Gallup polls have been asking some big picture questions about the major dimensions of health system performance–quality, coverage, costs and access–for nearly two decades now. This allows me to show you a long time series of trends that leave little doubt that despite many lofty promises made for Obamacare (or the high hopes of its proponents), Obamacare essentially left American health the same or worse on quality, coverage, costs and access . I found literally no evidence in these data that it made things better.
The Democratic party is moving steadily toward a full embrace of Medicare for All as its official health-care policy. While the term is flexible enough to mean different things to different people, the overall direction is clear enough. The party is advocating for the enrollment — eventually — of all Americans in a government-run insurance plan of some sort.
Even here in the United States, government-run health care programs such as those of the Veterans Administration and the Indian Health Services have appalling records of patients dying while waiting for care.
For anxious mothers like me who don’t want to wait three days for results from a lab culture while my child suffers, government-run health care doesn’t promise speedy service.
Give Working Families A Break
The Trump administration is using its regulatory authority to provide Americans more flexibility and choices of affordable health coverage, but it should take additional steps to help working families struggling with the cost of health coverage.
The administration has proposed allowing employers to establish defined contribution arrangements that enable their employees to purchase health insurance plans available outside the workplace.
But an important new option would be for an employee to use an HRA contribution to buy into their spouse’s plan at work.
Last month, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas issued a ruling declaring Obamacare unconstitutional. The case was brought by 20 Republican state attorneys general. Seventeen Democratic state attorneys general responded January 3 by appealing to the U.S. Court of Appeals for the 5th Circuit.
Judge O’Connor appears to be on a bit of an island — the conventional wisdom on both the right and left is that his decision will be overturned by a higher court.
House Democrats used their new majority on Thursday to squeeze Republicans on health care, taking the first step to intervene in a court case in which a Texas judge has ruled the Affordable Care Act unconstitutional.
That move will be followed by a vote next week designed to force GOP lawmakers into a political corner: agree to defend a law many members have spent years reviling or appear to oppose popular ACA protections for millions of Americans with preexisting medical conditions that many have pledged to uphold.
Thursday’s authorization was part of a collection of rules the House adopted to guide its operation in the new Congress. It gives Pelosi permission to intervene in the Texas court case and allows the chamber’s counsel to work on the litigation.
The number of uninsured Americans is rising. Last year, 27.4 million Americans went without health insurance, an increase of 700,000 from 2016, according to a just-published analysis from the Kaiser Family Foundation. Government mandates deserve much of the blame. Regulations and red tape have driven premiums through the roof, pricing many Americans out of the insurance market. Nearly half of uninsured people cite high premiums and prohibitive deductibles as the reasons they aren’t covered. Free-market reforms would enable millions more people to afford insurance that fits their needs and those of their family.
What will Nancy Pelosi do now once she is back in the Speaker’s chair? In light of Judge Reed O’Connor’s recent ruling that Obamacare is unconstitutional and that the entire law must be scrapped, there is likely to be strong pressure to pass some sort of legislation to improve protections for people with pre-existing conditions. Of course, Rep. Pelosi also will face pressure from those who want to resurrect the idea of a public option—an idea she supported during the fierce debates of 2009-2010, but which foundered for lack of votes in the race to the finish line. And with various progressives jockeying for position in the 2020 race, there likewise will be a vocal minority urging a push for Medicare for All. To her credit, Rep. Pelosi has wisely desisted from endorsing that singularly bad idea. But it would be a shame if Nancy Pelosi squandered this opportunity by merely re-arranging deck chairs on the Titanic. By now it is manifestly clear that Obamacare—like so many ambitious government programs before it–has massively overpromised and underdelivered.
Most of the real action on health reform is likely to happen in the regulatory space over the next two years, and the Trump administration can build on the opportunities it already has created with a regulatory fix that would increase access to health insurance for working families.
We submitted a comment letter on Friday recommending a change to the administration’s proposed rule that adds flexibility to Health Reimbursement Arrangements. We recommend the administration also allow funds from one spouse to be used to buy into group health coverage offered by the employer of the other working spouse.
About one-fourth of employees offered health insurance at work do not participate, generally because of cost. This change would increase uptake by allowing spouses to use funds deposited into an HRA account by one employer to obtain a family insurance policy offered by the other spouse’s employer.
When a federal judge recently ruled that the Affordable Care Act is unconstitutional, many in the media were caught off guard. Little attention had been paid to the case, which was brought by the attorneys general of 20 states and by the Texas Public Policy Foundation (representing individual clients who have been harmed by Obamacare).
But when U.S. District Judge Reed O’Connor handed down his ruling, he suddenly had everyone’s attention. What has followed has been an exercise in opinion-forming and prediction-making—based on too little information and even less understanding of how we got here.