Preview Of The Coming Medicare For All Debate

The pre-existing condition scare tactics continue.

I testified yesterday—as the sole witness called by the Republican minority—during a House Education and Labor Committee hearing on “Examining Threats to Workers with Preexisting Conditions.”  

It was the first hearing of the new Congress under the new Chairman Bobby Scott, D-VA, and virtually all members on both sides of the aisle stayed to ask questions. (The hearing lasted for three and a half hours!)

I continually stressed the guarantees that already exist to protect people with pre-existing conditions, and members on the Republican side underscored their commitment to making sure these protections remain.

Ranking Member Virginia Foxx, R-NC, said in her opening statement, “Americans with pre-existing conditions need health insurance. This is a fact and a value that Congress and the President have affirmed countless times. 

“It’s also the law,” she affirmed. 

“Insurance companies are prohibited from denying or not renewing health coverage due to a pre-existing condition. Insurance companies are banned from rescinding coverage based on a pre-existing condition. Insurance companies are banned from excluding benefits based on a pre-existing condition. Insurance companies are prevented from raising premiums on individuals with pre-existing conditions who maintain continuous coverage.” She cited existing protections under the Health Insurance Portability and Accountability Act (HIPAA) and Republican support for additional protections in the House-passed American Health Care Act of 2017.

The Democrats focused on the district court decision in Texas v Azar that struck down the individual mandate and with it, the Affordable Care Act, including the law’s guarantee of pre-existing condition protections.  The decision has been appealed and could wind up before the U.S. Supreme Court by next year.

Chairman Scott said consumers would lose not only these protections but also would face annual and life-time limits on coverage and lose cost-sharing subsidies and guaranteed preventive services.  He and others continually criticized short-term limited duration plans and association health plans, two new consumer-friendly options allowed under Trump administration regulatory authority.

The hearing was a preview of the coming debate over Medicare for All, including the belief of many members that neither the private sector nor the states can be trusted to provide protections.  Member after member on the Democratic side implied that if Texas v Azar were upheld, people throughout the health sector could lose their coverage if they have pre-existing (i.e., chronic) health conditions. 

First, that is not the case, and second, the commitment in Congress to provide continued protections, whatever the outcome, is unquestioned.

In my testimony, I highlighted:

  • the central role that employer-sponsored health insurance plays in our health sector
  • new opportunities to reduce costs and expand access to coverage
  • bipartisan support for pre-existing condition protections and the need for further improvements
Here are the links to:
Webcast of my five-minute testimony
The Full Webcast of the hearing
My written testimony

I relied heavily on Doug Badger’s latest paper on employer-sponsored health insurance (ESI) where he describes the central role that ESI plays in underpinning the larger health sector.  

Here are some points I highlighted:

The Value of ESI: Nine out of 10 workers are employed in the U.S. by companies that offer health insurance, a system that provides coverage for nearly 173 million people.  These benefits are tax free both to workers and companies—a generous benefit but one that leverages nearly $3 in spending by private companies for every $1 in federal revenue losses.

Employers and employees want the best value for their health care dollars—balancing both quality and cost.  Long before the ACA mandates, employers offered preventive services because they know that addressing health issues before they become a crisis leads to better outcomes and minimizes costs.  

ESI Supports Public Programs: These employers also play a vital role in supporting the overall health sector.  Physicians and hospitals are paid less under Medicare and Medicaid than under employer plans. Because private insurance pays more, they provide the margins many providers need to maintain quality and even keep their doors open.  

Leading proposals to expand Medicare coverage to all Americans would extend these public reimbursement rates universally, diminishing quality and access to care.

New Options: The Trump administration is offering several options through its regulatory authority to help individuals and employees with more affordable coverage:

  • Association Health Plans, for example, allow small firms to group together to buy coverage with the economies of scale of larger companies. The Washington Post reports a new study shows that AHP benefits are comparable to most workplace plans, and plans aren’t discriminating against patients with preexisting conditions.
  • States also have new flexibility under Section 1332 of the ACA to lower costs and increase access to coverage. Several states have received waivers to create risk-mitigation programs.   
    • They separately subsidize patients with the highest health costs, which leads to lower premiums and increased enrollment.
    • In Alaska, premiums for the lowest-cost Bronze plan fell by 39 percent in 2018.
    • Maryland is seeing an even larger cost drop this year.

Putting the sickest people in the same pool with others means premiums are higher, often much higher, especially for those without subsidies.  Virginia State Sen. Bryce Reeves told us of an email from a constituent in Fredericksburg: He made a good living and tried to provide for his family but said his insurance premiums cost $4,000 a month! “That’s more than my mortgage,” he told Sen. Reeves. “What am I supposed to do?”

Unfortunately, millions of people are dropping out of the individual health insurance market. Cost relief is essential.

Protection for the vulnerable.  There is strong bi-partisan support to maintain pre-existing condition protections.  The ACA assures that people cannot be turned down or have their policies cancelled because of their health status, and these protections are still in place. The American Health Care Act, passed by the House of Representatives in 2017, maintained pre-existing condition protections as did legislation that was considered in the Senate.  

Need for reform: People with chronic health conditions are vulnerable and need protection. But a woman with serious health problems provided us with a testimonial about why changes are needed.

Janet reports that in 1999, she was diagnosed with Hepatitis C.  She lives in Colorado and applied for coverage in the state’s high risk pool and was accepted.

Her premiums in 2010 were $275 a month.  Then her liver failed, and she needed a transplant. The $600,000 bill was covered 100% with a $2,500 out of pocket maximum, she told us.

Colorado’s high-risk pool was closed when the ACA took effect, so she moved into the marketplace.  Her premiums rose to $450.  By 2018, they were $1,100 a month with a deductible of $6,300. But her anti-rejection meds weren’t covered.

She said, “almost everything I needed was denied, which threw me into the world of having to appeal (sometimes several times) to get the care I needed.

“Those of us who are self employed but make more than the threshold for tax credits wind up footing the whole bill ourselves,” she said.  “I have to spend $19,500 before my insurance pays anything, and it still doesn’t cover all my prescription costs.”

She keeps her insurance because if something happened and she needed another transplant, she said it would bankrupt her family.

Democrats and Republicans are committed to the goals of better access to more affordable coverage and better protection for those with pre-existing conditions. It was all-in-all a civilized hearing, but we must first start with a commitment to maintain consumers protections and work together to solve the problems of access to care and costs of coverage.


Read it in Forbes
http://bit.ly/Forbes020719