How to pay for health care in America has been a major public policy issue for several years.  Federal legislation, regulations and court cases have both expanded and limited options for health insurance coverage and the obligations of health insurers.  A couple recent articles reflect that this issue will continue to evolve based on input from the insurance industry and the medical profession.
The 2010 Affordable Care Act, also known as Obamacare, sought to provide insurance coverage to nearly all Americans, improve care outcomes, and lower costs.  As a result, millions of previously uninsured now have coverage to pay for care, children can remain on parents’ policies until age 26, and there are no longer denials based on pre-existing conditions or lifetime limits on coverage.  The Act required coverage of certain “essential health benefits” by all ACA policies – benefits that many healthy people do not want.  In response, the health insurance industry has advocated for the ability to issue more limited policies that would cost less.
As reported on August 1 by Julie Appleby for the Kaiser Health Network, the Trump administration has approved the selling of short-term health policies for up to 12 months (overturning a 90-day limit on such policies under the ACA).  These plans may be renewable for up to 3 years, and will likely have much more limited coverage than ACA plans.  Unlike ACA plans, these short-term plans can exclude persons with pre-existing conditions, limit coverage for medical conditions (such as maternity care, preventive care and mental health services), set annual and lifetime caps on coverage and cover fewer prescription drugs.
Just over 14 million people are enrolled  in ACA plans this year.  Officials predict that about 600,000 will enroll in the short-term plans in 2019, with 100,000 to 200,000 of those dropping out of ACA plans to do so.  This reduction in the number of ACA insureds – the “risk pool” – could likely cause premiums for those people to rise by an additional 1.7% according to industry groups.  Various changes to ACA rules have caused premiums for the average benchmark ACA plan to increase by 34 % this year.  This increase has been fueled by both medical inflation and the administration’s decision last fall to drop payments to insurers to help lower deductibles for certain lower-income policyholders.
“States do have the authority to regulate [short-term plans],” said Randy Pate, director of the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services. “We do think some states will move to limit them and some will embrace them.”
https://khn.org/news/trump-administration-loosens-restrictions-on-short-term-health-plans/
Doctors’ Views Changing
An August 7 Kaiser Health News article reports that physicians may be shifting in their ideas about health care financing.  After vigorous debate at this year’s American Medical Association convention in June, the organization acceded to the medical student caucus’ request to study the AMA’s decades-long opposition to a single payer health system.
“We believe health care is a human right, maybe more so than past generations,” said Dr. Brad Zehr, a 29-year-old pathology resident at Ohio State University, who was part of the debate. “There’s a generational shift happening, where we see universal health care as a requirement.”
Organized medicine, and previous generations of doctors, had for the most part staunchly opposed to any such plan.  The AMA has thwarted public health insurance proposals since the 1930s and long been considered one of the policy’s most powerful opponents.  But the battle lines are shifting as younger doctors flip their views, a change that will likely assume greater significance as the next generation of physicians takes on leadership roles.  The AMA did not make anyone available for comment.
In prior generations, “intelligent, motivated, quantitative” students pursued medicine, both for the income and because of the workplace independence — running practices with minimal government interference, said Dr. Steven Schroeder, 79, a longtime medical professor at the University of California-San Francisco.  In his 50 years of teaching, students’ attitudes have changed:  “The ‘Oh, keep government out of my work’ feeling is not as strong as it was with maybe older cohorts,” said Schroeder.  “Students come in saying, ‘We want to make a difference through social justice. That’s why we’re here.’”
A full single-payer system means everyone gets coverage from the same insurance plan, usually sponsored by the government.  Medicare-for-all, a phrase that gained currency with the presidential campaign of Sen. Bernie Sanders (I-Vt.), means everyone gets Medicare, but, depending on the proposal, it may or may not allow private insurers to offer Medicare as well.  Meanwhile, lots of countries achieve universal health care — everyone is covered somehow — but the method can vary.  For example, France requires all citizens purchase coverage, which is sold through nonprofits.  In Germany, most people get insurance from a government-run “public option,” while others purchase private plans.  In England, health care is provided through the tax-funded National Health System.
In the March New England Journal of Medicine survey, 61 percent of 607 respondent physicians said single-payer would make it easier to deliver cost-effective, quality health care.  Delving further, that survey data shows support is stronger among younger physicians, said Dr. Namita Mohta, a hospitalist at Brigham and Women’s Hospital and clinical editor at NEJM Catalyst.
https://khn.org/news/once-its-greatest-foes-doctors-are-embracing-single-payer/