BlueCross BlueShield Association, Issue Brief, March 2019
Many individuals who have significant medical conditions and need extensive and often costly care depend on the individual market for coverage.
Unfortunately, individual market premiums are often unaffordable for people who do not qualify for financial assistance, and coverage options for these people remain limited. For many, the cost of coverage and care is out of reach, with many purchasers required to pay more than 15 percent of their income for health insurance so they can obtain the medical care they need.
The individual market is a critical source of coverage for people from all walks of life, and it should be strengthened to make coverage more affordable while protecting those with pre-existing conditions. To achieve this, BCBSA recommends that policymakers take three critical steps:
1. Revise federal assistance to help more people afford coverage
- Congress should adjust tax credits to make coverage more affordable and boost enrollment among younger people.
- Congress should adjust the current tax credit structure to help those who are ineligible for tax credits today.
- Congress should improve cost-sharing protections to help lower-income people access medical care.
2. Enact policies to lower costs and remove financial barriers to accessing care
- Congress should establish a sustained federal funding system to support the cost of caring for those with significant medical needs.
- Congress should provide relief from the health insurance tax.
- Congress should modernize health plans that are linked with health savings accounts (HSAs).
3. Improve outreach to encourage people to obtain and maintain insurance
- Exchanges should provide enhanced outreach to ensure that people enroll in coverage.
- Exchanges should provide information on coverage status to states to improve outreach efforts and simplify enrollment.
- Policymakers should continue to allow consumers to automatically renew coverage.
By Don McCanne, M.D.
The support for single payer Medicare for All stems from the recognition that too many people are not being served well by our current dysfunctional health care financing system, resulting in impaired access to health insurance and health care and exposure to financial hardship. The vested interests that would lose by changing to a single payer public financing system have had initial success in shifting the media toward bemoaning the loss of private insurance that would occur under single payer. This Issue Brief from BlueCross BlueShield Association is important because it explains how the private insurance industry would address the problems of access and affordability facing the insurance beneficiary.
The basic problem is straightforward. Health care has now become so expensive that each beneficiary’s proportionate share of risk – the premium – that would fund a common risk pool now exceeds the financial resources available to the typical working family. It has long been understood that the government must cover the deficit. Earlier, Medicare for retirees with their limited incomes, and Medicaid for individuals living in poverty, filled in the largest gaps. Once insurance premiums exceeded the abilities of average-income families to pay them, more government intervention was required, and that resulted in enactment of the Affordable Care Act with its insurance premium and cost sharing subsidies plus its expansion of Medicaid.
Now it is widely recognized that not even the Affordable Care Act is meeting the needs. People well informed on health policy understand that the single payer model has become the obvious solution that would ensure affordable health care for all, but some are ideologically opposed, willing to sacrifice the suffering of others in order to reduce the role of government, and others are opposed because of the impact on the vested interests, especially the private insurers and the profiteers such as the pharmaceutical firms.
So it is understandable that traditional insurers such as Blue Cross and Blue Shield would want policies enacted that would not only salvage their industry but would also further nurture them. A quick look at their proposals leads to an obvious conclusion: They do not propose policies that would control future health care spending; instead they support proposals that would infuse more government money – our taxes – into their industry.
By providing more public support to the insurers, we would be perpetuating their very costly administrative excesses, while not receiving anything of substance from them in return for us increasing further our already too high national health expenditures. But, you say, more people would be insured? Taking money from the federal government, carving out a portion for themselves, and then passing the rest on to the actual health care delivery system is not providing us with value for our tax dollars that they keep.
This is where the media is failing us. A single payer Medicare for All program would meet our goals of universality, effectiveness, efficiency, equity, and affordability for each of us and for the nation as a whole. Simply throwing more money at the current, fragmented, dysfunctional system will perpetuate most of our problems, not to mention that it is the most expensive model of reform. If the media is going to cover reform, it is imperative that they understand fully the policy science behind it.
Although some in the media parrot the policy principles behind reform, it is difficult to believe that they understand the issues in depth when you listen to them whine about the potential loss of our revered private plans, especially the employer-sponsored plans. Really? We need to protect that industry when the result is to spend even more money while perpetuating unnecessary financial hardship, physical suffering and even premature death? Start whacking the media (figuratively) when they deserve it. Enough of their crescendo of journalistic crap about our precious private insurance industry.
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