Questions for Centrist Candidates on Health Care
The questions presented here involve the viability of health care plans offered by centrist candidates including — Joe Biden, Pete Buttigieg, and Amy Klobuchar. The plans offered by these three candidates center on modifications to the Affordable Care Act.
Currently, there are about 160 million people with employer-based insurance compared to roughly 11 million people with state exchange health insurance. Does your plan attempt to maintain the current relative balance the two markets or move more people into state exchanges?
The center piece of many centrist health plans is the addition of a public option inside state exchanges. Who would be eligible to purchase a public option under your proposal? What would be the cost of the public option? Would people who choose the public option receive the same premium tax credit as people who purchase a silver plan?
The addition of a public option on state exchanges could reduce the number of people purchasing private insurance on state exchanges. Would this crowding out of private insurance occur under your plan?
Currently, around 36 percent of workers are freelance workers without direct access to employer-based insurance. More than half of the workforce is expected to be working freelance by 2027. https://www.forbes.com/sites/elainepofeldt/2017/10/17/are-we-ready-for-a-workforce-that-is-50-freelance/#2031b5db3f82 Workers without an offer of employer-based insurance earning more than 400 percent of the federal poverty line do not receive any premium subsidies under current law. (A one-person household with income equal to $50,000 earns slightly more than 400 % FPL and is not qualified for the premium tax credit.) Does the ACA need to be modified to better provide health insurance for workers without access to employer-based insurance? Does your health plan make the necessary changes?
The current ACA prohibits people from receiving premium tax credits on state exchange health insurance policies if they receive an offer of “affordable” health insurance from their employer. The current definition of affordable health insurance is based on the cost of a self-only health plan even if the person must provide health insurance to an entire family. Should the affordable health insurance rule be modified or repealed?
The 2018 tax law eliminated financial penalties for individuals who did not have health insurance coverage as mandated by the ACA. Would your administration attempt to restore these penalties? Alternatively, do you support other provisions to make sure all individuals maintain continuous health insurance coverage?
The Trump Administration has issued executive orders allowing people to purchase short term health plans, which do not cover all essential health benefits required under the ACA. Go here for a description of these plans. https://www.kff.org/health-reform/issue-brief/understanding-short-term-limited-duration-health-insurance/ Many of the people with these health insurance plans end up with large health care bills. These plans attract relatively healthy individuals, which increases premiums on ACA plans. Would your Administration overturn the executive order on short term health plans? How would you assist people who are currently covered by these short-term health plans if they could not afford premiums on plans covering essential health benefits?
Deductibles and cost sharing have increased for people who have comprehensive health insurance. The growth of high deductible health plans has caused some people to forego necessary prescriptions and procedures and has caused some people to divert funds from retirement accounts to health savings accounts. Does your health plan propose solutions to problems caused by higher deductibles and increased cost sharing?
What would your Administration do about the problem of out-of-network health care bills? Do you support H.R. 3502 (https://www.congress.gov/bill/116th-congress/house-bill/3502?s=1&r=7) a bipartisan compromise that would force insurance firms to pay out-of-network bills and sets prices for providers? Do you support an alternative approach? If so, which one?
After enactment of the ACA many firms chose to self insure rather than take out an insurance policy from an insurance group. Firms that self insure take on additional financial risk and are exempt from some state and ACA regulations. Are you concerned about this trend? Should the federal government limit self insurance?
Senator Warren and Senator Sanders have been criticized for eliminating all private health insurance. A competing proposal called Medicare for America provides Medicare as a default option for all Americans but allows everyone to opt out and take private health insurance. The Medicare option in Medicare for America is highly subsidized and available to everyone. How does the cost and availability of the Medicare option in Medicare for America compare to the cost and availability of your public option?
A follow up question for Mayor Pete Buttigieg. You have described your plan as Medicare for anyone who wants it, a description which seems to match the Medicare for America approach. Several recent analysts have come to the conclusion that your approach to health care is closer to a limited public option in state exchanges than the Medicare for America approach that gives everyone automatic access to Medicare and allows people to opt out. Go here for a link to this assessment. https://theslot.jezebel.com/a-brief-history-of-pete-buttigieg-faking-it-on-medicare-1839164675 Can you guarantee that under your plan everyone will who want Medicare will be able to purchase Medicare rather than accept private health insurance coverage?
The uninsured rate for the non-elderly population fell from 20.6% in 2013 to 12.2 % in 2016 due to the ACA. https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ The uninsured rate started climbing in 2017. What are the projected uninsured rates under your plan?
One of Senator Warren’s main concern involves the large number of people with comprehensive health insurance that declare bankruptcy because of costs not covered by insurance. What does your proposal do to reduce the problem of medical bankruptcies by people who have private health insurance?
David Bernstein, an economist who lives in Colorado is the author of “Defying Magnets: Centrist Policies in a Polarized World,” available at Amazon and Kindle. Go here for the kindle version.
You may also be interested in an article that I wrote in the Des Moines Register on how progressive health care plans might be improved and made more pragmatic.
