Democratic U.S. Senate candidate Heidi Heitkamp sees room for improvement in the nation's healthcare law and in the response to challenges in oil country.
Heitkamp spoke to residents and staff at ManorCare Health Services in Minot following a facility tour Tuesday. She is running against Congressman Rick Berg, R-N.D., for the Senate seat to be vacated by Sen. Kent Conrad, D-N.D.
She said she supports strategies to get more people on health insurance. But she said there must be more emphasis in national healthcare reform on cost efficiency. A requirement that a person be hospitalized for three days to qualify for Medicare coverage for rehabilitation in a nursing home is foolish, she said.
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Heidi Heitkamp, left, Democratic candidate for U.S. Senate grips the hand of ManorCare resident Mary Bachmeier in a show of appreciation of Bachmeier’s courage and family devotion. Heitkamp visited with residents at the nursing home Tuesday.
"There might historically have been a reason for it but we shouldn't be perpetuating rules that make no sense. What I would like to see is a list of things that providers say can save us money in the long run," she said.
ManorCare treats primarily patients needing rehabilitation after hospital stays before returning home.
Mitch Leupp, ManorCare administrator in Minot, said in a prepared statement that the post-acute care system relies on a payment structure that is inefficient in its spending and doesn't do enough to help the nursing home maintain its quality improvements.
"It will be essential for our Washington leaders to help sustain Medicare funding levels in a manner than ensures the ongoing stability of our sector," he said.
"There's a lot of fixes that need to be made to health care reform, but the reason I would not vote to repeal health care reform is I would not want to lose the Frontier Amendment," Heitkamp said.
The Frontier Amendment provides $650 million to North Dakota hospitals to offset Medicare reimbursements in less populated states that are low compared to other states. That money likely will be permanently lost if the provision is repealed, Heitkamp said.
Heitkamp, who is married to a physician, opposes repeal of the healthcare law. Berg, also married to a physician, has voted to repeal the law, often called Obamacare.
Heitkamp doesn't like referring to the law's requirement that everyone have insurance as a mandate.
"It presumes that people don't buy health insurance because they don't want it. People don't buy health insurance because they can't afford it. We need to make it more affordable," she said.
Heitkamp called it a mistake that the state Legislature rejected a Republican legislator's plan that would have created a state exchange, where people could shop for an affordable insurance plan. State exchanges are part of the federal healthcare law. Heitkamp said the exchanges will increase competition and bring premiums down.
A nurse practitioner mentioned to Heitkamp how complicated multiple plans can be when it comes to choosing the best one, having had that experience with patients and Medicare's multiple Part D drug options.
Heitkamp agreed that the health system is too complicated, which hinders patients from making the best healthcare choices. The cost of services has been so obscured in the billing and reimbursement process that patients have been divorced from payments and have no incentive to reduce costs, she added.
"We need to be part of the solution by being responsible consumers," she said. "We need to get people educated on what things cost because we cannot afford 20 cents of every dollar in this economy in this country going to health-care related expenses. It's almost twice as much as the next most industrialized nation."
Research projects are that health care costs could reach 20 cents of every dollar by 2020.
Additionally, Heitkamp spoke of the need for affordable housing in Minot and western North Dakota so that the elderly and other people with long-time community ties don't have to leave their towns. She said a share of oil royalties on federal land, which totalled $318 million in 2011, should come back to North Dakota to assist with infrastructure development and housing.
If elected, Heitkamp said, she would establish state offices in oil-patch towns such as Dickinson and Williston, where there are no congressional offices now.