The Daily Herald (Everett,
WA) By The Herald Editorial Board November 22, 2019
Among
the more common focal points for the series of forums among the dozen or so
Democratic debates this year have been Americans' access to health care, and in
particular, how to provide and pay for it. That line of questioning continued
Wednesday night in Atlanta with the latest clashes over
Medicare for All and its alternatives.
No
doubt, the cost and availability of health care are of prime concern for
Americans, but — at least for the early months of the run for the Democratic
nomination — the issue has mostly served to provide the easiest path for
candidates and the media to define individual differences on the issue and
where the candidates fall on the moderate-to-progressive spectrum.
On the
progressive end you find Sens. Bernie Sanders, I-Vermont, and Elizabeth Warren,
D-Massachusetts, advocating for Medicare for All. On the moderate end sit South
Bend, Indiana, Mayor Pete Buttigieg and former Vice President Joe Biden, both
wary of requiring people to leave private insurance plans for a single-payer
system.
These
forums are the place for such debate; the discussion of how to best provide
adequate health coverage and care is vital to the physical health and economic
stability of families, and the nation, itself. But, for a change, that
long-range debate is overshadowing more immediate concerns; at least they
should be more immediate.
Sometime
in the coming weeks or months, the 5th Circuit Court of Appeals in New Orleans
is expected to issue its ruling in U.S. vs. Azar, appealing a
judge's decision for the U.S. District Court in Texas, one that
challenges the constitutionality and the continued availability of the
Obama-era Affordable
Care Act. The lawsuit was the most recent attempt to end what is
also known as Obamacare after a Republican-controlled Congress failed to repeal
and replace the program.
Finding
in favor of a coalition of Republican state attorneys general and governors,
Judge Reed O'Connor ruled last December the entirety of the Affordable Care Act
as unconstitutional. O'Connor determined that because Congress had earlier
repealed the ACA's tax penalty for those who declined to obtain health
insurance, the entire law was thus unconstitutional. O'Connor later issued a
stay while the case was on appeal.
Regardless
of the outcome in the 5th Circuit, the case is nearly certain to come before
the U.S. Supreme Court next year.
If the
ACA is ultimately struck down, it will leave a life-threatening crisis in the
hands of Congress and the White House, regardless of whether Democrats or
Republicans are in control.
Up to
20 million Americans would lose the health care plans they have gained under
the ACA and the expansion of Medicaid in a number of states, including
Washington state.
Popular
provisions of the ACA also would be lost, including rules that require insurers
to offer coverage to adults up to age 26 through their parents' insurance;
prohibitions of annual and lifetime coverage limits and the loss of caps on
out-of-pocket costs; and guaranteed coverage for those with pre-existing
conditions. About 130 million Americans younger than 65 live with pre-existing
conditions that — without the protections of the ACA — would expose them to
higher-cost insurance premiums or loss of coverage all together.
Even in
the face of opposition and attempts by the Trump administration to undermine
it, the ACA has gained in support and in stability in recent years. After years
of unpopularity among most Americans in polls, since April 2017 its popularity
in a Kaiser
Family Foundation tracking poll has trended upward with about
52 percent "favorable" to 41 percent "unfavorable."
Another
KFF poll found that 57 percent of Americans polled were worried that someone in
their family would lose health insurance coverage if the Supreme Court
overturns the ACA.
With
annual enrollment in the ACA now continuing until Dec. 15, about 930,000 have signed up
for coverage, even as the Trump administration has drastically cut
the program's outreach and marketing budget to about a tenth of the funding
that was provided during the Obama administration.
At the
same time, those enrolling are finding that insurance premiums through the
ACA's marketplace are about 4 percent
cheaper this year, its second decrease in as many years.
The
back-and-forth among Democrats over Medicare for All, a public option and other
reforms necessary to lower costs for medical care and prescription drugs are
necessary discussions. But, in particular for Medicare for All, that debate
needs to be tempered with some reality.
For
Democrats, passage of such a landmark change in health care as Medicare for All
would require more than just winning the White House, or even maintaining
control of the House and winning a majority in the Senate. The Senate would
have to experience a blue wave that would flood it with a filibuster-proof
majority.
As
informative — and defining — as the Medicare for All debate is, a few moments
spent by the candidates and debate moderators on how to respond if the ACA is
overturned or how it can be improved upon would be equally helpful as voters
consider who they will support.
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