Category Archives: Health Care Policy

Medicare-for-all: A New Vote

Senator Bernie Sanders (I-VT) speaks during an event to introduce the “Medicare for All Act of 2017” on Capitol Hill in Washington, U.S., September 13, 2017. REUTERS/Yuri Gripas

On September 13th, Bernie Sanders and 16 Democratic co-sponsors introduced the “Medicare for All Act of 2017” to establish a national health insurance program. Responses to the legislation, and its supporters, have ranged from praise to worry to scorn. Nobody expects the bill to pass. So should Democrats support this bill?

Supporters of the bill see the legislation as a way to focus the health care debate around universal coverage, rather than fixing Obamacare or “repeal-and-replace.” Pragmatic liberals, who may support universal health insurance, are worried there is not enough detail in Sanders’s legislation to demonstrate the feasibility of his plan. But Sanders has admitted his plan is meant to be a very rough draft – an opening bid.

Opponents are using the estimated cost of universal insurance coverage ($1.4 trillion per year) as another reason not to support the bill. Even Democratic legislators have expressed concern about the cost of universal coverage. Sen. Diane Feinstein recently told Politico she won’t support Medicare-for-all because “the cost is enormous.” Critics of the bill, however, are peddling an inconsistent argument. Some legislators who oppose the bill because of a lack of detail previously supported, and voted for, legislation introducing a high-cost program without specific details.

In 2002, 29 Democratic senators voted to send the United States to war in Iraq, despite the absence of a detailed plan. Depending on the source, the wars in Iraq and Afghanistan have cost between $1 trillion and $6 trillion dollars, which would have been enough to fund Sanders’s plan for approximately one to four years. Five Democratic senators, including Feinstein, who are currently not supporting the “Medicare-for-all” bill voted to approve the Authorization for Use of Military Force (AUMF), sending our country to war.

Our legislative history repeatedly shows that politicians ignore cost when they deem issues important. Another relevant example is the 2008 Troubled Assets Relief Program (TARP), which 39 Democratic senators voted to pass. Despite the high price tag, politicians considered the bill vital in the wake of the economic collapse of 2008, giving the Treasury Secretary broad leeway “to purchase troubled assets from any financial institution.”

Democrats need to put their reservations aside, as they have in the past, and support “Medicare-for-all.” If Democrats want to make national health insurance coverage mainstream, they need to visibly and repeatedly express support for the bill. Fox News and the Tea Party have succeeded in making more radical ideas mainstream by using discourse that consistently supports and familiarizes these ideas. Democrats should use this same tactic to build support for universal insurance coverage.

By making a significant, coordinated push to familiarize the public with universal health care coverage, Democrats can make a radical policy more socially acceptable in the future.

First-year Blake Rosser is a Master of Public Policy candidate interested in campaign finance reform and social justice.

The Intrinsic Durability of Obamacare

Source: Quora

Despite having control of the Senate, House, and Presidency, Republicans have been repeatedly unsuccessful in their attempts at repealing the Affordable Care Act and replacing it with an alternative. The fight drags on; on Tuesday, the Senate narrowly voted to advance to floor debate, and needed Vice President Mike Pence to cast a tie-breaking vote. An economic concept called loss aversion provides some insight into the uphill battle Republicans are facing with a healthcare replacement. It also indicates that voters are even less likely to support a “repeal-now, replace-later” plan.

Introduced by behavioral economists Daniel Kahneman and Amos Tversky, loss aversion refers to the idea that people feel more pain when they lose something than pleasure when they gain something.

Kahneman explains the phenomenon in this way: Let’s say I told you that I was going to toss a coin; If it lands tails, you pay $10. How much money would you need to gain if you won, before you took the bet? “People want more than $20 before it is acceptable,” says Kahneman, “And now I’ve been doing the same thing with executives or very rich people, asking about tossing a coin and losing $10,000 if it’s tails. And they want $20,000 before they’ll take the gamble.”

Companies use this glitch to influence our behavior, too. Would you pursue a $10 rebate as doggedly as you would avoid a $10 surcharge? Gaining something is only about half as enjoyable as losing something is painful, according to empirical studies. So in the world of politics the threat of losing something, be it a part of your income or a service you’ve become accustomed to, can have a heavy impact.

This became the case with the Affordable Care Act. Initially, and for many years, the ACA was opposed by the majority of Americans. It was not until serious discussion of losing the act became part of the public discourse that the ACA gained majority approval in Gallup polls.

While it is the Republican Party’s general consensus that Obamacare should be repealed, the Congressional Budget Office’s well-publicized projections of coverage loss, Medicare loss, and insurance regulation loss have made their proposals deeply unpopular to the public. In June, the CBO forecasted that the Senate’s plan would leave 22 million more people uninsured. The gains that they tried to sell, like decreasing taxes and lowering the deficit, have not been very effective. In an unexpected move last Tuesday, Republican Senators Mike Lee and Jerry Moran joined Senators Susan Collins and Rand Paul in announcing they would vote against the Senate’s latest bill. Because Republicans have only 52 seats in the Senate, losing any more than two votes is fatal. These defections sank the bill, which was only narrowly supported.

Finding consensus between the moderate and hard-right wings of the party has proven to be extremely difficult. “This has been a very, very challenging experience for all of us,” McConnell told reporters following the bill’s collapse. “It’s pretty obvious that we don’t have 50 members who can agree on a replacement.”

Once something becomes the status quo, it becomes more difficult to do away with because of loss aversion. It is this phenomenon that makes it difficult to alter welfare and service programs once they have been put in place, and it is one reason why Social Security is a third rail in Washington.

Politically, Obamacare is inherently difficult to repeal. Obamacare sought and succeeded at creating a rapid expansion of coverage over the course of President Obama’s tenure. An expansion in the economy that, once in place, created a new status quo; not only for individuals, but for health-related businesses. Interestingly, many at the far right of the Republican party came to power during the Tea Party movement. It was a movement that began in response to the threat of a different loss from the status quo; the increase in taxes that came with Obamacare.

The Senate’s latest proposal, to repeal parts of the Affordable Care Act with no required replacement until two years down the line, would increase the number of uninsured by 17 million next year and 32 million by the end of a decade. Immediately after its introduction, this idea was opposed by three Republican Senators, Shelley Capito of West Virginia, Lisa Murkowski of Alaska, and Susan Collins of Maine, who announced they would vote against it.

This plan is likely to generate and even stronger sense of loss aversion. Supporting Senator McConnell’s plan to repeal now is essentially a choice between keeping the status quo, and rolling the dice with the hopes of getting a better outcome in the future. This will be an even harder sell than the one from last week.

Political rhetoric about loss is common and effective. “Loss” was something that President Trump used to great effect in the election, by saying that people will lose their guns, lose their money (through higher taxation), or lose their job to globalization. Rhetoric is not reality however. Should Congress pass a bill that takes away people’s healthcare, voters will feel the losses directly. Despite Tuesday’s vote, repealing Obamacare is still a long shot.

Neil Browning is a 2017 Master of Public Policy graduate interested in public health, development, and international affairs. He was the editor-in-chief of the Sanford Journal from 2016-17.

Consumer Choice in Health Insurance Markets Under the Affordable Care Act

If you’ve never had to shop for health insurance, consider yourself lucky. Between searching for affordable premiums, making sense of co-pays and coinsurance, and finding a plan with your favorite doctor, choosing a good health plan can be a daunting task. As a health policy student, I tried my hand last month at choosing a plan on the North Carolina exchange. Despite being well-versed in insurance concepts, I too struggled to figure out which plan would be best for me among the many options.

The Affordable Care Act (ACA) has been successful in its goals of increasing access to health insurance while preserving choice and competition in health insurance markets. It brought nearly 11 million people into the individual market who previously didn’t have insurance, and it offered them a variety of health insurance options to choose from. Despite achieving such historic milestones, however, it remains to be seen what the future might hold for the ACA. Until then, policymakers must continue working to make the process of buying insurance easier for the average American. Continue reading

Why Planned Parenthood funding is more important than you think

1 in 5 women has visited Planned Parenthood at least once in her life.

1 in 5 women has visited Planned Parenthood at least once in her life.

Donations to Planned Parenthood affiliates in Texas tripled after Election Day. Many donors fear that a Trump presidency will strip Planned Parenthood of funding and limit the provision of reproductive health services to women. People are quick to equate Planned Parenthood with abortion, but the conversation should be much broader. Family planning clinics like Planned Parenthood provide affordable services for women that improve a wide-range of maternal health outcomes.

Maternal mortality – defined as the death of a women while pregnant or within 42 days of the end of pregnancy – is an important indicator of women’s health outcomes in a country. The US is one of the few countries worldwide that experienced an increase in maternal mortality between 2000 and 2015. Because family planning clinics provide prenatal services to women that reduce the risks of pregnancy, they are important combatants of these negative trends. Continue reading

Biggest Threat to Zika? Mosquito Love.

Photo Credit: James Gathany

Photo Credit: James Gathany

As of November 18th, the World Health Organization (W.H.O.) declared that Zika is no longer a global emergency. However, Dr. Peter Salama, executive director of the W.H.O.’s health emergency programs, stated that “we are not downgrading the importance of Zika. We are sending the message that Zika is here to stay, and the W.H.O response is here to stay.”

Though the W.H.O. has downgraded the threat of Zika, combating Zika remains a goal of the global health community. At the end of October 2016, $18 million was put towards a project to release millions of genetically modified Aedes aegypti mosquitoes. These mosquitoes were infected with a bacteria called Wolbachia to mate with Aedes aegypti mosquitos that transmit Zika, as well as Dengue and Chikungunya.

Continue reading

Medicaid Expansion and Health Insurance Uptake, In Two Maps

The New York Times just published an article detailing changes in newly-insured people through the Affordable Care Act, otherwise known as Obamacare. 

Since passage of the ACA, people have become insured for a variety of reasons. Some gained insurance through expanded Medicaid coverage. The below map is from The Advisory Board Company and shows states that accepted and denied the ACA’s Medicaid expansion.

The two maps do not coincide perfectly, but there are some correlations. Check out Arkansas, Kentucky, and West Virginia in relation to their non-Medicaid-expanded neighbors. Wisconsin, Pennsylvania, and Maine look similar on the first map for apparently different reasons.

What patterns do you see?