Health care debate heats up in Iowa
A strong turnout and often impassioned debate underscored that health care — the fear of losing it or not being able to afford it — is still a burning issue for Americans, just as it was during last year’s midterm election.
by Arielle Kane, Director of Health Care | Progressive Policy Institute
Last week PPI returned to Des Moines for a second “Conversation with Iowans,” this time about progressive alternatives to nationalized health care. The ideas forum featured former Colorado Gov. and presidential aspirant John Hickenlooper, Theresa Greenfield, a Des Moines business owner, PPI President Will Marshall and yours truly.
A strong turnout and often impassioned debate underscored that health care — the fear of losing it or not being able to afford it — is still a burning issue for Americans, just as it was during last year’s midterm election. Many participants told gut wrenching personal stories about their maddening interactions with our complex and costly health delivery system. One woman, for example, relayed how her Type 1 diabetes diagnosis had led to multiple hospital stays, medical debt, and anxiety every month over covering her insulin costs.
As Marshall noted, President Trump and Congressional Republicans, undaunted by their midterm shellacking, have resumed their campaign to destroy the Affordable Care Act (ACA) and replace it with some as-yet-to-be developed plan. That puts Democrats in a strong position to remind Americans they will protect their coverage.
Gov. Hickenlooper said that Democrats should build on the successes of the ACA even if there is work left to be done. He cautioned against calls for Medicare-for-all, saying that there are less disruptive ways to reach Democrats’ shared goal — specifically noting the majority of the 155 million Americans on employer-sponsored plans are happy with their coverage.
But some attendees insisted that single payer, now popularized as “Medicare-for-all” as the only way to get universal coverage and lower prices. But as I pointed out, you don’t need to enroll every American in Medicare to take advantage of its pricing structure. In fact, PPI proposes imposing a multiple of the Medicare fee schedule on the whole market. Such price regulation will bring down premiums and out-of-pocket costs making health care more affordable across the health care system.
Additionally, to get to universal coverage while preserving choice, we propose allowing older Americans to buy into Medicare at age 55 and expanding subsidies in the individual market. We recognize that there is a demand to expand access to the Medicare program and propose allowing older Americans without employer-sponsored coverage to buy into it. This would expand their options while also potentially taking the more expensive people out of the individual market risk pool, bringing down premiums for those remaining.
However, many don’t know that under current law, Medicare has 20 percent co-pays and no limit on out-of-pocket costs. Most commercial plans, however, have an annual cap on out-of-pocket expenses. This is why we also propose expanding subsidies so that those without employer-sponsored coverage can more easily afford commercial insurance in the individual market.
The reality is, any health care package needs 60 votes in the Senate. Currently Democrats have 49 seats in the Senate and a tough map to get to 60. This means that any bill would need universal support from Democrats and a few Republicans in order to pass — a bad climate for litmus tests.
Americans are hurting because of the cost of health care. Democrats are committed to bringing down costs, improving health care outcomes and reaching universal coverage. Unfortunately, it may just have to happen in a more incremental and pragmatic way than some activists would prefer.
