Health Consumer Advocate’s View: Fair, affordable health coverage is still possible

However, from my long years of experience in consumer advocacy, I know that a fair and balanced solution is possible.

The Affordable Care Act (aka the ACA, aka Obamacare) has greatly reduced the number of people without health coverage, but it hasn’t done enough to reduce costs. It relies on subsidies to insurance companies to make coverage affordable for millions, through an individual market system inherently unworkable and failing badly. A key problem is that the pools are too limited and don’t spread risk widely enough. Perpetual federal subsidies could prop up these policies, but that is inefficient and wasteful. It adds cost to a system that already wastes far too much money.

In Minnesota, we have an acute case of the insurance sickness: 130,000 people dropped their policies this year and last. The state approved $542 million in “reinsurance” for the health plans for the next two years, which was on top of money already spent to subsidize 2017 premiums.

The state cannot afford to keep up that rate of bailout. Something better must be done — and soon.

Dogged attempts to repeal and replace Obamacare are stymied in Congress due to the Republican majority’s inability to agree on what to do. That shouldn’t be surprising since its proposals would cause more than 20 million Americans to lose or drop coverage and make insurance premiums unaffordable for those who need it most.

The fact the ACA expanded Medicaid coverage in many states makes it hard for Congress to take away that benefit. The same goes for the ACA’s ban against insurance companies’ desire to refuse to cover people with pre-existing conditions.

The congressional majority insisted for seven years that the ACA was awful and causes everyone’s costs to go up; then the Republicans won electoral majorities by pledging to repeal the ACA and reduce health care expense. Now that they’re in power, their proposals might reduce premiums for very healthy people but raise them for many others and kick millions off of Medicaid. They seem to have a Robin Hood-in-reverse goal of eliminating taxes on the wealthy, which were raised precisely to enable more low-income people to get Medicaid coverage.

What does the future hold? Here are some scenarios.

First: Repeal and replace totally fails. The ACA stays in place but requires ever-increasing tax subsidies to maintain affordable coverage. Eventually, it will be difficult to keep the subsidies going.

Second: Repeal and replace finally succeeds, resulting, as mentioned above, in many people unable to get coverage because of inadequate income or overwhelming premiums due to age or health. The consequence would be great amounts of untreated illness, many premature deaths, and many bankruptcies.

After 38 years of consumer advocacy in health care policy, I know a third scenario is possible — if the public demands it: Create coverage that is fair, affordable, and economically efficient for everyone. For that we need to have everyone in the largest pools possible, reduce or eliminate middlemen administrative expense, curb excessive prices, and remove profits that financially benefit a small number of people at the expense of affordable care for millions.

A partial step in the right direction would be to simply lower the Medicare age to 50; a fuller step would be Medicare for all with some improvements.

This isn’t ideology. It’s simply economics — and fairness.

Buddy Robinson of Duluth is staff director for Minnesota Citizens Federation Northeast ( and co-coordinator of the Greater Minnesota Health Care Coalition. He also is in the Consumer Union’s national network of experts on health care consumer advocacy.


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