October 18, 2018

Voters will choose prescription for health care

Surprisingly, one issue that affects most of us — the high cost of health care — has remained in the background of the presidential campaign so far, even though large numbers of Americans will soon face insurance premium increases for plans purchased from the exchanges created by the Affordable Care Act (Obamacare).

One reason may be that the program is so complicated. Navigating through Obamacare makes shopping for a new car seem easy.

Still, Chris Jacobs, CEO of the Juniper Research Group and a Republican consultant in the presidential primaries, thinks the matter will emerge from the background at some point during the campaign. Jacobs wondered in The Wall Street Journal whether rate increases could become “an October” surprise, helping the Republican nominee, Donald Trump, to win. I doubt it. Health care is too complex for Trump, who seems intent on winning by using the raw emotion generated by his diatribes on crime, terror in the streets and immigrants.

Still, Trump is the candidate of discontent. Anything that makes the electorate mad is fuel for his outrage.

In a close election, every percentage point counts, especially in the 10 or so states considered battlegrounds. One of them is Iowa. There, the big insurance company Wellmark Blue Cross and Blue Shield is telling about 30,000 of its customers buying policies on the exchanges — marketplaces available on the internet — that their premium rates will go up by 38 percent to 43 percent next year, The Des Moines Register reported. There will be smaller increases for another 90,000 people.

The same thing is happening elsewhere in the country, although not to such an extent. Avelare Health, a consulting firm, told Kaiser Health News that insurance companies are seeking rate increases for the exchanges’ popular silver plan by an average of 11 percent in 14 states. In California, Obamacare premiums will increase an average of 13.1 percent next year.  

The exchanges currently are used by 13.7 million Americans not covered by employer plans, according to the authoritative website ACASignups.net. In California, this amounts to 1.57 million. Those who are insured through their employer are not affected, nor are those who avoid the exchanges and shop for insurance on their own.

The big advantage to buying through an exchange is that policies may be cheaper than those on the open market. And those with lower incomes are eligible for federal subsidies that can greatly reduce the cost of insurance.

To help understand the system, I ran examples through the rate chart on the website of California Covered, which runs the California insurance exchange.  I created a mythical family of four — husband, wife and two children with an annual family income of $60,000. I picked the most popular of the Obamacare offerings, the silver plan, which provides a wide range of care but includes deductibles. Benefits vary according to the price of the plan.

The monthly premium for the most expensive silver plan is $1,285. But the family’s income would make it eligible for a federal subsidy, bringing the premium down to $513 a month. For the cheapest silver plan, the monthly premium would be $1,087, reduced to $316 by the subsidy.

In addition, the two children might be eligible for free care through Medi-Cal, the state program heavily subsidized by federal Obamacare funds. Medi-Cal has been a big help — in many cases, a life saver — for children like the ones in my example and to the poor and working poor.

Medi-Cal was created decades ago for the very poor. Obamacare extended it to the growing ranks of the working poor. Medi-Cal offers free or low-cost health coverage with most recipients receiving care through managed health plans or HMOs.

As a result of the Obamacare exchanges and Medi-Cal, the number of uninsured Californians has dropped from 17 percent of the population to 8.1 percent.

These numbers are evidence of a great improvement in health care accessibility.  

The Republicans, however, including Trump, don’t think so. They want to repeal Obamacare and replace it with a system that would turn medical care for the poor over to the states, many of which are hostile to helping their impoverished residents. Federal subsidies would disappear. 

At the heart of the GOP plan is something that has been floating out of conservative think tanks for years — health savings accounts. The GOP wants most Americans to finance their own health insurance by putting aside money and depositing it in health savings accounts. These are like regular savings accounts, except that your money is not taxed when deposited. But it’s a question of whether there would be enough money in the family health savings account if cancer, heart disease, diabetes, mental illness or any number of long-term debilitating illnesses were to strike.

Moreover, the Republican plan would make it easier for insurance companies to refuse to issue policies to people with pre-existing conditions.  Before Obamacare, such refusals were a familiar story, often driving uninsured families into bankruptcy and poverty. 

The Republicans also advocate giving parents the right to refuse immunization for their children. And, of course, as an important part of its health care agenda, the party “stands firmly” against abortion.

The Democratic presidential nominee, Hillary Clinton, has proposed a number of changes in Obamacare. While keeping its current structure, she would create a government-financed insurance operation in addition to private companies on the exchanges. Theoretically, this would provide competition for the insurance companies and force them to lower rates.

Another change would greatly increase federal aid for community health clinics, which provide medical care for the very poor. And she would make everyone 55 and older eligible for Medicare, which now dispenses health care to those 65 and older. 

Her opponent in the primaries, Sen. Bernie Sanders, wanted to put everyone on Medicare, thereby assuring that all Americans would have the same decent medical coverage now available to the 65-plus set. But he has said he believes Clinton’s proposals would be a big step forward in providing health care to all Americans.

Both Clinton and Sanders have been addressing the complexities and challenges of improving America’s health care, a crucial step in creating a more equal society.

Trump and the Republicans offer a simpler prescription to the sick: You should have saved for a rainy day. 

BILL BOYARSKY is a columnist for the Jewish Journal, Truthdig and L.A. Observed, and the author of “Inventing L.A.: The Chandlers and Their Times” (Angel City Press).