PNHP

Uninsured have plateaued; underinsured are increasing

Clare Fauke

Uninsured have plateaued; underinsured are increasing

Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2018

By Robin A. Cohen, Ph.D., Emily P. Terlizzi, M.P.H., and Michael E. Martinez, M.P.H., M.H.S.A.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, May 2019

In 2018, the percentage of persons of all ages who were uninsured at the time of interview was 9.4% (30.4 million). There was no significant change from the 2017 uninsured rate of 9.1% (29.3 million). A total of 18.2 million fewer persons lacked health insurance coverage in 2018 compared with 2010 (48.6 million or 16.0%).

Estimates of enrollment in HDHPs and CDHPs

In 2018, 45.8% of persons under age 65 with private health insurance were enrolled in an HDHP, including 20.4% who were enrolled in a CDHP (an HDHP with a health savings account [HSA]) and 25.4% who were enrolled in an HDHP without an HSA (Figure 11) (see Technical Notes for definitions of HDHP, CDHP, and HSA). Among those with private health insurance, enrollment in HDHPs has generally increased since 2010. The percentage of persons enrolled in an HDHP increased 20.5 percentage points, from 25.3% in 2010 to 45.8% in 2018. More recently, the percentage of those enrolled in an HDHP increased from 43.7% in 2017 to 45.8% in 2018. The percentage of persons enrolled in a CDHP almost tripled, from 7.7% in 2010 to 20.4% in 2018. More recently, the percentage of those enrolled in a CDHP increased, from 18.2% in 2017 to 20.4% in 2018. The percentage of those enrolled in an HDHP without an HSA did not change significantly from 25.5% in 2017 to 25.4% in 2018.

https://www.cdc.gov…

The silent affordability crisis facing sick people

By Drew Altman
Axios, May 8, 2019

People with major medical illnesses are having serious problems paying for the health care they need — a crisis that is flying under the radar while attention is focused on hot policy issues like the Affordable Care Act and “Medicare for All.”

The big picture: A survey by the Kaiser Family Foundation and the Los Angeles Times shows that a strikingly large share of people with serious medical conditions are struggling to pay their medical bills, often wreaking havoc with their family budgets and causing them to cut back on care.

By the numbers: Take people with employer coverage who have a chronic condition such as hypertension, asthma, a serious mental health condition, diabetes, heart disease or cancer. It’s not a small group; just over half of those with employer coverage say someone in their family is currently receiving treatment for one of these or another chronic condition.

  • 6 out of 10 people in this group report that they or a family member skipped or postponed medical care or prescription drugs they needed because of costs, or tried a home remedy instead.
  • High deductibles can make things worse: Among those with chronic conditions whose deductibles are at least $3,000 for an individual or $5,000 for a family, three-quarters report skipping or postponing some type of care.
  • About half — 49% — say they or a family member had problems paying medical bills or difficulty affording their premiums, deductibles or co-pays in the last year.

There are ripple effects on family budgets, too. A substantial share of people reported taking measures such as increasing credit card debt (28%), using up most of their savings (26%), taking an extra job (19%), and borrowing money from others (14%) to pay for health care or insurance costs.

And this was over the last year. We ask the question that way because people can more easily remember more recent experiences. It’s not hard to imagine that the share of people with chronic conditions who experience these problems over the course of a longer time period is much higher.

People who do not have serious illnesses also struggle with affordability challenges, but fewer of them do (29%). Their worries that they will get sick and not be able to pay their bills fuels health care as a political issue.

The bottom line: It may not be surprising that people who are sick have more problems; they use more care. But it is the opposite of how a compassionate and functional insurance system should work.

https://www.axios.com…

Comment:

By Don McCanne, M.D.

Although the number of uninsured has declined since implementation of the Affordable Care Act (ACA), this year’s report can be summarized by noting that the number uninsured at the time of the 2018 analysis was 30.4 million, a statistically insignificant change from 2017 when it was 29.3 million (though this is being reported in the media as an increase in the numbers of uninsured). The point is that too many remain uninsured as the accomplishments of ACA have plateaued.

In terms of the numbers of people involved, an even greater problem is the statistically significant increase in the numbers of underinsured. The data on high deductible health plans, with or without a health savings account, demonstrate that this is a problem affecting far too many of America’s working families. In his Axios commentary, KFF’s Drew Altman describes the consequences of high deductible plans, concluding, “it is the opposite of how a compassionate and functional insurance system should work.”

Patching the Affordable Care Act or adding a Medicare public option will not fix this. Most of the perversities of our current health care financing system would remain in place. We need a bona fide, single payer, improved Medicare for All if we are going to ensure that affordable health care is there for everyone who needs it.

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Politics, not policy, is holding back the New York Health Act

What Happened to New York’s Plans for Single-Payer Health Care?

By Raina Lipsitz
The Nation, May 2, 2019

The Albany machine is working to torpedo the New York Health Act—again.

New York’s Democratic voters sent a new class of true-blue legislators to Albany in 2018. With the governor’s office and both houses of the state legislature firmly under Democratic control—and a raft of progressive bills rapidly signed into law—many hoped this would be the year New York finally enacted single-payer health care.

Health care was, after all, a top concern of voters in 2018, and support for single-payer legislation is strong and growing.

Yet recent reports indicate that the New York State Senate has no plans to vote on legislation this session, preferring to hold more hearings on a bill that has been proposed in the legislature since 1992. Assembly member Richard Gottfried, whom I interviewed in February, has sponsored the pro-single-payer New York Health Act (NYHA) for nearly 30 years, and the Assembly passed his bill in the past four legislative sessions. But a number of new or re-elected state senators, faced with the fresh possibility that single-payer might actually become a reality, have walked back their formerly full-throated support.

Pressed to clarify their positions, (Governor) Cuomo and a number of Democratic legislators played variations on this tune: Single-payer is ideal, but here and now—at the state level and without the elusive waiver—is not the time or place.

Cuomo has gained from strengthening alliances with legislators who support cost-free Democratic priorities but oppose or are willing to backtrack on those that require money. He and his allies prefer to avoid inconveniencing wealthy donors or worrying suburban voters. Cuomo fears the rich will flee New York if they have to pay higher taxes.

Knowing some unions oppose the bill “breaks my heart,” Dr. Martha Livingston told me in a phone conversation. She is the chair of SUNY Old Westbury’s public health department, the vice chair of the NY Metro chapter of Physicians for a National Health Program, and a national board member of the Labor Campaign for Single Payer Healthcare. “I speak as a union activist in my own union,” she said, and “my position and other unions’ position is, if we can get health care off the bargaining table, we can advocate for so much more in our members’ pockets.”

Katie Robbins directs the Campaign for New York Health and works for the New York State Nurses Association, the state’s largest union for registered nurses. The NYSNA and 1199SEIU are the NYHA’s two most powerful union backers. Robbins said in a phone conversation that she and her allies are “disappointed” that public-sector unions oppose the bill. She takes their concerns seriously and has called for “a labor roundtable to work through these issues.” It is, she said, both possible and “necessary” to make the bill work for unions.

State Senator Gustavo Rivera, the chair of the Health Committee and the bill’s sponsor in his chamber, acknowledged in a phone conversation that “attacks from the right” and “resistance from the left” have created “a very narrow path” to passing the NYHA.

Divisions over the NYHA exist both within and among unions. Many rank-and-file members have no opinion on or support single-payer at the state level, while many leaders oppose it. The Movement of Rank and File Educators (MORE) is an opposition caucus in the United Federation of Teachers. MORE member Peter Lamphere was blunt about why he thought UFT president Michael Mulgrew supported the Municipal Labor Committee’s decision to send a letter opposing the NYHA to Cuomo, Assembly Speaker Carl Heastie, and Senate Majority Leader Andrea Stewart-Cousins.

“Mulgrew has caved to Cuomo and some of the more conservative elements in the union movement on NYHA,” Lamphere wrote in an email. “MORE has a position in favor of [statewide] single payer and we campaigned on this in the UFT elections.”

Asked whether UFT members voted to oppose the bill, Mulgrew said the Municipal Labor Committee decided to send an opposition letter, and he was elected to serve on the committee. “You’re an elected rep from your union,” he said. “If you had to, every time you were asked to vote or to give your opinion, stop and go back to your union, you’d never get any of that work done.”

Few New York Democrats openly oppose it. But the New York Health Act won’t pass until they are all willing to fight.

“Single-payer is clearly the morally correct choice to make, and we need to be on the right side of history,” Dan Lupkin, a MORE member, told me on the phone. “There is a case to be made, and the union should be making the case for the greater good.”

It’s a case people like Gottfried have been making for decades. But insurance-industry money, tax phobia, political cowardice, and anxiety over scrapping a broken but familiar system remain.

At an April forum on the NYHA at Brooklyn College… “What you ought to care about is how much money leaves your wallet,” Gottfried told one skeptical man. “Under the act, less money will leave your wallet…. The fact that the money, after it leaves your wallet, is called a tax as opposed to a premium and a deductible and a copay—all that means is that the money will be going to an entity that is accountable to you as a voter, as opposed to going to an entity that is accountable to insurance company stockholders.”

This year, Cuomo called for a commission to study health care. The Senate is delaying a vote on the NYHA until public hearings are held.

Single-payer legislation has been studied, debated, proposed, and refined for three-quarters of a century. The only question left is how to make lawmakers do it.

https://www.thenation.com…

Comment:

By Don McCanne, M.D. 

New York seems to be primed to be the first state to enact a single payer system, but rumblings have indicated that there is some resistance within the state. The article in The Nation, excerpted above, provides clues to the intrigue involving the governor, a couple of unions, and some hesitant Democratic legislators.

I asked Assemblyman Richard Gottfried, who authored the New York Health Act (with Senator Gustavo Rivera sponsoring it in the Senate), if he had any comment on this article. His response:

“The article is generally accurate. Many large unions strongly support the NYHA— the NYS Nurses Assoc., 1199, 32BJ SEIU (building service workers), RWDSU (retail workers), UAW, much of the CWA, etc. The building trades in NYC have questions but want to work them out with us. They all know the importance of getting health benefits off the bargaining table and understand the advantages of single payer for their members. But most of our public sector unions are opposing it. We’re working on their concerns.

“Yes, there are legislators who campaigned in support of the bill and now need reassurance. Senator Rivera and I are talking with them.”

With the amount of money that we are already spending, we could easily have comprehensive health care for absolutely everyone, but mere politics remains the barrier. Mere politics? Is that the penalty we pay for supporting democracy in action? Leaving health care screwed up is some penalty for trying to do the right thing.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Politics, not policy, is holding back the New York Health Act

What Happened to New York’s Plans for Single-Payer Health Care?

The Albany machine is working to torpedo the New York Health Act—again.

By Raina Lipsitz
The Nation, May 2, 2019

New York’s Democratic voters sent a new class of true-blue legislators to Albany in 2018. With the governor’s office and both houses of the state legislature firmly under Democratic control—and a raft of progressive bills rapidly signed into law—many hoped this would be the year New York finally enacted single-payer health care.

Health care was, after all, a top concern of voters in 2018, and support for single-payer legislation is strong and growing.

Yet recent reports indicate that the New York State Senate has no plans to vote on legislation this session, preferring to hold more hearings on a bill that has been proposed in the legislature since 1992. Assembly member Richard Gottfried, whom I interviewed in February, has sponsored the pro-single-payer New York Health Act (NYHA) for nearly 30 years, and the Assembly passed his bill in the past four legislative sessions. But a number of new or re-elected state senators, faced with the fresh possibility that single-payer might actually become a reality, have walked back their formerly full-throated support.

Pressed to clarify their positions, (Governor) Cuomo and a number of Democratic legislators played variations on this tune: Single-payer is ideal, but here and now—at the state level and without the elusive waiver—is not the time or place.

Cuomo has gained from strengthening alliances with legislators who support cost-free Democratic priorities but oppose or are willing to backtrack on those that require money. He and his allies prefer to avoid inconveniencing wealthy donors or worrying suburban voters. Cuomo fears the rich will flee New York if they have to pay higher taxes.

Knowing some unions oppose the bill “breaks my heart,” Dr. Martha Livingston told me in a phone conversation. She is the chair of SUNY Old Westbury’s public health department, the vice chair of the NY Metro chapter of Physicians for a National Health Program, and a national board member of the Labor Campaign for Single Payer Healthcare. “I speak as a union activist in my own union,” she said, and “my position and other unions’ position is, if we can get health care off the bargaining table, we can advocate for so much more in our members’ pockets.”

Katie Robbins directs the Campaign for New York Health and works for the New York State Nurses Association, the state’s largest union for registered nurses. The NYSNA and 1199SEIU are the NYHA’s two most powerful union backers. Robbins said in a phone conversation that she and her allies are “disappointed” that public-sector unions oppose the bill. She takes their concerns seriously and has called for “a labor roundtable to work through these issues.” It is, she said, both possible and “necessary” to make the bill work for unions.

State Senator Gustavo Rivera, the chair of the Health Committee and the bill’s sponsor in his chamber, acknowledged in a phone conversation that “attacks from the right” and “resistance from the left” have created “a very narrow path” to passing the NYHA.

Divisions over the NYHA exist both within and among unions. Many rank-and-file members have no opinion on or support single-payer at the state level, while many leaders oppose it. The Movement of Rank and File Educators (MORE) is an opposition caucus in the United Federation of Teachers. MORE member Peter Lamphere was blunt about why he thought UFT president Michael Mulgrew supported the Municipal Labor Committee’s decision to send a letter opposing the NYHA to Cuomo, Assembly Speaker Carl Heastie, and Senate Majority Leader Andrea Stewart-Cousins.

“Mulgrew has caved to Cuomo and some of the more conservative elements in the union movement on NYHA,” Lamphere wrote in an email. “MORE has a position in favor of [statewide] single payer and we campaigned on this in the UFT elections.”

Asked whether UFT members voted to oppose the bill, Mulgrew said the Municipal Labor Committee decided to send an opposition letter, and he was elected to serve on the committee. “You’re an elected rep from your union,” he said. “If you had to, every time you were asked to vote or to give your opinion, stop and go back to your union, you’d never get any of that work done.”

Few New York Democrats openly oppose it. But the New York Health Act won’t pass until they are all willing to fight.

“Single-payer is clearly the morally correct choice to make, and we need to be on the right side of history,” Dan Lupkin, a MORE member, told me on the phone. “There is a case to be made, and the union should be making the case for the greater good.”

It’s a case people like Gottfried have been making for decades. But insurance-industry money, tax phobia, political cowardice, and anxiety over scrapping a broken but familiar system remain.

At an April forum on the NYHA at Brooklyn College… “What you ought to care about is how much money leaves your wallet,” Gottfried told one skeptical man. “Under the act, less money will leave your wallet…. The fact that the money, after it leaves your wallet, is called a tax as opposed to a premium and a deductible and a copay—all that means is that the money will be going to an entity that is accountable to you as a voter, as opposed to going to an entity that is accountable to insurance company stockholders.”

This year, Cuomo called for a commission to study health care. The Senate is delaying a vote on the NYHA until public hearings are held.

Single-payer legislation has been studied, debated, proposed, and refined for three-quarters of a century. The only question left is how to make lawmakers do it.

https://www.thenation.com…

Comment:

by Don McCanne, M.D. 

New York seems to be primed to be the first state to enact a single payer system, but rumblings have indicated that there is some resistance within the state. The article in The Nation, excerpted above, provides clues to the intrigue involving the governor, a couple of unions, and some hesitant Democratic legislators.

I asked Assemblyman Richard Gottfried, who authored the New York Health Act (with Senator Gustavo Rivera sponsoring it in the Senate), if he had any comment on this article. His response:

“The article is generally accurate. Many large unions strongly support the NYHA— the NYS Nurses Assoc., 1199, 32BJ SEIU (building service workers), RWDSU (retail workers), UAW, much of the CWA, etc. The building trades in NYC have questions but want to work them out with us. They all know the importance of getting health benefits off the bargaining table and understand the advantages of single payer for their members. But most of our public sector unions are opposing it. We’re working on their concerns.

“Yes, there are legislators who campaigned in support of the bill and now need reassurance. Senator Rivera and I are talking with them.”

With the amount of money that we are already spending, we could easily have comprehensive health care for absolutely everyone, but mere politics remains the barrier. Mere politics? Is that the penalty we pay for supporting democracy in action? Leaving health care screwed up is some penalty for trying to do the right thing.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.