Q&A with Sharif Street

State Sen. Sharif Street, the minority chair of the Senate Banking & Insurance Committee and a key figure in the creation of Pennie, the state-based health insurance exchange, spoke with City & State on issues related to health care accessibility and affordability, as well as the insurance market in the Southeast region. 

The conversation has been edited for length and clarity.

How has Pennie changed the health care insurance landscape since its creation?

I think Pennie has been doing a really good job of working with community-based organizations to get information out there to people – particularly for small business people who have issues with affordability and accessing health care. Pennie has made a significant impact in ensuring those folks have access. 

Where is coverage still lacking or not meeting the needs of individuals?

I think that we still have work to do in terms of reaching out to people, particularly younger people who are not on their parents’ insurance, and may be working as gig workers and don’t have employer-based healthcare. That’s probably the demographic we need to do a better job of reaching. Younger people sometimes believe the likelihood that they’ll get sick is lower and they prioritize having cash now over paying for health care. 

And there are two things with that: One is that they’re less likely to get preventative care; two, if they should have something catastrophic happen, it’s devastating because they’re not insured and have no way to get care. 

Why did the Senate proposal requiring benefit contributions for gig workers get met with opposition in committee?

I didn’t think that bill was designed to help gig workers at all. I think that it was designed to stop unionization and that there were definitional issues like classifying people as gig workers who were actually employees. I thought that was very troubling. It would only have exacerbated our problem by pushing people who are currently eligible to be employees and classifying them statutorily as gig workers in ways that will prevent them from being a member of a union and from gaining other employee benefits.

Do you see a reworked version of that bill – or any related gig worker legislation – coming from the committee this year?

I support the idea of access to health care for gig workers and access to benefits. I don’t know if it’ll come through that bill or a different vehicle, but I think that’s a nice idea. What I don’t want to do is classify people in a way that makes it harder for them to get employer-based benefits and makes it harder for them to be able to organize and be a part of the union. 

You’ve also introduced your fair share of insurance- and policy-related bills. Are you still pushing to codify federal essential health benefits and protect coverage for those with pre-existing conditions? And do you see that type of legislation moving this year?

I’m not sure, given the sparse number of legislative calendar days left this year, that we’re going to get those things soon. But what I can say is, in the next session, I will continue to do everything I can to increase access to health care, reduce out-of-pocket costs to ordinary people and bring down costs for regular folks. One of the things we looked at in the past is figuring out how to deal with rising pharmaceutical costs. I’ve worked on a pharmaceutical transparency bill and continue to pursue that as a potential way to bring down overall health care costs. 

We need to figure out how to bring down the cost of the system while increasing coverage to get the highest-quality care possible. We want to reduce costs and there are natural tensions in doing those things. But the reality is that if you have more people paying into the system, including young, healthy people as a group, then when someone, possibly a young person, has a traumatic issue, the system will be more ready to absorb it (and related costs). It won’t have us paying skyrocketing costs of uncompensated care at hospitals. The other thing we need to look at is increasing Medicaid reimbursement rates and subsidies to high-public-payer hospitals. This is important to me, because that will improve not only the quality of care for people on Medicaid, but also the quality of care for all people in communities where they’re using public-dependent providers.