Daily Post

The Buffett-Bezos-Dimon-Gawande insurance fail? A powerful policy lesson!

How Amazon, JPMorgan, and Berkshire Hathaway took on America’s health care system—and lost, Fortune, June 1, 2021, By Erika Fry

Was it a press release, or a declaration of war?

How else to explain the media and market frenzy that followed the announcement, issued on Jan. 30, 2018, that Amazon, Berkshire Hathaway, and JPMorgan Chase — three of the nation’s largest, most high-profile, and best-run companies, then with some $534 billion in revenues between them — were teaming up to take on the ever-more-expensive, ever-more-complex problem that is American health care.

To those who had toiled in the world of employer-sponsored health care for decades, trying but never really succeeding to come up with new ways to control costs and improve outcomes … the statement, from three powerful CEOs, was cause for celebration.

Five months in, the team announced another star would lead the venture: Atul Gawande, the surgeon and influential New Yorker writer whose clear-eyed analysis of America’s dysfunctional health care system had earned him the admiration of Barack Obama and Buffett. In March 2019, the venture finally got a name, Haven.

The project officially sputtered to an end earlier this year. Even with its star power, Haven couldn’t break the black box that is U.S. health care.

So, did Haven make a difference? Some argue the effort undermined progress by raising the obvious question: If they couldn’t do it, who can? In a recent Kaiser Family Foundation survey of very large employers, 85% of top executives think government support will be necessary to control costs and provide coverage.

Gawande goes further and has recently argued that the employer-sponsored system can’t be fixed. Noting how many Americans lost their health insurance in a global pandemic, he said, “A job-based system is a broken system.”


Comment by Don McCanne

I contend that the Haven health reform effort of Warren Buffett, Jeff Bezos and Jamie Dimon, along with Atul Gawande, was a spectacular success, as an experiment in health policy. They proved beyond any reasonable doubt that the private sector is incapable of fixing our highly dysfunctional health care financing system. The only model that has shown promise is a single payer Medicare for All system. But you cannot set that up as an employer-sponsored system; it will have to be a public system for all the people.

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Insurers That Squeeze Care are Killing Thousands of Enrollees Each Year

Mortality Effects and Choice Across Private Health Insurance Plans, The Quarterly Journal of Economics, May 6, 2021, Jason Abaluck, Mauricio Caceres Bravo, Peter Hull, and Amanda Starc. 

*The abstract is available at  While the full text is behind a paywall, an earlier version of the full paper is available here

From the Abstract: “We develop and apply a novel instrumental variables framework to quantify the variation in causal mortality effects across plans and how much consumers attend to this variation. We first document large differences in the observed mortality rates of Medicare Advantage plans within local markets. We then show that when plans with high (low) mortality rates exit these markets, enrollees tend to switch to more typical plans and subsequently experience lower (higher) mortality. . . . 

We then extend our framework to study other predictors of plan mortality effects and estimate consumer willingness to pay. Higher-spending plans tend to reduce enrollee mortality, but existing quality ratings are uncorrelated with plan mortality effects. Consumers place little weight on mortality effects when choosing plans. Good insurance plans dramatically reduce mortality, and redirecting consumers to such plans could improve beneficiary health.”

From the text:  “We find that the most widely used measure of plan quality, CMS star ratings, is uncorrelated with plan mortality effects. Higher premium plans have better mortality effects, as do plans with more generous prescription drug coverage and higher medical-loss ratios. Thus, in every way we measure, plans that spend more tend to reduce enrollee mortality.”


Comment by David Himmelstein and Steffie Woolhandler

A simple message emerges from this complex econometric analysis: insurers that skimp on paying for care (as measured by a low medical-loss ratio – the share of premiums devoted to patient care) or provide highly restrictive drug coverage, are killing their enrollees.

The study examined the mortality rates of patients covered by different Medicare Advantage (MA) plans. Not surprisingly, mortality varied among plans. That could just reflect differences in how sick the enrollees were to begin with, not anything the insurers did.

The compelling finding is that when plans with high mortality rates stopped offering coverage in a particular county – forcing their enrollees to switch to a different plan – the mortality rate for those forced to switch went down. (Similarly, when low-mortality plans shut down, the mortality rate of the enrollees forced to look elsewhere for coverage went up.) In sum, the study provides quite convincing, quasi-experimental evidence that MA plans’ quality influences the mortality of their enrollees. Indeed, the effect is so large that shifting MA enrollees from the worst 5% of plans to the average (not even the best) plan would save about 12,000 lives each year.

The researchers then looked at what differed between high and low mortality MA plans.  They found no correlation with the CMS star rating – a one star-rated plan was just as likely to do well by its enrollees as a five star plan. And, not surprisingly, seniors, who often look to these ratings were bad at choosing a plan with low mortality.

What made a difference – and a big one – was how much a plan spent on its enrollees. Plans that had a higher medical loss ratio (i.e. they spent more of their premiums on care, and less on overhead and profit) had lower mortality rates. (The medical loss ratio of  MA plans averaged 83% in 2020 vs. traditional Medicare’s 97.7%). Additionally morality was lower in plans with better drug coverage and those with higher premiums. 

As is often true of economists, these researchers drew the wrong conclusions from their important findings, clinging to the pro-market notion that additional tweaks could finally make commercially-driven health insurance work to patients’ advantage. They recommend that CMS improve its rating system to take account of MA plans’ mortality performance. As the authors note, however, private insurers would game any mortality-based rating system, just as they have successfully gamed CMS’ star system. The authors further suggest that health and life insurance be merged so that MA plans that kill people by squeezing care would have to pay out more in life insurance benefits.  

They ignore the obvious better choice: a single payer system that would have a loss ratio of 97.7%, as well as better drug coverage than the best MA plan. The data indicate that would save tens of thousands of seniors’ lives annually.

Daily Post

Let’s Not Mourn the Death of the Public Option

The health insurance public option might be fizzling. The left is OK with that., NBC News, June 5, 2021, By Benjy Sarlin and Sahil Kapur

“A decade later, Joe Biden campaigned on making the public option a reality, but so far, he’s done little to get Congress to enact one. Instead of outrage, influential progressives seem to be OK watching the promise go unfilled, preferring to pursue universal health care through other means, like expanding Medicare eligibility.

Elected officials, health care activists and experts who spoke to NBC News said the issue has fallen off the national radar and will be difficult to revive without a major push by the White House.

Responding to the pandemic has consumed much of Biden’s attention in his first months in office. And beyond that, he has a long list of agenda items to get to first, including many that are popular with progressives.

“I don’t think there’s a dynamic where we see it at the center of a political fight again,” said Alex Lawson, the executive director of the left-leaning group Social Security Works.”


Comment by Eagan Kemp

No one should mourn the end of a push for a public option in health care. It was never the solution the country needed for health reform. 

The risks inherent in a public option completely overwhelm any potential gains. Given the rapid rise in for-profit companies gaming Medicare through Medicare Advantage, there is no reason to believe that a public option would be any different when it comes to insurers dumping patients with high health needs, while retaining patients that are profitable. If the for-profit insurers can cherry-pick healthier Americans through seemingly more favorable plans (while they are healthy), then the public option could become overly burdened and unsustainable. 

In addition, a public option would have just been one more area of added complexity in our already fragmented health care system, which already struggled to respond to the COVID-19 crisis

A public option would also further entrench the power of for-profit insurers. And the massive administrative waste of private insurance companies would continue under a public option, whereas under Medicare for All the reduction in administrative savings would be more than $500 billion a year

In terms of political feasibility, there is the perception that less comprehensive reforms could have an easier chance of passing. However, the companies that profit off our healthcare system have shown they are just as opposed to the most basic public option proposal as they are to Medicare for All. Both the Partnership for America’s Health Care Future and Coalition Against Socialized Medicine—which strongly oppose Medicare for All as well as a public option —have shown they will not compromise on behalf of their corporate backers. 

While proponents of a public option may try to make their proposal sound “reasonable,” it wouldn’t come close to matching Medicare for All. Whether it is savings for families, savings for the country or ensuring that everyone in the country has guaranteed access to medically necessary care, only Medicare for All would create the health care system we need.

Daily Post

Public Insurers Provide Better Access, Financial Protection, & Satisfaction Than Private Insurers

Access to Care, Cost of Care, and Satisfaction With Care Among Adults With Private and Public Health Insurance in the US, JAMA Network Open, June 1, 2021, By Charlie M. Wray, Meena Khare, Salomeh Keyhani

Introduction: In the past decade, health insurance expansion has been a major aspect of health care reform in the US, with the Patient Protection and Affordable Care Act (ACA) increasing coverage to more than 20 million US adults.

We used the Behavioral Risk Factor Surveillance System (BRFSS) to compare experiences related to access to care, costs of care, and satisfaction with care among the 5 major forms of health insurance coverage (private employer–sponsored insurance, private individually purchased insurance, Medicare, Medicaid, and Veterans Health Administration [VHA] or military coverage) after accounting for respondents’ underlying health.

Results: …Compared with those covered by Medicare, individuals with employer-sponsored insurance were less likely to report having a personal physician (odds ratio [OR], 0.52; 95% CI, 0.48-0.57) and were more likely to report instability in insurance coverage (OR, 1.54; 95% CI, 1.30-1.83), difficulty seeing a physician because of costs (OR, 2.00; 95% CI, 1.77-2.27), not taking medication because of costs (OR, 1.44; 95% CI, 1.27-1.62), and having medical debt (OR, 2.92; 95% CI, 2.69-3.17). Compared with those covered by Medicare, individuals with employer-sponsored insurance were less satisfied with their care (OR, 0.60; 95% CI, 0.56-0.64)…

Conclusions and Relevance: In this survey study, individuals with private insurance were more likely to report poor access to care, higher costs of care, and less satisfaction with care compared with individuals covered by publicly sponsored insurance programs. These findings suggest that public health insurance options may provide more cost-effective care than private options.


Comment by Don McCanne

How many times do we have to say it? Public health insurance is designed to make health care accessible and affordable for the people. Private health insurance is designed to make a profit for the insurers. The policies used in the design of the various insurance products are selected on the basis of the desired results. Access to care, cost of care, and satisfaction with care are very important in the design of public insurance. In contrast, profits are of utmost importance in private insurance.

This study confirms that the private insurers will sacrifice access, cost, and satisfaction in order to increase profits. Patients have much higher access to care, financial protection, and satisfaction with public insurance. Shouldn’t we be demanding single payer Medicare for All so that we can all have what we want in health care, and so that we can free up the private insurers to engage in productive occupations that would be a greater benefit to society?

Daily Post

Time to Abandon Pay For Performance

Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System: A Qualitative Study, JAMA Health Forum, May 14, 2021, By Dhruv Khullar, Amelia M. Bond, Eloise May O’Donnell, Yuting Qian, David N. Gans, and Lawrence P. Casalino

“Participating in the MIPS program results in substantial financial and time costs for physician practices. We found that, on average, it cost practices $12 811 per physician to participate in MIPS in 2019. We found that physicians themselves spent a considerable amount of time to participate in MIPS. In 2019, physicians spent more than 53 hours per year on MIPS-related activities, which translates to nearly $7000 per physician. If physicians see an average of 4 patients per hour, then these 53 hours could be used to provide care for an additional 212 patients a year—equal to more than a full week’s work for a physician.”


Comment by Adam Gaffney

Pay-for-performance (P4P) is an increasingly central part of the American healthcare landscape. The Affordable Care Act added a multitude of new P4P programs to Medicare, including the Hospital Readmissions Reductions Program (HRRP) and the Hospital Value-Based Purchasing Program (HVBP). Then, the Medicare Access and CHIP Reauthorization of 2015 gave us the Merit-based Incentive Payment System (MIPS), a new P4P program that imposes financial sticks and carrots on individual clinicians across the country based on a slew of complicated performance metrics.

Much research suggests that these programs have little effect on patient outcomes. The HRRP was much lauded for apparently reducing readmissions, but later research attributed much (or all) of this apparent reduction to changes in diagnostic coding. There is also some evidence HRRP may have harmed some cardiac patients. Meanwhile, studies of the HVBP have found virtually no impact. Fewer studies, however, have examined the costs of such programs.

That’s what makes this study, led by Dr. Dhruv Khullar at the Weill Cornell Medical College, so valuable. The researchers interviewed the leaders of 30 physician practices across the nation who participated in the MIPS, and quantified the costs of participation in the program. Overall, they found that we spend more than $12,000 per physician annually to cover the administrative costs of participation in MIPS. Additionally, “MIPS-related activities” suck up over 200 hours of labor per year from practice staff, including 53.6 hours from frontline clinicians. And this is merely for a single P4P program.

There is little evidence, in other words, that P4P programs substantively improve care — and growing evidence that they further inflate our already enormous administrative costs while sapping the time and energy of practicing doctors. For these reasons, P4P should not be included in a Medicare for All reform. Notably, the House Medicare for All Bill excludes this payment mechanism. The underlying political idea of P4P is a fundamentally neoliberal one: the idea that we are all motivated only by pursuit of the dollar. Instead, doctors want to provide the best care they can. That it is not to say that there isn’t room for quality improvement in our healthcare system — far from it — but a paucity of profit incentives is not the culprit. Further, an increasing number of studies show that P4P is redistributive — shifting funds from providers that care for poorer patients (who tend to have worse outcomes) to the providers of the wealthy.

Daily Post

Single Payer Must Include Rational & Compassionate Long Term Care

Health Care Use and Out-of-pocket Spending by Persons With Dementia Differ Between Europe and the United States, Medicare Care, June 2021, By Sabrina Lenzen, Pieter Bakx, Judith Bom, Eddy van Doorslaer

Background: Persons with dementia need much care, but what care is used and how the burden of financing is divided between persons with dementia, caregivers, and public programs may differ between countries.

Objective: The objective of this study was to compare how health care use and out-of-pocket (OOP) spending associated with dementia differ between the United States and Europe, with and without controlling for background characteristics.

Research Design: We use prospectively collected survey data from the United States-based Health and Retirement Study (n=48,877) and the Survey of Health, Ageing, and Retirement in Europe (n=98,971) including all adults over the age of 70 years. Dementia status is imputed using a validated algorithm…

Results: Persons with dementia in the United States use 50% less formal home care per year than persons living with dementia in Europe [mean (SD)=236.8 h (1047.4) vs. 463.3 h (1371.2)], but use more nursing home care [75.1 d (131.4) vs. 45.5 d (119.4)). Dementia is associated with higher OOP spending in the United States than Europe [$4406 (95% confidence interval, 3914-4899) vs. $246 (73-418).

Conclusions: The far greater reliance on nursing home care in the United States likely causes much higher expenditures for people with dementia and insurance programs alike.


Comment by Steffie Woolhandler and David Himmelstein

When individuals require extensive assistance with daily living, most patients and families prefer home care to care in a nursing home. The COVID-19 pandemic has highlighted the sorry state of long term care – particularly nursing home care – in the US. This study documents the far greater reliance in the US as compared to Europe on nursing homes (67% more nursing home days per year on average) for the care of dementia patients, a corollary of the US deficit for home care (49% fewer hours). And the out-of-pocket costs to patients are also strikingly different: more than $4000 higher per patient in the US in 2017.

Single payer reform must include a rational and compassionate long term care program. Although not detailed in this article, the programs in several European nations include key elements that should be adopted in the US – e.g. salaries for family members who forego other paid employment to care for a disabled loved one, and the provisions of full time (or respite) live-in caretakers.

Daily Post

ACA Marketplace 2021 Enrollment Rise in Nonexpansion States – No Cure

UI effect? ACA marketplace enrollment soared at low incomes in nonexpansion states in 2021, XPOSTFACTOID, May 3, 2021, By Andrew Sprung

I don’t think it’s an exaggeration to say that enrollment [in ACA marketplace plans] at the lowest subsidy-eligible income levels in nonexpansion states exploded this year. 

Enrollment at 100-150% FPL in these fourteen states increased by 16.7% over 2020. For comparison, total marketplace enrollment in all states at all income levels was up 5.2% this year. The total increase in this income bracket in these fourteen states, 424,957, is 71% of the entire increase nationwide, 594,918. 


Comment by Isabel Ostrer

Over one million Americans have newly enrolled in Affordable Care Act marketplace plans this year. This was facilitated by President Biden expanding the enrollment period as a response to Covid-19 pandemic-caused mass unemployment and ongoing health fears for many Americans. Many millions remain uninsured.

Indeed, the pandemic has exposed the rickety scaffolding on which U.S. health insurance is constructed. Over half of Americans receive insurance through their jobs. But the rest of adults under age 65 — working or not — face a conundrum. They must either be poor enough to qualify for Medicaid (a near impossibility in certain states — like Texas, where an adult must earn <14% of the federal poverty line (FPL) to qualify for Medicaid) or earn enough to qualify for subsidized coverage through the ACA marketplace (in nonexpansion states subsidies start at 100% FPL). 

What happens to Americans who fall through the scaffolding? There is huge pent-up demand for health insurance in this group. With recently increased unemployment income (also pandemic-era legislation), many adults in nonexpansion states have been nudged into an income tier where they qualify for subsidized marketplace plans. As health policy expert Sprung points out in his post, every nonexpansion state except Wisconsin has seen a surge in enrollment among adults who earn 100-150% FPL. 

Despite these coverage gains, tens of millions of Americans remain ineligible for health insurance. Instead of propping up our piecemeal insurance system and padding the pockets of private corporations in the process, the obvious solution is a shift to unified single payer insurance. All Americans deserve access to affordable, comprehensive health insurance. Single payer is the answer.

Daily Post

COVID Payment Burdens Echo How U.S. Health System Routinely Fails Patients

Covid Killed His Father. Then Came $1 Million in Medical Bills., NY Times, May 21, 2021, By Sarah Kliff

Insurers and Congress wrote rules to protect coronavirus patients, but the bills came anyway, leaving some mired in debt.

“People think there is some relief program for medical bills for coronavirus patients,” said Jennifer Miller, a psychologist near Milwaukee who is working with a lawyer to challenge thousands in outstanding debt from two emergency room visits last year. “It just doesn’t exist.”

Many large health plans wrote special rules, waiving copayments and deductibles for coronavirus hospitalizations. When doctors and hospitals accepted bailout funds, Congress barred them from “balance-billing” patients — the practice of seeking additional payment beyond what the insurer has paid.

Interviews with more than a dozen patients suggest those efforts have fallen short. Some with private insurance are bearing the costs of their coronavirus treatments, and the bills can stretch into the tens of thousands of dollars…

Some hospitals are not complying with the ban on balance billing. Some are incorrectly coding visits, meaning the special coronavirus protections that insurers put in place are not applied. Others are going after debts of patients who died from the virus, pursuing estates that would otherwise go to family members…

Coronavirus patients face significant direct costs: the money pulled out of savings and retirement accounts to pay doctors and hospitals. Many are also struggling with indirect costs, like the hours spent calling providers and insurers to sort out what is actually owed, and the mental strain of worrying about how to pay.

Ms. Miller, like many other patients, described trying to sort out her complicated medical charges — in her case in color-coded folders — while also battling the mental “brain fog” that affects as many as half of coronavirus long-haul patients.

“I have a Ph.D., but this is beyond my abilities,” she said. “I haven’t even begun to look at my 2021 bills because we’re still dealing with 2020 bills. When the bills come nonstop, you can only deal with so much.”


Comment by Jim Kahn

COVID care was supposed to be the exception: amidst a pandemic, insurers agreed to cover all medical care related to this infection, with no cost-sharing for patients. But it didn’t happen. These interviews in the New York Times show how patients and their surviving family members were saddled with tens of thousands of dollars in cost-sharing, and many hundreds of hours at the kitchen table and on the phone trying to sort out the deluge of bills, long after their loved one was gone.

What went wrong? The short answer is that our system is so inherently complex and dysfunctional that it couldn’t pull itself together, even in an emergency.

Here are the sordid details: 

Our system relies extensively on cost-sharing (deductibles, copays). That means that forgiving the cost-sharing burden is an issue – not so in other wealthy countries. 

Second, it’s complicated to manage these complex financial rules, leading to huge administrative burdens for insurers, providers, and… patients and families.

Third, the insurers “agreed” to cover all COVID care. No force of law.

Fourth, a catch: the offer to forego cost-sharing depends on a diagnostic code for COVID. What if somebody has multiple medical problems – as is true for many of the sickest with COVID? If the COVID code isn’t prominently noted, that person loses out.

And, finally, preoccupation with profit. Another recent New York Times story describes how hospital chains used federal COVID relief funds to grow their clinical empires and thus profits. Shareholders win, people lose.

When will we learn? We must commit to universal, equitable high quality care – healthcare justice – combined with the efficiency of simplicity. What’s that called? Single payer.

Daily Post

Time to Take to the Streets to Demand Medicare for All!

Sanders, Jayapal Put Single Payer Medicare for All on Back Burner, Corporate Crime Reporter, May 10, 2021, By Russell Mokhiber

Single payer activists want Medicare for All front and center in Congress.

But Senator Bernie Sanders and Congresswoman Pramila Jayapal have put the issue on the back burner.

Sanders has yet to reintroduce his single payer legislation in the Senate. 

Instead, Sanders is pushing for a step by step approach – dropping the Medicare age to 60 and expanding it to cover dental, hearing and vision.

This step by step approach is justified by Sanders supporters like Michael Lighty who wrote recently that “Medicare for All isn’t yet winnable – expansion is.” 

And while Congresswoman Jayapal introduced her Medicare for All legislation (HR 1384) in March, she made it clear that she was more interested in the Sanders step by step approach.

Inside the beltway progressives refuse to challenge Sanders and Jayapal.

But Kay Tillow of The All Unions for Single Payer Health Care in Louisville, Kentucky says that the step by step approach won’t work.

And she questions why Sanders and Jayapal didn’t just re-introduce HR 676, the original single payer proposal in the House.

Tillow wrote to Jayapal at the end of December 2020 with her concerns…

“We are deeply concerned that HR 1384, the bill that succeeded Congressman John Conyers’ HR 676, dropped some of the key principles that were in Conyers’ model single payer bill,” Tillow wrote to Jayapal. 

“There is no reason for any compromises to be made at this point. We need model legislation that sets the stage for the struggle that is to come. If a principle is not placed on the table at the beginning of the bargaining, it is conceded. Unionists know that the outcome does not improve in the negotiations. The effort for the integrity of the single payer model in actual legislative form needs to be made.”


Comment by Don McCanne

Bernie Sanders, Pramila Jayapal, and Michael Lighty – heroes of the single payer Medicare for All movement – are also political pragmatists. But Kay Tillow is a political realist. “If a principle is not placed on the table at the beginning of the bargaining, it is conceded. Unionists know that the outcome does not improve in the negotiations.”

Recent media reports have indicated that our heroes recognize the political barriers to reform and are now posturing with the view that we should support beneficial measures that may not get us all the way there. Perhaps the most prominent isolated policy that is gaining support is lowering the eligibility age for Medicare – a view that some think that President Biden may eventually agree to as a compromise.

Where are the insurers and the medical-industrial complex on this? Of course, they are opposed. But are they really? Almost half of Medicare has already moved into the private insurance Medicare Advantage plans. Since some believe that Medicare for All is inevitable, what better strategy could they have than to complete the conversion to private Medicare Advantage for All? That concept is sneaking into the health policy literature, and it certainly wasn’t us who put it there.

Oh, you say, that won’t happen because we will be able to follow up with the Medicare public option. But isn’t that just another insurance plan that will be plugged into the Medicare Advantage insurance exchange?

Never fear. We are being told that President Biden has proven to be a great progressive like Franklin Delano Roosevelt. But wasn’t it FDR who threw health insurance out of the Social Security Act?

Kay Tillow has warned us that we can’t take anything off of the table, but we already have, and we are poised to take much more off.

Instead, we should be taking to the streets screaming for health care justice for all. Listen… silence. We have to change that. Now!

Daily Post

Guarantee Coverage for All Medically Necessary Services – Including Reproductive Care

Supreme Court to review Mississippi abortion law that advocates see as a path to diminish Roe v. Wade, Washington Post, May 17, 2021, By Robert Barnes

“The Supreme Court announced Monday that it will review a restrictive Mississippi law that provides a clear path to diminish Roe v. Wade’s guarantee of a woman’s right to choose an abortion.

Abortion opponents for months have urged the court’s conservatives to seize the chance to reexamine the 1973 precedent. Mississippi is among many Republican-led states that have passed restrictions that conflict with the court’s precedents protecting abortion rights, hoping for a chance to get a case before a Supreme Court that they think is more amenable to their arguments.

In accepting the case for next term, the court said it would examine whether “all pre-viability prohibitions on elective abortions are unconstitutional.” That has been a key component of the court’s jurisprudence, and the announcement sounded ominous to abortion rights advocates.”

The incomplete promise of Medicaid expansion, Vox, May 17, 2021, By Dylan Scott 

“In November, Missourians voted to expand Medicaid under the Affordable Care Act, granting access to health insurance to roughly 230,000 people living in poverty. Now the state’s Republican legislators are defying the will of their voters by refusing to implement the expansion.

In late April, the Missouri Senate blocked funding for Medicaid expansion. Last week, Gov. Mike Parsons cited the lack of funding to justify withdrawing the expansion plan entirely.

The pattern demonstrates that, nearly a decade after the Supreme Court ruled that states could choose whether to expand their Medicaid programs, the fight over whether to do so is far from over. So far, 38 states and Washington, DC, have expanded Medicaid, covering nearly 15 million people. In the dozen states that have not, 4 million people are uninsured who would receive Medicaid coverage if their state expanded eligibility under the ACA. More than 95 percent live in the South, they are disproportionately Black, and many are not eligible for subsidies to buy private coverage on the ACA markets.”


Comment by Eagan Kemp

While these two stories may not initially seem linked, Medicare for All supporters know that they both highlight just how tenuous access to health care remains when subject to the whims of states. Numerous states continue to fail their residents by refusing to expand Medicaid and also by attempting to restrict access to reproductive services, especially abortions. 

The answer to both of these problems is Medicare for All, which would guarantee coverage for all medically necessary services, including abortion and the full spectrum of reproductive health care services, and ensure that everyone in the U.S. can finally get the health care they need, regardless of where they live. 

Failure to pass Medicare for All and end the Hyde Amendment that sharply limits federal funding for abortion means that states can restrict health care access. If the Supreme Court overturns or severely curtails the protections provided by Roe v. Wade, many states would pass even more restrictive provisions inhibiting the right to choose. Many of the same states continue to refuse to expand Medicaid, even when approved in a referendum by a majority of state voters, as is in Missouri. 

This situation will place many pregnant women in a catch-22: both unable to afford the massive medical bills that come with pregnancy because they cannot access Medicaid (which pays for >40% of pregnancies nationwide), and unable to seek a legal abortion.

The time has come to protect reproductive rights from reactionary state forces, reverse the Hyde Amendment, and finally ensure that everyone in the U.S. can get the care they need when required. It’s time for Medicare for All.