We live in a representative democracy. We elect our representatives to go to national, state or local office to represent our interests and solve problems. Of course, not all problems can be solved and the policy triage of what gets attention and what doesn’t is the decision of the representative based on what his or her constituents want or need.
For years, a huge problem in America was the rapid increase in the numbers of people without health care coverage. In the 1960s, the nation developed Medicare, health insurance for those over the age of 65 and Medicaid, health insurance for the poor.
In the 1990s, the President and the Congress expanded coverage to help cover all those under the age of 18. Yet, despite the fact that near-universal coverage existed for those under the age of 18, those over the age of 65, and the poor, the number of Americans without coverage continued to swell, peaking at about 50 million eight years ago.
For the rest of the advanced nations of the world, it was inconceivable that such a situation existed. Western Europe, Canada, Japan and others have health care coverage for all of their citizens. As a result, despite spending far more on health care than any other nation on Earth, the United States had more uninsured, incredibly uneven health care quality, and a mediocre life expectancy compared with other developed, wealthy nations.
It was a problem.
Former President Obama and the Congress agreed to legislation to attempt to address that problem. The solution that they came up with had a modest impact on the spiraling cost of health care, but did cut in half the number of Americans that lacked health insurance.
You could argue with their solution – one which essentially expanded the number of Medicaid-eligible Americans and offered subsidies to help others purchase health insurance – was inadequate to the task, but no one could argue that they did not try.
For years, Republicans argued that they could do it better. They argued that if they were granted control of the White House and the Congress, they would repeal the Affordable Care Act and replace it with something better. We now know that their pledge was pure fiction. They had no plan to replace the ACA with anything. All they wanted to do was repeal.
While the majority of the House of Representatives was quite willing to take away coverage from tens of millions of Americans, leaving millions without coverage was something that some Republicans in the Senate could not agree to. Combined with unanimous Democratic opposition, the effort to repeal the law and take away health insurance coverage from over 20 million Americans ground to a halt.
President Trump, who as a candidate consistently said that he would fix the health insurance system and make it better, has now decided to just make it all worse. In a stunningly callous series of decisions, the President to doing all he can to deny health insurance for primarily low and moderate income Americans – individuals who currently have coverage will now lose it.
Last week, the President acted to eliminate subsidies to health insurance companies that help pay out-of-pocket costs of low-income people. His decision came on the heels of his plans to make sweeping changes in the nation’s insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers.
Without the subsidies, insurance markets could quickly unravel. Insurers have said they will need much higher premiums, probably 20 percent higher, if the subsidies were ended.
Part of the President’s rationale was that he believed that such payments were illegal, but he has offered no alternative to cover those who will soon be desperately in need of coverage.
And that’s not what elected officials are supposed to do. They are supposed to make a good effort to solve problems. They should allocate the nation’s limited resources where needed and apply the best evidence to develop policy solutions.
To strip away people’s health insurance coverage with no alternative is indefensible and will cost an estimated one million Americans dearly. Without coverage, sick people delay care, which can lead to even more devastating health consequences. And those serious illnesses can cost those individuals and their families their financial security as well.
Many people will suffer unnecessarily due to the President’s decisions and from the actions of those in Congress who are doing all they can to take away people’s health insurance. Our elected representatives should care about people, not use them as fodder in the nation’s political wars.
Blair Horner is executive director of the New York Public Interest Research Group.
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