Health insurance was on the collective minds of American voters in the 2018 midterm elections. Health care, broadly defined, drove many people to the polls voting with feet and ballots to protect their access to a health plan covering a pre-existing condition or to protest the cost of expensive prescription drugs. These were the two top health care issues among voters in late 2018, a Kaiser Family Foundation poll at the time assessed.
Yesterday, President Trump verbally re-branded the Republican Party as “the party of healthcare.”
That Presidential pronouncement was tied to a letter written on U.S. Department of Justice letterhead RE: the Texas v. United States case. Two sentences succinctly stated, “The Department of Justice has determined that the district court’s judgment should be affirmed. Because the United States is not urging that any portion of the district court’s judgment be reversed, the government intends to file a brief on the appellees’ schedule.”
Texas v. United States was the case brought by state Attorneys General beyond Texas, including Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Kansas, Louisiana, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah, West Virginia, and Wisconsin, along with two governors from Maine and Mississippi.
The Los Angeles Times reported this story as, The Trump approach to healthcare: Break it and figure out the rest later.
“Break” is an appropriate description, because about 21 million people who finally enrolled in health insurance would lose their benefits. Twelve million people would lose Medicaid coverage. About 2 million young people would also lose coverage, now health-insured under their parents’ health plans. The millions of people covered by employer-sponsored health plans would also be impacted: the ACA baked in assurances for lifetime caps on personal health spending, as well as guarantees for covering pre-existing conditions. Medicare enrollees, too, would face higher payments.
More details on losing stakeholders are covered in this extensive New York Times analysis. which observes, “Nor is the Affordable Care Act some minor statute that can be shoved aside without disruption. It is now part of the basic plumbing of the American health care system.”
I’ll speak simply. Assuring access to the health care system is a social determinant of health, as the inventory from Kaiser Family Foundation includes in their chart here. Ensuring health coverage is smart, economically, because insurance bolsters peoples’ on-ramp to needed medical services and prescription drugs. That underpins health security, and the economic benefits of productivity at work, ability to seek that job, opportunity to pay (more) taxes, and energy to participate in daily life — social, emotional, financial, and indeed, political and civic.
Health care insurance and service access are social determinants of health. The healthcare industry has been paying more attention in the past few years to social determinants; especially food and nutrition (through, say, healthy food prescriptions and hospital programs like the Geisinger Food Farmarcy); transportation, with Lyft and Uber playing growing roles in medical transportation filling the mobility gap; and, greater attention to environmental and climate programs, learning from the Flint water crisis and downstream (literally) negative health impacts, along with knowledge about air particulates’ negative impact on respiratory conditions like asthma and COPD.
A strong primary care backbone builds a stronger health care system for all health citizens in the rest of the developed world. Through my health economic lens, I’ve reinforced this in my work and writing, most recently here on Health Populi.
It’s encouraging to see that health insurance companies have begun to incorporate social determinants services into health plans, increasingly common now in Medicare Advantage plans supporting long-term social supports addressing housing (Kaiser Permanente’s program), loneliness and social isolation (CIGNA’s concept), and transportation (via Lyft’s growing health division working with a range of plans and providers). Interestingly, health insurance stocks took a hit on the markets by the end of day yesterday.
Health Populi’s Hot Points: Do I state the obvious here? For some of us who went to school in public health, nursing, medicine, social work, education, it is obvious and even cliché that having health insurance bolsters health.
It’s not so obvious to some public policymakers or voters who have chosen to erode the Affordable Care Act (ACA). Even with the continued paring back of aspects of the ACA, 8.5 million people signed up for ACA marketplace health plans by the December 15, 2018 deadline.
By the end of 2018, a Gallup poll found that most Americans believed that the U.S. government should ensure health care for Americans. I spelled that “ensure,” with an “e.” In the poll, most people also didn’t want the government to run that system. Ensuring health care is making certain people have access to necessary health care. That’s the prevailing opinion in the overall America.
Perhaps this fellow had something to do with keeping enrollment alive for American health care in 2019.