By Katie Lannan
Lowell (Mass.) Sun, Feb. 23, 2017
BOSTON — With President Donald Trump and congressional Republicans pledging to repeal the federal Affordable Care Act, some backers of single-payer health care are holding up their preferred system as an alternative.
Making the shift to a national single-payer system could save more than $504 billion annually in administrative costs, according to a pair of Harvard Medical School lecturers writing this week in an American College of Physicians medical journal.
In an article published Tuesday in the Annals of Internal Medicine, Dr. Steffie Woolhandler and Dr. David Himmelstein called a publicly financed single-payer system “the only way” to fulfill Trump’s campaign promises of more coverage, better benefits and lower costs.
An executive order Trump signed Jan. 20, the day of his inauguration, established the administration’s policy “to seek the prompt repeal” of the Affordable Care Act and directed department and agency heads to “encourage the development of a free and open market in interstate commerce for the offering of health-care services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.”
Woolhandler and Himmelstein say proposals floated by House Speaker Paul Ryan and Health and Human Services Secretary Tom Price would “shrink the coverage of poor and low-income persons in the United States” and could shift costs onto patients and state governments.
They say replacing the current insurance system with a “single, public plan covering everyone for all medically necessary care” — similar to an expanded Medicare program — could allow for better benefits at a lower cost, with savings used to extend coverage to the 26 million people who remain uninsured.
In Massachusetts, where the uninsured rate is below 3 percent, past efforts to establish a state-level single-payer system have failed to gain much traction on Beacon Hill.
Sen. Jamie Eldridge, who filed legislation that would set up “Medicare for all” in Massachusetts, called the 21 co-sponsors signed onto his bill this session “the largest we’ve had in about six years.” There are 200 members in the Legislature.
“I certainly am a strong supporter of maintaining and protecting the ACA at the federal level, but clearly there are discussions by mostly Republicans in Congress about repealing it and changing it,” Eldridge told the News Service. “And I think it’s an interesting opportunity, interesting time, for single-payer advocates like myself because if you did see changes at the federal level, I think there would be an opportunity to advocate for single-payer health care more strongly at the state level.”
Rep. Denise Garlick of Needham has also filed a “Medicare for all” bill, while Rep. Jennifer Benson of Lunenburg and Sen. Julian Cyr of Truro are sponsoring legislation that would require the state to measure its health-care spending against projected spending under a single-payer system. If the “single-payer benchmark” showed greater savings, state officials would be charged with developing an implementation plan to move towards single-payer.
Versions the Medicare-for-all and single-payer benchmark bills were each included in dead-end study orders last session.
“I think people are realizing that as much as the ACA had protections around pre-existing medical conditions, that it did provide expanded Medicaid, that for a lot of sort of working-class, middle-class families, they probably saw their premiums go up significantly because the ACA wasn’t really designed to reduce health-care costs, it was really designed to cover more people,” Eldridge said. “So if we’re looking to do both in an environment where federal funding could be cut to Massachusetts or other aspects of the ACA, is it time for Massachusetts to take the next step?”
Gov. Charlie Baker has proposed a slate of health-insurance market reforms. His $40.5 billion fiscal 2018 budget includes an annual assessment on certain employers without at least 80 percent of their workers covered by employer-sponsored health care, rate growth caps for health-care providers, a five-year moratorium on new coverage mandates, and additional consumer transparency efforts aimed at helping patients understand the cost of care.
With health-care costs continuing to climb — hitting $57.4 billion in 2015, according to the Center for Health Information and Analysis — and exceeding state spending benchmarks, efforts are underway to rein in medical spending. Senators are studying cost containment practices used in other states, and a commission seeking to address unwarranted variations in prices charged by different providers is due to release its report next month.
Woolhandler and Himmelstein are both professors at the City University of New York’s Hunter College.