CSR fails

Almost two million Americans go through bankruptcy every year because of medical bills and illness, despite most having had insurance, owning their own homes, having attended college, and having held responsible jobs.

Under the ACA, insurers have consolidated and narrowed networks, resulting in restricted access to care.

There are still about 28 million Americans without any health insurance.

Many physicians refuse to see uninsured patients, even those with Medicaid coverage, and waiting times can be lengthy if they are to be seen.

There are still widespread disparities of care, including by race/ethnicity, socioeconomic status, age, gender, location, and disability status, that lead many people to forgo necessary care and suffer worse outcomes.

Studies by the Commonwealth Fund find that the U. S. ranks #11 among 11 advanced countries in overall ranking, cost-restricted access, efficiency, equity, and healthy lives (2).

Under our multi-payer system with some 1,300 private insurers seeking to enroll healthier patients and avoid sicker patients, the health care bureaucracy is massive and expensive—the overhead of the private health insurance industry is $792 per capita, more than five times that of Canada with its single-payer public financing system.

Facing uncertainty over the future of government funding for cost-sharing payments under the ACA, the extent of deregulation that will come out of the current political debate, and the future of Medicaid, insurers are planning sharp premium increases in 2018 and threatening to exit even more markets than they have left already. People living in rural areas are especially vulnerable to these changes.

The new Trump budget proposal would cut federal spending by $3.6 trillion over ten years, with deep cuts to Medicaid and other safety net programs.

Comparison of Three Financing Alternatives

1. Continuing the ACA (ObamaCare)

The ACA brought important improvements in access to care, providing new coverage for 24 million Americans, especially through expansion of Medicaid in 31 states. It established ten categories of essential health benefits, and also required insurers to stop denying coverage for pre-existing conditions and allow children to stay on their parents’ coverage until age 26. Cost-sharing reduction (CSR) payments were made to help 7 million people afford coverage through the exchanges, about 60 percent of all new enrollees.

Despite these improvements, the ACA falls far short of our needs on many counts. Costs and prices of health care services have continued to soar, forcing many people to forgo necessary care and incur worse outcomes. Although the ACA expanded funding for community health centers, we still have a porous safety net that will become even more so under the proposed Trump budget proposal. Most Democrats are strongly defending the ACA against Republican attacks, calling for continuation of CSR payments and reconsideration of the public option, which was dropped in 2009 due to strong opposition from the insurance industry. That opposition remains today, and if put in place, the public option would attract more expensive, high-needs patients, relieving private insurers of the costs of covering them.