Health care system now covers 90% of Americans

The website main page. (HHS via AP)

America’s much-maligned health care system is covering 9 out of 10 people, a fact that hasn’t stopped the 2020 presidential candidates from refighting battles about how to provide coverage, from Bernie Sanders’ call for replacing private insurance with a government plan to President Donald Trump’s pledge to erase the Affordable Care Act and start over.

The politicians are depicting a system in meltdown. The numbers point to a different story, not as dire and more nuanced.

Government surveys show that about 90% of the population has coverage, largely preserving gains from President Barack Obama’s years. Independent experts estimate that more than one-half of the roughly 30 million uninsured people in the country are eligible for health insurance through existing programs.

Lack of coverage was a growing problem in 2010 when Democrats under Obama passed his health law. Now the bigger issue seems to be that many people with insurance are struggling to pay their deductibles and copays.

“We need to have a debate about coverage and cost, and we have seen less focus on cost than we have on coverage,” said Colorado Sen. Michael Bennet. He is among the Democratic presidential candidates who favor building on the current system, not replacing it entirely, as does Sanders. “The cost issue is a huge issue for the country and for families,” Bennet said.

A report this year by the Commonwealth Fund think tank in New York found fewer uninsured Americans than in 2010 but more who are “underinsured,” a term that describes policyholders exposed to high out-of-pocket costs, when compared with their individual incomes. The report estimated 44 million Americans were underinsured in 2018, compared with 29 million in 2010 when the law was passed. That’s about a 50% increase, with the greatest jump among people with employer coverage.

“When you have 90 percent of the American people covered and they are drowning in their health care bills, what they want to hear from politicians are plans that will address their health care costs, more than plans that will cover the remaining 10 percent,” said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan research organization that tracks the health care system. “When Democrats talk about universal coverage more than health care costs, they are playing to the dreams of activists and progressives … much less to the actual concerns of the 90 percent who have coverage today.”

Sanders’ office responds that the Vermont senator’s “Medicare for All” plan would solve both the coverage and cost problems for individual Americans. Medical care would be provided with no deductibles or copays. No one would be uninsured or underinsured.

“The simple answer is that our health care system becomes more unmanageable for more and more Americans every year,” Sanders spokesman Keane Bhatt said in a statement. “This is not a system that needs a few tweaks. This is a system that needs a complete overhaul.”

But other countries that provide coverage for all and are held up by Sanders as models for the U.S. don’t offer benefits as generous as he’s proposing. If he is elected president, there’s no way of telling how his plan would emerge from Congress, or even whether something like it could pass.

Four other 2020 Democrats are co-sponsors of Sanders’ bill: Sens. Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California, and Elizabeth Warren of Massachusetts.

On the other side of the political spectrum, Trump is talking about big changes. His administration is seeking to have federal courts declare the entire Obama-era health care law unconstitutional, jeopardizing coverage for 20 million people, jettisoning protections for patients with preexisting conditions, and upending the rest of the 970-page statute, now nearly 10 years old.

The president says there’s nothing to worry about. Earlier this summer Trump told ABC News that he was working on a plan that would provide “phenomenal health care,” protect people with preexisting conditions, and would be “less expensive than ‘Obamacare’ by a lot.”

White House spokesman Judd Deere said in a statement that the Obama law was “sold and passed on a litany of broken promises” and now “Democrats are proposing even more radical government takeovers of our health care system.”

As president-elect, Trump promised a health plan but never offered one upon taking office. Instead he backed bills from congressional Republicans, including one he called “mean” during a private meeting.

Trump says he might come out with his new plan within months, but that passing it would hinge on his getting reelected and Republicans winning back the House in 2020 while keeping control of the Senate.

That’s a bit of political deja vu.

Republicans controlled Washington back in 2017 when Trump, then-Speaker Paul Ryan, R-Wis., and Senate Majority Leader Mitch McConnell, R-Ky., tried for months to repeal and replace the Obama law, only to fail. The repeal effort was widely seen as contributing to Republicans losing the House in 2018.

Since then, many GOP lawmakers have tried to avoid the issue altogether.

Economist Sara Collins of the Commonwealth Fund, who led the study about underinsured Americans, says cost and coverage problems are intertwined. Citing the Democrats’ debate over Medicare for All, she says what’s missing from that discussion is that “one doesn’t have to go that far in order to improve the financial situation for millions of people — you can do that with much more targeted, incremental policies.”

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Is Biden’s embrace of Obamacare risky?

Democratic presidential candidate former Vice President Joe Biden. (AP Photo/Matthew Hinton)

Joe Biden had just rolled out his health care plan when he made what could be a fateful pledge to a crowd in Iowa: “If you like your health care plan or your employer-based plan, you can keep it.”

The remark echoed assurances President Barack Obama made repeatedly as he sold the Affordable Care Act, which became known as “Obamcare.” But Obama’s promise proved an exaggeration, if not a falsehood, and it anchored early GOP attacks on the law as new regulations led private insurers to cancel certain policies, even if they had to offer replacements to consumers.

Biden’s promise on job-based coverage , which almost 160 million Americans use, underscores the risks of positioning himself as the health overhaul’s chief defender. Fully embracing the health law and pledging to expand it also means exposing Biden to attacks from all sides: from the left that wants more than what Biden is offering; from the right that loathes the law in any form; and from the middle, where voters remain skeptical about the nation’s complex and expensive health care system.

“This is one of those issues where the pendulum has swung back-and-forth since ‘Obamacare’ passed,” Democratic pollster Paul Maslin said, pointing to health care’s role in Republican victories in 2010 and Democratic wins last November. “Right now we have the advantage,” Maslin said, “but I’d be a fool to say there’s no risk here.”

Indeed, the Republican National Committee has seized on Biden’s policy rollout. “Biden has to deal with the fact that he would be the 2020 face of Barack Obama’s notorious lie that if you like your health care plan you can keep it,” said Steve Guest of the Republican National Committee.

Biden is at the center of a broader Democratic divide over the future of health care that will likely be an animating issue at this week’s primary debate in Detroit.

The former vice president is proposing to add a “public option” that would allow Americans to choose whether to buy government insurance or buy private policies. He also would boost existing subsidies that consumers use to buy policies on the law’s exchanges. That would mark a significant expansion but still be a more incremental approach than Vermont Sen. Bernie Sanders’ “Medicare for All” proposal, which would essentially replace the private market with government insurance.

Biden’s campaign says his position reflects voters’ slow embrace of the 2010 law, while acknowledging voters’ concerns about the cost and consequences of a single-payer, government health insurance system and their distrust of private insurers and the pharmaceutical industry.

“I knew the Republicans would do everything in their power to repeal ‘Obamacare,’” Biden says in an online campaign ad. “They still are. But I’m surprised that so many Democrats are running on getting rid of it … and if I’m elected president, I’m going to do everything in my power to protect it and build on it.”

An Associated Press-NORC Center for Public Affairs Research poll this spring found 57% of adults wanted the health law to remain; 42% percent said it should be kept, but with changes. Four out of 10 favored a rollback, but just half of those called for total repeal. Meanwhile, 53% favored adding a nonmandatory government insurance plan to the market; less than one-fifth opposed that course. That’s a more favorable split than on single-payer, which garnered 43% support and 31% opposition.

Which party ultimately wins on health care, Maslin and other Democrats argue, depends on who voters believe will better protect access to care, regardless of the details. “People still don’t like the way the market works,” from rising premiums to spiking drug costs, Maslin noted, but they distrust a politician “who might be taking something away.”

Republicans capitalized in 2010, when voters saw Obama’s new law — adopted but not yet in place — as the threat and rewarded the GOP’s mantra of “repeal and replace.”

By 2018, after years of GOP failures to offer an alternative, voters had grown accustomed to key provisions, chiefly the guarantee of coverage for those with existing health conditions and Medicaid expansion to cover the working poor and lower middle class. Last November, Democrats won a net 41-seat gain in the House and seven new governorships, many of the victories driven by suburban voters who’d seen a deluge of ads defending the law and hammering Republicans for attempts to gut it. Trump continues to pursue repeal, and the administration backs a pending federal lawsuit to strike down the law in its entirety.

A few months into the new Congress, the AP-NORC poll found Democrats with a 17-point advantage, 40% to 23%, on the question of which party voters trusted more on health care.

“People may have different feelings about our different approaches, but they’re more popular than Trump’s repeal that would make the problem worse,” said Jesse Ferguson, a Democratic strategist who has worked on health care messaging in recent election cycles.

Added Maslin: “Part of me says we’d be better off with no plan, let Republicans continue to screw it all up. But that’s just not responsible.”


Associated Press Deputy Polling Director Hannah Fingerhut in Washington contributed to this report.

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Copyright © 2019 The Associated Press. All Rights Reserved

Trump backs down on health care push

President Donald Trump (AP Photo/Manuel Balce Ceneta)

President Donald Trump is suggesting he will defer until after 2020 his push for a Republican health care plan to replace the Affordable Care Act.

Trump tweeted late Monday that Congress will vote on a GOP plan after the elections, “when Republicans hold the Senate & win back the House.”

Republicans were cool after Trump surprised them last week with an unexpected pivot to the issue and his claims the GOP will be the party of health care. They don’t yet have a comprehensive plan to replace the law, known as “Obamacare.”

Trump’s effort to repeal former President Barack Obama’s health care law narrowly failed in the Senate in 2017. And while Republicans gained Senate seats last fall, there’s no indication that GOP senators want another fight over repealing “Obamacare,” particularly not those up for re-election next year.

Health care, especially protections for people with pre-existing conditions, resonates with voters and helped Democrats in the November elections.

According to AP VoteCast, a survey of more than 115,000 midterm voters nationwide, nearly 4 in 10 Democratic voters identified health care as the most important among a list of key issues. A Quinnipiac University poll last week found 55% of Americans supporting the improvement and not the replacement of the nation’s health care system.

With Democrats controlling the House, any attempt to dismantle the law could not pass Congress.

Still, Trump last week appeared to commit his party to a new push for a plan to replace the health law.

“We are working very hard on that,” Trump said as he was heading out to a Michigan rally.

He said Republicans “are going to work together to come up with something that’s really spectacular.”

In his late-Monday tweets, Trump claimed Republicans are developing a plan with cheaper premiums and deductibles that “will be truly great HealthCare that will work for America.”

Challenges to the 2010 law are making their way through courts.

Last week, the Trump administration told a federal appeals court it wants the entire Affordable Care Act struck down, an outcome that could leave millions of people uninsured and reignite a winning political issue for Democrats.


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Can Dems fashion a working health care message?

The Capitol in Washington at sunrise. (AP Photo/J. Scott Applewhite)

Cheered on by a handful of activists, liberal House Democrats announced outside the Capitol that they were forming a caucus to push for “Medicare for All” — shorthand for government-financed health care.

At the same time Thursday, Democratic senators were introducing a resolution aimed at putting Republicans on the defensive about Trump administration efforts to undermine former President Barack Obama’s health care law.

Neither proposal has much chance of going anywhere in the Republican-run House or Senate. But the bigger problem for Democrats is that the two messages — fundamentally reshaping the nation’s health care system versus defending Obama’s popular law — divide the party as it tries grabbing control of Congress in this fall’s elections.

All Democrats oppose President Donald Trump’s repeated efforts to scuttle Obama’s Affordable Care Act, and many have backed expanding government-paid health care, including Minority Leader Nancy Pelosi, D-Calif. But many also think drawing campaign-season attention to Democratic efforts to reinvent the country’s $3 trillion-a-year health care system, a costly and complex undertaking, is a mistake.

Promoting “Medicare for All” opens the door for Republicans to accuse Democrats of plotting tax increases, unaffordable federal costs and the loss of employer-provided coverage, these Democrats argue. They say it’s better to play offense by focusing on controlling medical costs and opposing GOP efforts to demolish the 2010 health care law.

“Every Democrat is being asked, ‘Do you support this or do you not?’ and it’s becoming a political wedge in an election year,” Rep. Kathleen Rice, D-N.Y., said of the “Medicare for All” drive. “And I think we should be focusing on the terrible things that are happening under this administration right now.”

The new caucus has more than 60 members, nearly 1-in-3 House Democrats, including many from safely blue districts where liberal voters prevail. Backing “Medicare for All” lets them tap into activists’ fervor for universal health care that helped propel Vermont independent Sen. Bernie Sanders to an unexpectedly strong challenge to Hillary Clinton for the 2016 Democratic presidential nomination.

“If you live in America, you’ve got a right to affordable quality health care, period,” said Rep. Debbie Dingell, D-Mich., a caucus founder, prompting applause from supporters watching her group’s news conference Thursday.

Rep. Pramila Jayapal, D-Wash., another leader, later said she backs a 2017 House bill providing free health care financed partly by boosting taxes on wealthy Americans. That bill has more than 120 Democratic co-sponsors. But she said her group’s goal is to build consensus for legislation it may introduce next year, with decisions remaining about costs, financing and other questions.

A similar bill by Sanders last year drew 16 Democratic co-sponsors, including at least four potential 2020 presidential contenders. Sponsors haven’t released price tags, but Sanders said a version he promoted during his 2016 campaign would have cost $1.4 trillion annually — a figure some analysts said was far too low.

“The only proposal here is a ‘Medicare for All’ caucus to figure out what the right proposal is,” Jayapal said.

That’s not stopping the GOP from getting ready to jump on the issue. By combing through candidate and newspaper websites, social media and other sources, Republicans have compiled quotes from around two dozen Democratic House challengers embracing “Medicare for All.” A Republican provided the information on condition of anonymity to disclose internal preparations.

“It would break Medicare,” said House Majority Leader Kevin McCarthy, R-Calif. “And it would end any private insurance as we know it.”

Trump and congressional Republicans tried repealing the ACA last year and failed. But they’ve taken incremental whacks at it, including cutting federal subsidies to many insurers, erasing the penalty for people who don’t buy insurance and opening the door to low-cost plans providing less coverage.

That’s exactly where many Democrats running in swing districts are concentrating their messages.

Democrat Clarke Tucker, challenging Arkansas GOP Rep. French Hill, said in an early TV ad, “I’ll stand up to anyone who tries to take your health care.” And Rep. Ami Bera, D-Calif., said in an interview, “I’d say we ought to focus on Republican efforts to undermine the ACA right now and the impact that’s had on costs going up.”

That was also the focus for Democratic senators in their resolution Thursday authorizing the Senate’s legal counsel to intervene in a lawsuit in which 20 GOP-led states allege the health care law is no longer constitutional.

The Trump administration said last month it will stop defending key parts of the law in court, including provisions protecting patients with pre-existing medical conditions. Polls show large majorities favor helping those consumers.

Democrats want the Senate counsel to defend the protections for people with pre-existing problems. There’s little chance Republicans controlling the Senate will allow such a vote, which Democrats hope would put GOP senators in an uncomfortable position.

“This is a test of the Republican Party, whether or not they are going to do the right thing,” said Sen. Bob Casey, D-Pa.


Associated Press writer Kevin Freking contributed to this report.


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