Clear and Present Dangers to Our Healthcare
Even as our attention has turned to other concerns—the immigrant situation, the upcoming reconfiguration of the Supreme Court, and continuing revelations of corruption in high places, we must continue to keep a watchful eye on what’s happening with healthcare, an issue that has risen to the top for millions of Americans. Healthcare is expected to be a major ballot issue in November. Let’s
take a look at existing and looming dangers to key components of our healthcare system that you need to be aware of as a healthcare consumer and voter: Medicaid, Medicare, and the Affordable Care Act (ACA). Major funding cuts, loss of consumer/patient protections, and disruptions of the insurance market in these programs are likely to spill over to the employment-based healthcare market down the road.
The estimated cost of the GOP-Trump tax cuts mostly for the wealthy has increased to $1.9 trillion, emboldening lawmakers this summer to demand further cuts to Medicare, Medicaid, Social Security, education, and more. It is important to keep tabs on what is happening, as confusing as it may be. Basically, we have GOP Congressional leaders working on budget resolutions that could affect healthcare dramatically, another group of conservatives including the Heritage Foundation retooling a repeal of the ACA, and the President making executive orders and his own budget plans that affect healthcare. Let’s break down what all this activity suggests by program: Medicaid, Medicare, and the ACA.
MEDICAID. This program, which along with Medicare celebrated its 53rd birthday on July 30, covers 1 in 5 low-income Americans, including many with complex and
costly needs for care (Kaiser Family Foundation, KFF, Issue Brief). As of April 2018, 73.8 million people were enrolled, 2.9 million in Pennsylvania (Center for Medicaid
and Medicare Services, CMS). About 12 million people in 31 states and D.C. received Medicaid coverage through the ACA expansion (Center on Budget and Policy
Priorities, CBPP). Virginia recently voted to expand Medicaid and three others are actively considering expanding. The program has a 74 percent approval rating by Americans (KFF tracking poll).
Numerous studies have shown that the Medicaid expansion has greatly improved access to care, as well as the quality of care in states like Pennsylvania that have
adopted the expansion. Rural areas especially have benefited. Many more patients with asthma, depression, hypertension, and high blood pressure have received
appropriate drug treatment, as well as weight screening and follow-up. These visits and improvements are occurring in areas of the country that tend to be underserved and hard to affect. (The Upshot, New York Times, July 2)
GOP leaders are now proposing a $1.5 trillion cut to Medicaid (offset by spending on block grants to states). These spending caps and block grants would fundamentally change the nature of the program. Given the limited funding amounts proposed, states would not be able to adjust to higher costs due to enrollment increases and other factors, creating considerable financial risk (CBPP). In addition, under the new ACA repeal proposal, Medicaid expansions would no longer receive promised Federal dollars. This would have a disastrous impact on rural community health centers in Medicaid expansion states. If the GOP Congress and Trump Administration have their way, all the gains in expansion states would be lost.
MEDICARE After years of idle GOP threats to this popular program, the ballooning budget deficit to pay for tax breaks for the very rich has finally made this danger more of a reality. GOP House leaders are now proposing a $537 billion cut to the Medicare program over 10 years. In addition, they would transform Medicare into a “premium support system,” in which Medicare’s guaranteed, earned benefit package would be replaced with a fixed-dollar amount (or voucher) that beneficiaries would use to purchase health insurance.
Under such a system, seniors would pay for all costs beyond the voucher’s value. The value of vouchers would be pegged to GDP. As healthcare costs grow at a faster rate than GDP, seniors would pay an increasing share of the costs. According to the Congressional Budget Office, most seniors would spend over two-thirds of their income on healthcare. This shift from public to private financing would put the 59 million older adults and people with disabilities who rely on Medicare’s promise of affordable, comprehensive health care at risk of higher costs, fewer coverage options, and greater uncertainty (KFF). As a result, many would drop their coverage.
THE ACA A coalition of prominent conservative individuals and organizations recently released a new ACA repeal plan similar to last year’s failed Cassidy-Graham bill. In addition to ending the Medicaid expansion, it would end subsidies in the ACA individual marketplace, protections for people with preexisting conditions, and required coverage for “essential benefits” such as prescription drugs, mental health and substance abuse treatment, and maternity care. An estimated 21 million people would likely lose their healthcare if the new plan became law (CBPP).
Already, the GOP Tax Law voted in at the end of 2017, which included eliminating the individual mandate, and some of Trump’s executive orders are having a destabilizing effect on the insurance exchange marketplace for individuals. Insurance companies cannot be sure they will continue to receive payments or other government protections from losses in the ACA exchanges as healthy people drop out, leaving companies with a larger proportion of sick people. Trump’s attempt to expand less-costly short-term, bare bones insurance plans, if successful, would drive additional healthy individuals out of the exchange marketplace. Such high-risk plans benefit only the healthy—but god-forbid should they get sick!
The situation will only worsen if Republicans maintain control of Congress after the November elections. With continuing efforts to sabotage or repeal the ACA and the resulting destabilization of the insurance market, insurance premiums would likely rise in the double digits once again and more companies will drop out. We are fortunate in Pennsylvania that our insurance commissioners have worked hard to convince insurers to keep premiums as low as tolerable. So far, their efforts have helped stabilize the Pennsylvania marketplace. But that could not continue forever.
As New York Times columnist David Leonhard concludes succinctly in his July 5 column, The New Plot Against Health Care: “Every single Republican health care plan drafted so far would deprive a large number of people of insurance coverage and raise costs for many others. The main point of the plans, in fact, is to reduce federal spending on health care—largely to reduce taxes on the affluent.” Next November will not be a time to sit out mid-term elections. They are likely to be one of the most important in decades. Stay informed, be engaged, plan to vote, and encourage others to join you.
Jeanne Duffy, Ph.D., has served as a college professor, an analyst and project manager for several large companies, and a college administrator in charge of foundation and government support. She is an active member of Gettysburg Democracy for America’s healthcare taskforce.
This article originally appeared in the Gettysburg Times on July 12, but has been edited and updated.