A Real Solution for the Health Insurance Market

Is having health insurance a right or a privilege? Is having access to quality medical care a right or a privilege? The core issue of the health insurance discussion should be about the minimum of health care provided to all Americans. Health insurance is a mechanism of paying for this health care.

When it comes to each of us and our families, there is no doubt we want the best health care. And when it comes to our children, everyone agrees there should be health care. However, this is not the case under the American Health Care Act. The AHCA would allow for insurance companies to deny coverage for pre-existing conditions. The nonpartisan Kaiser Family Foundation estimates that 27% of adults under age 65 have health conditions that would likely leave them uninsurable under practices that existed before the health care overhaul. Being insurable or uninsurable is a result of a roll of the dice. If you are lucky and have not yet had a medical issue, you win and have the privilege of purchasing health insurance. 

Pre-Existing Conditions Reduce Health Insurance Opportunities

If you are not lucky and have some type of medical condition ranging from acne to cancer, you would not be able to get health insurance, or even if you were able to get it through the proposed high risk pools to be run by each state, there’s only enough money to insure anywhere from 5% to 30% of those who would need it and the premiums would be significantly higher. Prior versions of this bill were estimated by the Congressional Budget Office to lead to 24 million Americans losing coverage in the short term and 52 million by the year 2020. (For related reading, see: American Health Care Act aka "Trumpcare" Explained.)

My son was diagnosed with Type 1 Diabetes last January. Type 1 Diabetes is an auto-immune virus that attacks the pancreas, eventually causing the pancreas to fail. The only way for my son to survive is through a rigorous insulin dosing protocol and careful 24/7 monitoring of his blood sugar. If his blood sugar goes too low, he could end up in the hospital and if his blood sugar goes too high, he could end up in the hospital. With type 1 diabetes, there are multiple medications and supplies that are expensive. While it can be genetic, neither my wife nor I have anyone in our families who has Type 1 Diabetes. Now my son is not only faced with a serious and challenging chronic illness, he may also not ever be able to get health insurance. Is this the world we wish our children to live in?

The Affordable Care Act Is a Good Place to Start

The Affordable Care Act while not yet perfect, allowed us the peace of mind that our son would be able to purchase health insurance. The Affordable Care Act though is not truly affordable and does leave a number of Americans with coverage gaps. The Affordable Care Act is a starting point rather than an end point. As with anything, it is always easier to build upon something and improve upon it rather than continuously re-inventing the wheel.

We can all agree everyone should have access to emergency treatment. If we dial 911, an ambulance comes and the 911 operator does not first ask about our health insurance. And under the Emergency Medical Treatment and Active Labor Act of 1995, all hospitals are required to treat individuals regardless of insurance. This means we already have, by federal law, a starting point for all Americans to have healthcare coverage.

And in this country, we already a great public/private partnership between the federal government and private insurance companies that has been in place for decades. As far as I can recall, there has been no talk of repealing this program, only talk of improving this program. And this amazing program already covers 17% of Americans. All Americans either through age or disability will participate in this plan. And yes, this plan is Medicare.

Medicare Expansion

So here’s the practical solution to the healthcare conundrum—the expansion of Medicare to all Americans. Medicare Part A is mostly already in place for all Americans as it covers emergency care (mentioned earlier). This is already funded. Medicare Part B covers preventative services that could be easily adapted to match the ACA’s essential benefits. Medicare Part D covers prescription drugs. And the private marketplace provides Medicare Advantage Plans (known as Medicare Part C) that takes the place of Medicare Parts A and B and privatizes them along with the availability of Medigap/Medicare Supplement plans that cover additional medical services. This allows for all Americans to easily have access to health care. (For related reading, see: What Does Medicare Cover?)

Medicaid expansion needs to be supported and continued. Thirty-one states have already have expanded Medicaid, with other states either in process or reviewing it. Medicaid is our country’s largest insurer with more 70 million beneficiaries. Moving to an expanded public/private partnership could help reduce the federal tax burden. Medicare Advantage policies offered through private health insurance companies are now 35% of the overall Medicare marketplace.

And there are some very simple ways to save money to pay for the plan.

  • Introduce "legitimate pricing," full cost disclosure: savings of 33% ($1 trillion) 
  • Terminate employer health insurance: Excluding premiums from taxes was worth about $250 billion in forgone tax revenue in 2013 
  • Reduce fraud: healthcare fraud costs the nation about $68 billion annually, with other estimates ranging as high as 10% of annual healthcare expenditures ($320 billion) 
  • Increase virtual health care: annual savings of $7 billion
  • Fix Medicare Advantage overspending on inflated risk scores ($10+ billion annually, per the Government Accountability Office
  • Review Medicare coding errors: $20 billion per year

This is a critical time for our country and our representatives to come together and work for the good and the will of their constituencies. It is time to exercise our First Amendment Right to free speech and speak up for ourselves, our children, our families and our friends.

(For more from this author, see: What Can Happen if the Affordable Care Act Is Repealed.)