Whether the Affordable Care Act (ACA) was ever an effective way to combat the issues facing our healthcare system is arguable – but it is clear that our political process has not helped. The Commonwealth Fund recently reported that the uninsured rate for working-aged Americans (between 19 and 64) has increased from 12.7% in 2016 to 15.5% today. This is more severe for those earning less than 250% of the federal poverty level ($30,000 for an individual and $61,000 for a family of four), at over 25% uninsured. And, their survey indicates that 9% of those with individual coverage, 5% of those covered by their employer and 5% of those covered by Medicaid plan to drop coverage because of legislation eliminating the individual mandate penalty. The Urban Institute estimates that an additional 6.4 million people will be uninsured next year and an additional 2.5 million Americans will switch to plans which do not provide minimum essential coverage due to recent policy change which allows short-term medical coverage. And they estimate that costs to the federal government will increase by 9.3% over 2018.
So we are back to fewer people covered for more money and out-of-control cost escalations. Years ago, I echoed former Senator Daniel Moynihan’s advice that lasting social legislation needs 70 votes in the Senate. The present track on healthcare proves this out. Political tides are taking a bad situation and making it much worse. And now, political pundits are predicting that work on healthcare legislation is finished until after the mid-term elections. Since it is likely that Republicans will lose control of at least one chamber of Congress, the impasse will get worse before it gets better. And infighting continues to exacerbate the problem.
The states will be able to move the needle a bit – but I am not sure in which direction. The Medicaid eligibility work requirement which is getting traction in many states is going to increase the uninsured rate – not decrease it.
The instability in the marketplace and the rising uninsured rates do not favor the status quo. Next week I will be meeting with the White House and several key congressional representatives on these issues. Stay tuned – I will let you know what they say.