Matters of Life and Death (Gwen Moritz Editor’s Note)

Someday our federal lawmakers will have the luxury of turning their attention away from impeachment and back to matters of life and death. One of those is health insurance.

Currently, we rely on a patchwork of public (mainly Medicaid and Medicare) and private (individual and group) insurance, and the holes in it are starting to grow again. According to Census Bureau data released in September, the share of Americans who had no health insurance at all in 2018 grew to 8.5% from 7.9% in 2017. It was the first year-over-year increase since the Great Recession hit in 2008-09, although we’ve retained much of the gain made since the Affordable Care Act took full effect in 2014. (In 2013, despite four years of improvement, 13.3% of Americans were still uninsured.)

Several factors seem to have contributed to the uptick, and it’s fair to say that most of those factors are political. The number of Americans with private insurance was statistically unchanged last year, as one would expect when the unemployment rate is steady or even falling. (That could change this year since Congress did away with the “individual mandate” that imposed a tax penalty for not having health insurance.)

The number covered by Medicare grew, as one would expect when 10,000 baby boomers are turning 65 every day. But the number covered by Medicaid declined, which would be a positive if they were gaining coverage elsewhere — and that doesn’t seem to be the case.

Of the additional 2 million Americans without insurance last year, about a third are immigrants. Immigrants here illegally are not eligible for Medicaid in the first place, but the impact on eligible noncitizens “may reflect the administration’s more aggressive stance on immigration,” Joseph Antos, a health economist at the American Enterprise Institute, told Kaiser Health News.

We have traditionally covered children pretty well, but the uninsured rate in the population under 19 years old grew by 12% last year alone (from 4.9% to 5.5%).

States that did not expand Medicaid to households surviving just above the poverty level are where the holes in the patchwork become most obvious. In the tight labor market, more people find jobs and lose eligibility for traditional Medicaid — but they still can’t afford private insurance.

(Last week the Kaiser Family Foundation released the results of its annual survey of employer-provided health insurance. For the first time this year, the average premium for an employer-sponsored family policy topped $20,000, and the average cost to the employee is $6,015.)

The ACA was designed to cover low-income workers with expanded Medicaid, but a U.S. Supreme Court ruling made that optional. Not coincidentally, the highest uninsured rates in 2018 were in states where elected lawmakers turned down federal money to cover their working poor: Texas (17.7%), Oklahoma (14.2%), Georgia (13.7%) and Florida (13%).

A federal judge in Texas ruled the ACA unconstitutional last December, but it has been left in effect while his ruling is appealed. Arkansas Attorney General Leslie Rutledge is one of the plaintiffs who won that ruling, but legal observers are split on whether her side will continue to prevail. Whether or not she eventually has the satisfaction of having a couple of hundred thousand working Arkansans lose their insurance, Congress will eventually get around to making changes.

Arkansas’ own U.S. Rep. Bruce Westerman, R-Hot Springs, has introduced an idea for health insurance that he calls the Fair Care Act of 2019. It gets rid of the ACA’s employer mandate along with the individual mandate, and eliminates some of the taxes — especially on high income households — that were used to pay for the ACA. It would also allow carriers to charge more for older and high-risk customers — basically the kind of fewer-taxes, less-regulation, market-based approach one would expect from the Republican side of the aisle.

Democrats, meanwhile, are leaning toward more government-provided health insurance, whether that’s allowing younger Americans to opt into Medicare or expanding Medicare to be universal.

I remain intrigued by the concept of Universal Catastrophic Coverage, which will be the topic of next week’s column.

Email Gwen Moritz, editor of Arkansas Business, at GMoritz@ABPG.com and follow her on Twitter at @gwenmoritz.