for Montclair Local

Is the Affordable Care Act a fixer-upper or a tear-down? How can universal healthcare work as a private and public sector model and be affordable? What is the cost and coverage of Medicare for all/single payer? These are some of the questions asked at Blue Wave NJ’s forum held on Oct. 10.  

The Affordable Care Act was a “halfway revolution” that cut the ranks of uninsured by around 40 percent, but left the dysfunctions in the healthcare system in place. Tens of millions are underinsured and around 9 percent of Americans are uninsured, according to the grassroots, Democrat group. 

Blue Wave NJ hosted the forum to outline proposals for healthcare reform and remind residents that the enrollment period for state-mandated coverage is Nov. 1-Dec. 15.

The event, held at First Congregational Church, featured two national experts in healthcare policy with about 50 residents in attendance. They discussed what Democrats could deliver if they gain a narrow majority in Congress in 2021. 

“Over 30 million uninsured children and increasing healthcare costs is the twin impetus for coming together. Healthcare as a right, not a privilege. These are the core points that set the table for why we are here,” said Heather Howard, a Lecturer at the Woodrow Wilson School of Public and International Affairs at Princeton University. 

New census data shows that since the Affordable Care Act was implemented (it passed in 2010, but most provisions were put in place in 2014), the number of uninsured has gone up, even though the law initially put a tremendous dent in the number of people without healthcare, she noted. But premiums and out-of-pocket costs increased, along with out-of-network costs and surprise medical bills. “Our unit costs for healthcare are higher than costs in other industrialized countries,” Howard said. “Our life expectancy has gone down due to the depths of suicide, opioid addiction and alcoholism.”

Fifty percent of the population gets coverage through their employers. Others are in a patchwork of Medicare, Medicaid and similar single payer systems, Howard noted. 

Emerging federal models include single payer/Medicare for all, in which the government provides health coverage, ending private insurance; a Medicare expansion, which incorporates the individual insurance market, Medicaid, and CHIP, but allows individuals and large employers to opt out; Medicare buy-ins for those ages 50-64; and a public option plan to compete with the ACA marketplace alongside private insurers.

Stan Dorn, Director of the National Center for Coverage Innovation and Senior Fellow of Families USA, said that states can look to Massachusetts for an example of sensible reform. The state offers inexpensive universal coverage that goes beyond a public option, he noted. 

“If your income is below the poverty level you can go into a program for around $30 a month. There’s no deductible. Every plan is the same. Out-of-pocket costs depend on income. Premiums and doctors in network are the only variables to the consumer. If you pick the cheapest plan, it’s free. The number two plan is $20-$30 a month,” Dorn said. “Great prices are also available to small businesses at reasonable costs. It’s a good public program, not public option.”

Making healthcare affordable is reliant on systematic changes and bipartisan support, Dorn said. 

“Reverse the sabotage taking place with junk insurance that offers no coverage for pre-existing conditions,”  Dorn said. 

In 1997 Senators Hatch and Kennedy cut the number of uninsured children by two thirds. From 2016 to 2018, there were 400,000 uninsured, which means 100 children in America will lose their health insurance by the time this event is done. Even with subsidies of $100 a month on a full-time minimum wage worker, if their boiler breaks, they can’t pay for health insurance, he said.  

“States like Massachusetts learned how to squeeze money from a stone, find a way to level the costs. New York offered a plan for those at up to 200 percent of the poverty level, for $20 or less. They signed up 700,000 people,” Dorn added.

Private insurance offers value and could work with a public option, Dorn stated. There’s more flexibility but insurers’ cost control approaches will vary. 

“Medicare savings on something like speech therapy may have six criteria. Healthcare rationing is outdated through inconvenience. Other cost controls include eliminating dental benefits. Private insurer savings are value waste insurance designs on prescription drugs and surgeries at certain hospitals,” Dorn said. 

Freelance writer Andrew Sprung, who has written in the New York Times, The Atlantic and the New Republic regarding healthcare policy, cautioned that opponents of Democrats’ efforts to reform healthcare will use fear tactics. 

“There are two arguments used against Medicare for all. ‘They’re coming for your Medicare, granny! Premiums are going to go up.’ The torrent will appear in Facebook ads and other places. We have to figure out a way to fight it,” Sprung said.

Belleville resident David Yennior, 72, said he supports Senator Bernie Sanders’ single-payer plan. “You’ve got to have the backbone to fight for healthcare reform. CEOs of healthcare companies are making tens of millions and shareholders of companies are owned by the one percent. More people are getting laid off and losing insurance.We need to do better as a country,” Yennior said.

New Jersey’s enrollment period for health insurance through the Affordable Care Act exchange is Nov. 1 through Dec. 15. is the online portal to questions about the marketplace as well as enrollment. Consumers may also enroll by calling 1-800-318-2596.