The evidence accumulates that partisans’ persistent attacks on the Affordable Care Act and Medicaid run counter to their constituents’ needs and wishes, but will Republicans course-correct or will voters soon force them to?
It may be inconvenient in these polarized times for public policy to be rooted in research and fact, rather than bluster and shouting. But the New York Times and Washington Post have posted not one but several stories that raise questions about recent actions by the Trump Administration and the Republican-controlled Congress affecting health care access.
Aaron E. Carroll, a professor of pediatrics at Indiana University School of Medicine and health care policy analyst, wrote for the New York Times’ evidence-based “Upshot” column about research on the ACA-driven expansion of Medicaid. It has prompted publication, he reported of “77 studies, most of them quasi-experimental in design … They include 440 distinct analyses.” Of these works:
More than 60 percent of them found a significant effect of the Medicaid expansion that was consistent with the goals of the Affordable Care Act. Only 4 percent reported findings that showed the Medicaid expansion had a negative effect, and 35 percent reported no significant findings. Negative effects could include more un-insurance and increased wait times, but none showed decreased quality [of care] …. The majority of analyses looked at access to care, and they showed that after the Medicaid expansion, insurance coverage improved, and the use of health services increased. It’s harder to study quality than access, but 40 analyses in 16 studies did so. About half of these reported improvements in quality measures like diabetes monitoring or preventive care screenings.
As Olena Mazurenko, the lead author of a systematic review Medicaid expansion studies, told Carroll: “With dozens of scientific analyses spanning multiple years, the best evidence we currently have suggests that Medicaid expansion greatly improved access to care, generally improved quality of care, and to a lesser degree, positively affected people’s health.”
Meantime, both the Washington Post and New York Times have reported on the resilience of ACA markets — with a key caveat — in the face of continued efforts by Republicans, notably now by the Trump administration, to gut Obamacare. As the Washington Post described developments:
The number of Americans who bought and began to pay for Affordable Care Act health plans grew slightly this year, despite repeated efforts by the Trump administration to undermine the insurance marketplaces created under the law, new federal figures show. As of February, a month after the start of 2018 coverage, 10.6 million people had paid premiums for ACA health insurance, about 3 percent more than the year before … The increase is striking because it happened even though federal health officials last year slashed ACA funding to grass-roots groups that help consumers sign up for coverage, cut advertising and other outreach activities by 90 percent, and shortened the enrollment period by half.
But Margot Sanger-Katz, a seasoned health reporter, also wrote in the “Upshot” column that there’s a negative number to be kept in the fore in examining ACA enrollments:
Last year, as insurance prices rose by an average of just over 20 percent around the country, people who qualified for Obamacare subsidies hung onto their insurance. But the increases appear to have been too much to bear for many customers who earned too much to qualify for financial help. According to a new government report, about a million people appear to have been priced out of the market for health insurance last year.
As she goes on:
Individuals who earn more than around $48,000 have to pay full price for their health plans; that group has faced a second round of big premium increases in 2018 and is looking at a third round of them in some parts of the country next year.
In other words, continued attacks on the ACA by the Trump administration — whether by administrative actions or by legal challenges, especially a Texas case that questions Obamacare’s protections against insurers denying coverage based on preexisting conditions — are intensifying market uncertainty and jacking up health insurance costs for middle- and higher-income Americans who don’t qualify for subsidies. (The administration launched yet another attack on the ACA over the holiday weekend, announcing it will suspend payments of billions of dollars of insurer risk-adjustment payments for coverage of sicker patients.) Many of the hardest-hit consumers fall in the 40-to-64 age group, many of them major Trump supporters.
At the same time, though, Reed Abelson of the New York Times looked at the broader ACA markets and he reported:
As health insurers across the country begin filing their proposed rates for 2019, one thing is clear: The market created by the Affordable Care Act shows no signs of imminent collapse in spite of the continuing threats by Republicans to destroy it. In fact, while President Trump may insist that the law has been “essentially gutted,” the ACA market appears to be more robust than ever, according to insurance executives and analysts. A few states are likely to see a steep spike in prices next year, but many are reporting much more modest increases. Insurers don’t appear to be abandoning markets altogether. In contrast to last year, regulators are not grappling with the prospect of so-called “bare” counties, where no carrier is willing to sell ACA policies in a given area.
Confused? Don’t be. In my practice, I see the harms that patients suffer while seeking medical services, and their struggles to access and afford safe, effective, efficient, and even excellent medical care. Despite what the partisans say, Obamacare has proved to be an advance in health care access — and it makes little sense to keep trying to repeal or slash it, especially without providing better options.
As Michael Neidorff, chief executive for the insurer Centene, told Abelson: “People want insurance.” He and others in the field emphasize that patients also need coverage to protect not just their health but also their fiscal well-being, so they don’t get slammed with medical debt and medical-related bankruptcy.
Meantime, Americans who are chronically and mentally ill, the elderly, children, and many other ailing and handicapped rely on Medicaid for health care help, and in the world’s wealthiest nation, it’s unacceptable to think why we can’t provide even more of it, especially via ACA expansion. Yet another state, Nebraska, may ask voters to expand Medicaid in that state. At the same time, it’s difficult to see other states and the administration seek Medicaid cuts or to slap on work and other rules to make life harder still for program participants.
Republicans insist that the government should have little or no role in the private sector, especially in health care. They argue that social programs cost the nation too much. But the administration has been showering Big Business with advantages — including a $1.5 trillion tax cut that mostly benefited wealthy corporations and the richest of the rich. That tax cut also will send the national debt soaring in the next decade by $2.3 trillion. Health care companies already have reaped billions of dollars in benefits from the GOP tax cut. They haven’t passed it on the patients, now have they?
Health care is a critical concern for voters (see info graphic above) as the nation races toward critical midterm elections. It’s never too early: If you read about how politicians are addressing your medical care and you shake your head in dismay, frustration, or even anger, register to vote. And be ready to head to the polls in November.