August 28, 2018

The 4 ways Sen. John McCain changed health care (and 2 more ways he tried)

Daily Briefing

    Sen. John McCain (R-Ariz.), a two-time Republican presidential candidate and six-term senator known for his bipartisan deal-making on issues ranging from campaign finance reform to health care, died on Saturday after a battle with brain cancer.

    McCain, who was 81 years old, was diagnosed in 2017 with a glioblastoma, an aggressive brain tumor that can be difficult if not impossible to treat, according to the Mayo Clinic. McCain began treatment for his condition in July 2017.

    On Friday, his family announced that McCain would discontinue treatment, saying "[T]he progress of disease and the inexorable advance of age render their verdict."

    McCain's health care legacy

    McCain was a decorated Navy pilot and prisoner of war in Vietnam who spent his more than 30-year congressional career championing the military and veterans. But he also leaves behind a health care legacy, which Kaiser Health News' Emmarie Huetteman writes was "seemingly driven less by his interest in health care policy than his disdain for bullies trampling the 'little guy.'"

    In particular, four key stances help illustrate how McCain reshaped U.S. health care policy:

    1. In July 2017, McCain cast a cinematic "thumbs down" on the GOP health reform bill: McCain was an outspoken critic of the Affordable Care Act (ACA), which he felt did not adequately address the health care system's growing costs. But last July, just weeks after undergoing surgery to remove his brain tumor, McCain in a late evening vote famously walked into the Senate's chamber, stood before Senate Majority Leader Mitch McConnell (R-Ky.) and cast a thumbs-down vote—joining Republican Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska) in defeating the GOP's "skinny repeal" bill. McCain in his memoirs said his goal was not to "save" the ACA but rather to urge his colleagues to aim higher. In a July floor speech he said, "Why don't we try the old way of legislating in the Senate, the way our rules and customs encourage us to act?"

    2. Despite his GOP colleagues' urging, McCain held fast against ACA repeal: McCain once again proved an immovable hurdle to the GOP's repeal-and-replace efforts in September 2017, when he said he would not support a bill authored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.). McCain said, "I would consider supporting legislation similar to that offered by my friends Sens. Graham and Cassidy were it the product of extensive hearings, debate, and amendment," but he objected to the process that had led to the bill. McCain's opposition, along with resistance from Collins and Murkowski, was enough to stall movement on the Graham-Cassidy plan.

    3. McCain was a strong voice in the charge to reform VA health care after the wait-time scandal: Throughout his career, McCain has championed veterans' rights, seeking to improve their access to reliable health care. McCain was fiercely outspoken following the 2014 VA wait-time scandal and worked on several reforms that were included in a bill President Trump signed into law in May to the existing Veterans Choice Program. In 2015, McCain also spearheaded a bipartisan coalition to pass a law designed to bolster mental health and suicide prevention programs for veterans.

    4. McCain was key to passing the Americans with Disabilities Act in 1990: According to KHN's Huetteman, McCain also was "instrumental" in passing the Americans with Disabilities Act of 1990—the United States' first comprehensive civil rights law geared toward individuals with disabilities. McCain was an early co-sponsor of the bill, championing the rights of disabled service members and civilians. McCain himself suffered injuries during his nearly six years as a POW in Vietnam that limited the use of his arms.

    Two major health care defeats

    McCain also fought on the losing side of major health care battles, often pushing for reform alongside Democrats—to his Republican colleagues' consternation.

    1. McCain fell short in boosting tobacco taxes. In 1998, McCain introduced a bill that would have regulated the tobacco industry and increased taxes on cigarettes by $1.10 per pack in an effort to discourage more kids from smoking and fund more research. McCain at the time said, ''This bill is not about taxes. It's about whether we're going to allow the death march of 418,000 Americans a year who die early from tobacco-related disease and do nothing.'' The bill ultimately failed in the face of opposition from Republicans, but since then, cities and localities have sought to discourage smoking and raise research funds through cigarette taxes.

    2. McCain tried, and failed, to pass a "patients' bill of rights." McCain also joined with two Democratic senators in 2001 to try to pass legislation to guarantee patients with private insurance the right to emergency and specialist care, as well as the right to seek compensation for being improperly denied medical care. However, the bill failed after President George W. Bush threatened to veto the measure.

    It was McCain's independence and willingness to break party lines that over the years earned him the nickname "maverick."

    What becomes of McCain's seat

    McCain's passing means his Senate seat is now open. However, according to Vox, McCain's seat will not be on Arizona's November ballot because the deadline has passed. Instead, Arizona Gov. Doug Ducey (R) will appoint a replacement who will serve until 2020.

    McCain will lie in state in the Capitol Rotunda

    On Sunday, McConnell confirmed that McCain will be given the honor of lying in state in the Rotunda upon the Lincoln catafalque. According to Roll Call, McCain will be the first person to receive that honor since Sen. Daniel Inouye of Hawaii, also a war hero, in 2012.

    "The nation mourns the loss of a great American patriot, a statesman who put his country first and enriched this institution through many years of service," McConnell said (Lesniewski, Roll Call, 8/26; Hawkings, Roll Call, 8/25; Scott, Vox, 8/25; McFadden, New York Times, 8/25; Bresnahan/Wright, Politico, 8/25; DeBonis et al., "PowerPost," Washington Post, 8/24; Weissmann, "MoneyBox," Slate, 8/26; Scott, Vox, 8/27; Huetteman, Kaiser Health News, 8/25; Rosenbaum, New York Times, 6/18/1998).

    Next, get URMC's end-of-life conversation prompts

    When it comes to end-of-life care, most organizations struggle to meet patients' needs. In a recent poll, 87% of Americans age 65 and older said that they believe their doctor should discuss end-of-life issues with their patients; however, only 27% of those polled had actually discussed these issues with their doctor.

    Download URMC's conversation prompts to start improving end-of-life care for patients.

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