Campaign Trail Stories — Intro

In 2018 I participated in the Blue Wave by running for CO House District 44. Unlike most Run For Something candidates, I had no expectation of actually winning. A few hopes and dreams sure. It would have been nice. But Douglas County is deep red and my Republican opponent had won her previous election by over 30 points.

I was running as a message candidate. Using the race as a vehicle for network building and communication. My goal was to make your receipt at your local pharmacy show two pieces of information it currently doesn’t show. The rebate your insurer was getting for the drug you were purchasing and the net contribution of your insurer to the purchase. So if you were purchasing a $340 vial of insulin, the insurer was getting a rebate of $300, and contributing $15 to your purchase, then you should only be paying $25 for your insulin. Which is, coincidentally, about what that same vial from the same manufacturer costs in other countries. 👀

But I knew that this wasn’t happening because I was writing the code that calculated your copayments. Our first problem was the size of the rebates. No other country makes insurers pay $340 for a drug up front then get a $300 check back later. They just price the drug at, you know, its actual price. But in America we have a program called Medicare Part D that requires, by law, that Medicare pay the sticker price for all drugs without negotiating. And mysteriously, starting in 2003 when it passed, the stickers started skyrocketing. But only Uncle Sam and the uninsured pay sticker. Every other purchaser gets rebates negotiated by their insurance. Hefty ones. We had entire formularies of thousands of drugs that were 95% off with a minimum cost of $5 after rebates were applied.

Our second problem was that after the ACA was passed some insurers stopped passing on the rebates. The profit caps introduced in the ACA were restrictions on “premiums”. 85% of premiums must be spent on medical care. But a rebate .. well that isn’t a premium is it? Laws, like software code, don’t care what you meant. They care about about what you typed. Since most customers don’t even know the rebates exist, they won’t know if their insurers started pocketing the rebates. All they would know is that Obamacare passed and now their Rx costs are skyrocketing.

And if you are keeping partisan score here you’ll note that we are now 1–1 in terms of who is responsible for the current mess. Both sides did something dumb that they are refusing to admit was a mistake. Not because they are corrupt but because the people who wanted these dumb ideas vote and if you piss them off you won’t get their votes. Explaining to someone that their political One Cool Trick doesn’t work rarely goes well.

My mission — which since this is all probably new information to you is a mission that failed — was to raise public awareness of what was going on. I ran on transparency legislation that would put those numbers on your receipts. Imagine you are diabetic and your insulin receipt said this:

• Price: $340
• Rebate: $300
• Net Insurer Contribution: -$285 (They paid $15 but then kept your rebate)
• You pay: $325 (Instead of the $25 you would be paying if your rebate hadn’t been stolen)

Then we could skip past all the arguing about what is really going on in Rx prices and go straight to the huge bipartisan majority fixing this obvious insanity part.

Which sort of happened.

I continued political involvement after my loss to get http://leg.colorado.gov/bills/hb19-1216 passed — which caps out of pocket insulin copayments in Colorado. This law has since been passed in other states and for other drugs to curb the largest industry excesses.

If you are the kind of person who clicks links to bills and reads their text you probably noticed something weird. “A PERSON OR BUSINESS SHALL NOT BE COMPELLED TO PROVIDE TRADE SECRETS, AS DEFINED IN SECTION 7–74–10”. Which .. oh my, oh deary me … defines the rebates as trade secrets.

You know, the thing I spent two years of my life trying to shine some light on? How can I say this is “my bill” when it literally outlaws the very thing I was trying to do?

Well … they never would have passed it if I hadn’t convinced all of them, on the left and the right, that rebate theft was real. Problem is it was also really embarrassing. The legislators would happily have taken on Big Pharma or Big Insurance. What had them running scared was their own primary voters. The hardcore political participants who show up not in November, but in March. When the caucuses decide what names even go on your primary ballot. These tend to be the types of people with way to many bumper stickers on their cars who divide the world into “agrees with me” and “complete evil” with an occasional allowance for misguided “sheeple”.

Campaign Trail Stories is about my time running and advocating. Its a frank look at real politics, real candidates, and how little control the political parties actually have over anything.