On Monday evening the Washington Fair Trade Coalition invited the top three Democrats running for Congress in Washington's 8th District to a little room at Bellevue College to discuss their opinions on trade.
For the first hour or so, Kim Schrier, Shannon Hader, and Jason Rittereiser spent a lot of time agreeing that the United States should include better environmental, labor, and human rights standards in trade agreements. But the conversation heated up when the audience started asking questions.
Though the forum focused mainly on trade, audience members were interested in the candidates' views on several local issues. While fielding a question about foreign students attending school in Washington and then returning to their home countries, Rittereiser turned to Schrier in the middle of his answer and, apropos of nothing, said, “But, Dr. Schrier, how are we going to trust that you’re going to fight for healthcare in D.C. when you built a practice here that has refused to treat the vast majority of poor kids on Medicaid?"
Shots fired. Where's my popcorn. Oh my god no he didn't. Does anyone have some tea because I am so thirsty, etc. etc.
Schrier, seemingly prepared for this line of attack, extended her hand for the microphone before Rittereiser even finished his sentence. “That’s a little bit of [dodging?] with the truth there," she replied. "I see kids from all backgrounds. I see kids on Medicaid, I see kids on Apple Care, and I don’t look at insurance when they walk through the doors."
Just in case anybody missed Rittereiser hijacking a conversation about education to talk about complications related to Schrier's pediatric practice, Tuesday afternoon his campaign drove home the point in a press release.
"The practice Schrier built does not accept children covered by four of five Apple Health insurance plans provided to low-income families who qualify for Medicaid in Washington. Schrier’s practice rejects Community Health Plan of Washington, Molina Healthcare of Washington, Coordinated Care, and Amerigroup Washington, and only accepts UnitedHealthcare Community Plan, which covers just 18% of children in King County on Apple Health," the release reads.
"On average over the last year, this policy excluded over 9,900 children each month who were enrolled in Apple Health through the Children’s Health Insurance Program (CHIP) from seeking treatment at Schrier’s practice," Rittereiser's team reckons, based on numbers of kids enrolled in the four plans Schrier's practice doesn't accept. Those numbers, says a spokesperson for Rittereiser's campaign, come from the Washington State Healthcare Authority and only represent the number of kids who could theoretically apply for care, though of course Schrier couldn't treat all of them. The release also links to a WebMD profile of Schrier that shows her not accepting Medicaid.
A representative from the Office of the Insurance Commissioner confirms that only UnitedHealthcare has a contract with Virginia Mason, the hospital that employs Schrier.
A spokesperson for Schrier told me that Rittereiser's comments show how little he understands about the health insurance market. "His understanding of how different providers interact with hospitals and medical centers is misleading, inaccurate, and indicative of why we need doctors in Congress who understand how these different organizations work," she said.
Though Rittereiser emphasizes Schrier's claims of "building" her own practice, Schrier can't control which insurance companies her hospital draws up contracts with. Hospitals often only work with one Medicaid plan because they fear the government won't adequately reimburse them for treating Medicaid patients, and they’re also interested in streamlining administrative processes. A spokesperson for the HCA says they "encourage providers to contract with more than one Apple Health (Medicaid) managed care plan, but it’s not a requirement," which is one of the million ways the current system is fucked up.
By "building" her own practice, of course, Schrier is talking about "building" up her reputation and recruiting a network of patients. Virginia Mason handles the billing and insurance, and Schrier takes referrals or new patients as they come. "When a patient comes to her door, she doesn’t know what kind of insurance they have," Schrier's spokesperson said. "But she has worked with families who are on Medicaid to get over that hurdle and get coverage that allows them to see her as their pediatrician."
But Rittereiser's people are clearly trying to make this a moral argument. "Voters deserve to evaluate candidates not just on their talking points, but on how they have lived their values," a spokesperson for Rittereiser said in response to the claim that Schrier can't control what insurance her hospital takes. "Doctors and lawyers are faced with important economic decisions in how they build their practices, and we believe the next representative from this district should be someone who has demonstrated a commitment to serving the people they aspire to represent."
This is a funny line of attack for a former Seattle-based King County prosecutor to open up, but we can follow it along and see where it goes.
Schrier says she got into pediatrics because she was diagnosed with Type I diabetes at a young age and remembers how much that sucked for her. She wanted to make that process suck less for kids. Sixteen years ago she moved to Issaquah because her husband got a job there. As she built her practice in the Puget Sound region, her spokesperson says, she saw "patients from all different income levels, all different ethnicities, all different countries of origin." She's literally been healing the people of the district for almost two decades, but obviously only a certain segment of the population.
Rittereiser's campaign is saying that she could have chosen a different path. She could have chosen to work for hospitals in the region who take more forms of Medicaid. She could use whatever time she has left to volunteer at a clinic that services a higher proportion of low-income patients.
That's real. But Schrier's practice at Virginia Mason has also given her a front row seat to the exact health insurance horror show she's claiming she wants to fix in Congress. Yeah, she could have been helping more poorer people if she wanted to, but her position at Virginia Mason has given her a different kind of valuable experience.
And let's look at Rittereiser's life choices. The healthcare system isn't the only American institution with problems, after all.
Rittereiser's campaign says the voters of the 8th deserve "someone who has demonstrated a commitment to serving the people they aspire to represent," but it's unclear how many people Rittereiser has served in the 8th District.
Rittereiser works for an employment law firm in downtown Seattle. Before signing on at HKM he lived in Seattle while working for three years and four months as a prosecutor in King County, a county that disproportionally jails black and Native people.
Rittereiser's spokesperson tells me the candidate is "proud" of his work at the prosecutor's office, emphasizing his work in the Special Assault Unit and the Violent Crime Unit, where he focused on "keeping our community safe and bringing justice to victims of sexual assault and other violent crimes." His rotation on the Special Assault Unit lasted for a year and a half, which represents a little under half his time at the office.
Though putting rapists away is a good noble pursuit, especially when so few rapes and sexual assaults are prosecuted in the first place, presumably Rittereiser could have chosen to go into public defense or some other kind of law that we desperately need, one that serves larger populations of people without the means to hire their own representation.
So, who's a better person: a former prosecutor who participated in a fucked up criminal justice system, or a doctor who participated in a fucked up healthcare system? The voters will decide! But if the argument is that Schrier could have served a more disadvantaged population than she does, then, well, Rittereiser could have, too.
In other news, Dino Rossi is bad.