Remember the uninsured? Those 45 million among us dominated the 2008 presidential campaign, then the 2012 campaign. What could the nation do? We had outlawed pre-existing exemptions, we allowed dependents to stay on their parents’ insurance until age 25 (saving parents the problem of their unemployed uninsured progeny); we had extended Medicaid to let states cover more children (thanks to the Children’s Supplemental Health Insurance Program, another relic from a more bipartisan age). Still the problem seemed intractable.
At the same time, a corollary problem emerged: Model-T policies that wouldn’t propel a car. Enrollees had happily signed onto “affordable” policies that didn’t cover much; those enrollees didn’t discover the “not covereds” until they got sick.
The Affordable Care Act arrived under President Barack Obama. This flawed solution cobbled together subsidies for people to buy private insurance policies on regulated “exchanges,” it finally axed pre-existing conditions; it offered states subsidies to expand their Medicaid programs, if they wished. And, crucially, it regulated the “basic policies” that insurers had to offer, thereby getting at the corollary travesty: the underinsured, those folks who thought they were insured until they discovered that their insurance wouldn’t cover what ailed them.
With loss of a job, comes the crisis of coverage.
At the end of the plotting, the plotters pared the number of the uninsured. We didn’t have universal coverage, but the “uninsured” no longer rebuked our notions of fairness. Conservative states that refused to extend Medicaid continued to see a swath of their citizens uninsured, but that was the states’ choice.
Statistically, more of us had decent coverage. We went from 46.5 million uninsured in 2010 to 35.9 million in 2014, to 29.1 million in 2015, to 26.7 million in 2016.
Fast forward four years. The slide reversed: 27.4 million in 2017 to 27.9 million in 2018.
The Trump administration undercut the “individual mandate” of the Affordable Care Act: people don’t need to enroll, don’t need to pay a penalty tax. Of course, once people opt out, the financial underpinnings suffer (in contrast, we don’t let people opt out of Social Security or Medicare payments). This also leaves some people – those who opt out – without coverage.
The “public charge” rule encouraged some legal immigrants to drop coverage. (Under this rule, which last month a federal judge temporarily blocked because of the COVID-19 pandemic, immigrants who have used government benefits would have that taken into consideration when they apply for green cards).
The Model-T policies have been brought back with cheap premiums and paltry benefits.
And now, when the Trump administration wants to shelve the Affordable Care Act entirely, we see more Americans losing their jobs, thanks to COVID-19. To date, more than 20 million Americans have lost their jobs because of this virus.
With loss of a job, comes the crisis of coverage.
Unemployment and COVID-19-related subsidies might barely cover a mortgage, food and transportation, as long as the subsidies last. Eventually the ex-employee risks losing the group health insurance with the employer-subsidized premiums.
There are some safeguards. The ex-employee can get insurance if his or her income qualifies for Medicaid, and if the state has elected to extend Medicaid; if she or he qualifies for a subsidy on the state’s exchange; if she or he can afford COBRA [Consolidated Omnibus Budget Reconciliation Act]; or if she or he can go onto a spouse’s policy. If the company furloughs the employee, the company could defer premiums, letting the furloughed employee keep the policy – delaying payment until the company resumes operations.
A lot of “ifs.”
We are returning to the past, as the number of people without health insurance rises – at a time when a lethal virus is making many of us sick. One estimate: 5.4 million Americans, laid off, have lost health insurance.
If we decimate the Affordable Care Act, we risk returning to our all-time highs. A sad return to the future.
Joan Retsinas is a columnist for The Progressive Populist.
