New Republic - July 16, 2020
One of the many things that made the United States uniquely vulnerable to the coronavirus pandemic is the relationship between health care and employment in this country. About half of all Americans have employer-provided insurance; if you don’t, you are left to a mass of overlapping state and federal programs, though depending on where you live, you might find none of them overlap with you. It has been clear from the start that this patchwork health care nonsystem would cause unique problems fighting the coronavirus, and people are undoubtedly dead directly because of these problems. Months into the pandemic, the twin crises of Covid-19 and gaps in insurance are compounding each other: A new report from Families USA suggests that more than five million people have lost their insurance already; another report, from the Urban Institute, predicts another 10 million will lose their coverage by the end of the year.
It is easy to look at any issue plaguing America, from the coronavirus and health care to crumbling schools or roads, and say that the Republicans are standing in the way of progress, which they are. But there’s another dynamic at play with health care. It plainly doesn’t matter very much to our leaders—whether it’s Nancy Pelosi or Donald Trump—whether people have insurance and whether they get health care. Once a government gets used to a situation where tens of millions of people don’t have health insurance, which has always been the case in the U.S., how do we get our leaders to care when another five or 10 million are added to that number? Once you have accepted that some people don’t get to have health care, as if they’re just part of the scenery, why would another five million people at risk of financial ruin or death spur action?
The Trump administration’s response to the health insurance crisis has been predictably nonexistent. The Los Angeles Times noted Tuesday that the Trump administration has not made any sort of push to stem the loss of health insurance, with no effort to encourage people to sign up for Affordable Care Act marketplace coverage, for example. Larry Levitt, executive vice president of the Kaiser Family Foundation, told the paper that this is because the ACA is such a “political football,” adding, “what you’d normally think would be good government simply isn’t happening.” Expecting Republicans to practice good government is like expecting a dog to practice good hygiene.
On the Democratic side, there has been a range of proposals, but none that have been advocated for very forcefully. The Heroes Act, a $3 trillion stimulus bill passed by the House that was never intended to survive whole in the Senate, would fully subsidize Cobra, the program that allows laid-off workers to keep their employer-provided insurance. This usually comes at a laughably unaffordable cost, as employees must pay both their portion and the employer’s portion of the premium, but the Democratic bill would pay insurers to make it free for ex-employees instead. The left-wing criticism of this is that it provides a huge giveaway to insurers, who charge far more than they need to in premiums to rake in massive profits, instead of expanding government health insurance to laid-off people. (And, of course, many employer-sponsored insurance plans are too expensive for people to use even if their premiums are paid, because of high deductibles and co-insurance.)
That’s all true, but put that aside for a moment and think strategically. Even if making Cobra free for ex-workers were the best possible thing Democrats could get out of the Senate, why roll it into this bill that will never pass? Minimizing the loss of health insurance is among the most urgent tasks of this pandemic, along with controlling the spread of disease, providing economic relief, and preventing a wave of evictions. (Not on the list: getting bailout funds to lobbyists.)
If the Democrats wanted to run on health care against Trump, which worked in 2018 and which Joe Biden has shown an interest in doing despite struggling to articulate basic facts about his health care plan, this would be a perfect time to introduce a bluff-calling bill. Expanding Cobra is the barest minimum the government could do to provide health insurance in this crisis; Republicans don’t even have a counterproposal, because they fundamentally do not want more people to have health insurance. Expanding Cobra is such a centrist, even right-wing idea that Republican strategists write in their memos that Republicans should do it, because the alternative is expanding Medicaid, which is increasingly popular. And we can’t have that.
The Democrats could cut and paste the Cobra segment of the Heroes Act, introduce a stand-alone bill, call it the Health Access Protection Act or something suitably Third Way–ish, and dare the Republicans to vote against keeping laid-off workers on their health insurance—if, that is, they really believed in and wanted this solution to happen. There’s plenty of money for ads on the Democratic side, still. You could argue that splitting off any one part of the bill would damage the chances for success on the overall bill, or you could see the Democrats’ inability to capitalize on the fact that more than five million people have lost their health insurance as further evidence that they do not understand what a crisis American health care was already in long before the first Covid-19 case.
The lack of urgency that has characterized the federal response to this crisis—in 10 days, the expanded unemployment benefits expire, and we have no idea whether anything will be done to extend them—is simply a continuation of how the government has tolerated the obvious failures of the system up to this point. People without health insurance, like those with insurance, have bodies that break down, stop working, throw out weird symptoms and lumps and fluids, produce anxiety or depression. When these things happen to uninsured people, they often end up going to the emergency room, and rack up bills that they can’t pay, costing hospitals and the government money and often ruining their lives.
A person without health insurance can still catch the coronavirus, infect others, and get dangerously or fatally sick, without knowing that they are supposed to be able to go to the doctor about that for free: The Department of Health and Human Services reported last week that it has paid out far fewer claims for Covid-19 testing and treatment for the uninsured than it expected. Everything about the health care system is complicated, hostile, and potentially ruinous for people without health insurance, so it’s not surprising if a lot of people couldn’t shake that experience off within a matter of weeks and months. It’s true that our health care system was not designed to handle a pandemic, but it would be more accurate to say that our system was not designed to provide health care to people en masse, whether that is regular checkups or chemotherapy.
All of this would be fixed by passing Medicare for All, which Democratic voters like and which gets favorability ratings comparable to or better than the Affordable Care Act’s. It would not pass the Senate, of course, but it would provide a club to beat Republicans with. Barring a sudden change of heart on single-payer, it would still be easy and beneficial for Democratic leadership to do anything at all to show they care about people who have lost their health insurance. Propose a bill. Hold a press conference. Take a camera and go to a hospital, a homeless shelter, or a McDonald’s and talk to uninsured people who would tell you that yes, actually, I would like it if Mitch McConnell would allow me to have health insurance. All of this would be better than nothing, as inadequate as expanding Cobra would be. But Democrats won’t do these things, because they don’t really care. Once you’ve accepted 27 million uninsured, what’s another five million lives?