2020 New Year Concerns: Why the Hell Are Consumers Trusting Congress on Health Insurance? Part IV

Part IV addresses the October, 2019 findings that more children are uninsured in the years 2016 through 2018, which are already being used in partisan politics in 2020 campaigning.

Here it's pretty obvious that the number of uninsured, the argument relied upon to justify many of Obamacare's features, including the individual mandate, even when the uninsured are children, should NOT be a reason to vote one way or the other necessarily.

We're already living with the consequences of President Obama's approach of over-simplifying the health industrial complex problems facing consumers into "the number of uninsured." That has already proven to be a focus that might sound great politically, but in reality made the barrier of cost to access to needed health CARE services, in many instances, worse, even for those with insurance.

Number of Uninsured is NOT the key cause or solution to COST as a Barrier to Needed Health Care Services:

Flashback: Obamacare focused on the number of uninsured, as if lack of health INSURANCE was the primary factor responsible for COST of CARE becoming a barrier to access to needed health care. Some might still nod their heads at this assertion, ignoring the dangerous consequences of concluding that merely getting more people insured is a solution to the cost barrier to needed medical care instead of a focus on the type of health INSURANCE that would protect people from the financial risk of ruin from illness or injury.

Obviously, to the extent insurance FAILS to cover the costs associated with illness and injury and thereby prevent financial ruin, it is a less useful tool and therefore, merely having insurance does NOT prevent COST from being a barrier in obtaining needed medical services.

It cannot be argued that this was an Obama "mistake," because Congress and Obama made very certain, from the outset, that their health insurance would be not only remain superior in its coverage compared to what they deemed good enough for the rest of us, but that taxpayers would continue to pay for their public employee superior coverage. Ignored but known, Obama distracted the public from the fact that the quality of health insurance coverage and its cost matter as much or MORE than merely "having" health insurance.

Flash Forward: Medicare For All continues the dangerous trend of focusing on getting people insured rather than making sure that the health insurance product does what it's supposed to, protect consumers from the financial ruin IF they need medical services. Like Obamacare, there are no promises to make the consumer financial product of health insurance adequate to protect us against the financial risk of illness or injury, AND Medicare For All gives government even more authority and decision-making power on what our health CARE options will look like, specifically with enormous powers granted to the Secretary of HHS:

Go to Section 401(a)(1), Administration: "The Secretary shall develop policies, procedures, guidelines, and requirements to carry out this Act, including related to— (A) eligibility for benefits; (B) enrollment; (C) benefits provided; (D) provider participation standards and qualifications, as described in title III; (E) levels of funding; (F) methods for determining amounts of payments to providers of covered services, consistent with subtitle B; (G) the determination of medical necessity and appropriateness with respect to coverage of certain services; (H) planning for capital expenditures and service delivery; (I) planning for health professional education funding; (J) encouraging States to develop regional planning mechanisms; and (K) any other regulations necessary to carry out the purpose of this Act.
(2) REGULATIONS.—Regulations authorized by this Act shall be issued by the Secretary in accordance with section 553 of title 5, United States Code."

Further, under section 201, the Secretary is authorized "on a regular basis, evaluate whether the benefits package should be improved or adjusted to promote the health of beneficiaries, account for changes in medical practice or new information from medical research, or respond to other relevant developments in health science, and shall make recommendations to Congress regarding any such improvements or adjustments." (Sec 201 Comprehensive Benefits, (b) Revision and adjustment)."

Note, in addition to Medicare For All's enormous power and authority granted to the HHS Secretary, there appear to be no time limitations on how long Congress can take to assess and act on those HHS Secretary 201 recommendations EVEN IF THEY ARE essential for consumers. Medicare For All therefore creates a worsening two-fold problem, governmental overreach and dependence on a functioning Congress to make needed adjustments to protect consumers.

Cost Sharing:

Flashback: Obamacare resulted in increased cost sharing by consumers. Not only did consumers see steep increases in their deductibles, copays and coinsurance, but insurers increased the prices of premiums for their plans upwards of over 100 percent, in many cases.

Of course, these increases for exchange participants were disguised through the Obamacare government payments in the form of premium assistance, and for some, government cost-sharing provisions, yet STILL COST, even the reduced cost to participants on exchanges didn't prevent the COST of obtaining and using health insurance from remaining a persistent hurdle for consumers purchasing Obamacare exchange plans.

We know this from outcomes, first and foremost that in 2020 no candidates support Obamacare as is and instead are talking about either improving, replacing or repealing it.

We also know from reporting on enrollment in Obamacare exchange plans the such enrollment overall has never met promises or expectations and that even enrollment among all metal level plans has indicated that consumers sought cheaper bronze plans if they could, if they were healthy, specifically, which provide premium assistance, federal money for buying insurance, but unlike silver plans do not provide the option of the added benefit of cost sharing funds for USING health insurance for enrollees within lower income guidelines.

We also know that in 2015, Obama's Administration raised the prices for silver plans, but a lot less than prices were raised for bronze plans in that benefits year to further lure people into silver plans by offering better "value."

We also know that Obama's Administration changed the law regarding short-term health insurance plans, restricting those plans in 2015, in another effort to get people onto exchange plans.


Flash Forward: Without even attempting to calculate the tax increases that likely will be never-ending to support Medicare For All, what we are informed of is that OUT OF POCKET PAYMENTS could very well skyrocket causing more financial ruin for citizens under Medicare For All than we have now (where already 66 percent of bankruptcies include medical expenses as a cause).

This is for two reasons, first, because we have an unlimited tax increase potential as government determines what funding is needed and secondly because Medicare For All is presented as a bare minimum preventive care plan, primarily, with specific provision of all the uncovered services, drugs, and needed medical care being covered by the PURCHASE of private supplemental insurance plans with no limitations on what's charged for such supplemental coverage and-or the cost of services these private supplemental "contract" plans cover.

Even under Medicare For All, in Section 202, No Cost-sharing, we find that (a) The Secretary shall ensure that no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, be imposed on an individual for any benefits provided under this Act, except as described in subsection (b).
(b) Exceptions.—The Secretary may set a cost-sharing schedule for prescription drugs and biological products." 202 (b)(1)(a) notes that such cost sharing be limited to $200 per person each year, adjusted annually for inflation.

We've already got experience with the Federal government determining our out of pocket limits. Under current law, this number has jumped significantly. In 2011 the out of pocket maximum for self-only was $5,950, and for a family was 11,900. As of 2020, it is 8,200 for individual plans and 16,400 for family plans.

We might be tempted to say, "Well, 200 bucks is a lot better than the thousands of today," but remember, Medicare For All doesn't EVEN CONSIDER all the out of pocket expenses to consumers purchasing private health insurance contracts for uncovered services, which we know will be an enormous part of insurance purchasing because of the bare minimum coverages of Medicare For All, AND we know that there is no LIMIT to what can be charged not only for those supplemental insurance coverages, but for the health care services provided for under those contracts.

Further, we have no idea how much our taxes will go up to cover the costs of the bare-minimum Medicare For All coverage, but we do know that cost sharing of at least 200 bucks per person per year for prescription drugs and biological products is built in, with provision for increases in that amount for inflation.

Flashback: Obamacare did not address balance billing or surprise billing except for emergency stabilizing treatments in emergency rooms. Today, we see that Congress is still "working" on a federal fix to balance billing (and surprise billing) though many states have begun to address this devastating financial risk to consumers.

Flash Forward: Under that same NO COST SHARING section 202 of Medicare For All, (which actually provides for cost sharing) we are also promised no balance billing: 202 (c)Notwithstanding contracts in accordance with section 303, no provider may impose a charge to an enrolled individual for covered services for which benefits are provided under this Act.

Basically, Medicare For All as outlined is like an HMO, authorized providers giving authorized services (as yet unknown and always subject to change by the HHS Secretary), and likely pretty "basic," meaning lots of preventive stuff with inadequate opportunities for real care for NEEDED medical services are not subject to balance billing, everything else, you're on your own.

An enormous part of medical services are likely NOT to be covered by Medicare For All, and only covered by private insurance contracts, which is why the law spends much time in describing such contracts under section 303.

Starkly drawing a difference between balance billing (those charges uncovered by insurance for which a consumer is financially responsible) and surprise billing (those charges uncovered by insurance for which a consumer was unaware," Medicare For All only prohibits SURPRISE billing.

Let's get to that Sec 303: Use of private contracts. Subject to the provisions of this subsection, nothing in this Act shall prohibit an institutional or individual provider from entering into a private contract with an enrolled individual for any item or service" as long as neither the provider, his institution or we, the consumer are making any claim that such service is covered under the Act, which we already know or should know will be the bare minimum as outlined in the Act's "list."

This one goes to the heart of our financial ruin.
Section 303 reminds consumers under (2)(C) that the beneficiary (consumer) "acknowledges that no limits under this Act apply to amounts that may be charged for such items or services," and that consumers are ultimately responsible for the costs charged by providers.

Medicare For All legislation advises us that what providers charge for such services covered by contracts is UNLIMITED as long as the consumer signs a contract saying they're aware of the cost and that they the consumer know they the consumer are responsible for it.

This is even more financially risky because outside of the Medicare For All basic insurance, consumers who purchase policies to cover these UNLIMITED expenses from insurance companies will not be protected by how much can be charged in premiums or copays or coinsurance or deductibles.

This alone should be enough to warn people off the Medicare For All as outlined by Bernie Sanders in his bill.

So what about that specious argument to vote one way or another because of a growing number of uninsured children?

Flashback: Even with Obama fans' determination to boost Obama's long list of failed promises about Obamacare by narrowing and focusing on the singular goal that Obamacare would "solve" the problem of the uninsured, we know even this didn't happen. There remain millions upon millions of people without health insurance, including the increase of children uninsured.

Flash Forward: Although conceivably, all would eventually have insurance under Medicare For All, we cannot be certain because we know all the changes to Obamacare that occurred after the law's enactment changing the original law. See https://galen.org/2016/changes-to-obamacare-so-far-3/, which includes "43 that the Obama administration has made unilaterally, 24 that Congress has passed and the President has signed, and 3 by the Supreme Court," 70 Changes to Obamacare… — So Far," POSTED BY Grace-Marie Turner, January 28, 2016.

What we do know is that under section 106, Medicare For All promises an effective date of FOUR YEARS after the law's passage (though for children under 106(b) coverage (through age 19) would begin January 1 of the first year after enactment, leaving plenty of time for similar changes to the proposed law.

There is no reason to suppose that President Trump has been worse for children than President Obama when it comes to health insurance. Actually, arguably the opposite is true.

Here we'll go to one of those October, 2019 anti-President Trump articles that desperately tries to lay the "blame" for the increased number of uninsured children at the Trump Administration's feet, an October, 2019 report out of Georgetown by Joan Alker and Lauren Roygardner, "The Number of Uninsured Children is on the Rise," https://ccf.georgetown.edu/wp-content/uploads/2019/10/Uninsured-Kids-Report.pdf. All cites will be from this report unless otherwise indicated.

The article begins: "From 2016 to 2018 there were more than 400,000 more children uninsured in the United States." OK, so from one year before Trump's presidency, which began on January 20, 2017, the number of uninsured children has been on the rise. That's right, from BEFORE Trump was President.

Spoiler alert, to get to the meat of the report's partisanship reasoning let's go straight to the report's conclusion:
"This serious erosion of child health coverage is likely due in large part to the Trump Administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP.

These actions include attempting to repeal the ACA and deeply cut Medicaid, cutting outreach and advertising
funds, encouraging states to put up more red tape barriers that make it harder for families to enroll or renew their eligible children in Medicaid or CHIP (or ignoring it when they do), eliminating the ACA’s individual mandate penalty,
and creating a pervasive climate of fear and confusion for immigrant families. That has left many of these families
reluctant to enroll their (largely) citizen children in public coverage for fear of having this held against them."

OK, let's get rid of the easiest fallacy first, that somehow eliminating the ACA's individual mandate penalty increases the number of uninsured children. Financially this makes little sense since the individual mandate penalty funds collected by government are not destined to be spent on healthcare. As a matter of fact, it's unclear where these penalty dollars are spent by government. So, unless this is a sneaky way of arguing for a higher individual mandate penalty, which many Democrats have advocated because people chose to pay the penalty rather than purchase health insurance, this is not persuasive.

Nor is it persuasive that the argument that the repeal of the individual mandate accounts for the increased cost of Obamacare exchange plans, thereby somehow increasing the number of uninsured children. Most obviously, because the elimination of the individual mandate penalty was not effective until 2019, meaning that only for 2020 tax filings might the elimination of such penalty come into play.

Further, if partisans try to stretch it further and claim that anticipation of actions attempting to repeal Obamacare somehow influenced individuals' annual choice of health insurance for a year prior to President Trump's presidency or that elimination of the individual mandate encouraged people to opt out of purchasing health insurance, somehow retroactively inspiring insurers to raise prices for consumers on Obamacare exchange plans, this would be a lie.

Obama's own government told us that Obamacare plans would continue to rise in price way back in 2015, long before Donald Trump and before the 2016-2018 statistics of more uninsured children.
That's right, in 2015, Obama's Administration, Congressional Budget Office stated, "For the years 2016-2018 the cost of silver plans on the exchanges is expected to rise “…at an average rate of 8.5 percent per year… for two reasons: REINSURANCE PAYMENTS THAT THE GOVERNMENT MAKES TO INSURANCE PLANS whose enrollees incur particularly high costs for medical care WILL BE PHASED OUT over the next two years, placing upward pressure on exchange premiums [AND] PLANS INITIALLY OFFERED THROUGH THE EXCHANGE APPEARED TO HAVE, in general, lower payment rates for providers, NARROWER NETWORKS of providers, and TIGHTER MANAGE OF THEIR SUBSCRIBERS' USE OF HEALTH CARE than do employment-based plans. CBO and JCT anticipate that many plans will not be able to sustain such low provider payment rates or such narrow networks over the next few years, placing upward pressure on exchange premiums.” (CBO, Pub. 49973, page 22). [caps added].

It wasn't the only warning issued by the CBO under Obama: "Private Health Insurance Premiums and Federal Policy," https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/51130-Health_Insurance_Premiums.pdf:
"Over the period from 2005 to 2014, premiums for employment-based insurance grew by 48 percent for single coverage and by 55 percent for family coverage. CBO and JCT expect them to grow at similar rates over the next decade." -CBO

That's right, premiums went up by 55 percent for families from 2005 to 2014, that's according to the CBO under Obama, and there was NO SLOWDOWN of those increases anticipated by Obama's Administration over the next 10 years, so doing our math, that brings us to 2024. Not at all an indication that President Trump had much to do with premiums rising.

Back to the Georgetown report's next claim blaming Trump for more uninsured children: "These actions include attempting to repeal the ACA and deeply cut Medicaid," both cited by the report as apparently creating the increased number of uninsured children from 2016 to 2018. This must also be immediately dismissed because note the magic word "attempting." In fact, the ACA is not repealed and Medicaid has not been deeply cut.

Back to the Georgetown report's next claim: "…creating a pervasive climate of fear and confusion for immigrant families. That has left many of these families reluctant to enroll their (largely) citizen children in public coverage for fear of having this held against them." This is just straight-up partisanship drivel since even the irrationality of Trump haters can't blame the President for immigrant families not enrolling their children in public health insurance for which they're eligible.

Remember under Obamacare, (see healthcare.gov), "Immigrants who are 'qualified non-citizens' are generally eligible for coverage through Medicaid and the Children’s Health Insurance Program (CHIP), if they meet their state’s income and residency rules." There were already restrictions under Obamacare for non-citizens only, also not singling out their citizen children at all beyond state residency requirements that apply to all.

Contrary to its own reasoning, the Georgetown report under the heading "Sources of Coverage," states that In 2018, the largest source of coverage for children continued to be employer-sponsored insurance, though there was no statistically significant change between 2017and 2018 despite the continued strong economy and low unemployment rates."

The report acknowledges a strong economy and low unemployment, in addition to the fact that most children are insured through their parents' employer sponsored health insurance.

Obviously then, changes to employer-sponsored health insurance that would discourage dependent coverage of children would contribute to more uninsured children.

Well, that's Obama's gimmick of the family glitch, unaddressed and uncorrected for a decade because it would cost the federal government too much to fix. The family glitch also NOT President Trump. The family glitch gets a dismissive mention by the Georgetown folk: "The 'family glitch' may be contributing to the difficulties that families are facing in accessing marketplace subsidies."

Difficulties accessing marketplace subsidies to insure their children? That IS the family glitch under Obamacare, because employees who have access to affordable employer-sponsored self-only health insurance are INELIGIBLE for premium assistance if they purchase an Obamacare exchange plan.

This left full-price individual insurance plans, short term health insurance or CHIP to cover these employees' children. (Which is addressed further on.)

The Georgetown writers assert: "Children from higher-income families are also seeing increases in their uninsured rates, though those rates are still considerably lower than the national average. This likely reflects the rapidly increasing cost of employer-sponsored family coverage, reduced participation in subsidized Marketplace coverage, and the repeal of the individual mandate penalty."

As noted, the rapidly increasing cost of employer-sponsored family coverage was part and parcel of Obamacare, predicted by Obama's own government for many years. The family glitch, we know is laid at Obamacare's feet and remains ignored and uncorrected for a decade. We've already addressed the "repeal of the individual mandate," which only took effect for year 2019, tax filing in April, 2020.

What about families that tried to deal with gaps in insurance from unemployment or inability to afford employer-sponsored dependent coverage or individual marketplace plans for whatever reason by choosing to purchase short-term health insurance as a stopgap for making that decision?

Well, we know that it was Obama's administration in 2015 considered that a "loophole,' a means of avoiding participating in the marketplace and instead of expanding premium assistance coverage to such "ineligible families," the Obama Administration in 2015 severely restricted the availability of short-term plans. That Obama decision, President Trump has reversed.

But what about CHIP, that plan that covers children whose parents earn too much for Medicaid but still fall within some income requirement guidelines? This is where the "report" gets even more twisted in its reasoning. Switching to public insurance, Medicaid/CHIP, the report states that Medicaid/CHIP "administrative data clearly show that Medicaid/CHIP enrollment has declined substantially for children."

The report states that "children from low- and moderate-income families earning between 138 percent and 250 percent of the federal poverty level ($29,435 - $53,325 annually for a family of three) had the sharpest increase in their
uninsured rate and the highest uninsured rate compared to other children. Most of these children are likely eligible for Medicaid or CHIP but not currently enrolled."

Well, if they're eligible but not enrolled, that isn't on Donald Trump unless you argue that by reducing the budget for advertising for Obamacare, President Trump is somehow responsible for uninsured children. This seems pretty unlikely primarily because MEDICAID AND CHIP do not have an OPEN ENROLLMENT PERIOD. You CAN APPLY FOR MEDICAID OR CHIP AT ANY TIME.

Instead of partisan politics, a little reality check indicates that Obamacare actually wanted to get rid of CHIP and anticipated moving those children either into expanded Medicaid or onto Obamacare exchange plans.

FLASHBACK: Though often categorized together, Medicaid and CHIP, the children's health insurance program, are not the same in some very important ways. CHIP typically covers children whose families do NOT MEET the poverty level required for Medicaid. That's right, CHIP usually requires different income guidelines so the threshold for obtaining CHIP is usually less restrictive in terms of limits on income, eg those with higher incomes can utilize CHIP. CHIP also often includes state residency requirements.

As KHN.org explained in 2014, "ACA And The Children’s Health Insurance Program," https://khn.org/news/aca-and-the-childrens-health-insurance-program/, "The Children’s Health Insurance Program (CHIP) was enacted in 1997 to extend health coverage to children in poor families with modest incomes too high to qualify for Medicaid. The Affordable Care Act now offers many of those same families federal subsidies through the health insurance exchanges, calling into question whether the program should be continued over the long term."

However, as we know, or should know, Obamacare plans were always considered still too expensive by many, including the vast majority who received premium assistance, and especially for families unlucky enough to be victims of the family glitch who were ineligible for premium assistance, making it obvious that some preservation of the old CHIP program was necessary. Although Obamacare deemed the CHIP program dispensable and thereby merely included funding only through 2015, with a provision that after that Congress would have to authorize additional funding, under President Trump, in 2018, Congress funded CHIP for a full decade, that's right, 10 years.

The article concludes that "There are no signs that this disturbing trend in children's health coverage will abate unless national and state leaders fully rededicate themselves on a bipartisan basis to the goal of ensuring that all children have access to affordable, comprehensive health insurance."

Ah, and therein lies the next problem. Medicare For All will not be comprehensive health insurance, which should be pretty obvious if you read Section 201, Comprehensive Benefits which continue the trend of listing coverages, many of which are preventive rather than NEEDED medical services. Further, Medicare For All anticipates the inadequacy of its basic coverage with its Section 303, Use of Private Contracts provisions.

In other words, Obamacare created the conditions that could foreseeably cause an increase in uninsured children with his "vision" of doing away with CHIP and moving everyone onto exchange plans or into Medicaid, with the uncorrected family glitch, meaning that even those who couldn't afford dependent coverage might shop on exchanges but were ineligible for premium assistance, by limiting the availability of using short-term health insurance which might provide some protection to children whose parents earned too much for Medicaid but could not be insured under another program.

Medicare For All as proposed, will, like Obamacare focus on making sure everyone has some kind of health insurance, and therefore in its simplest terms could address the "problem of the uninsured," including the "problem of uninsured children." However, as written, Medicare For All will not likely protect children who are ill from the cost of treating their illness because it continues the Obamacare preventive care focus at the expense of truly protective illness/injury coverage and because private contracts will likely be necessary for purchase in order to obtain meaningful risk coverage, much like today's Medicare supplemental insurance, and because such uncovered services by Medicare For All will remove any limits to how much can be charged both for the supplemental policies and by providers to people who purchase such plans.

Under Medicare For All, there is also the "idea" that everyone, even public employees will have the same coverage within Medicare For All, but like Obamacare, it is unlikely Congress will legislate away their superior benefits paid for by taxpayers. Read carefully, Medicare For All anticipates getting rid of the Title 5 chapter 89 of United States Code for federal benefits, it doesn't say there won't be new ways enacted by Congress for public employees to be funded by taxpayers.

In fact, it's obvious from our Obamacare experience that public employees and Congress will protect themselves through the excuse that the federal government is an employer, and therefore, as an employer can choose to provide superior benefits to employees, including Congress who not only just happen to pass the laws for themselves, but are funded by taxpayers for those choices. Even without the "employer" door, old-time tricks of increases in their salaries to cover those "uncovered" costs, or other money allotments to cover the cost of purchasing supplemental plan style contracts funded by taxpayers could easily be used by Congress.

The federal government has proven itself inadequate in addressing the cost as barrier to needed medical services problem in the US. These risks to children's health and all of our health continue with each party's proposals and rather than being a justification to vote one way or the other, should be an inspiration for consumers to focus on what we need from the product of health insurance in order to make it a useful tool in protecting us from the risks of financial ruin that today accompany illness or injury and then communicate that to our government representatives.