve known Greg a long time,” said Andrew S. Davidson, the president and chief executive of the Oregon Association of Hospitals and Health Systems. “He is not interested in upending the progress we have made in this state.”
Representative Kurt Schrader, a Democrat whose district includes the southern suburbs of Portland and the capital, Salem, predicted Mr. Walden “will be mindful of the implications of any legislation for our state, which is leading the nation in the transformation of health care.”
Unlike Mr. Walden, Oregon has embraced the Affordable Care Act. State officials say many of the changes proposed by congressional Republicans, including a rollback of federal funds for the expansion of Medicaid, would reverse much of the progress they have made.
Oregon has a history of health care innovation that predates the Affordable Care Act. In the early 1990s, it ranked medical procedures according to their costs and benefits, and Medicaid uses this list to decide which services to cover. Under a federal waiver granted in 2012, Oregon treats Medicaid beneficiaries through 16 “coordinated care organizations,” which are governed by local citizen councils. The organizations have slowed the growth of health spending and improved the health of Medicaid beneficiaries, according to performance data collected by the state.
Even as he writes legislation to unwind the Affordable Care Act, Mr. Walden takes pride in Oregon’s success under the law.
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Todd Meier for The New York Times
“Our state of Oregon has had quite a bit of innovation over the years,” Mr. Walden said. “We’ve got the coordinated care organizations in place that have actually brought better health care outcomes at lower cost. There are great ideas out there among the states, but right now, they have to come back and beg permission from a federal bureaucrat to be able to do much of anything innovative.”
When Mr. Walden first ran for Congress in 1998, conservatives called him too liberal. Since then, he has taken more conservative positions, and the party has moved to the right.
“Times change,” he said. “You get a terrorist attack. You have different administrations come and go. Culture changes. My bedrock principles have stayed the same. I favor more local decision-making and less Washington decision-making.”
Mr. Walden never wavered in his opposition to the Affordable Care Act. On the day the House passed the bill in March 2010, he and other Republicans stood on the Capitol balcony, before a throng of protesters, and held up signs with handwritten letters that spelled out their message: “Kill the Bill.”
A month later, on the House floor, Mr. Walden announced the goal that he hopes soon to achieve, using words that became the mantra for Republicans: “We need to repeal and replace this law.”
Over the last four years, Mr. Walden has been a genial attack dog for Republicans. As chairman of the National Republican Congressional Committee, he averted a political blood bath for his party and secured the election of Republicans in many districts that voted for Hillary Clinton in the presidential election. Many of those House campaigns revolved around attacks on the health law that he is now charged with replacing.
Oregon tried to run its own health insurance exchange, but had a disastrous experience and decided, after a year, to use the federal website, HealthCare.gov. The state has a competitive insurance market, but consumers have still seen substantial increases in prices, with the average premium for a popular benchmark plan on the exchange rising 27 percent this year and more than 20 percent last year, according to the federal government. (Subsidies cushion the impact for most consumers.)
“Medicaid did better than expected, and subsidized commercial insurance did worse,” said Dennis E. Burke, the president of the Good Shepherd Health Care System in Hermiston, Ore. “We have seen steep increases in premiums for commercial insurers, and as a result healthy people have dropped out.”
People newly covered under the health law “proudly present an insurance card,” Mr. Burke said, but in many cases their plans have high deductibles, and the hospital has difficulty collecting the patient’s share of the bill.
But Mr. Burke is not so quick as his congressman, Mr. Walden, to seek repeal.
“I think it could be fixed,” Mr. Burke said. “We need more of a retooling.”
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