The coronavirus crisis has underscored the need for comprehensive health insurance coverage in the United States. Every individual needs affordable and consistent access to a medical provider, hospital, diagnostic tools, vaccines and medicines, both for that person’s health and for all of society. Poor health has many repercussions, not just susceptibility to infectious diseases. Children, spouses, employers, friends, institutions and businesses lose when people are not active, productive and well.
Once America moves beyond the pandemic crisis, politicians and others will have to shore up our existing health care infrastructure and insurance coverage. Because the country will have taken an economic hit, and likely be in a recession with a huge deficit and growing unemployment, proposals to cover the uninsured, like “Medicare for All” (supported by Bernie Sanders and Elizabeth Warren), will be popular. Beware. “Medicare for All” is both ill-defined and poorly thought out. Most interpretations include government price setting and less involvement by the private market. Government price setting will likely exacerbate physician shortages and reduce access to new medicines and treatments. Already, investment in infectious disease research is lacking and primary care physicians are in short supply.
Since the enactment of the 2010 Affordable Care Act, more Americans are using preventive care and fewer are failing to fill prescriptions or see physicians. The biggest expansion in health insurance coverage since 1965, the ACA today covers 20 million individuals despite the Trump administration’s best effort to undermine enrollment. Preventive care, including vaccines are covered, and people with pre-existing conditions cannot be denied coverage. While the ACA is still flawed, with insurance coverage options lacking in some areas and some insurers discriminating against people with serious illnesses, it should not be replaced by a worse system which assumes that only the federal government has the answers when states and health providers have worked to improve the ACA.
Some states, for example, have taken creative approaches and have been successful in managing high-cost patients in the individual insurance marketplaces. Minnesota adopted a reinsurance plan in 2018, which resulted in a 13 percent decrease in premiums in just the first year, while expecting another reduction of 8-9 percent for 2019. Maryland also adopted a plan in 2018 and reported a 13.2 percent decrease in premiums for the first year. While Wisconsin and Maine do not have official numbers from the first year, estimates place the rate decreases at 3.2 percent and 9 percent, respectively.
While there is no federal requirement to do so, many states have opened special enrollment periods during the pandemic to cover people left unemployed and uninsured. However, many states have reopened enrollment for the newly uninsured and the federal government should require a special enrollment period for all states.
While physicians opinions are mixed about the ACA, the majority want to change but not repeal the law. Many favor expanding Medicaid eligibility and employing either the Temporary Assistance for Needy Families or Supplemental Nutrition Assistance Program benefits to facilitate the enrollment process. Physicians are concerned with the administration’s attempts to undermine the ACA, believing instead that fixing the ACA’s imperfections should focus primarily on extending coverage of the uninsured — not dismantling the existing coverage enjoyed by many Americans today. In addition, more than 150 million Americans have health insurance through their employers. A single-payer option such as Medicare for All would destabilize, if not eliminate insurance coverage for this group. This would have a devastating impact on the supply of physicians, particularly in lower income and rural areas. Many other repercussions would arise. For decades, American unions have fought for a combination of wages and health care benefits when negotiating on behalf of their members. “Medicare for All” effectively undermines these agreements, creating a need for restitution.
Physicians advocate for their patients with a unified voice on issues that truly matter. These issues include removing obstacles to patient care, leading the charge to confront public health crises and creating the future of medicine through improved technology, physician training and public education. In the absence of a non-partisan federal perspective on health care, it is increasingly important for physicians to provide the necessary expertise and leadership. Hospitals, states, mayors and local providers have shown extraordinary resilience and great responses in this crisis. We need to lean on and empower them to provide solutions to expand access to preventive care and treatment for serious illnesses. The Affordable Care Act is a framework to do just that. Not only does it increase insurance coverage, it charges individuals for premiums and out-of-pocket expenses on a sliding scale. “Medicare for All” is just an ill-defined catchy phrase, obscuring a federal grab for control, which would have a devastating impact on the medical community and the people served by it.
Kirsten Axelsen is a visiting fellow at the American Enterprise Institute. She also consults with clients, including biopharma companies. Peter Carmel, MD, is chair emeritus of neurological surgery at Rutgers New Jersey Medical School. He is a former president of the American Medical Association.
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