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Our current system has allowed the greatest health insurance enrollment losses in history

July 14, 2020

Topics: Quote of the Day

Families USA, July 2020

Results in Brief

  • Because of job losses between February and May of this year, 5.4 million laid-off workers became uninsured.
  • These recent increases in the number of uninsured adults are 39% higher than any annual increase ever recorded. The highest previous increase took place over the one-year period from 2008 to 2009, when 3.9 million nonelderly adults became uninsured.
  • Nearly half (46%) of the increases in the uninsured resulting from the COVID-19 pandemic and economic crash have occurred in five states: California, Texas, Florida, New York, and North Carolina.
  • In eight states 20% or more of adults are now uninsured: Texas, where nearly three in ten adults under age 65 are uninsured (29%); Florida (25%); Oklahoma (24%); Georgia (23%); Mississippi (22%); Nevada (21%); North Carolina (20%); and South Carolina (20%). All but Oklahoma are also among the 15 states with the country’s highest spike in new COVID-19 cases during the week ending on July 12.
  • Five states have experienced increases in the number of uninsured adults that exceed 40%: Massachusetts, where the number nearly doubled, rising by 93%; Hawaii (72%); Rhode Island (55%); Michigan (46%); and New Hampshire (43%).
  • No federal COVID-19 legislation signed into law has attempted to restore or preserve comprehensive health insurance, which improves health outcomes, limits financial insecurity, and promotes economic recovery. Federal lawmakers can fill that gap in the next COVID-19 bill.


Health Care Administrative Costs in the United States and Canada, 2017

By David U. Himmelstein, M.D., Terry Campbell, M.H.A., Steffie Woolhandler, M.D., M.P.H.
Annals of Internal Medicine, January 21, 2020

Total Costs of Health Care Administration: Health care administrative costs in the United States in 2017 totaled $812.0 billion, $2497 per capita ($2696 per insured person), or 34.2% of total spending in the categories for which data are available. The comparable estimates for Canada are $551 per capita ($593, assuming U.S. wage rates in doctors’ offices), or 17.0% of expenditures. The difference amounts to over $1900 per capita (or over $2100 per insured person), equivalent to more than $600 billion in excess administrative spending in the United States.



By Don McCanne, M.D.

The COVID-19 pandemic and its economic consequences have caused the greatest losses in health insurance enrollment in U.S. history: 5.4 million laid-off workers have become uninsured. However, it is important to understand that all was not well before the pandemic. Nearly 28 million people were already uninsured and tens of millions more were underinsured – unable to afford the out-of-pocket costs that were not covered by insurance.

Of major significance, these are nonelderly adults. Medicare – for those over 65 – continued to provide stable coverage after the onset of the pandemic. There would be no uninsured now had we had in place a single payer Medicare for All program.

The experience in California also provides us with some important lessons. As one of the most progressive states, California went out of its way to maximize the benefits of the Affordable Care Act and other public programs. Thus we can get a perspective of how well the financing system works when stressed. The number of workers in California who became uninsured due to job loss between February and May 2020 was 689,000. In total, 3,227,000 adults are uninsured in California. There are now about 27% more uninsured adults in California than there were in 2018.

Regardless of all of the praise ACA receives, the program clearly is not working as it should. There are proposals to temporarily fill in some of the gaps, but these proposals fall far short of the comprehensive reform that we need, and most of them would be only temporary, at the end of the pandemic defaulting to our current unsatisfactory financing system.

The primary reason given for not enacting single payer Medicare for All is that it costs too much. Yet comparing our highly inefficient health care financing system with Canada’s single payer system indicates that more than $600 billion in annual administrative waste is recoverable – more than enough to expand the provision of comprehensive health care services to absolutely everyone, permanently, without spending more in inflation adjusted dollars than we already do.

One major candidate for president would forgo this in order to perpetuate, with tweaks, our clearly inadequate health care financing system with its profoundly inefficient and costly administrative excesses. The other major candidate is supporting a repeal of ACA without offering any effective substitute, leaving us worse off than we already are.

I mean, when California has one of the very best programs and it alone has over 3,000,000 adults who are uninsured? That’s unacceptable. It’s criminal! We need to change the system: single payer improved Medicare for All. Now!

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About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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