The Middletown Press (Middletown, CT)
Medicare for all comes to the fore
But with Dems set to take over House, may never reach Senate floor
U.S. Rep.-elect Jahana Hayes won election in Connecticut’s 5th District on a platform that included a call for “Medicare for all” — a government-run system of health care that she argued would provide comprehensive care at affordable cost.
“We should not have to choose between the health of our family members and paying the rent,” said Hayes, who rose to prominence as Connecticut’s Teacher of the Year in 2016 while teaching high school social studies in Waterbury. “Seniors should not choose between their prescription drugs and their groceries for the week. We can do better.”
With Democrats taking control of the House for the first time in eight years, “Medicare for all” will get a thorough workout by a party frustrated over the Affordable Care Act —Obamacare — not being fully able to deliver on its promise of affordable health care within the nation’s private-insurance system.
However, even if it passes the Democratic-controlled House, “Medicare for all” would face a dim future in the GOP-controlled Senate and almost-certain veto by President Trump.
In the Congress concluding now, there were eight separate proposals to open Medicare up to all or some below the retirement age. Two plans would create “Medicare for all,” a single-payer system similar to Canada or England that virtually eliminates private health insurance. The remaining proposals were variations on what is known as the “public option” — a Medicare buy-in as a choice on a laundry list of health-care options offered through the Affordable Health Care Act.
GOP pushback
Trump and Republican leaders in Congress have derided all such proposals as amounting to “government-run” health care.
“Most voters do not agree with single-payer insurance or government insurance, because they realize it would not be affordable unless our taxes were dramatically higher,” said former Meriden Mayor Manny Santos, the Republican candidate defeated by Hayes.
At a minimum, there are very real questions about the need for a single-payer system in a state like Connecticut, where above 90 percent have health insurance through employers, Medicaid, Medicare, or the state’s Obamacare exchange Access Health CT.
The state’s percentage of uninsured dropped from about 9 percent before the Affordable Care Act to 5.5. percent last year, lower than the national average of 8.7 percent.
Among Connecticut House Democrats on Capitol Hill from the western part of the state, Hayes is alone in her support for “Medicare for all.” Rep. Jim Himes, by contrast, supports bolstering the Affordable Care Act, which has taken several hits in the Republican-controlled Congress since Trump took office.
But, Himes added, Congress should explore the “public option” for “cost, feasibility and competitiveness.”
Rep. Rosa DeLauro, a stalwart left-of-center progressive on most issues, declined to back “Medicare for all” last year. Her resistance led to a picket line at her New Haven office.
Sen. Richard Blumenthal supports “Medicare for all,” while his fellow Connecticut Democrat, Sen. Chris Murphy, favors a “public option.”
The Affordable Care Act has succeeded in bringing down the nationwide rate of uninsured. Republicans undercut it through reductions of payments to insurance companies providing subsidized care, as well as putting an end to Obamacare’s “universal mandate” requiring all to have health insurance or pay a tax penalty.
Nevertheless, the Affordable Care Act stayed afloat and managed to turn into a positive for Democrats this year. During the campaign, Democrats in Connecticut and elsewhere charged that Republican proposals would take insurance guarantees away from those with pre-existing conditions.
But health experts agree that Obamacare has left a portion of those in need of health insurance out in the cold.
Access Health CT signed up 114,134 this year for private health insurance coverage, a 2.3 percent increase over last year. In addition, some 216,00 have signed up through the ACA’s provision expanding Medicaid to those just above the poverty level.
The system in Connecticut works best for those at the lower end of the income scale who qualify either for Medicaid expansion or subsidies to buy insurance on Access Health CT. But for those who earn too much for any subsidies, health insurance often comes with costly premiums and high deductibles.
“There is definitely a problem for those people not receiving subsidies,” said Ellen Andrews, director of the non-partisan Connecticut Health Policy Project. “They feel like they’re paying premiums for nothing.”
Taxes vs. premiums
Before the Affordable Care Act, rates of those without insurance in Connecticut were higher in the income brackets just over the poverty level who earned too much for Medicaid. Higher income people had lower rates of no insurance.
But now those ratios have been reversed, said Andrews. The percentage of uninsured among those making $100,000 or more went up between 2015 and 2017 while the comparable percentage for those in the $25,000-$50,000 bracket went down.
Whether a “Medicare for all” single-payer system would rectify these imbalances remains uncertain. Health experts say it largely depends on the details. And the Congressional Budget Office, the government’s referee on cost impact, has not studied what the monetary trade-offs would be.
Most experts and advocates agree that under “Medicare for all,” taxes would go up sharply. But premiums would fall or be eliminated altogether. And some experts say the overall cost of health care would drop because doctors and hospitals no longer would have to maintain complicated billing systems and the network of employees necessary to support them.
Opponents of “Medicare for all” see it as a precursor of health care rationing and long waits for medical appointments and procedures. But experts say the Medicare system as it stands now is fully functional, with seniors for the most part getting the treatment they need on a timely basis.
“Every doctor and hospital takes Medicare, so you wouldn’t be getting a surprise bill from an anesthesiologist who is not in network,” said Karen Pollitz, a health policy expert at the nonpartisan Kaiser Family Foundation. “It’s not a problem for anyone now on Medicare. Hospitals are not turning away Medicare patients in the parking lot.”