Despite a strong economy and low unemployment, the number of Americans who lack health insurance is rising. The uninsured rate among adults in the fourth quarter of 2018 climbed to 13.7 percent, well above the low point of 10.9 percent in 2016, according to Gallup’s National Health and Well-Being Index.
That means 7 million Americans fell out of coverage over the last two years. What happened? For one thing, premiums rose sharply in 2018. For example, the benchmark silver plans sold on healthcare.gov, which covers roughly 70 percent of health care costs, rose an average 32 percent. Additionally, cutbacks in spending on outreach, advertising and enrollment assistance may account for the decline in coverage among low-income households. The expiration of the Accountable Care Act’s (ACA) individual mandate is another likely suspect.
In any event, it’s clear that the campaign of sabotage against the ACA waged by the Trump administration and Congressional Republicans is taking a toll.
Undaunted by their failure in 2017 to “repeal and replace” the ACA, President Trump and Republicans have pursued their obsession with killing “Obamacare” by other means. First, the Trump administration ended Cost Sharing Reduction (CSR) payments to insurers for discounts they are required to give to low-income enrollees. Getting rid of CSR payments led to a 10 percent increase in 2018 silver plan premiums, according to the Congressional Budget Office.
The White House also shortened and reduced advertising for the 2018 open enrollment period. They slashed funding for navigators, who assist consumers in signing up for insurance, from $63 million in 2016 to $10 million. Finally, Congress passed a tax reform package at the end of 2017 with only Republican votes and eliminated the individual mandate that required everyone to get coverage or face a penalty.
Republicans paid dearly in last year’s midterm elections for their relentless assault on the ACA. Voters identified the fear of losing or being unable to afford health coverage as their top concern. Seizing on these worries, Democrats threw GOP incumbents on the defensive for their anti-ACA obsession, winning 40 seats and flipping the House of Representatives.
Unfortunately, the Republican efforts to sabotage the law are working and the uninsured rate rose across income groups compared with the fourth quarter of 2016. Though there may be different reasons why low-income and higher-income people aren’t enrolling, the fact is, the uninsured rate is climbing.Uninsured rate
Democrats should work to undo some of the damage done by the Trump administration and Congressional Republicans by reinstating CSR payments to insurers. They could also build on the ACA and pass legislation that would help those above 400 percent of the federal poverty level afford coverage ($48,560 for a single person household and $100,400 for a four-person household). However, because they only control one chamber of Congress, they could work on other policies as well, ideas that have been traditionally bipartisan, to help put downward pressure on prices. Things like:
- Instating a broad-based reinsurance program which helps insurers cover the cost of particularly high claims
- Prohibiting or limiting balanced billing (out-of-network bills) to consumers
- Helping small businesses afford comprehensive health care coverage
- Increasing price transparency throughout the health care system
Democrats are in a better position to defend the ACA now that they have taken over the House. While an ideological battle over Medicare-for-all is likely to play out during the 2020 primary, they should not get so lost in the clouds and neglect promises they made to voters to stabilize and tweak the ACA on the ground.