The Covid-19 pandemic has forced many Americans to reconsider their transportation options, what with fears of infection and the slashing of public transit systems’ routes and schedules. That has made used cars, motorcycles, and bicycles hot commodities.
Those who are working and considering how their finances might stretch may take little comfort in another reality of the U.S. health care system — the relentlessly increasing cost of employer-provided coverage. Who can afford a second car while also footing the rising bill for health coverage?
As the nonpartisan Kaiser Family Foundation said in its annual report on this issue:
“Annual premiums for employer-sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,644 for single coverage. Fifty-five percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 56%.”
The KFF study, conducted partly before and after the pandemic began, suggests that workers may be getting a bit of a break on their deductibles and the overall cost of their health coverage for now. That’s because employers and insurers, along with everyone else in the world, did not anticipate how the coronavirus would cause demand for medical services to plummet, leading to reductions in pay-outs to providers.
Still, employers and insurers have not had a chance to determine how Covid-19 care may ring up health costs for companies, affecting how much they pay for insurance and push off on to employees as deductibles. Experts also worry that as the nation returns to greater normality, including demand for medical services, workers may see even more worrisome spikes in the cost of their job-provided coverage.
History provides little cause for cheer, as the independent Kaiser Health News service (which is unconnected to the family foundation) reported:
“While health insurance costs rose a modest amount in 2020, as has been the trend in recent years, they soared 55% in the past decade — more than twice the pace of inflation and wages. About 157 million Americans rely on employer-sponsored coverage — far more than any other type of coverage, including Medicare, Medicaid and individually purchased insurance on the Affordable Care Act exchanges. More than half of employers provide insurance to at least some workers. ‘Conducted partly before the pandemic, our survey shows the burden of health costs on workers remains high, though not getting dramatically worse,’ Drew Altman, KFF’s CEO, said in a statement. ‘Things may look different moving forward as employers grapple with the economic and health upheaval sparked by the pandemic.’”
Uncertainty in health coverage
Workers with employer-provided coverage also may be caught up in any tumult associated with a pending U.S. Supreme Court case pursued by Republicans in the White House, Congress, and state houses. The case seeks to kill the Affordable Care Act and the crucial safeguards in it on how insurers deal with patient-consumers, including bars on their denying coverage based on pre-existing conditions and imposing annual and lifetime limits. Obamacare also allows parents to keep their children on their policies until age 26 and has requirements for preventive and women’s health care.
The ACA contains extensive, detailed legal measures to enforce the consumer-patient insurance safeguards. Political partisans attacking Obamacare have never explained how pre-existing condition and other protections would be preserved if the court strikes down the ACA (a stronger prospect with a conservative-stacked bench, including a justice nominee who has made clear her Obamacare opposition).
Just to be clear, an executive order by the president cannot preserve pre-existing condition protections, any more than standing in the middle of a jammed highway and chanting bibble-di-boobldy-boo will conjure a wall of magical elephants to keep a pedestrian safe.
Much attention has focused on how killing the ACA would strip 20 million or so poor, working poor and middle-class Americans of their health insurance, obtained on Obamacare exchanges. Less attention has been paid to the calamity that could be caused if striking down the ACA affects the expansion of Medicaid, a program that has provides tens of millions of poor, elderly, and chronically ill Americans coverage.
But let’s go a step further — perhaps it will be the step too far for most voters: An estimated 60 million or so Americans have pre-existing conditions and could see their coverage imperiled with any demise of Obamacare. This number does not include the 7 million Americans who have been infected by the coronavirus, and, if insurers’ practices before are any guide, would now have a new pre-existing condition.
To be clear, what is murky in all the combat over Obamacare has been what employers and their insurers will do, if they no longer are constrained by ACA standards. As companies struggle to recover from the pandemic, and if Obamacare isn’t around as a standard-setter, will profit-hungry CEOs and company insurance plans continue all the protections Americans have embraced? Hint: How many executives, as they furloughed or fired tens of millions of Americans, took a pay cut themselves, in solidarity with their staff?
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
The 2020 election is storming into its closing days, with Americans zeroing in as never before on issues involving health and health care — including the federal coronavirus response and what to do about the ACA and health coverage. Health insurance cannot be the alpha and omega of the national discussion. It is a vital way that we all can share and minimize the bankrupting risks of outrageously costly medical services. This is true because not only are all of us a blink away from a catastrophic illness or injury, too may of us battle on the financial edge. As studies have shown, 4 in 10 Americans would experience real hardship handling a sudden expense of $400.
How cruel can the coverage get?
Vox, an online news site, has reported on the “politics of incredulity” and their effect on voters and health care. Simply put, ordinary and reasonable Americans cannot fathom how any politician, in the wealthiest nation in the world, could oppose efforts to provide all Americans excellent medical services and health coverage that made them more fair, accessible, and affordable. Such “heartless monsters” don’t exist, right?
Well, consider this report, also newly issued, on the state of America’s kids and health insurance, based on U.S. Census data, as reported by the New York Times:
“The share of children with health coverage in the United States fell for the third consecutive year in 2019 … after decades of increases. The decline occurred during a period of economic growth — before the coronavirus pandemic caused broad job losses that might have cost many more Americans their health insurance. A report … by the Georgetown Center for Children and Families found that the ranks of uninsured children grew the most in Texas and Florida, and that Latino children were disproportionately affected. Nationally, the number of children without health insurance rose by 320,000 last year alone, to a total of nearly 4.4 million children, the report found. ‘What’s so troubling about this data is we were making so much progress as a country,” said Joan Alker, the center’s executive director and an author of the report. ‘And now that progress is clearly reversing.’”
The newspaper also reported this:
“A large body of evidence has shown that children’s health insurance coverage has long-term benefits for children and their families, improving health outcomes, educational attainment and even adult earnings. Last year, some state and federal officials suggested it was good news that more than a million children were dropped from Medicaid and CHIP enrollment from December 2017 to June 2019, arguing that more Americans were getting coverage from employers in an improving economy. But census data seems to counter the notion that many families gained employer insurance: The rate of uninsured children increased in some states with declining Medicaid and CHIP enrollment, including Tennessee, Texas, Idaho, and Utah. The 2019 data shows that trend has continued for another year.”
We’ve got a lot of work to do. Please vote and do so early.