Smart Talk

Smart Talk is a daily, live, interactive program featuring conversations with newsmakers and experts in a variety of fields and exploring a wide range of issues and ideas, including the economy, politics, health care, education, culture, and the environment.  Smart Talk airs live every week day at 9 a.m. on WITF’s 89.5 and 93.3.

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Host: Scott LaMar

ACA Repeal and Replacement in PA / Addressing the Opioid Crisis

Written by Rich Copeland - Producer, WITF's Smart Talk | Mar 17, 2017 8:00 PM
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What to look for on Smart Talk Monday, March 20th, 2017:

Two weeks ago, House Republicans unveiled their plan to repeal and replace the Affordable Care Act.  The plan reorganizes the Medicaid expansion program for states, shifts premium support from subsidies to tax credits and places penalties on having gaps in coverage.  It has drawn criticism from the right as not doing enough to repeal 'Obamacare' and from the left for eviscerating a program Democrats see as successfully providing healthcare access to more Americans.

The Pennsylvania Health Access Network is a regional organization committed to providing affordable health care access to all Pennsylvanians through education, advocacy and legislative lobbying.  PHAN's assessment of the replacement bill was not positive. 

"The latest GOP plan to repeal the ACA would put the health and financial security of low and moderate income Pennsylvanians at risk" said PHAN Executive Director Antoinette Krause.  "It would effectively end Medicaid Expansion by repealing the extra funding Pennsylvania receives to cover hard working families and shift costs onto our state budget. Nearly 1 in 5 Pennsylvanians rely on these programs, 43% are children, and 32% are seniors and individuals with disabilities."

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Antoinette Kraus - Executive Director, Pennsylvania Health Access Network / Teresa Miller - Pennsylvania Insurance Commissioner

Kraus joins us on Smart Talk to parse out PHAN's analysis of the replacement bill and how the GOP rewrite of the ACA could impact Pennsylvanians.  Pennsylvania Insurance Commissioner Teresa Miller also joins the conversation to discuss an column she penned over the weekend outlining the negative impacts of the proposal.

Also, governments from the municipalities to the states are desperately looking for ways to address to opioid crisis that is permeating every community across America.  The town of Washington Court House, Ohio, has adopted the policy of criminally charging those who are resuscitated following an overdose.  Those charges would be dropped when that person successfully completes treatment. 

The purpose isn't punitive; its to identify and provide services for thosewho are using drugs and overdose.  Critics fear it will discourage others from calling for help in the event of an overdose.

Lancaster County District Attorney Craig Stedman thinks it might be a good policy to enact locally.  In speaking with Lancaster Online, the DA made his case: "We are not going to enforce our way out of things, but there is a lot of merit to having the potential of charges to force people to get help rather than end up in the morgue."

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Lancaster County District Attorney Craig Stedman

District Attorney Stedman joins Smart talk to discuss options for dealing with the region's opioid crisis.


- Being an insurance agent for 25+ years, I have written individual health insurance policies--this year without compensation as carriers have not paid any commission on any new policies! However, I have seen tax subsidies for many folks who need the premium help and cannot afford the monthly $600+/person cost.

Any additional response from the Insurance Commissioner on the sustainability of PPACA related to its funding and costs...if we do nothing and make NO changes?!? Some changes are definitely needed! Has anyone addressed the rising costs first...overall tort reform, pay more for certain pre-existing conditions...?!? My own personal coverage went from just under $800 monthly 3 years ago with a $9,000 family deductible and additional $12,000 coinsurance to over $1,600 per month with a $12,700 deductible and over $13,000 additional coinsurance!  Has anyone considered Medicare down to age 18 and what the costs might be?                                                                          - Mike, Schaefferstown

- The Trump administration warns us not to trust the CBO's estimates related to TrumpCare costs .. to taxpayers and recipients .. and the number of people that will lose coverage.

With so many variables these are understandably difficult "things" to estimate and project.

The cost to build a wall across the US border is a little more concrete (HaHa!) and seemingly easier to estimate .. regardless of who pays for it.  Given this and how "off" the Trump and GOP cost estimates to build this wall have been .. why should anyone trust their numbers relative to healthcare?

Healthcare is very complicated .. who knew!?!                             - Jeff

I am a Registered Nurse working in community health and am a member of the American Psychiatric Nurses Association (APNA)

The APNA is clearly stating that this bill would be disastrous for those requiring mental health services. 

They state "An estimated 11 million Americans with incomes below 138 percent of the federal poverty level currently have coverage for mental health and substance use disorders, provided at parity with coverage for general medical services through Medicaid expansion plans. The current bill, called the American Health Care Act, would remove the requirement that Medicaid benchmark plans cover essential health benefits, which include mental health, substance use and behavioral health services."  

There are two organizations in Pennsylvania working on this.

House Bill 1688 is a Medicare For All bill.  Listeners can learn more about this by going to

The economic impact on Pennsylvania would be beneficial and one can learn more by looking at the savings calculators on the website for individuals and businesses.

I encourage listeners and legislators to learn more by perusing the website.

Single Payer makes economic and ethical sense as it would decrease municipal taxes and every Pennsylvania would have health care coverage.                        - Melissa

- Part of the reason why across state competition is because population density is not consistent across states and provider density is different across states; those things contribute to the cost of providing care and the ability of companies to negotiate contracts and utilize networks to provide insurance.

 People in Idaho cannot access doctors and hospitals in Pennsylvania and the companies in PA cannot properly calculate the cost of providing health insurance to people in Idaho.

 One possible side effect could be that the usual insurance companies in one state will be forced out of business by improperly calculated rates by an out of state insurance company; the result would be that the out of state plan will raise its rates AFTER the other company goes out of business.

 There are many other reasons why across state competition isn't really possible but I feel it is not being discussed in a way that makes it make sense to regular people.      - name withheld

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