What the Health?

Breaking down Tompkin’s County’s Candidates Healthcare Plans

Opinions on healthcare reform during the 2018 congressional race for New York’s 23rd district mirrored disparate partisan views on healthcare nationwide. Exit polls revealed 41 percent of voters felt healthcare was a priority.

Republican Tom Reed took 55 percent of the vote in NY-23rd district’s congressional race, beating Democrat Tracy Mitrano. Both candidates’ views on healthcare reform reflected their parties’ views, offering a hint as to where the healthcare debate may head in the future.

With the midterm elections granting Democrats control of the House and Republicans control of the Senate, the future of healthcare in the United States remains contested, though with Democrats in control of the House, the fate of former President Obama’s Affordable Care Act (ACA), dubbed Obamacare, seems secure.

If Democrats and Republicans agree on one thing, however, it’s that the AFA is flawed. Democrats like Mitrano support stabilizing it, while Republicans like Reed support completely repealing and replacing it.

To understand the AFA, it’s easiest to think of it like the legs of a table, suggests Jon Greene of the vlogbrothers. The AFA is a table with three legs and they rely on one another in order for the plan to remain effective and stable but if one leg of the plan doesn’t work or is removed altogether, the entire thing is fallible.

Since its rollout in 2010, the rate of uninsured people has dropped to nearly half (8.8 percent compared to 16.3 percent in 2010), but individual enrollment has steadily declined, even as enrollment in the ACA has stabilized. A stall in enrollment onto a healthcare plan leaves 28 million Americans without health insurance, a number high enough to curtail the slow rise in premium costs that would impact the elderly, sick and poor communities. So, in short, one of the ACA legs is struggling.

The ACA has granted health insurance access to a demographic that otherwise would not have access to it, but there are still obstacles. Many people who remain uninsured are unable to get health insurance because their job doesn’t provide it.  Some are ineligible for financial assistance to purchase healthcare because they live in states that chose not to expand Medicaid. 

Mitrano garnered attention from voters because of her broad stance on healthcare reform and her support of supervised injection facilities. Reed’s position on healthcare hadn’t changed in spite of his contentious race with Mitrano. He said his goal is to stabilize the individual market and reduce the costs to small businesses and consumers.

Reed* faced criticism in 2017 for his support of the American Health Care Act, the Republican response and replacement to the ACA. For months after sending the bill to senate, Reed was met with boos from his constituents at town hall meetings whenever he mentioned “Repeal and Replace,” according to NPR.

Reed voted in favor of the American Health Care Act of 2017, otherwise known as a budget reconciliation bill. The bill passed in the House. The decision to send it to the President where it will be made law now rests with the Senate, which returned the bill to its calendar in September 2017.

The function of the bill is to reevaluate future funding and allocations agreed upon by Congress for the Affordable Care Act, but the decisions will have more than an impact on Congress’ budget. The amendments proposed within it will affect the future of healthcare costs to consumers too.

So far, the bill has come under scrutiny for its suggestions to repeal and amend various taxes, expansions and mandates made within the Affordable Care Act. Some of the most contentious are:

• Rescission of obligated funds to Community Health Center programs that provide abortion services, like Planned Parenthood, for a year. The motivation for this action is to appeal to groups opposed to legal abortion procedures, but prior attempts to defund the organization suggest that defunding it decreases access to contraception, women’s health and impacts many smaller health care clinics more.
• Repeal of Medicaid expansion proposed in the ACA by 2020. The bill outlines that states that haven’t expanded will no longer be able to by the next election and patients who haven’t benefited in states that did expand will not be able to join.
• Repeal of mandate requiring insurers to meet benefit standards. This move gives states more authority to govern healthcare spending and more oversight over health insurance regulation, but it also also means that the government will no longer negotiate the price of insurance on behalf of the buyer as the exchange market is diminished.
• Repeal of ACA taxes used to fund the law, including taxes on high-income earners
  • One of those taxes is the medical device tax law, a 2.3 excise tax on medical devices sold domestically. Congressman Reed, a member of the Problem Solvers Caucus, a bipartisan congressional action group, conceived of the repeal of the medical device tax. New research shows that the tax did not produce its intended outcome. It “lowered industry research and development spending by $34 million [and is] responsible for the loss of approximately 21,800 jobs from 2013 to 2015,” reports the Tax Foundation.

The new bill will no longer have an income-based subsidy, but it will be age-based. Under the ACA, the ratio that a sick pool was held to was standardized a 3:1, which meant that the elderly and the sick could not be charged more than three times more than a healthy or young person. Under AHCA, the ratio is now 5:1. 

According to the Center for Budget Policy and Priorities, insurance enrollment for 2019 is expected to drop dramatically: “In 2019 alone, eliminating the penalty will lower Medicaid enrollment by 1 million people and non-group insurance enrollment (on and off the marketplace) by 3 million, while raising the number of uninsured by 4 million, the Congressional Budget Office (CBO) estimates.” 

Consumer confusion has also driven up premium costs by 16 percent as insurers tried to anticipate consumer and administration behavior.

But the bill is part of a three-step process to repealing and replacing the ACA, which is to avoid a Democratic filibuster through the budget reconciliation process– stabilize the health insurance market. The aim is to stabilize the marketplace and promote market freedom. Republicans are only at the first stage of their attempt to stabilize the market.

“I absolutely see having access to care that you can rely upon to get the care you need is something we need to have across America,” Reed said in an interview with NPR. “But how do you do that? Can you do that with a legislative pen? That was what the Affordable Care Act was trying to mandate. And it just doesn’t work. And so what you’ve got to do is create a marketplace, both health insurance and in health care, that allows for people to access that care in an affordable, reasonable manner.”

Mitrano’s support of stabilizing the existing AFA instead of repealing and replacing it was consistent with the beliefs of her party.

Mitrano said she had three main problems with the current healthcare system: the lack of competition within the health insurance market; the extravagantly high administrative and advertisement costs to consumers; and the government’s lack of effort to negotiate prices down for the consumer. By reassessing and then addressing these concerns, Mitrano said we could afford to pay for a single-payer system.  

In order to create a sustainable and economically efficient healthcare system, Mitrano’s plan to stabilize the ACA was to implement a single-payer health care system model incrementally. She said a single-payer healthcare system would not raise taxes for most. 

“A single-payer mode brought in incrementally will achieve [the goal of stabilizing the healthcare system] and will not bear down on the public unless you are extravagantly wealthy,” Mitrano said. “It will not raise taxes for working and middle class range.”

She said her plan also included lowering the Medicare eligibility age to 55 and keeping the age limit that young adults can remain on their parents healthcare plan until the age of 26.  

Lowering Medicare eligibility could mean citizens could opt to be automatically enrolled into the Medicare program upon turning 55. Once on Medicare, they could choose to remain with their previous insurer or could choose to join a Medicare Advantage plan. This approach would remove the responsibility of covering this group (age 55 and up) from the private insurers and encourage them to reduce premiums to attract the investment in healthcare by younger people and families, who face less health risks on average and are less apt to apply for healthcare because of high costs.

In 2016, 45 percent of uninsured adults said they did not have health insurance because the premiums were too expensive. Since the age increase to 26 went into effect, 6.1 million people have gained health insurance between 2010 and 2016. The Kaiser Foundation reported between 2013 and 2016, “the uninsured rate among nonelderly adults, who are more likely than children to be uninsured, dropped from 20.5 percent in 2013 to 12.2 percent in 2016, a 40 percent decline.”

*Congressman Reed was contacted multiple times for his input on his and his party’s efforts, but could not be reached for comment.

 

Health Insurance Jargon:

• Medicare: provides health insurance for people 65 and older and younger people with disabilities
• Social Security Administration: independent social insurance program consisting of retirement, disability and survivors’ benefits.
• Medicaid: Joint state and federal program that helps people with limited income. Poverty does not necessarily qualify one for Medicaid.
• Affordable Care Act: “Obamacare” mandate every household obtain adequate healthcare.
• Single-Payer Healthcare: “Medicare for all” would get rid of profit oriented private companies. The delivery of care would be in private hands but the program would be paid for by taxes based on ability to pay.
• Premium: The amount you pay for your health insurance every month
• Safe Injection Sites: legally sanctioned facilities that allow people to consume pre-obtained drugs under the supervision of trained staff and are designed to reduce the health and public order issues often associated with public drug consumption. They are also called overdose prevention centers, safe or supervised injection facilities (SIFs), and drug consumption rooms (DCRs).
• Subsidy: a sum of money granted by the government or a public body to assist an industry or business so that the price of a commodity or service may remain low or competitive.