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Let's turn bad news on health coverage into a path toward change

Let's turn bad news on health coverage into a path toward change

Quoting British Prime Minister Benjamin Disraeli, Mark Twain famously said “there are three kinds of lies: lies, damned lies, and statistics.” So it goes whenever the Congressional Budget Office (CBO) releases a report on the implications of recent legislative action (or inaction, for that matter). Its latest report on 2019 individual health insurance market premiums and coverage trends over the next decade has stoked health-care reform woes for pretty much everyone— regardless of which side of the aisle they sit, or where they stand on the health care reform debate.

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At the core of the report are four projections:

 

  • Individual premiums will rise by an average of 15 percent in 2019, with two-thirds of that increase attributable to the repeal of the Affordable Care Act (ACA)’s Individual Mandate at the end of 2017.
  • By 2028, there will be 35 million noninstitutionalized U.S. citizens without health insurance 5 million more uninsured than their 10-year projection made in 2017.
  • Premium costs are expected to rise by 7 percent annually between 2020-2028—more than 50 percent faster than group insurance cost projections and more than triple the normal cost-of-living increases and inflation rate.
  • Federal subsidies, taxes and penalties will result in a net taxpayer bill of $685 billion this year, rising to $1.2 trillion by 2028.

This paints an all-around, unequivocally dire picture, and has sparked much political finger-pointing: from the left have come cries of “ACA sabotage,” and from the right, admonishments of “we told you the ACA is broken.

This begs the question: how can we find a productive path forward when the numbers don’t look great to anyone, and are being used toward different aims?

The first step is aligning expectations on what we consider success — or at least, what we consider to be contributing to success.

The three most frequently cited measures of success for the ACA are: total coverage, affordability, and program costs. These are also reliable metrics for health-care reform in general — not the only ones, but important when assuming both private and public sector participation. Yet recent measures to ensure that each is contributing the greatest possible benefit for Americans have often undercut the other key measures.

For example, the CBO previously estimated that repealing the Individual Mandate would save the federal government more than $338 billion over 10 years — but it would do so at the cost of 14 million fewer Americans with health insurance.

Likewise, the Trump administration announced executive orders rolling back Association Health Plan (AHP) and short-term, limited-coverage insurance (STI’s) regulations to their pre-ACA status, asserting that it would give employers and individuals more affordable options. Yet, according to an analysis of public comments by the Los Angeles Times, 95 percent of the hundreds of commenters, both citizens and organizations, were opposed to the expansions. The only groups in favor of them are brokers, who stand to make more from non-ACA-compliant plans, and small to mid-sized employers, whose views were mostly provided by the aforementioned brokers.

These orders came after the president’s decision to stop funding the ACA’s cost-sharing reduction payments to health insurers, which we now know will cost taxpayers billions more over 10 years — while ironically saving ACA-subsidized individuals substantially on their monthly premium costs thanks to “silver plan loading.” If nothing changes, silver plan loading could help increase or at least sustain ACA-subsidized enrollments, but it will absolutely mean taxpayers will have a larger ACA bill to pay.

That every move made on the left and right seems to have an unintended consequence underscores the profound complexity of the problem we are trying to solve, and the seriousness with which we need to treat it. Yes, it is important to ensure that we are being fiscally responsible in all of our efforts, because it is both sound policy and our responsibility to the generations that follow. It is equally important that we don’t accept that an additional 3 million Americans should go without coverage, let alone 35 million in total.

If we can agree to these two principles — fiscal responsibility and moral responsibility — and we can find common ground based on them, they will prove to be surprisingly effective guides. But first we have to agree that the bad news dealt by the CBO report is not only worth fixing; it’s also, in fact, a blueprint for change.

Let’s tackle the issue of our time with the best data available to us, and use that data not just to make a partisan point, but to work together for the greater good of all. For as we have seen time and again, partisan bickering can be distressingly effective in distracting us from the common goal: making sure that Americans are healthy and insured.

George Kalogeropoulos is the CEO and co-founder of private health insurance marketplace HealthSherpa. Shandon Fowler is the owner and principal of Four8 Insights, which is a benefits and health-care consulting company. Fowler is a paid consultant to HealthSherpa.