Healthcare: What’s at Stake in November
Over the last decade or so, Democrats have consistently favored expanding the government’s role in ensuring access to healthcare. The Republicans, for their part, have argued for cuts in government spending and a reliance on profit-driven markets to provide coverage either through policies available at the workplace or in individual markets. The Democrats, determined to get at least a minimal plan through a Congress dominated by special interests, borrowed a Republican idea, originally promoted in Massachusetts by Governor Mitt Romney, an idea that eventually became the Affordable Care Act. Along the way they abandoned the so-called public option, the chance to buy a Medicare-like plan offered by the federal government, but kept the Romney-derived idea of an individual mandate, the requirement that all individuals must purchase insurance or pay a fine.
Ironically, in an effort to compromise with Republicans and with special interests in the healthcare industry, Democrats ending up creating a plan—the Affordable Care Act—that has delivered mixed results. Millions gained coverage but many Americans experienced higher premiums or lost insurance options that they preferred.
Now we are in a new season. Republicans continue to place their hopes on unregulated markets while Democrats have begun to offer some new options ranging from—among moderates—the right of Americans over the age of 55 to buy into the Medicare program all the way to a Canadian style Medicare-for-All program funded through tax dollars. For Democrats the shared goal is to provide universal access to affordable care to all Americans. For Republicans the goal seems to be to reduce government involvement in healthcare in the belief that government interference distorts markets and raises costs. In general, they seem to have decided that publicly supported universal coverage is not affordable in the United States. For them, markets must decide what comes next.
Given these commitments, the election in November could hardly be more important for those who care about healthcare. If Republicans continue to control the US Senate and House, and/or gain the Pennsylvania governorship, significant damage will likely be done to our ability to access affordable healthcare in at least three important ways: through sabotage of the Affordable Care Act, sharp cuts to Medicaid, and privatization of Medicare.
If the Republicans remain in charge, President Trump’s campaign of sabotage against the Affordable Care Act is likely to continue and intensify. So far this has meant executive orders delaying implementation of key provisions; shortening of the open enrollment period on the healthcare exchanges from three months to six weeks; severe cuts in funding for groups that help people navigate the complex enrollment process; the likely disappearance of the mandate requiring individuals to purchase insurance next year; and most recently, a new rule that will allow insurance companies to offer short term policies that do not have to meet the guidelines for coverage that were part of the law. These junk policies will give their buyers the illusion of coverage but will likely let them down in a crisis. All of our Republican contenders running for office in Pennsylvania have been, or pledge to be, enablers of this campaign of sabotage against the Affordable Care Act along with sharp cuts to Medicaid (including an end to the expansion that was part of the ACA) and privatization of Medicare. (Please take a look at Jeanne Duffy’s excellent article for details on privatization and proposed cuts in these programs.)
As mentioned above, a lot comes down to the way Republicans define the problem. They are interested in saving money by cutting government spending. Providing affordable coverage to all is just not on their agenda. Focusing on cuts in spending forces them, however, to ignore (or try to hide) quite a few inconvenient truths such as the fact that a very large portion of Medicaid spending goes to support the severely disabled and the elderly in nursing homes. Without Medicaid there would be no money to pay for their care. A second, even larger such truth might be the fact that unregulated markets really don’t work that well for providing coverage to all at an affordable price. That was certainly true in the days before the ACA when over 40 million Americans went without coverage and medical bankruptcy was common. On the other hand, nonprofit, publicly administered approaches do work. If we are willing to take a look at other industrialized countries around the world from Switzerland to Taiwan, we can see that this is true.
To avoid facing up to these facts, Republicans will often take the conversation into the proverbial weeds. Recently in the media, for example, proposals for Medicare for All have been attacked as unaffordable. Lots of cherry-picked statistics are invoked, statistics whose real purpose is to create doubt about the feasibility of reform, not really to guide and inform an attempt at a workable solution. Refuting these statistics takes time and effort and few readers or listeners are willing to pay attention long enough to make an informed decision about the matter. This same strategy worked well in delaying action on tobacco and more recently has been popular among climate change deniers.
A second tactic involves what you might call strategic quibbling. Senator Casey recently ran an ad attacking his opponent Lou Barletta for his support of Paul Ryan’s plan in 2011 for privatization of Medicare. The onscreen text said: “Congressman Lou Barletta voted to end Medicare” The voiceover, however, said “Congressman Lou Barletta voted to end Medicare as we know it.” Politifact, the online fact checker, ruled this “the lie of the year” in 2011, which fact the Barletta has brought up now to attack Casey.
But is privatized Medicare in the form of vouchers that those eligible could use to cover premiums really “Medicare”? Maybe in name but not in substance. Privatization shifts all the risk away from the government onto the individual. Government pays a set amount; if costs rise, it’s up to the individual to take up the slack. Great for saving money and cutting government spending, but not so great for the individual who is facing a medical crisis.
Over the years in the Senate, Casey has been a strong advocate for the Affordable Care Act and the Children’s Health Insurance Program (CHIP). According to his website, “He has introduced a bill to allow the importation of safe and affordable prescription drugs and believes that we need a public health insurance option available for every American. He supports plans to expand Medicaid and allow Americans to buy-in to Medicare starting at age 55.” Barletta, for his part, supports the Trump agenda.
Governor Wolf has also provided some solid improvements in access to healthcare despite the fact that the legislature remains in Republican hands. He expanded Medicaid coverage to an additional 720,000 Pennsylvanians reducing the state’s uninsured rate to 5.6%, the lowest it has ever been, and he helped expand enrollment in the CHIP program by 21%. His opponent Scott Wagner is a self-described “free market man” who recently gained the backing of Americans for Prosperity, the Koch brothers advocacy group. He also basically supports the Trump agenda on healthcare.
Barletta and Wagner are a real threat to progress on expanding access to affordable care. We need to do everything we can to keep Governor Tom Wolf and Senator Bob Casey on the job.
Will Lane, Chair
Gettysburg Democracy for America