Affordable health care in a pandemic
By John Marshall
In the midst of our crippling covid pandemic, the Justice Department and a coalition of 20 Republican-controlled states – Kansas among them – asked the Supreme Court in late June to declare the Affordable Care Act unconstitutional.
Two weeks later, in mid-July, a national study by a consumer advocacy group, Families U.S.A., found that from February through May the pandemic had cost 5.4 million Americans their employer-based health insurance. That figure is 40 percent higher than the 3.9 million laid-off workers who lost their insurance during the great recession of 2008-2009.
Pending court action otherwise, the ACA – effective in 2014 – will remain law. The government will subsidize soaring costs of health insurance, and 55 million Americans with pre-existing conditions – more than a quarter of non-elderly adults – will remain eligible for coverage, for now. The covid crisis will increase dramatically the number of people with pre-existing conditions and, likely, without insurance.
Crucial to the ACA was a mandate that had required individuals to buy in and insurers to cover all enrollees regardless of health status. (Individuals who declined to participate would pay a fine.) With no mandate to buy in, the insurance risk pool is weighted heavily by patients with health issues, a lot of them expensive. Without healthy people sharing the risk, affordable care is far more costly.
But last year’s trillion-dollar federal tax “reform” included fine print that cancelled the individual mandate by eliminating the fine for opting out. This invalidates the entire Act, argue Kansas and the anti-ACA coalition.
If the ACA is quashed, up to 20 million people would lose their insurance immediately, according to studies by the Urban Institute; tens of millions with employer-sponsored coverage could face longer waiting periods for coverage or have no coverage at all for pre-existing medical conditions; among other casualties, Medicaid would fall and adult children under age 26 would be stricken from parents’ policies. (Kansas is among the 13 states that have not expanded Medicaid coverage under the ACA.)
In attacking the ACA, Kansas seems to pine for that time not long ago when only the healthiest people – never sick, never injured – could afford their insurance. But once treated for even common illness or injury – bad flu, a busted leg – patients were stained with a “preexisting condition.” Into the high risk (high price) pool they went; that, or buy insurance that excluded coverage for certain illnesses or injuries, or anything remotely tied to that preexisting condition.
The Kansas charge against “Obamacare”, as the ACA was christened, was first led by former Gov. Sam Brownback and sustained by his Republican allies, including Jeff Colyer, a former lieutenant governor and governor, Attorney General Derek Schmidt and Senate President Susan Wagle.
The critics believe states should manage the matter on their own, that the federal government has overreached. Their mission overturns the premise that all citizens should have good health care they can afford, regardless where they live or work.
From the outset, the irony in “affordable care” is that its fate remains with those who have no real stake in it. State and federal legislators are insured by gold-plated, government-subsidized policies. Congress has excluded its own insurance from the legislation in debate; and most lawmakers have little notion of the cost or complexity of this issue beyond the line item in their government paycheck.
Citizens confront bleak options as the Trump Administration and its allies continue to starve the ACA, drive up its costs, shrink its staff and its presence. There are new codes and confusing strictures for enrolling in the program; ever higher premiums for threadbare insurance and soaring co-pays and deductibles; the most “affordable” option: go cheap and hope no one is hurt or gets sick.
Thanks to Congress and the budget knives of Republicans, insurance under the ACA has become less affordable and more exclusive. Those without insurance are more inclined to give up than give it a go. They can only wonder how long they or their families can stay healthy, or only a little sick.
This, in mid-pandemic.
Our leaders in government say they are working for us, protecting our “rights.” Maybe they are. But the next time they talk about freedom in health insurance, ask them why this liberty has turned so cruel, and at such a wicked price.
