‘Medi­care for all’ on U.S. House agenda

The News-Times (Sunday) - - Front Page - By Dan Freed­man

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 com­pre­hen- sive 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 pri­vatein­sur­ance 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 Don­ald 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 sin­gle­payer 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 health­care 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 pre­ex­ist­ing 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, di­rec-

tor of the non­par­ti­san 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.”

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