How Health Care Is Shaping American Politics

With Meghna Chakrabarti

High deductibles and medical bills are feeding resentment and political alienation of the middle class, reports the Los Angeles Times. We unpack.

Guests

Noam Levey, writes about national health care policy out of Washington, D.C., for the Los Angeles Times. (@NoamLevey)

Elana Schor, national political reporter for the Associated Press. (@eschor)

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Los Angeles Times: “Rising health insurance deductibles fuel middle-class anger and resentment” — “Health insurance — never a standard protection in the U.S. as it is in other wealthy countries — has long divided Americans, providing generous benefits to some and slim-to-no protections to others.

“But a steep run-up in deductibles, which have more than tripled in the last decade, has worsened inequality, fueling anger and resentment and adding to the country’s unsettled politics, a Los Angeles Times analysis shows.

“Many wealthy Americans — already reaping most of the benefits of the last decade’s economic growth — have weathered the dramatic increase in deductibles in recent years in part by putting away money in tax-free Health Savings Accounts.

“Very poor Americans, millions of whom gained coverage through the 2010 Affordable Care Act, can see a doctor or go to the hospital at virtually no cost, thanks to Medicaid, the half-century-old government safety net program.

“Squeezed in the middle are legions of working Americans who face stagnant wages, insurance premiums that take more and more of their paychecks and soaring deductibles which leave them with medical bills they can’t afford.

“‘The system increasingly doesn’t work for this group in the middle,’ said Drew Altman, longtime head of the Kaiser Family Foundation, or KFF, a California nonprofit that researches the U.S. health system.

“‘These people may have health insurance … but they can’t pay the bills.’ ”

New York Times: “Joe Biden, Echoing Obama, Pledges to Shore Up the Affordable Care Act” — “It was the singular promise that doomed the public perception of President Barack Obama’s health care law — and now former Vice President Joseph R. Biden Jr. is using it on the campaign trail.

“‘If you like your health care plan, your employer-based plan, you can keep it,’ Mr. Biden told an AARP forum on Monday. ‘If you like your private insurance, you can keep it.’

“Mr. Biden restated nearly verbatim Mr. Obama’s Affordable Care Act promise — which was named Politifact’s ‘Lie of the Year’ in 2013 and has been ridiculed by Republicans for years — as he detailed for the first time how he would tackle health care as president.

“Mr. Biden’s proposal would create a so-called public option that would enable anyone to sign up for a government-run health plan like Medicare, allow more people to get subsidies to help pay for their health insurance and reduce the maximum percentage of income they could spend on premiums.”

The Hill: “Harris vows to put ‘people over profit’ in prescription drug plan” — “Sen. Kamala Harris (D-Calif.), a 2020 presidential candidate, on Tuesday unveiled a prescription drug plan that aims to put ‘people over profit’ by cracking down on pharmaceutical companies for high-priced medications.

“Harris said she can help lower the cost of prescription drugs and make health care more affordable to consumers by allowing the federal government to set fair prices for pharmaceutical companies, and forcing these companies to pay rebates if medications are sold at artificially high prices.

“‘As President, I will not stand idly by as Americans pay thousands of dollars for prescription drugs while big pharmaceutical companies rake in massive profits,’ Harris said in a statement. ‘This plan puts people over profit by forcing these companies to reduce prices for consumers and holding them accountable when they gouge Americans.’ ”

Brookings Institution: “Health care is an opportunity and liability for both parties in 2020” — “One of the central policy debates of the 2020 presidential contest will be health care. Democratic candidates and President Donald Trump have firm, yet divergent positions on a plethora of specific issues related to individuals’ access to health care. However, despite each party having the opportunity to use the issue to their advantage, both parties are running away from popular positions on issues that the American public believes are centrally important to the future.

“In a November 2018 Gallup poll, voters were asked ‘How important will healthcare be to your vote in Congress this year?’ Fully 80% said it would be extremely important or very important. This finding is not surprising. Far from the lips of politicians or the teleprompters of cable news shows, Americans engage with the health care sector on a regular basis; through doctor’s visits, hospital stays, caring for aging parents, paying a copay for an x-ray or seeing the premium taken out of their weekly paycheck. Health care composes about one-sixth of the American economy, making the issue omnipresent for almost all Americans.

“In a setting where a policy issue is front and center to voters and those voters consider it very important to the electoral choices they make, the party or candidate with ideas that connect with those voters can position herself to be very successful—but both parties have significant liabilities on the issue.”

The Atlantic: “The American Health-Care System Increases Income Inequality” — “For most people, a single doctor’s visit can be a financial obstacle course.

“Many patients throughout the year pay hundreds or thousands of dollars in premiums, most often through workplace contributions. Then, at the doctor’s office, they are faced with a deductible, and they may need to pay coinsurance or make a copayment. If they have prescriptions, they’ll likely fork over cash for those, too.

“And that’s just for basic primary care for one person. Repeat that process for an entire family; add in any labs, referrals, specialists, emergency-room visits, and surgeries; and the result for even healthy families is dozens and dozens of payments, and often thousands of dollars. This series of expenditures before, during, and after care is euphemistically called having ‘skin in the game.’ But the reality is, the American insurance system is designed to make health care financially unpleasant, often to the point where patients forego necessary care.

“A new study in the forthcoming March issue of the American Journal of Public Health sheds light on just how all that “skin in the game” affects the material conditions of patients. The research—by Andrea Christopher at the Boise Veterans Affairs Medical Center, David Himmelstein and Steffie Woolhandler at the City University of New York at Hunter College, and Danny McCormick at Harvard Medical School—indicates that household spending on health care is a significant contributor to income inequality in the United States. It also indicates that medical expenses push millions of Americans below the federal poverty line, including 7 million people who make more than 150 percent of the poverty level. Four million of those Americans are pushed into the ranks of extreme poverty.”

Hilary McQuilkin produced this hour for broacast.

This article was originally published on WBUR.org. [Copyright 2019 NPR]