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Complexities and deficiencies of the temporary health system tweaks

March 23, 2021

Topics: Quote of the Day

By Margot Sanger-Katz and Sarah Kliff
The New York Times, March 22, 2021

The new stimulus bill made tens of millions of Americans eligible for new health insurance subsidies. But many will have to wait to get help: It will probably take a year for the full emergency aid to reach people, because of website complications and other logistical problems.

The health law’s complex structure makes it hard to retool insurance subsidies, let alone create a new program for the unemployed. The systems that distribute the benefits depend on government coders who update websites, and marketers who help people understand the new programs and jump through various administrative hoops to collect them.

Getting those lower prices will require work: Americans who already have Obamacare insurance will have to go back to the website where they bought their insurance; make sure they don’t want to switch plans; and certify that they want the new, expanded tax credits. Those who fail to do this will keep paying their current price. They should eventually receive the additional funds as a large refund with their 2021 taxes next spring.

People who have bought their own insurance elsewhere will need to cancel their current plan and switch to an eligible one.

Another key part of the stimulus provides free health plans with a generous set of benefits to Americans who received unemployment insurance this year. Even though the coverage will be retroactive to Jan. 1, the new benefit will take months to set up, and won’t appear on Healthcare.gov until this summer. That timeline may require people to visit Healthcare.gov as many as three times: once to sign up for a plan, then to get the new income-based subsidies, and again to get the special unemployment benefit once it’s ready.

The slow rollout of government aid is partly the result of the technological challenge of updating Healthcare.gov, which is connected to a maze of federal systems to verify people’s residency, income and insurance choices.

The slowness also reflects a policy debate within the administration about how automatic the new benefits should become.

If the Biden administration automatically increases people’s tax credits, some people could face a higher risk of a large tax bill.

Research suggests that the more complex social welfare programs are to access, the more likely it is that eligible people will fall through the cracks.

Although the stimulus bill passed with overwhelming Democratic support in Congress, a substantial share of Democratic lawmakers would prefer a simpler, more universal path to wider health coverage. This month a majority of House Democrats co-sponsored a bill to create a “Medicare for all” system, which would automatically provide government health insurance to all Americans, without the current system of subsidies and signups.



By Don McCanne, M.D.

Many are celebrating the increase in health care benefits included in the stimulus bill. Improving coverage is a good thing, but how much do we have to celebrate here? First of all, many will be left uninsured or underinsured. Structural defects such as the profound administrative excesses will be perpetuated or even increased. Much of the program is temporary and thus won’t provide long term solutions. Some will have disruptions of their current programs plus further disruptions when the programs sunset.

Many potential tweaks discussed during the presidential campaign have not been included, so some are hoping that these may be enacted in the future along with making some of the temporary changes permanent. If so, most defects in our current system will remain in place. Also, efforts to make the system universal, equitable, affordable and inefficient will cease, as Congress and the administration move on to other pressing issues.

It is sad because we already have pending legislation that would fix these problems on a permanent basis: H.R.1976 – the single payer Medicare for All bill. Why would we want to continue with the complexities and deficiencies of the current approach when we can have it all now by enacting and implementing Medicare for All?

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About the Commentator, Don McCanne

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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