COVID Underscores the Need for Health Care Insurance Overhaul
By Marc Lavietes, MD, Secretary of Physicians for a National Health Program, NY
On April 10, 2023 President Biden ended the Covid national emergency. Covid has been responsible for more than one million deaths in the U.S. Since 2020, our life expectancy has decreased by three years. Our economy, employment rates and social mobility have suffered. Paradoxically, because of government interventions such as the National Emergency Declaration, the number of Americans with health insurance has increased. National Health Insurance Survey data show that in 2020, 31.6 million (9.7 percent) had no medical insurance; a year later, 27.2 million (8.3 percent) were uninsured. This decrease is explained by these emergency policies. Soon, after a 60-day waiting period, these policies will expire. We will return to our poorly regulated, for-profit multiplayer system. Millions of Americans will lose their medical insurance.
Presently, Americans pay more for medical care than do persons in any other Western industrialized country. By contrast, basic indices of health care quality such as longevity and maternal and infant mortality are superior in all of those countries.
Passage of a universal, not-for-profit single payer health care plan would go a long way to making health care available and affordable to all Americans. Given our current polarized political climate, such legislation is not possible at a national level. In New York State however, a bill entitled the New York Health Act (NYHA) is now co-sponsored by majorities in both the State Senate and Assembly. Although many New Yorkers remain unaware of this bill, the NYHA has steadily gained support among activists and interested parties over the past 30 years.
This bill describes a “Medicare for All” program for state residents. It establishes a trust fund. All money to finance health care goes into that fund. Physicians and hospital bill that fund directly. Prices for medical services and procedures will be established via negotiation between patient advocates and providers. There are no constraints or limitations on how physicians organize their practices or how patients choose their physician. While opponents to universal health care often invoke the notion of freedom, in truth, a centralized single payer system is more likely to provide freedom–freedom for patients to choose their own doctor and freedom for physicians from unnecessary time consuming paperwork.
Administrative cost is a major driver of our inflated health care expenditures. Approximately 25 percent of our health care dollars is spent on administration. No other country spends as much as five percent. The Covid relief package was designed essentially as a series of alterations to our current system, a system that has been shaped by the Affordable Care Act of 2010. A brief look at some of the details of this package and its aftermath makes clear that our system is unnecessarily complicated, user unfriendly, inefficient and costly.
As an immediate response to the Covid crisis, Congress passed the Families First Coronavirus Response Act. This provided funding for states so that recipients could maintain continuous enrollment in Medicaid. States were barred from removing persons deemed ineligible from Medicaid during Covid. Now, the yearly Medicaid renewal process that had been suspended during Covid will soon be restored. People who fail to comply with the renewal process, as well as those whose incomes have increased to exceed Medicaid limits, will become ineligible. Tens of millions of current Medicaid beneficiaries will be required to complete application forms to determine eligibility. Many will lose coverage. As of this writing, the process of rescinding Medicare benefits has begun in a few Southern states. Secondly, for people enrolled in marketplaces established by the Affordable Care Act, premiums will increase. During Covid, marketplace insurance has been free for those newly unemployed. Cost has been reduced for those enrolled in the marketplace prior to Covid. Going forward, premium subsidies, (that is tax credit to businesses to cover sick leave for employees), will be eliminated. The yearly registration period will be restored. All of these processes are complicated. Many recipients will require trained facilitators to navigate the system. In general, our current system is composed of many disparate funding mechanisms that vary with beneficiaries’ income and age; Medicaid for lower income people; the ACA marketplaces for middle income people; Medicare for older people; CHIP for children; COBRA for newly unemployed; ERISA for some retirees and lastly, private insurance. Medicaid and the ACA marketplaces, both programs that are limited to persons with specified ranges of income, require annual recertification or registration. With the NYHA, the premium would be calculated solely from your income. No one would renegotiate their plan yearly.
The objectives of a successful health insurance program are to maximize coverage, minimize cost and to simplify the administrative process. This is best achieved by pooling risks of older often less healthy people with the population at large. Our current system is counterproductive. It condones profit seeking insurance providers who cherry pick younger and healthier customers, inflate – often fraudulently – billings and then deny coverage for services. Our State legislative leaders, Senate Majority Leader Stewart-Cousins and Assembly Speaker Paulin, are reluctant to bring the NYHA bill for vote because of opposition primarily from the Municipal Labor Council (MLC). NYHA sponsors are currently revising the bill so as to satisfy MLC objections. All New Yorkers would be well served by passage of this bill.