Caveat emptor: It’s not only an open season ‘for’ but also ‘on’ health coverage

cardformedicare-300x188Americans in coming weeks will make important decisions on the national and personal level about how best to safeguard themselves and their loved ones with a crucial component of the U.S. health care system: their insurance coverage.

Though the exact timing of the open enrollment season varies by geography and plan, it’s that key time for millions who get their coverage via Medicare and may wish to make changes. These are important weeks, too, for many who obtain health insurance under the Affordable Care Act, aka Obamacare. Many workers are hearing a lot from their human resources folks about their employer-provided plans.

It’s clear from the political polling and the sometimes-dreary Democratic presidential debates that there’s huge interest and lots of devil in the details about Americans’ health insurance options.

It, sadly, can be life changing and life saving for patient-consumers to take the time from their already hectic lives to drill into all the information they can get. Those HR folks should earn their pay by answering every question, none too small and none ever “dumb” about company programs. The internet has resources — please use these with care, likely giving the credibility nod to public offerings from the federal government. Talk to savvy family members, work colleagues, and your trusted doctors, dentists, lawyers, and accountants to ensure you’re making informed choices about your health coverage.

Health insurance matters. It’s wildly imperfect, including the coverage most of us get through our work, where premiums keep climbing and so do deductibles. This one-two punch means that too many Americans, even though they appear to have insurance, don’t get the help they need with soaring costs for medical care and prescription drugs.

This also leads to the scandal of U.S. health care — crushing medical debt and medical bankruptcy.

Even with the ACA, too many of the working poor and the middle class can’t afford the rising costs of health coverage, and, they, too, get staggered with sky-high medical bills and prescription drug expenses. Too many patients, in a tragic policy repeat, also are finding that they made a Faustian bargain, agreeing to lower monthly premiums for “skinny” health plans that provide no help if they get sick or injured.

Though it may be daunting to do so, it’s also vital for voters now to keep their sights laser-fixed on the politicians’ views about health care and coverage. Health insurance has been a central obsession of national politics for a decade — and the partisan fog on this issue can get deeper than what San Franciscans encounter on cold winter nights.

Let’s make it simpler and try to cut through some of the counter factual humbug.

Republicans don’t believe the federal government should play a role in health care, or they will do anything they can to minimize it. This has underpinned their religious-zealot-style campaign to kill not only Obamacare but to slash at Medicare and Medicaid.

It’s a judicial fact: GOP wants to strip millions of health coverage

The Trump Administration may find itself the junk yard dog that chased and finally caught the big truck that rumbles down the street every day: Legal scholars expect a decision any day now by an appellate court on a challenge by the administration and Republican state attorneys general seeking to invalidate the ACA — including its protections for those with pre-existing conditions and against caps on lifetime payments. Republicans are working overtime, behind the scenes, to figure how to delay a potential nightmare of their own making, with the U.S. Supreme Court potentially taking up and undoing the ACA just as Americans head to the polls for the 2020 presidential vote.

Republicans have had a decade to offer voters their own health insurance plan. But aside from promoting coverage that consumers long ago found to be little more than a con and rip off, the GOP hasn’t offered or acted. The party faces chaos, if it finally succeeds in killing the ACA and strips millions of Americans from coverage they have now. The administration also may be confronted with upheaval in employer-provided plans: Who expects corporations — if Obamacare doesn’t require it — to pay for preventive care, or women’s health services, or to maintain pre-existing condition and lifetime limit protections? Why would profit-focused CEOs want their firms to let parents keep their children on their health policies until age 26?

The ACA needs fixing, no doubt, especially as it hasn’t addressed coverage affordability for older working Americans and those in the “gig economy.” But there’s a reality that Republicans duck and Democrats fail to trumpet Obamacare, especially as it expanded Medicaid to help children, the elderly, and the poor and working poor, has helped address a crucial need: making Americans healthier. The data is building but the recent research findings cannot be ignored:

  • A 2017 study found that in Michigan, where expanded Medicaid covers about 650,000 people, patients who had cardiac bypasses or valve operations had fewer complications compared with similar patients in Virginia, which had not yet expanded Medicaid.
  • A 2018 study found infant deaths, especially among black infants, decreased more sharply in areas with expanded Medicaid (although the study does not indicate which families had coverage through ACA expansions).
  • More than 25,000 Ohio smokers got help that led them to quit through the state’s Medicaid expansion.
  • A National Bureau of Economic Research paper from July that examined “deaths from all causes among adults from their mid-50s to mid-60s, found that dying in a given year has been significantly less common in the states that expanded Medicaid.” Amy adds: “The paper said that perhaps 15,600 deaths could have been avoided if the expansion had been nationwide, but it cautioned that is a rough estimate in part because the study was unable to look specifically at the people who signed up for Medicaid.”

So, what has been the administration response? Republicans in the states, with the administration’s encouragement and assent, have sought to impose draconian work and paperwork hurdles on some of the poorest and most vulnerable with the false claim that burdensome requirements will protect the tax dollar and make the needy more responsible. Courts already have been skeptical of and may strike down what Republicans call Medicaid “innovations.” As the pro-business and conservative Wall Street Journal reported (in its more bias-free news columns), the Medicaid work rules have been nothing less than cruel, aimed not at helping those in need but instead in humiliating them and tossing them from public help just when it is most needed.

The attack on Medicare

Lest any voters mistake the overall GOP menace to Americans health, President Trump not only obscured his actual actions on the program but engaged in duplicitous praise of Medicare. He promised to defend it from cuts, while, progressive experts say, he has been driving a stake in its fairness and access for all seniors.

The GOP has watched with pleasure, experts warn, as health insurers have moved in to “supplement” Medicare benefits for Americans 65 and older. Trump, by executive order, has told the officials who run the senior health coverage plan to equalize in as many was as they can the private offerings with anything Medicare has. That may sound innocuous. But, at a time of record income inequality, the administration is fostering a haves and have-nots’ system, in which richer, healthier seniors pay for significantly better and private options, leaving taxpayers to foot the bill for the poorest, sickest, and most vulnerable elderly. Insurers, who have done little and failed to contain costs in health care for most Americans, also would bring their bad habits now into Medicare, under the Trump order. It would discourage Medicare cost-control efforts by forcing the federal program to equalize payments with private insurers. This, progressive experts warn, will send costs higher, while depleting Medicare funds — all while the GOP pushes to slash the program’s funding, arguing private insurers are doing great, thank you.

This is not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the ever-rising cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs. Health care should be a right and not a privilege. We’ve got lots of work to ensure this is so, especially by using and improving the health insurance available, especially so it provides real financial protection and appropriate cost- and risk-sharing to as many as possible.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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