Editor’s Note: Scott Serota is president and chief executive officer of the Blue Cross Blue Shield Association. The opinions expressed in this commentary are his own.
Everyone should have access to health care, no matter who you are or where you live.
To achieve this, we need to implement common-sense solutions that protect people with pre-existing conditions, expand access to coverage and care—and lower costs for everyone.
How do we do that? The Affordable Care Act provides the framework. The health reform law, enacted in 2010, protects people regardless of their health status, guarantees a robust set of essential benefits, extends new protections for those with employer-based coverage, gives states incentives to expand Medicaid and offers significant financial assistance to eligible individuals who purchase coverage on their own.
Today, 90 percent of Americans are covered. The imperative is to close the gap that leaves the remaining 10 percent so vulnerable, without disrupting coverage and care for the nearly 300 million Americans who already are covered.
Most of the uninsured today already are eligible for coverage, and there is financial assistance available to help them afford it. For example, two-thirds are eligible for Medicaid or for tax credits to help them purchase policies on the exchanges established under the ACA. In many cases, people simply don’t know they are able to access programs that literally could change their lives. A recent Commonwealth Fund survey found that 40% of uninsured, working-age adults were not aware of their state’s marketplace or HealthCare.gov. This must change.
We need to educate people on why obtaining and maintaining insurance is important and provide information on how to do it. Federal funding for outreach to those who are eligible for coverage should be restored to 2014 levels and states must reinvigorate their enrollment efforts.
We also need to address the persistently high cost of health care in the US. Premiums and out-of-pocket costs remain too high.
In the ACA market, Congress should enhance tax credits for younger people to make coverage more affordable and boost enrollment among younger, healthier adults to help balance the cost of caring for those who are ill. In addition, lawmakers should adjust the current tax credit structure to ensure no one purchasing coverage in the individual market pays more than 12% of their income for health insurance, a level that would bring more people into coverage while being mindful of the cost to taxpayers. Cost-sharing protections to reduce out-of-pocket costs for lower-income people who are having trouble affording the care they need also should be expanded.
Right now, 5% of people who buy coverage in the individual market represent almost 60% of medical claims’ costs. To protect those with serious conditions and lower premiums for everyone, Congress should establish a sustained federal funding mechanism to support the cost of caring for those with significant medical needs. Combined with improved enrollment outreach, this would reduce premiums by 33% and enable 4.2 million more people to obtain coverage, at a fraction of the cost of proposals being debated today.
These are solutions that Congress can and should enact right now. They would not upend care for anyone. Nor would they create a new system like Medicare for All that would, like all ambitious legislation, have unintended and unforeseen consequences. For example, under Medicare payment rates, some hospitals struggling to stay open in rural and some urban neighborhoods might close. And we simply cannot predict what changes in doctor-patient relationships might have to occur if millions of Americans who currently receive insurance through their employers were to move into a government system.
There already are legislative solutions at hand to address the cost of medical care that can be enacted with bipartisan support. For example, we can rein in prescription drug costs in part by taking action to bring more low-cost generic drugs to the marketplace faster, as envisioned under the CREATES Act, and adopt recent proposals to reduce Medicare beneficiaries out-of-pocket expenses for prescriptions. Likewise, there’s bipartisan support for protecting consumers from surprise bills from out-of-network clinicians, which can upend even the most careful and cost-conscious decisions patients make when choosing to get care at an in-network medical facility.
The foundation is there for us to build on what we have to make it better and ensure everyone has coverage at a more affordable price.
Vigorous and sometimes noisy debate is vital to our democratic system. But it must inform and enable the quieter work of enacting pragmatic solutions that can benefit millions.
