Amid calls to start over, US health sys­tem cov­ers 90%

The Fresno Bee (Sunday) - - News - BY RI­CARDO ALONSO-ZALDIVAR

Amer­ica’s much-ma­ligned health care sys­tem is cov­er­ing 9 out of 10 peo­ple, a fact that hasn’t stopped the 2020 pres­i­den­tial can­di­dates from re­fight­ing bat­tles about how to pro­vide cov­er­age, from Bernie San­ders’ call for re­plac­ing pri­vate in­sur­ance with a gov­ern­ment plan to Pres­i­dent Don­ald Trump’s pledge to erase the Af­ford­able Care Act and start over.

The politi­cians are de­pict­ing a sys­tem in melt­down. The num­bers point to a dif­fer­ent story, not as dire and more nu­anced.

Gov­ern­ment sur­veys show that about 90% of the pop­u­la­tion has cov­er­age , largely pre­serv­ing gains from Pres­i­dent Barack Obama’s years. In­de­pen­dent ex­perts es­ti­mate that more than half of the roughly 30 mil­lion unin­sured peo­ple in the coun­try are el­i­gi­ble for health in­sur­ance through ex­ist­ing pro­grams.

Lack of cov­er­age was a grow­ing prob­lem in 2010 when Democrats un­der Obama passed his health law. Now the big­ger is­sue seems to be that many peo­ple with in­sur­ance are strug­gling to pay their de­ductibles and co­pays.

“We need to have a de­bate about cov­er­age and cost, and we have seen less fo­cus on cost than we have on cov­er­age,” said Colorado Sen. Michael Ben­net. He is among the Demo­cratic pres­i­den­tial can­di­dates who fa­vor build­ing on the cur­rent sys­tem, not re­plac­ing it en­tirely, as does San­ders. “The cost is­sue is a huge is­sue for the coun­try and for fam­i­lies,” Ben­net said.

A re­port this year by the Com­mon­wealth Fund think tank in New York found fewer unin­sured Amer­i­cans than in 2010 but more who are “un­der­in­sured,” a term that de­scribes pol­i­cy­hold­ers ex­posed to high out-of­pocket costs, when com­pared with their in­di­vid­ual in­comes. The re­port es­ti­mated 44 mil­lion Amer­i­cans were un­der­in­sured in 2018, com­pared with 29 mil­lion in 2010 when the law was passed. That’s about a 50% in­crease, with the great­est jump among peo­ple with em­ployer cov­er­age.

“When you have 90 per­cent of the Amer­i­can peo­ple cov­ered and they are drown­ing in their health care bills, what they want to hear from politi­cians are plans that will ad­dress their health care costs, more than plans that will cover the re­main­ing 10 per­cent,” said Drew Altman, pres­i­dent of the Kaiser Fam­ily Foun­da­tion, a non­par­ti­san re­search or­ga­ni­za­tion that tracks the health care sys­tem. “When Democrats talk about univer­sal cov­er­age more than health care costs, they are play­ing to the dreams of ac­tivists and pro­gres­sives … much less to the ac­tual con­cerns of the 90 per­cent who have cov­er­age to­day.”

San­ders’ of­fice re­sponds that the Ver­mont sen­a­tor’s “Medi­care for All” plan would solve both the cov­er­age and cost prob­lems for in­di­vid­ual Amer­i­cans. Med­i­cal care would be pro­vided with no de­ductibles or co­pays. No one would unin­sured or un­der­in­sured.

“The sim­ple an­swer is that our health care sys­tem be­come more un­man­age­able for more and more Amer­i­cans every year,” San­ders spokesman Keane Bhatt said in a state­ment. “This is not a sys­tem that needs a few tweaks. This is a sys­tem that needs a com­plete over­haul.”

But other coun­tries that pro­vide cov­er­age for all and are held up by San­ders as mod­els for the U.S. don’t of­fer ben­e­fits as gen­er­ous he’s propos­ing. If he is elected pres­i­dent, there’s no way of telling how his plan would emerge from Congress, or even whether some­thing like it could pass.

Four other 2020 Democrats are co-spon­sors of San­ders’ bill: Sens. Cory Booker of New Jer­sey, Kirsten Gil­li­brand of New York, Ka­mala Har­ris of Cal­i­for­nia, and El­iz­a­beth War­ren of Mas­sachusetts.

On the other side of the po­lit­i­cal spec­trum, Trump is talk­ing about big changes. His ad­min­is­tra­tion is seek­ing to have fed­eral courts de­clare the en­tire Obama-era health care law un­con­sti­tu­tional, jeop­ar­diz­ing cov­er­age for 20 mil­lion peo­ple, jet­ti­son­ing pro­tec­tions for pa­tients with pre­ex­ist­ing con­di­tions, and up­end­ing the rest of the 970-page statute, now nearly 10 years old.

The pres­i­dent says there’s noth­ing to worry about. Ear­lier this sum­mer Trump told ABC News that he was work­ing on a plan that would pro­vide “phe­nom­e­nal health care,” pro­tect peo­ple with pre­ex­ist­ing con­di­tions, and would be “less ex­pen­sive than ‘Oba­macare’ by a lot.”

As pres­i­dent-elect, Trump promised a health plan but never of­fered one upon tak­ing of­fice. In­stead he backed bills from con­gres­sional Repub­li­cans, in­clud­ing one he called “mean” dur­ing a pri­vate meet­ing.

Trump says he might come out with his new plan within months, but that pass­ing it would hinge on his get­ting re­elected and Repub­li­cans win­ning back the House in 2020 while keep­ing con­trol of the Se­nate.

That’s a bit of po­lit­i­cal déjà vu.

Repub­li­cans con­trolled Wash­ing­ton back in 2017 when Trump, then-Speaker Paul Ryan, R-Wis., and Se­nate Ma­jor­ity Leader Mitch McCon­nell, R-Ky., tried for months to re­peal and re­place the Obama law, only to fail. The re­peal ef­fort was widely seen as con­tribut­ing to Repub­li­cans los­ing the House in 2018.

Since then, many GOP lawmakers have tried to avoid the is­sue al­to­gether.

Econ­o­mist Sara Collins of the Com­mon­wealth Fund, who led the study about un­der­in­sured Amer­i­cans, says cost and cov­er­age prob­lems are in­ter­twined. Cit­ing the Democrats’ de­bate over Medi­care for All, she says what’s miss­ing from that dis­cus­sion is that “one doesn’t have to go that far in or­der to im­prove the fi­nan­cial sit­u­a­tion for mil­lions peo­ple – you can do that with much more tar­geted, in­cre­men­tal poli­cies.”

J. SCOTT APPLEWHITE AP

Amer­ica’s health care sys­tem is cov­er­ing more peo­ple than ever, pre­serv­ing gains made un­der Pres­i­dent Barack Obama’s Af­ford­able Care Act, which is al­most a decade old.

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