The Times, Trenton

Trumpcare Works Well For Only The Wealthiest

Giving patients control means making these programs stronger and available to more people, not tearing them down.

The Times of Trenton — August 5, 2019

By Maura Collinsgru
Guest Columnist

Last month was the 54th anniversary of Medicare and Medicaid, two landmark programs that changed health care in our country forever. Before these programs, and the Affordable Care Act that would follow years later, many people in this country lacked access to health care. Today millions of Americans and New Jerseyans have more affordable, quality options than ever before.

While these programs give people more certainty, and a degree of control over their health care planning and costs, nearly a third of insured individuals nationwide continue to struggle with the high cost of premiums, deductibles and co-pays.

The Trump administration says that more transparency for hospital and drug pricing, while expanding health savings account and high deductible health plans, will put patients back in control of their health care. Unfortunately, nothing could be further from the truth.

More transparency at every level of the health care system is needed to craft better health care policies and lower costs. But transparency by itself does not put patients back in control of their health care. And for many Americans, high deductible health plans will do the exact opposite. These plans don't help because they simply shift more costs onto consumers who risk higher out-of-pocket costs for lower premiums. The vast majority of Americans can't afford that risk.

High deductible plans could work well enough for the wealthiest in this country. U.S. Health and Human Services Secretary Alex Azar speaks of saving by shopping around for a procedure himself. But let's remember that Azar has a financial portfolio that could be worth $20 million. Most patients have little ability to shop for services, even with careful planning. And its impact is minimal on the overall cost of health care in this country. Shoppable health care services consumers paid for out-of-pocket account for just 7% of our health care spending.

For similar reasons, health savings accounts are likely beyond the reach of many working families. When you're worried about scraping up money for your rent or utilities or car payment, it's highly unlikely that you're saving for that surprise medical bill you may suddenly be saddled with. Just 40% of Americans last year reported they couldn't cover a $400 medical expense.

Having control over your health and health care costs shouldn't mean having the freedom to choose between paying for groceries or a procedure. Or the ability to choose a health plan with high out-of-pocket expenses that easily bankrupts you and your family when you have a medical emergency. If all the health care options available to you are bad ones, you're not in control. You simply have a list of bad options.

For many Americans, having control of your health care doesn't really mean the ability to shop around. It's about the ability to afford quality care over a sustained period of time, regardless of how much you earn, where you live, your gender identity or the color of your skin. Medicare, Medicaid and the Affordable Care Act gave millions more people that ability. If anything, the Trump administration's relentless attacks on all three of these programs, through legislative, policy and legal actions, threaten to rob American of what control they have over their health care at this point in time.

Giving patients control means making these programs stronger and available to more people, not tearing them down. And it means not buying into plans hyped by the Trump administration that will work for the wealthiest, but no one else.

Maura Collinsgru is the health care program director for New Jersey Citizen Action, and the convener of the New Jersey for Health Care Coalition.

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