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WASHINGTON, D.C. — Rep. Raul Ruiz is the only Latino physician out of 15 doctors in Congress. Also a member of the House Committee on Energy and Commerce, which has jurisdiction over health issues, he has been actively involved in the debate over the GOP health care plan to replace Obamacare, officially named the Affordable Care Act.
Ruiz, a California Democrat, worked as an emergency room doctor, so he is accustomed to long hours and executing triage procedures,which have seemed needed regarding the health plan that has even drawn opposition within the GOP.
Ruiz worked as a doctor in his hometown of Coachella, California., a region that is medically underserved and where many residents couldn’t afford care. He has spent hours in committee working on the bill Republicans drafted, but has been unhappy with what the GOP is offering.
Latinos are 40 percent of all uninsured Americans, although the number of Latinos without insurance has dropped with Obamacare.
Ruiz spoke to NBC Latino about the bill that could go to a vote this week. There has been some work to improve the bill that emerged from committee since the interview.
NBC Latino: You clearly support Obamacare, but there have been some gripes in the Latino community and others about larger deductibles and out-of-pocket costs and higher premiums. Even if you don’t like the GOP health care plan, isn’t it a good thing for Congress to be reworking Obamacare considering those cost increases?
Ruiz: The Affordable Care Act was a giant step in the right direction, however, it is imperfect and needs to be improved. Premiums and deductibles are up because health care costs are out of control. The ACA decreased the rise of premiums and deductibles, nonetheless we have to reduce overall cost of health and medicine.
This Republican plan will do the opposite. It will make premiums and deductibles go up even higher, 24 million will be uninsured — there will be less coverage, there will be less protection because Medicaid insurance will not ensure essential benefits, per capita block granting will reduce Medicaid eligibility, states will reduce what they are willing to pay for — and there will be reduced reimbursement rates to hospitals and doctors for patients on Medicaid...There’s nothing to reduce health care costs and out-of-pocket payments.
They have a lot of tax shelters and tax credits that if you are wealthy enough to save money into a health saving account or any type of supplemental accounts then you will be able to get a tax credit...It’s important to remember over 80 percent of American families have said they could not find $1,000 if they were forced to pay an emergency bill. Most Americans don’t have enough to be putting money aside for any future cost on top of what they have to pay for in premiums and deductibles if they do have health insurance.
NBC Latino: Four million more Latinos got insurance through Obamacare, but there are still many Latinos uninsured. Why should we continue the Affordable Care Act?
Ruiz: We have seen one of the largest improvements in covering Latinos with health insurance under the Affordable Care Act in our nation’s history because of the support through the Medicaid expansion and the subsidies for the premiums for hard working families.
One of the solutions for decreasing premiums for all families is to enroll more Latinos in health insurance. (But) Republicans have sabotaged the exchanges and we know that many states have not wanted to participate in enrolling more people; therefore the health risk pools of insurance markets were manipulated negatively by their efforts and that is one of the reasons why premiums and deductibles are higher for everybody.
The way we reduce that or decrease premiums and deductibles is to have a concerted effort to motivate and encourage people to enroll in health insurance.
I’m an emergency medical doctor. I've taken care of people who have had unexpected health issues, they had car accidents or serious diseases. Everyone will get sick. I’ve taken care of uninsured patients, no one told me they were uninsured because of choice. They tell me they are uninsured because they can’t afford health insurance. Every doctor wants their patient to have health insurance.
NBC Latino: There has been discussion that the GOP backed plan would dismantle Medicaid. How would that affect Latinos?
Ruiz: Latinos rely on Medicaid proportionally more than many other groups. Medicaid provides not only care for a low or moderate income individual, but also provides nursing home care for the elderly and disabled populations.
This bill will fundamentally transform the Medicaid program in a way that will drastically decrease our responsibility to care for the least among us. Instead of being responsible to provide a percent of health care needs for these population groups, it is going to ration care to these individuals and essentially cut eligibility of so many millions of individuals now on Medicaid, leaving them without health insurance.
The way they achieve this is through the per capita block grant. They give states a certain amount of money. But states could face higher (unexpected) health costs – Florida had Zika – or some public health crisis...say an outbreak of the H1N1 flu epidemic. The money the federal government gives the state is not going to cover the true cost of care, so the state is going to have to cut costs.
So they are going to cut or decrease (Medicaid) eligibility, cut people, meaning there will be more uninsured and uncompensated care; decide not to pay for expensive cancer treatment or certain illnesses. They’re not going to want to cover say, mental health services and will decrease reimbursement rates to physicians and hospitals.
Anything would be eligible now to be on the chopping block. That means the hardworking middle-class family that is barely making ends meet and has assistance to take care of grandmother in a nursing home or long-term stay facility will now have to take on those costs inside their own home and out of their own pocket.
NBC Latino: Do you think when all the legislating is done we will have an Obamacare replacement or a tweaked Obamacare?
I think President (Donald) Trump and Speaker (Paul) Ryan are stubborn enough to push this disastrous bill through the House and Senate to become law. There is a glimmer of hope that 24 Republicans may vote against this bill in order for it not to pass in the House and there may be modifications. I’m concerned some Republicans are voting against against it because (they think) there are not enough cuts to the subsidies and the other popular provisions of the Affordable Care Act. I think there will be a more difficult time passing it in the Senate than the House.
NBC Latino: There was a lot of work put into enrolling Latinos in Obamacare...If Obamacare is replaced, do you think Latinos will still seek out insurance or have Latinos come to expect insurance and there could be blowback if they are cut off?
Ruiz: We aggressively did a covered California enrollment outreach initiative in my district and you cannot apply methods to enroll people in health insurance and simply translate the language from English to Spanish and expect similar results because the Latino community has a different culture, different social networks, receives its news through different venues and has different methods of having social support systems.
There needs to be more outreach and resources spent in the Spanish-language media in the Latino community and it has to be supported with an aggressive grassroots door-to-door church, youth sports network to explain and walk families through it.
NBC Latino: Tell me about the negotiations. How ugly was it? Did you find any agreement? You clearly are very opposed to what came out.
Ruiz: It was very clear that given that they rushed the bill through committee markup only after 48 hours of revealing it to everyone on the Democratic side that they had no true intention of negotiating any improvements or amendments to the bill. All of our amendments were voted down by party line. None of the Republicans thought there needed to be any change to this disastrous bill. Through discussion, we found there was some common ground. There was (some) agreement a per cap block grant would not cover sufficiently a public health scare or disaster that a state would experience.
NBC Latino: How does the bill treat community health centers that many lower income people and immigrants depend on for health care?
Ruiz: This bill, specifically for ideological, extreme ideological reasons, will completely defund Planned Parenthood and in order to try to politically message themselves out of this issue, the GOP will increase the amount of money to Federal Qualified Health Centers (FQHC) on top of what they have received through Affordable Care Act. There’s no guarantee they will continue funding them (in later years). It will have to be reauthorized and be re-appropriated.
Coming from a very underserved community that amount of funding will not cover the needed infrastructure and capacity in FQHC's (to make up for) the void that Planned Parenthood would leave behind in communities.
In Eastern Coachella, we have a physician shortage, there’s one full time equivalent position for 9,000 residents. The medically recommended number in the U.S. is one per 2,000 residents. In medically underserved areas it is one per 3,500 … Removing the Planned Parenthood general medicine public health services is going to leave a bigger burden and need that the slight increase in funding for FQHC's will not cover.
NBC News: But Republicans tell us their plan will give Americans more choice, more options for doctors.
Ruiz: You don’t have a choice when there is no doctor...The (GOP argument) is a severe manipulative misdiagnosis for personal partisan gain. Doctors prefer their patients to have health insurance. That’s why the American Medical Association, American College of Physicians are all opposed to the extreme Republican AHA bill. You will never find a physician who says they prefer their patient to be uninsured.
We have a physician shortage crisis in the U.S. and this bill does nothing to address that. If they decrease reimbursements to providers and hospitals because of the rationed Medicaid block grant, you will have physicians less likely able to practice in underserved rural areas and they will have fewer options of practicing in certain communities they want to practice in and that is a direct problem from the Republicans' health care bill.
We need to address the physician shortage with a pipeline program, a future physician leaders program, increase (general medicine) training and residency in underserved and rural areas, get more doctors to stay where they are trained. This bill does nothing to address that.
NBC Latino: So is dealing with this bill more difficult than surgery … than the emergency room work you used to do?
Ruiz: With every word of a health care bill I see a different face of a patient. With everything I do, I keep them in mind because ultimately these (GOP) policies will effect human beings in a negative way.