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Health Care and Anti-Poverty Declaration 2017

Preamble-- Given that the American Health Care Act (AHCA) will be voted on in the House of
Representatives in the coming week, and possibly in the Senate not long after that, we the students of the
Quaker Advocacy class at Carolina Friends School are concerned with the integrity of this country's social
programs and anti-poverty initiatives. We recognise that poverty in the United States is caused by several
contributing factors, including a stagnant federal minimum wage, lack of access to quality public education,
and a bloated and overly expensive health care system. We believe that the AHCA will exacerbate these
issues and put already struggling families in even more difficult positions. Furthermore, we believe that the
spending caps proposed in the AHCA lay the groundwork to undermine other social programs like SNAP.
To this end, we have created, and come to consensus on, this document regarding access to health care in
the United States and anti-poverty initiatives.

Strengthen Medicaid-- We recognize that nearly 70 million people benefit from Medicaid. We oppose
legislation that would shift Medicaid to being a block-grant program. The block-grant funding of Medicaid
proposed in the AHCA would provide states with a set amount of funding. States that spend more than their
grant will have to pay the difference out of the state budget. This model doesn't allow for Medicaid funding
to accommodate economic downturn, health outbreaks, changes in health care costs, or changes in
demographic trends. Block grants could leave millions of people, mostly impoverished, disabled, vulnerable
populations, uninsured and unable to access the health care they need and deserve. As we've seen in the
past, block grants to the states have proven ineffective in mitigating the negative effects of poverty.

The AHCA will hurt North Carolina-- Changes to tax credits under the AHCA will cost older, rural NC
residents thousands each year. Under the ACA, tax credits are determined according to the local cost of
insurance, which is very important for rural North Carolinians because insurance is typically more
expensive in rural areas. Under the American Health Care Act, tax credits are determined according to a
national rate irrespective of higher rural costs. In Wayne county, and other rural areas, individuals
could see their costs increase by an estimated eleven million dollars. In addition, the AHCA removes
protections for older North Carolinians and allows insurers to charge older North Carolinians five times as
much as younger enrollees. As a result, premiums for older, rural North Carolinians will be much higher
and the subsidy much lower, making insurance unaffordable for thousands of North Carolinians. The AHCA
will continue to leave hundreds of thousands of North Carolina citizens uninsured and unable to afford
medical care. The ACA specifically allocated funds to provide affordable health insurance to 500,000 North
Carolinians who make too much to qualify for Medicaid, but too little to afford private insurance. The
Medicaid expansion made possible through the ACA should be adopted in North Carolina.

Retain SNAP-- 45 million low-income people, half of whom are children, receive food assistance through
programs like SNAP. Two thirds of these beneficiaries are poor families with children, seniors, and people
with disabilities. We believe that the program should be protected and oppose any future cuts to this
program. Currently, SNAP only finances people for an average of nine months and gives them around
$1.40 per person per meal. This amount should be increased. SNAP also helps boost the economy, with
each dollar given in benefits contributing $1.73 in return to the economy. SNAP is also extremely effective,
with under a 4 percent error rate, allowing disadvantaged, impoverished groups to provide a basic human
necessity for their families.
Change the Role of Government in Health Care-- One of the leading causes of excessive U.S. health
care costs is the governments reluctance to leverage its influence. We believe that our government should
negotiate reasonable prices with drug companies, hospitals, and other health care entities. Health care is
an inelastic demand: sick people will pay whatever cost, reasonable or excessive, to restore themselves to
health. Therefore, we believe that health care should not be subject to the forces of market-based supply
and demand. We believe that government-negotiated prices will likewise decrease excessive administrative
costs arising from the reimbursement arms-race between insurers, drug companies, hospitals, and health
care providers. Reducing the overall cost of health care would lessen the economic burden on individuals
as well as taxpayers and the federal government.

Greater Transparency-- We believe that increased transparency in all health care sectors could help to
rein in prices and improve quality of care. Data related to relative cost, quality, necessity, and customer
experience should be publicly available. Toward this end, we should improve data warehousing and create
standard measurements and regular reporting practices for cost and quality. These measures would
empower doctors and patients to compare medical costs, quality measures, and patient experience, as well
as select cost-effective procedures. Greater transparency will lead to a more effective system overall. We
realize that increased transparency could lead to a system in which private entities use data to hyperinflate
prices in communities in need; therefore, we ask legislators to consider ways to curb companies from using
data to extort people in need.

Change our Priority from Profit to Care-- We recognize that the current health care system is largely
motivated by profit, rather than providing patients with quality care. As a class, we believe that this
motivation is fundamentally immoral, especially to those who are at a financial disadvantage. The
fee-for-service system gives health care professionals an opportunity to overlook the specific needs of a
patient, and opt to perform as many services as possible. A patient enters into a trusting relationship with
medical professionals in hopes that they will prioritize their wellbeing. Manipulating the patient, or their
insurer, to pay as much as possible for services is immoral, inefficient, and drives up costs for everyone.
We believe that we should move away from the current fee-for-service reimbursement model. This
reimbursement structure rewards health care providers for the volume of services they administer rather
than delivering successful care. We therefore request that the U.S. investigate alternative reimbursement
models, such as bundled, capitation, and value-based care. Adequate access to healthcare has proven to
reduce long-term healthcare costs.

Health Care is a Human Right-- We believe that health care is a human right and should be provided to
all people in the United States. Many citizens forgo health insurance because of its cost, despite its
necessity. Excessive health care costs are due to multiple factors including the financial burden of the
uninsured, ineffective pricing structures, and special interests. One fact is clear, though: our current system
is bankrupting our country and is insufficient to meet our needs.

Molly Bahr Amy Hansen Lauren Boyle Karina Heyward-Rotimi

Samuel Chilton Nola Bea Kim Mayer Matthew Costello Mlana Lore
Phoebe Dodge Jason Manning Eli Eichner Ian Marks
Soren Emerson Genna McDermed Henry Spuria Kevin Pignone
Rose Fisher Shelby Sendlinger Ian Gilmore-Cronin Gabi Ruvo
Andre Maillard