Affordable Care Act hikes could spark Medicare for All

Bill Knight column for Mon., Tues. or Wed., Oct. 31, Nov. 1 or 2

Illinoisans who don’t have health insurance through their jobs or from individual policies they bought face premium hikes as sign-up starts this week for the Affordable Care Act, and those who fault President Obama for everything from Bears quarterback Jay Cutler to another danged week of Daylight Saving Time aren’t hesitating to blame Obama.

There’s plenty of blame to go around, but focusing exclusively on Obama is like denouncing an architect when the rent goes up. Building designers, engineers, contractors or carpenters aren’t landlords, and Obama didn’t decide to raise premiums.
Here, now, it’s the insurers, and their greedy move could be the Step Too Far that rekindles consideration of Medicare for All.

In Illinois, premiums would go up 44 percent for the lowest-priced “bronze” plans, and about 300,000 people not in employers’ plans, Medicare or Medicaid could be affected. Out of 10.5 million enrolled nationwide, about 1.6 million face higher prices.

Besides insurers’ premiums increasing, policyholders’ choices in insurance exchanges – central to the ACA – are decreasing. In states using HealthCare.gov, the number of plans is dropping from 47 to 30 because corporations such as Aetna, UnitedHealth Group and Humana are pulling out of some states, concerned that they otherwise won’t continue making millions in profits – essentially blaming policyholders who actually need the coverage. (If health insurers covered only young and healthy people and paid no medical expenses, they’d REALLY make profits.)

When Bill Clinton on Oct. 3 called it a “crazy system … with their premiums doubled and their coverage cut in half,” he was talking about private companies being in charge of public good.

However, insurers’ actions in the ACA – signed into law in 2010 but not fully implemented until 2014 – could spark demands for Medicare for All.

In the meantime, ACA officials recommend shopping around for less-expensive plans and using available subsidies, which increase along with premium prices. But Health and Human Services Sec. Sylvia Mathews Burwell also adds that lawmakers share responsibility, too, not only for insisting on keeping the insurance industry in its powerful position, but Congress’ “efforts to undermine the ACA,” like trying to kill the ACA more than 60 times, blocking funds to help protect insurers with high-cost customers, and refusing to expand Medicaid. Some 3 million people can’t get Medicaid help because the Supreme Court OK’d states’ right to decline expanding Medicaid.

“It’s not because of any policy in the Affordable Care Act that the rates are going up,” Obama said. “If state leaders purposefully try to make something not work, then it's not going to run as smoothly.”

Further, constant criticism by right-wing radio, Fox News and their ilk contribute to the ACA’s low approval rating while its actual provisions (preventive care, coverage for those with pre-existing conditions, protections for young people, and cancer screenings) are popular.

U.S. Sen. Bernie Sanders said, “Health care cannot continue to be dependent upon the whims and market projections of large private insurance companies whose only goal is to make as much profit as possible. That is also why we need to pass a Medicare-for-All, single-payer system.”

The ACA is having success, too. Experts expect enrollment to rise to a monthly average of 11.4 million next year, health-care jobs are increasing, and hospitals’ finances improving, according to the new book “150 Years of Obamacare” by Daniel Dawes, who notes that a recent Gallup survey showed that the percentage of uninsured nonelderly adults is 11.5, a historical low, down from about 20 percent in 2012.

Plus, putting the country’s health-care spending into perspective, projections in 2009 called for health-care spending to increase 19.3 percent of Gross Domestic Product by now, but the ACA has helped hold that to 18.1 percent, according to economist Dean Baker.

Meanwhile, Medicare for All could build on strengths and fix weaknesses by encouraging cost control because service, not profit, would be the priority. As Margaret Flowers of the Physicians for a National Health Program explains, “Insurance companies cherry-pick the healthy. The only thing that will turn this system around is to expand traditional Medicare. Everyone is in it. All the health-care providers are in it. Everyone pays through a progressive tax. Then we can get the cost savings that we need to provide high-quality universal care.”

[PICTURED: Editorial cartoon by Pat Bagley/ Salt Lake Tribune, from politicalcartoons.com.]