The Affordable Care Act’s first date with the Supreme Court suggested that the conservative-dominated court is unlikely to trash Obamacare. Though a final ruling on the arguments presented Nov. 10 likely will not come until June, questions from the justices implied that Trump
Saving the ACA was at the top of president-elect Joe Biden’s health care agenda. In fact, according to his website, he wants to expand ACA to offer a public option, a government program somewhat like Medicare that would compete with private insurance companies. The new option would be available to people of all ages. Biden also hopes to expand premium subsidies, currently limited to those who earn less than 400% of the federal poverty level (that’s now $104,800 a year for a family of four, for example), to cover more people.
He’s also promised to expand health insurance subsidies to people who are now on COBRA plans because of COVID-19-related job losses. As anyone who has ever been forced to rely on a COBRA plan knows, it is exorbitantly expensive and beyond the means of most people who are unemployed.
Biden has also said Medicare should be available at age 60, not 65, and should include dental, vision and hearing health care as part of the package rather than requiring supplemental policies.
Outlawing “surprise billing” is another goal. These unexpected bills, often from out-of-network providers, have bankrupted many American families. (Can we honestly expect a person having emergency surgery for an intestinal blockage to pop up from the operating table and say, “Oh, wait – before you anesthetize me, can everyone in the room verify they’re on my insurance network?”)
Many of the items on this health care wish list represent discrete, achievable goals, depending on whether Biden is battling a GOP-dominated Senate. The bigger challenge for Biden and team will be fulfilling the promise of “making our health care system less complex to navigate,” as his website says. Our health care system today is dominated by mega-businesses – providers, insurers, pharmaceutical companies and hospital corporations – and mergers and acquisitions among them are at an all-time high. It’s a system impossible for the ordinary person – much less a person with active cancer or heart disease, or injuries from an accident – to navigate.
Anyone who has heard the dreaded recording, “Prior authorization is not a guarantee of payment” from an insurer understands this. Patients who find out at the check-out stand that a medication that cost $20 for a 30-day supply for years now will set them back hundreds of dollars a month also get it. So do rural residents who are referred to a specialist only to learn that the only doctor of the type they need in a 100-mile radius is booked for six months.
Biden needs to appoint a health-care czar (in addition to a COVID-19 czar) who can put together a team to untangle this mess, or at least begin to do so. That team needs to develop stated goals and timelines for their achievement. It should also assess what the end-users’ problems are, not just what policy wonks think they are. Accessibility, affordability and, yes, navigability should be the topmost concerns.
Americans pay more than any other developed nation for our health care, and our system is usually rated at the bottom of the global pile. We deserve better.
