Health Insurance Coverage in 2020: A Looming Crisis in Affordability

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      There are other paths to universal coverage and improved affordability, like a single payer or “Medicare for All” approach. The reforms outlined here don’t preclude such a path but could be a practical first step toward a more regulated insurance system that includes more public financing. But ongoing policy inaction on insurance coverage combined with the raging pandemic is certain to tip the nation’s health care affordability problems into crisis for U.S. households.

      USThe United States entered the pandemic with 30 million uninsured people and more than 40 million underinsured. These numbers are certain to climb this year. The Congressional Budget Office projects that the U.S. economy will contract by more than 5 percent in 2020 and 25 million fewer people will be working in the third quarter of 2020 compared to the end of 2019. The Urban Institute estimates that this employment disruption will leave 3.5 million more people uninsured by the end of the year. And millions more will suffer income loss through furloughs, wage cuts, and declining business revenue. Unless there is a significant drop in premiums and deductibles in private coverage, many households will face health care costs that take up a growing share of shrinking budgets.

      Coverage insecurity will leave people with mounting medical debt, as well as significant financial barriers to getting the health care they need to survive the pandemic and lead healthy and productive lives. Several policy options at the federal and state levels could move the nation toward universal, comprehensive coverage and provide relief to U.S. families.

      Comment by Don McCanne of PNHP:  It looks like we’re stuck in that time machine: tens of millions uninsured, tens of millions more underinsured, and pervasive personal financial hardship.

      The authors do propose a set of incremental patches that would expand coverage, though the system would still fall far short of covering everyone, plus the proposed measures would lessen financial hardship for some but by no means for all. The authors note that these reforms would not preclude single payer Medicare for All, but these steps would significantly increase our national health expenditures while falling far short of our goals for reform. Notably, they would further increase the administrative complexity which is the largest source of wasteful health care spending in the U.S. Also such reforms would allow our public stewards to walk away once again for another decade or two without enacting and implementing the reform we desperately need – single payer Medicare for All. This would perpetuate the financial hardship, physical suffering and even death from our uniquely American health care financing system that is so highly dysfunctional.

      What are we going to do? Continue to receive these disconcerting reports, tsk tsk them, and put them in the files? Aren’t our files full enough already?

      Incidentally, we have some files over at PNHP that we can pull out. Affordable, equitable, efficient, comprehensive care, for everyone, automatically, for life, without all of the administrative waste and without personal financial hardship. Might require a touch of social solidarity, but what on earth would be wrong with that?

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

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