Friday, November 9, 2018

Can corporate power continue to keep Americans sick? Maybe the election will help

Do you think that insurance companies should be allowed to deny insurance to people with pre-existing conditions? If not, you are in agreement with most Americans, 81% of whom feel this way according to a survey conducted by the Commonwealth Fund, the Harvard School of Public Health, and the NY Times for the report Being Seriously Ill in American Today (the link is to the Commonwealth Fund site discussing the study, and you can download the PDF there). That is a lot of people, and is why most politicians give at least lip service to the idea. Of course, despite the fact that you may have heard Republicans who are currently in Congress saying that they support it as they ran for re-election, the fact is that virtually all of them voted against it when they voted to repeal the Affordable Care Act (ACA, Obamacare) and, when that was unsuccessful, to strip it of its major impacts. This protection was one of the most important of ACA’s rules, and is highly valued even by most Americans who profess to hate Obamacare, Obama, love Donald Trump and vote for the Republican Party. And this is, in no small way, a reason for the Democratic takeover of the House.

Sadly for the GOP supporters who want their pre-existing conditions covered, their love is not being reciprocated by their elected officials. As discussed by the President of the Commonwealth Fund, David Blumenthal, in an article in The Hill, 20 Republican-led states, led by Texas, are filing suit against the federal government arguing that they should not have to enforce the ACA’s ban on refusing insurance to people with pre-existing conditions. What is more is that the federal government, under the GOP and the Trump administration’s Department of Justice, is refusing to defend the suit; this means that they are not arguing in favor of the law of the land, but more that they are not defending the right of the American people to have this guarantee. Tough luck, 81% of Americans!

Of course, this would not necessarily mean that people with pre-existing conditions (about 52 million Americans, depending upon a fairly strict definition*) would not be able to get insurance, although it is likely that many (such as those with terminal cancer) would not. It does mean that they could be charged much higher premiums for their insurance, though. This would go back to what is called “individual rating” where the individual’s health risk determines the amount of their premium, as opposed to the “community rating” required under ACA. And, of course, as discussed in another Commonwealth Fund brief this would also impact the premiums of those actuarially deemed to be a greater risk: mainly older people (including those Trump and GOP voters), but also for many conditions, women – the majority of the population! Even the insurance companies are not sure what to do as they set their rates for 2019.

It is clear that President Trump is doing all he can to distract people from the result of the November 6 elections – he is a master of distraction – such as by firing Attorney General Sessions the next morning. But the Democratic House of Representatives will not be confining itself to investigations of him and his campaign, but also moving forward with legislation to accomplish what are seen as “progressive” goals, or goals I would reframe as “actually in the interests of the people of the US, as opposed to the billionaires and large corporations. Health care is the foremost of these. It will start with ensuring that the important provisions of the ACA are kept in place, in particular the protection for those with pre-existing conditions. The House can do this because it is current law, and it can block any Senate effort to change it.

Moreover, the House is likely to work on advancing the goal of “Medicare for All” in the coming session. This is the opinion of Sen. Bernie Sanders (D-VT), the most well-known advocate for single payer, makes this point clearly in an excellent interview with Rolling Stone’s Matt Taibbi. This will not pass the GOP-controlled Senate, and may not even pass the House, but the effort will definitely be made and it will have strong support, a big change from the Clinton plan of the 1990s and even ACA when single payer was “not on the table”. Establishment Democrats, beholden to their own very wealthy donors (especially Wall St.) may not be happy to go against corporate America, but they will if they have to and they will have to because their voters want it. As Sanders says, “…it’s wildly popular. And that’s what Democrats have got to do.”

On one side, we have the interests of the vast majority of the American people. There are those without health insurance coverage, including those who would be eligible for Medicaid under ACA if they lived in states that had expanded Medicaid, but have the misfortune of living in Republican-controlled states that did not. This will get better soon, as three states, Idaho, Nebraska, and Utah, just voted to expand Medicaid, and Maine will likely do so now that its soon-to-be-former governor won’t be around to veto it. It is a popular program, even in these “red” states. But those who will still be uncovered in the 14 states that remain is a lot of people. Then there are the people who have insurance, but terrible insurance, with absurdly low annual and lifetime caps, that should not be legal. But they are. Then we have the people who have more “standard” employer based insurance, who are being killed by the premiums, deductibles, co-payments, and co-insurance costs. Then we have those who are on Medicare who are unable to afford a Medicare Supplement policy to cover the things Medicare doesn’t – especially the 20% of the cost, since Medicare covers only 80%. Maybe not so big on a $100 office visit (although $20 is a lot for many people) but a big deal for a $5000 hospitalization.

So how many people is that altogether? I don’t have the numbers, but it is certainly the large majority of the American people. In fact, 90% is probably a conservative guess, which would mean 10% of Americans have insurance with affordable premiums, copays, deductibles, or are so rich it doesn’t matter. Of course, this small group includes not only most legislators, but corporate executives, pundits, and even many liberal leaders. Remember: the median US household income is about $61K, and a household (not individual) income of $150,000 is the top 8% and of $200,000 the top 3.65%!

Who is on the other side? Well, drug companies, consistently the #1 profit industry in the US. Insurance companies, making huge amounts of money skimming from the “health care expense” pool. Large health systems, doing very well, thank you. In other words, incredibly wealthy vested interests and their lobbyists that contribute a lot to politicians. This is not a fair match-up either way, most of the people vs. most of the money.

But maybe the “most of the people” finally have a chance. Wouldn’t that be a refreshing change?

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