As part of our occasional series of interviews with members of Congress, MedPage Today News Editor Joyce Frieden sat down with Rep. Blake Farenthold (R-Texas) last week at his office to discuss his views on repealing the Affordable Care Act, high drug prices, and other healthcare issues. Farenthold, who was initially backed by Tea Party Republicans although he does not always vote with them, is vice chairman of the House Oversight & Government Reform Subcommittee on Information Technology and is also a member of the House Judiciary Committee, where he serves as vice-chairman of the Subcommittee on Regulatory Reform, Commercial and Antitrust Law.
For Rep. Blake Farenthold (R-Texas), repealing the ACA isn't just a goal: it's a mission.
The ACA, or Obamacare, as Republicans like to call it, "was the reason I ran for Congress in the first place," Farenthold, now in his third term, told MedPage Today. "I didn't like the fact that our previous Congressman [Solomon Ortiz, a Democrat] was such an adamant supporter of it. If you were to list the top five reasons I'm here, that would be one of them."
"We've got to get back to something that's actually affordable," he said of the law. Farenthold said he generally supports most of the reform ideas that came out of the Republican Study Committee -- such as making insurance portable and allowing plans to sell across state lines -- with a few exceptions.
Comprehensive Repeal
The bulk of what Republicans have been talking about in terms of replacing Obamacare "have been bullet points" rather than a comprehensive repeal plan, Farenthold said. He said he agrees with House Speaker Paul Ryan's (R-Wisc.) goal to see a replacement for the ACA passed out of the House this year. "To me that's the top priority for getting done this year. It's really important to show the American people there's an alternative."
The Congressman, a graduate of the University of Texas at Austin and St. Mary's University School of Law, did note that there are a couple of pieces of the law that he likes, including its focus on strengthening community health centers. "I have seen a lot of success with community health centers," he said. "We've got to find a way to keep them working. They really serve the underserved."
He also wants to maintain much of the protection against discrimination given in the law to people with pre-existing medical conditions. "There is going to have to be some solution there," Farenthold said. "[I see it] ending up looking more like a risk pool," similar to the way auto insurance works.
Bigger Supply of Providers
Increasing the supply of healthcare providers is one thing he said isn't discussed often enough in Republican alternatives to the ACA. This could be done by increasing residency programs -- and reallocating them to where the need is -- and helping with the cost of college and medical school, Farenthold said.
"There are opportunities with student loan repayment and other incentives to drive people to particular fields [in healthcare] in the government's interest," said Farenthold, citing as an example the Clay-Hunt Act passed by Congress; one provision of that law reduces medical school debt for clinicians providing mental healthcare for veterans. "Generally I think the market will sort it out," he added.
Healthcare leaders also need to look at the scope of practice for nonphysician providers, he continued. "I do think we need to look at scope of practice and see what [duties] can be pushed down to less trained folks," he said. "I'm not sure you need to see a doctor for a runny nose. You've got to have increased use of nurse practitioners and physician assistants to take the load off."
In terms of a bigger change, the Congressman noted that the U.S. currently has four different healthcare delivery systems: Medicare, Medicaid, the Department of Veterans Affairs (VA), and private insurance. "Do we need that many concurrent delivery systems?" he asked. "What if we said we were going to shut down the VA and roll it into something like Medicare?"
Reimbursement for VA patients could be at 110% of Medicare, so veterans "would move to the top of the line where they belong," he said. There could still be a medical subspecialty focused on veterans' healthcare, but it would be outside of the VA itself, he said. Or, rather than rolling the system into Medicare, it could be collapsed into private insurance. Either way, the U.S. could "completely do away with a government bureaucracy."
Skin in the Game
On the consumer side, "I'd like to see everybody skin in the game" when it comes to paying for healthcare, said Farenthold. "Even if you are uninsured or underinsured, you ought to pay $5 -- everybody should pay something."
Farenthold said he learned a lesson about the value of being monetarily invested in a service when he was working as a computer system developer. "Every quarter we gave away a free website to a charity," he explained. 'They were the worst clients -- they never made a deadline, they were just very hard to work with."
Then the company switched from giving away the websites for free to giving them at a 75% discount. "All of a sudden [the charity clients] met their deadlines and were a joy to work with. I came to learn that something you get for free has no value to you, and I think that translates to healthcare. If you go in and get your healthcare basically for free, there's no incentive to take care of yourself or follow the doctor's instructions."
Farenthold also got experience with electronic health records (EHRs) while running his own computer consulting business. "We wrote a medical records-type program for a group of urgent care clinics. We actually developed a fairly decent system for under $100,000, customized to their needs," he said. "But HIPAA was getting in our way and we couldn't provide the physical security needed, so we ended up bailing out."
"Why don't we come up with an EHR that fits the way doctors practice, whether that's them dictating their notes and somebody in India putting them in the computer [or something else]?" he said. "The degree of micro-regulation of how that's done is actually having an adverse effect. We need good standards to get good data, but I think we're focusing on the front-end standards instead of back-end standards."
Medical liability reform is another area of interest for Farenthold, a lawyer, who noted that his state was a leader is passing tort reform legislation. "You've got to strike the right balance where victims of true negligence are compensated but not where [a physician] is sued and ends up settling because of the potential high liability and time and money it takes to defend a lawsuit ... My law school professor once told me, 'You can beat the rap, but you can't beat the ride.'"
High drug prices are another concern. "Pharma and I don't get along well because I am an advocate for patent reform and they're not," he said. "I would also streamline the process for getting generics approved." The latter is especially important "because a [brand-name] company could buy up generic competitors so that they're the only ones making that drug, so I think there's a real issue there."
Today's high drug prices are due in part to FDA and part to "bad actors" in the pharmaceutical industry, he continued, adding, "I told them in the [recent House hearing on high drug prices] -- or I meant to if I didn't -- 'If you don't behave yourself and do the right thing, the government is going to come in and try to make you do it, and you're not going to like what the government does.'"
Farenthold would also like to see more transparency in healthcare pricing. "If I bought groceries the way I bought healthcare, it would be steak and lobster every day" because I only pay the deductible and don't worry about the actual price, he said. "And it's worse in medicine because you don't know the price ... People need to have more say in their healthcare and there needs to be more transparency in pricing."