Friday Memo- November 1, 2019

Dear Team:

As Washington, D.C., hits a new low in government dysfunction, it is useful to consider earlier eras when the federal government positively tackled the nation’s health care needs.  Both major parties contributed —not always cooperatively, but constructively—in making Americans healthier.

Let’s take a short stroll down memory lane, not for rosy feeling of bygone times, but for a vision of what we can fight for in the future. I am fond of a comment George Soros, the 89-year-old funder (about $32 billion) and leader of the Open Society Foundation:  “I am too old to remember the past. I can only remember the future.”

The Affordable Care Act, “Obamacare,” is nearly ten years old. It remains a partisan target, with the White House, the United States Senate, and a number of Republican led states still trying to tear it down.  Though flawed, it is standing stronger than ever, with millions of Americans signing up for health insurance during the annual enrollment period which is starting today.  Without Obamacare, many of these folks would go uninsured.

Americans who sign up for Obamacare for 2020 will find that their average premiums have dropped 4 percent for the most popular health plans. In a half dozen states, there is a double-digit decline in the cost of premiums.

Meanwhile, ominously, a federal appeals court in Texas is expected to rule soon in a case, supported by the Trump Administration’s Justice Department, which could find the entire ACA unconstitutional, killing the law and leaving millions without health coverage.   That would be a disaster for U.S. health, and a likely political disaster for the Republican Party.

Why? The ACA now is deeply embedded in the American health care system, with over 10 million people enrolled in Obamacare plans and millions more benefiting from the expansion of Medicaid in roughly two-thirds of the states. It is good health care coverage and includes the required coverage of pre-existing conditions.

Remember, the ACA is mostly about coverage, not the efficient day-to-day delivery of quality care. Improvements are still needed, and there is an intense debate among the Democratic presidential candidates who support either a single payer Medicare for All (Senators Bernie Sanders and Elizabeth Warren), or enhancements to the ACA that would allow people to hold on to private coverage or buy into Medicare (Vice President Joe Biden and Mayor Pete Buttigieg).

The point is this: the ACA is working. It has delivered on the promise of extending health care coverage, allowing for a healthier population. It has saved lives.

Obamacare fits into an historic pattern that has bent the arc of U.S. health care in a humanitarian direction. Traditionally, the federal government has played the critical role in making America healthier. The time will come, let’s hope soon, when Washington will once more take up that role.

In 1965, in the wake of President Lyndon Johnson’s landslide election the year before,  both Medicare and Medicaid were enacted. Congress was overwhelmingly Democratic that year, and efforts to provide health coverage for America’s elderly (Medicare) — which had failed since the end of WWII — finally succeeded.

Medicaid, or coverage for people with low incomes, came along with Medicare – almost as a legislative afterthought.

The Medicare enacted during the Johnson Administration provided health insurance to Americans aged 65 and over. Today’s Medicare covers those men and women, along with younger people with serious and prolonged disabilities. That expansion of Medicare took place in 1972, during the administration of President Richard Nixon, a Republican.

In 1997, during the Democratic administration of Bill Clinton, Medicaid was effectively expanded by enactment of the Children’s Health Insurance Program (CHIP), providing health insurance for children in families with incomes up to 200 percent of the federal poverty level. Democratic Senator Ted Kennedy and Republican Senator Orrin Hatch co-sponsored the original CHIP legislation.

The next major health reform from Washington occurred during the Republican Administration of George W. Bush. Until then, as valuable a program as Medicare was, it had not kept up with medical innovation. By the dawn of the 21st Century, prescription medicine had become a major, and expensive, tool in health care delivery, but Medicare did not cover the cost of drugs. In 2003, it was a Republican Congress that enacted Medicare’s Part D prescription drug benefit – a vital part of Medicare today. And then in 2010 a Democratic Congress passed the ACA, signed into law  by President Barack Obama.

We need a muscular federal government to get U.S. healthcare right. There were times that the political parties could agree that health care is a national responsibility that the federal government must lead. There is no such consensus today in Washington, but elections matter and in time that will change.

There is a rich precedent of a White House and Congress doing good by the American people’s healthcare.  We should work to make that past, our future.