As proponents of Medicare for All struggle to defend their plan to repeal the foundations of American health care — including employer-provided coverage, Medicare, Medicaid, the Affordable Care Act (ACA) and the Children’s Health Insurance Program (CHIP) – and replace it all with a costly, one-size-fits-all, government-run, health-care system, many are claiming that a majority of Americans support their scheme. For example, in a recent opinion piece published by The Hill, George Goehl writes that “across party lines, a majority of Americans are in favor of Medicare for All.”

© Greg Nash

© Greg Nash

This claim is misleading at best, as polling makes clear that many Americans are not aware of what “Medicare for All” actually is, and when they are informed of what it means for them, a majority oppose it. In fact, a national poll conducted by the Kaiser Family Foundation earlier this year found that 70 percent of Americans oppose Medicare for All when they learn it would “lead to delays in some people getting some medical tests and treatments,” while 60 percent oppose it when they learn it would threaten the already at-risk Medicare program.

Sixty-percent also oppose the government-run system when they learn it would force most Americans to pay more in taxes, while 58 percent oppose it when they learn it would eliminate employer-provided and other private coverage.

Another national survey by Kaiser shows that most Democrats and Democratic-leaning independents “say they want Democrats in Congress to focus their efforts on improving and protecting the ACA” rather than passing Medicare for All. This should come as no surprise, as Democrats flipped the House last November in large part by focusing on strengthening the Affordable Care Act and protecting Americans with pre-existing conditions, not on upending our entire system.

Meanwhile, the nonpartisan Congressional Budget Office (CBO) recently reported that under Medicare for All, “patients might face increased wait times and reduced access to care,” and such a system “could also reduce the quality of care,” while “[t]he number of hospitals and other health care facilities might also decline as a result of closures, and there might be less investment in new and existing facilities.”

They have also confirmed that Americans “would not have a choice of insurer or health benefits,” and that Medicare for All “might not address the needs of some people.” A one-size-fits-all system, they confirm, “would significantly increase government spending and require substantial additional government resources,” which would mean significant tax increases for working families.

In the wake of last month’s House Budget Committee hearing on the impacts of a one-size-fits-all government-run health care system, it’s clear that many lawmakers on both sides of the aisle are taking experts’ warnings and the public’s opposition seriously.

Assessing the bill’s prospects, Bloomberg reported that Medicare for All “is hitting serious obstacles in the U.S. House … [and] the effort appears unlikely to go much further,” as the legislation “hasn’t gained much support since its release in February,” while POLITICO reported that “House Democratic leaders, who worry Medicare for All could hurt the party with moderate voters, have allowed hearings on the plan, but they haven't committed to floor votes.”

That’s good news for patients, families and taxpayers, but Americans should be aware that other, so-called “moderate” proposals — like “buy-in” or “public option” systems — would also cost taxpayers’ hard-earned money, put families’ access to and quality of care at risk, and ultimately lead to the same unaffordable one-size-fits-all system they reject.

These new government-run insurance systems are intentionally designed to be “stepping stones” to one-size-fits-all health care — a fact acknowledged even by those in favor of such proposals, including one U.S. Senator who admitted it would cause the “slow death” of employer-provided and other private coverage and serve as an “on ramp to a single-payer system.”

Recent research provides important insight into the negative impacts a new government insurance system would have on Americans’ access to quality care. One study found that hospitals “could face financial peril,” and its affects could even “force the closure of essential hospitals,” while another study found that a government insurance system like “buy in” or a “public option” would “compound financial stresses [hospitals] are already facing, potentially impacting access to care and provider quality.”

In the end, these risky government insurance systems would cause Americans to pay more to wait longer for worse care.

Families, patients and taxpayers shouldn’t be forced to suffer these consequences – and with roughly 90 percent of Americans now covered, there are far more sensible ways to extend coverage to millions more. Rather than embracing costly proposals like these, which would upend our care and start over from scratch with a one-size-fits-all government-run system, our leaders should be building upon what works in American health care, while coming together to fix what doesn’t.

Lauren Crawford Shaver is the executive director of the Partnership for America’s Health Care Future, a partnership made up of health-care industry organizations and lobbying groups, including: American Medical Association, Federation of American Hospitals and Blue Cross/Blue Shield. She was previously the deputy assistant secretary for public affairs in health care at the U.S. Department of Health and Human Services and has worked on numerous Democratic political campaigns over the last decade.

Original post written by Lauren Crawford Shaver at The Hill.

AuthorMeg McComb

Claire Haas and her husband are at a health insurance crossroads.

Gov. Gavin Newsom wants to help an estimated 850,000 Californians pay their health insurance premiums and would fund his plan with a tax penalty on people who don’t have coverage. (Lydia Zuraw/California Healthline illustration; Getty Images)

Gov. Gavin Newsom wants to help an estimated 850,000 Californians pay their health insurance premiums and would fund his plan with a tax penalty on people who don’t have coverage. (Lydia Zuraw/California Healthline illustration; Getty Images)

If they were single, each would qualify for a federal tax credit to help reduce the cost of their health insurance premiums. As a married couple, they get zip.

“We talk about getting divorced every time we get our health care bills,” said Haas, 34, of Oakland. She has been married to her husband, Andrew Snyder, 33, for two years.

“We kind of feel like we messed up. We shouldn’t have gotten married.”

The couple pays about $900 in monthly premiums — which adds up to about 14% of their annual income, said Haas, a self-employed leadership coach and consultant. Snyder is an adjunct professor of ethnomusicology.

Under a proposal by Gov. Gavin Newsom, an estimated 850,000 Californians could get help paying their premiums, including people like Haas and Snyder, who together make too much to qualify for federal financial aid but still have trouble affording coverage.

To pay for the health insurance tax credits, the Democratic governor is proposing a tax penalty on Californians who don’t have health insurance — similar to the unpopular federal penalty the Republican-controlled Congress eliminated, effective this year.

If Newsom’s $295 million plan is enacted, California would be the first state to offer financial aid to middle-class families who have shouldered the full cost of premiums themselves, often well over $1,000 a month.

“This is a gap in the Affordable Care Act, but there’s been no action at the federal level,” said Matthew Fiedler, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy.

Democrats in Congress introduced legislation this year to expand the federal subsidy to more people, but those efforts have stalled in the past in the face of Republican opposition.

In California, legislators are debating Newsom’s penalty and tax credit proposals as part of budget negotiations, which must be wrapped up by June 15. Democrats control the legislature, but Republicans and taxpayer groups are opposed to the proposed penalty, saying people should have a choice about whether to buy insurance.

“It’s a very costly and regressive tax on young people who can’t afford it,” said David Wolfe, legislative director of the Howard Jarvis Taxpayers Association. “They likely aren’t going to get sick, and they want to take that chance.”

Three other states — Massachusetts, New Jersey and Vermont — and the District of Columbia already have adopted state health insurance requirements. Health experts say these mandates encourage young, healthy people to buy coverage alongside older, sicker — and more expensive — enrollees.

If lawmakers approve a state tax penalty, modeled after the now-defunct ACA mandate, some Californians could owe thousands of dollars if they fail to buy insurance.

“Without the mandate, everybody’s premiums go up,” Newsom said at an event in Sacramento in early May. “Every single person in this state will experience an increase in their costs if we don’t have a diversified risk pool.”

Massachusetts and Vermont provide state financial aid to low-income people who qualify for federal aid under the ACA, according to the USC-Brookings Schaeffer Initiative for Health Policy. Newsom wants to go a step further and give financial help to middle-income earners — which could include families of four earning up to about $154,500.

Under his proposal, 75% of the financial aid would go to about 190,000 of these middle-income people who make between 400% and 600% of the federal poverty level. That’s between about $50,000 and $75,000 a year for an individual and between about $103,000 and $154,500 for a family of four.

The average household tax credit in this category would be $144 per month, according to Covered California.

The remaining money would go toward tax credits for about 660,000 people who earn between 200% and 400% of the federal poverty level, or roughly between $25,000 and $50,000 for an individual and $51,500 and $103,000 for a family of four. The average household tax credit in this category would be $13 a month, Covered California estimated.

Exactly how much Californians could receive would vary depending on where they live, their ages, incomes and family size, said Peter Lee, Covered California’s executive director.

For example, a couple, both 62, living in the San Francisco Bay Area making $72,000 a year doesn’t qualify for federal tax credits. They now pay a $2,414 monthly premium — or about 40% of their income.

That couple could qualify for a $1,613 state tax credit under Newsom’s proposal, lowering the cost of health insurance to about 13% of their income, according to a Covered California analysis.

By comparison, the ACA defines an affordable employer-sponsored health plan as one that costs about 9.5% or less of an employee’s household income.

California’s high premium costs are among the biggest concerns middle-income customers raise with Kevin Knauss, an insurance agent in the Sacramento region.

“I have clients, especially those who are self-employed, who have literally discussed the possibility of not working for two or three months or stepping back from projects” so they can earn less and qualify for federal tax credits, Knauss said.

Other insurance agents said they’ve met middle-income families who are willing to forgo insurance for one family member — often the breadwinner — to bring down costs.

Alma Beltran, a small-business owner in Chula Vista, Calif., doesn’t have health insurance, and neither do her husband and 17-year-old daughter.

Beltran knows it’s a risk but said the premiums this year were simply unaffordable: $1,260 a month for a plan with a whopping $13,000 deductible.

“I decided to let my business grow at the expense of my health insurance,” said Beltran, 53, who manufactures labels for the beer and wine industry. “This is the first year ever that I haven’t had health insurance.”

Such stories are why some lawmakers think Newsom’s proposal doesn’t go far enough. For instance, some households wouldn’t qualify for a state tax credit until they spent a quarter of their income on premiums.

“We’re still talking about a substantial portion of someone’s income,” said state Sen. Richard Pan (D-Sacramento). “I appreciate the governor’s leadership, but I think that we do need to more.”

The state Senate wants the governor to double the funding to about $600 million, not only by relying on the penalty revenue but by dipping into the state general fund. California is projected to have a $21.5 billion budget surplus for budget year 2019-20.

While Newsom said he supports giving consumers larger subsidies, he said his plan is fiscally responsible because it has a dedicated revenue source from the proposed health insurance penalty.

“Perfect’s not on the menu, but better than any other state in America is,” Newsom said.

Original post written by Samantha Young and Ana B. Ibarra at California Healthline

AuthorMeg McComb