Medicare for All vs Obamacare Forever

By Angela de Joseph

As the executive director for one of the first community organizations certified as an enrollment entity for Covered CA, our state brand for the ACA aka “Obamacare” insurance marketplace, I was on the front lines from day one of the rollout. I managed a team of 14 certified enrollment counselors (CECs) and we enrolled over a thousand families in affordable health insurance plans and Medi-Cal, our version of Medicaid.

It was rewarding to help people obtain access to healthcare services and in fact, save lives. But, the administration and implementation was a house of horrors. The computer system stalled and crashed daily. We could not get through to the help center after being on hold for hours. The website, paperwork, and procedures were confusing. Our CECs were working around the clock and through the holiday season to compensate for the system failures and meet the enrollment deadlines which kept extending.

The good news is that we survived the rocky start and Covered CA is working very well now. We are fortunate to live in California where the extra resources and commitment to make it work overcame the early difficulties. The Covered CA website application process has been simplified, there are adequate trained phone operators on the helpline and our hospitals and clinics are staffed and able to process enrollments for patients on a daily basis.

In 2018, Covered CA had an increase in enrollments despite the current federal administration cutting the ACA advertising budgets, shortening the enrollment period and the constant threat to dismantle the ACA causing uncertainty in the insurance market. The need and demand for affordable health insurance were outpacing the negative spin.

The new tax reform law that was passed by the Republican majority Congress and signed in to law by the president on Dec. 22., 2017, repealed the individual mandate beginning in 2019. As expected, removing the penalty for not being insured led to a decline in new ACA enrollments. However, the total number enrolled in Covered CA this year only saw a net drop of 0.05% due to the high number of renewals.

The ACA is far from perfect but it is providing 20 million people with health insurance and instead of handicapping it by removing the individual mandate, we should have been improving the program and expanding Medicaid to cover more of our population. In light of my first-hand experience with the sheer complexity and effort required to get the system up and running and the number of people being helped, I am reluctant to toss the ACA out in favor of a Medicare for All program.

I understand that the concept of “Medicare for All” is covering everyone and that is a must. But, I’m not sure Medicare is the panacea. I only know that navigating my mother’s health care needs through the Medicare system was difficult and burdensome. Also, Medicare is not free. It has premiums, co-pays, and deductibles. My neighbor and her husband have a “gap” plan to supplement Medicare and still have over $1,000 per month in out of pocket costs.

Eliminating all of the upfront fees in Medicare plans and shifting the cost to higher payroll taxes as in the plan unveiled by Senator Bernie Sanders this week and the elusive “wealth tax” in the plan submitted by Rep. Pramila-Jayapal in February, means upheaval across the healthcare and insurance industries, push back from taxpayers and political fights. Increasing the Medicare rolls by 80%, from 60 million people to 300 million is not going to be a cakewalk.

According to the Kaiser Family Foundation January 2019 tracking poll, only 23% of Republicans, 51% of Independents and 81% of Democrats surveyed, favored a Medicare for All plan. Surprisingly, 47% of Republicans, 78% of Independents and 91% of Democrats favor a government program such as Medicare that is open to anyone but would allow people to keep their current insurance.

If the Democrats prevail in 2020, and everything goes perfectly, and we know it won’t, then in my estimation, it will be several years from now that we could actually have Medicare for All.

In the meantime, I will fight tooth and nail to protect Obamacare.