MONDAY , JUNE 17 , 2019
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Speaking about health care

Speaking about health care

The US health care system faces two significant pressures.

Critical Issues

Costs. While there is a debate about the cause of rising health care costs, there is no debate that health care costs are increasing.  As noted by the Economist on September 2, “In America, nearly one in every five dollars spent is on health care, a larger share than in any other country.”

Kimberly Amadeo, July 25, 2017, Why Reform Health Care, https://www.thebalance.com/why-reform-health-care-3305749

The United States needed to reform health care because the cost was so high. It was the #1 cost of bankruptcies. The increasing costs threatened to consume the entire federal budget. It made the cost of preventive care unaffordable. That sent many low-income people to the emergency room, raising costs even higher. High costs made the U.S. health care system cost twice as much per person compared to any other developed country. As a result, health care contributed $3.2 trillion, or 17.8 percent, to gross domestic product. That’s the highest percentage in the developed world.

Coverage.  According to the Centers for Disease Control, 28 million people do not have health insurance.

ACA/Obamacare

In 2009, Congress passed the Affordable Care Act, also known as Obamacare. This law did a number of critical things to try to increase health care access (and it probably reduced the number of uninsured by approximately 15 million).

First, it provided subsidizes for individuals to purchase health care plans based on their financial need.

Second, it required every American to have health insurance. Those who choose not have it have to pay a special health care tax.

Third, it made it illegal for companies to place a lifetime limit on the amount of health care someone can receive under a policy.

Fourth, it allowed students to stay on their parents’ health insurance longer, until they are 26.

Fifth, it prohibited companies from denying insurance  (or from charging very high prices) to those with preexisting medical conditions.

This law is credited with reducing the number of uninsured Americans by approximately 20 million.

Despite the benefit of reducing the number of uninsured, there is a lot of pressure to further reform health care because of rapidly escalating costs  to consumers (whether from Obamacare or otherwise) and to the government, which much subsidize the costs of health care for those who cannot afford it and subsidize the exchanges where the health care is sold. Currently, the exchanges are subsidized by actions of the executive branch, and those exchanges may end if they are not properly subsidized.

Trump repeatedly threatens to stop funding the exchanges.  Some House members have proposed a bill to have Congress provide the funding, but Paul Ryan nixed the idea, saying that the focus must be on repeal and replace, not stabilizing Obamacare (NY Post).

While politicians cannot agree on a solution, everyone agrees that costs are rising.

Kimberly Almaedio also offers a great explanation of how most people currently receive coverage, and the costs of that.

Kimberly Amadeo, July 25, 2017, Why Reform Health Care, https://www.thebalance.com/why-reform-health-care-3305749

Group health insurance companies are profitable when more money is received in premiums than is paid out in claims. Most people in the U.S. receive group health insurance from their employer, who also pays part of the premium. Companies can offer health insurance as an untaxed benefit. In a way, federal tax policies subsidize the employer-provided group insurance system. Those who don’t have an employer-sponsored plan must buy individual health insurance. That’s expensive. In the past, companies could deny you coverage if you had a pre-existing disease or condition.

As an alternative, you could affiliate yourself with a group, such as AARP or COSTCO. They offer lower rates because they tend to have a pool of healthy people.

The federal government subsidizes health care for those who are over 65 through Medicare. Part of Medicare, the Part A Hospital Insurance program, pays for itself from payroll taxes.

Medicare Part B (the Supplementary Medical Insurance program) and Part D (Prescription Drug program) are not 100 percent covered by premium payments. Overall, Medicare payroll taxes and premiums cover only 57 percent of current benefits. The remaining 43 percent is financed from general revenues. The federal government also subsidizes health care for families below a certain income level through Medicaid. It is funded by federal and state general revenues.

Trump

Trump ran on a campaign to “repeal and replace” Obamacare, investing heavily in the argument that Obamacare raised health care costs. Pennsylvania, a swing state that Trump won, experienced some of the highest cost increases.

Trump ran on a campaign to simply “repeal and replace” Obamacare.  The problem with repeal is that at least 20 million Americans will lose access to health care. “Replacing” it is even more difficult, because people expect both at least as much care as is currently provided PLUS lower costs. No one has any idea how to accomplish both of those goals, which is why Trump’s effort to simply, “repeal and replace” have failed, at least so far. And the provisions that prohibit companies from denying coverage to those with pre-existing conditions, as well as letting kids stay on their parents’ health care until they are 26, are very popular.

Although simply repealing Obama care (and potentially replacing it with something else down the line) did not have political support, people do understand that the combination of access and cost issues must be addressed.

Nancy G. Brinker has served as U.S. ambassador to Hungary, U.S. chief of protocol, and as a Goodwill Ambassador for Cancer Control to the U.N.’s World Health Organization. She is the founder of Susan G. Komen, the world’s largest breast cancer charity, and is now continuing her work as a cancer advocate, August 1, 2017, The Hill, http://thehill.com/blogs/pundits-blog/healthcare/344835-washington-must-reset-healthcare-reform

While the recent healthcare debate in Congress failed to reform broken remnants of the Affordable Care Act, including exchanges that lack choice, competition and cost controls, the process had the redeeming quality of shedding light on prospective solutions that require immediate attention. Allowing the status quo to remain, or for these exchanges to collapse under their own weight, wouldn’t be a “win” for President Trump or Republicans. A lack of action would represent nothing short of an abdication of our government’s responsibility to promote the general welfare. It would send an unassailable signal to the American people that political point scoring trumps personal health and sow fear among our population. At no time has adult leadership been more important.

Proposals

In order to address different access and cost issues, a number of different proposals have been made, all of which you should be prepared to speak about.

Single payer. The single payer system functions in a way that the government becomes the single payer and completely takes over the management and distribution of health care. This is the system that was promoted by Bernie Sanders during the presidential election season. This is also known as Medicaid for all and was recently (9-1-17) supported by Senator Kamal Harris.

Public option.  Under a public option system, the government would become a provider of health care provider, but not the sole health care provider.  The government would compete in the insurance markets, just as any other providers would.

Managed competition (with more federal support).  In the status quo, insurance companies compete against one another and offer health insurance that is purchased by companies or individuals on the exchanges.  Proposal to improve managed competition include expanding federal subsidies, mandating cost controls, and allowing insurers to sell policies across state lines. The idea behind the across state lines proposal is that it would encourage competition, reducing costs.

Although Congress is not likely to agree on a comprehensive reform, there is some support for more modest reforms.  And, even today, the following bipartisan proposal was released

Cost-sharing-reduction payments. CSR payments help to offset the cost to insurers for offering poorer Americans plans with low out-of-pocket costs. These payments have been the subject of a lawsuit under the Obama administration. Trump has repeatedly threatened to cut them off. The governors urged the leaders to fund them for at least two years.

  • Create a fund to help states address rising premiums. The governors said they wanted Congress to create a $15 billion-a-year stability fund that would allow states to create programs to lower premiums for people in the exchanges. They also suggested offsetting the move by cutting spending in other areas.
  • Exempt insurers from the federal health-insurance tax for plans in underserved counties. The governors’ plan would exempt insurers from the federal tax on plans provided to people in counties with only one insurer on their exchanges. Such a move, they say, would help encourage insurers to enter rural counties that may be in danger of going without coverage on the exchanges.
  • Allow people in underserved counties to buy into government benefits. The plan would let people in counties with one insurer on their exchanges buy into the Federal Employee Health Benefits Program. In essence, that would create a so-called public option for underserved counties.
  • Re-create the federal reinsurance program. That program helped to stem losses by insurers and spur their participation in the exchanges. The program was phased out, but the plan would reinstate it.

The plan would also encourage open enrollment and institute other programs to allow states more flexibility in addressing their needs.

You can read more about the proposal here.

Preparing to Speak

As a speaker, you need to be prepared to talk about at least all of the following for health care.  Evidence on all of the *topics is included in the releases linked at the top of this document.

Should the US adopt a single payer health care system?*

Should the US adopt a public option?*

Should an individual tax credit to purchase health insurance be provided?*

Does the government have a moral obligation to provide health care?*

Should Obamacare be repealed?*