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Trump Responsible for Lower Premiums? ... "Laughable"

ACA defenders take issues with HHS Secretary's recent claims

By Shannon Firth, Washington Correspondent
MedPage Today, September 28, 2018

Secretary of Health and Human Services Alex Azar announced Thursday that insurance premiums on the federal exchange for benchmark plans are expected to fall by 2% nationally and and went on to credit President Trump for the decline, as well as what Azar said were numerous other improvements in the nation's healthcare system.

Azar also ridiculed the "Medicare for All" proposals backed by many Democrats, in a speech he delivered in Nashville that was covered in detail by MedPage Today.

The secretary's assertions did not sit well with supporters of the Affordable Care Act (ACA) and Medicare for All contacted by MedPage Today.

'Laughable' Claim

"When you make a change in something as big as healthcare financing, you're not going to see the results immediately," said Carol Paris, MD, a retired psychiatrist and president of Physicians for a National Health Program (PNHP), in a phone interview.

"It's more likely that [President Trump's] defunding the cost-sharing reductions created so much uncertainty in the insurance market last year that [insurers] set their premiums higher than they might have otherwise to give them some wiggle room."

Insurers were overcautious and set their premiums too high, she added. "What we're really seeing this year is the markets correcting themselves for chaos created by the Trump administration last year."

Manan Trivedi, MD, president of the National Physicians Alliance, also questioned Azar's logic: "ACA premiums are stabilizing despite the Trump administration...Americans could have seen premium costs go down in actual dollars if Trump and Azar didn't recklessly repeal the individual mandate, allow the sale of stripped-down, short-term, junk insurance plans, and refuse to reimburse insurance companies for discounts they are required by law to offer to low-income customers," he said in an email.

"These moves are a direct attempt at sabotaging the ACA," he added, noting that despite the administration's efforts the ACA's popularity and stability continue to grow.

Eagan Kemp, a healthcare policy advocate for Public Citizen, called Azar's comments "laughable."

"From ending the individual mandate through the tax scam bill, to undermining ACA enrollment by refusing to support enrollment efforts, to allowing the sale of junk plans (both short-term plans and association health plans) without adequate state or federal oversight, this administration has shown nothing but disdain for the health of the American people," he wrote in an email.

Claire McAndrew, director of Campaigns and Partnerships for Families USA, a left-leaning think tank, echoed Kemp and Trivedi highlighting that this administration had actually increased the rate of uninsurance, while at the same time opening the door to expanding "junk plans" that don't provide patients with protections for preexisting conditions -- referencing short-term health plans and association health plans.

"Any marketplace improvements are despite this administration, not because of it," she wrote in an email to MedPage Today.

Can You Keep Your Doctor?

Left-leaning scholars were also skeptical of Azar's remarks around Medicare for All.

Paris was not convinced by Azar's argument that seniors find traditional Medicare lacking. In his speech, Azar argued that one-third of seniors have chosen Medicare Advantage plans because the provider more options and broader networks.

Healthier seniors are driven towards Medicare Advantage plans by lower premiums and "massive amounts of advertising," but plan networks can be very narrow, Paris argued.

Also, when seniors enrolled in Medicare Advantage plans get sick, as quickly as they can they switch to traditional Medicare, where the choice of doctors and hospitals is much broader, she continued.

"How Azar gets away with saying that people will have less choice of doctor and hospital with Medicare for All is ridiculous," she added.

On Thursday, Azar suggested that because Medicare's payments are significantly lower than private plans, doctors might opt out entirely and choose to take only cash.

"We're not going to lose our physician work force with Medicare for all," she said.

It didn't happen in the U.S. in 1965, when Medicare was first enacted -- despite plenty of "fear-mongering," -- and it also didn't happen in Canada when it switched to a single-payer system, Paris noted.

(See MedPage Today's series "A Tale of Two Nations" for more on Canada's health system versus the United States.)

'Staggering' Costs to Taxpayers?

Paris also challenged the "staggering" cost of the program that Azar decried. She cited a report from the right-leaning Mercatus Center, suggesting that the Medicare for All could potentially save the country $2 trillion. (The same paper also noted that the program would "place unprecedented strain on the federal budget.")

But, from Paris's perspective, "at the end of the day for 95% of Americans, they'll have more money in their pockets, not less, because in exchange for having their taxes go up modestly, they are no longer paying premiums, copays, deductibles, [or] worrying about out-of-network expenses.

And "surprise bills" are what worry Americans most, Paris said, citing a recent Kaiser Family Foundation poll -- even more than prescription drugs or insurance deductibles.

"It isn't surprising that Azar would be all about scare tactics on Medicare for All, given that his former employers in the healthcare industry are concerned about the growing support for Medicare for All," said Public Citizen's Kemp.

"With 70% of Americans (including 85% of Democrats and, surprisingly, 52% of Republicans) supporting Medicare for All, Secretary Azar and [CMS] Administrator Verma are getting the message that they need to take on Medicare for All. But no matter what corporate talking points they put out, they know that the American people are tired of paying more for less in healthcare," he continued.

Trivedi said he was not shocked to see a former drug company executive pan the expansion of "low-cost, high-quality healthcare" to millions of Americans.

"The truth is moving to a universal healthcare system like Medicare for All would be the best thing for Americans' health and Americans' pocketbooks -- it unfortunately might not be greatest for the bottom line of the drug and medical device industry, to which so many in the Trump administration are beholden to," Trivedi said.

Finally, another policy expert noted that there isn't one single Medicare for All plan.

"While some 'Medicare for All' proposals may recommend using a Medicare-type model to create a public option or more universal healthcare system, in general these conversations are divorced from the actual Medicare program. Those that do recommend changes to Medicare focus on ways to fill gaps in coverage and lower costs for beneficiaries, improvements that are long overdue," said Lindsey Copeland, Federal Policy Director for the Medicare Rights Center.

"Medicare is successful, and we support extending that type of insurance to other Americans. We disagree that doing so would undermine the current program. Expanding health coverage to more people does not equate with taking it away from others."

https://www.medpagetoday.com...