I am reading a summary of the American Medical Associations recommendations to improve healthcare in America. Some democrats are pushing Medicare for All, the AMA is more concerned about those who are unable to afford basic health insurance rather than the millions who have access through their employers. This study says 82% of the uninsured fall below the 400% of the Federal Poverty Level “FPL” with 20% of those falling below the poverty line. More than three-quarters have at least one full-time worker in their family.
The crux of the affordability issue stems from the high cost of healthcare in the US. In 2017 we spent $3.5 trillion on healthcare, an average of $10,739 per person. This was up 3.9% from 2016 and makes up 17.9% of the gross domestic product.
Who doesn’t have insurance? A lot of eligible people. Here in Tennessee because we did not expand Medicaid or Tenncare there are the working poor who earn less than 133% of the FPL so they don’t qualify for a premium subsidy through Healthcare.gov Across the county there are 8.2 million individuals who are eligible for premium tax credits but still have not signed up for coverage. Another serious problem is those who have a working spouse who has access to affordable, credible coverage through work but the dependent premiums are not affordable. Because coverage is available at work, they are not eligible for a subsidy for their dependents leaving many uninsured. Then of course there are those who are “bullet proof” and because the individual mandate penalty is no longer effect have decided not to pay for insurance regardless of the cost.
What can be done to fix some of these issues? There are many suggestions in the report, many of which make total sense but unfortunately, we need our politicians to cross the isle and agree to make or change the laws. There are also many industries who will lose business and revenue if some of the changes were to happen and they have very strong political ties and contributions to try and prevent change from happening or water down the things that have the greatest impact to reduce costs.
Because Medicaid and Medicare reimbursements to doctors and hospitals are so low, commercial insurance reimbursements are exceedingly high to make up for the losses. If everyone were moved to Medicare level reimbursements the healthcare system would collapse financially. Just one more reason it’s so difficult to make serious changes and improvements to our healthcare system.
This is a fascinating report you can read it here