Thinking about health coverage

Wall Street Journal

Sept. 10

The number of Americans without health insurance rose last year, the Census Bureau reported Tuesday, and Democrats say this justifies more government control. Yet the reality is more complicated_in particular, note that having a Medicaid card is no guarantee of great medical care.

The good Census news is that real median earnings of men and women who work full time and year round “increased by 3.4 percent and 3.3 percent, respectively, between 2017 and 2018.” Some 2.3 million more Americans are working full time. The poverty rate fell 0.5 percentage points from 2017, to 11.8 percent, the fourth annual decline in a row.

Yet 8.5 percent of Americans lacked health insurance in 2018, up from 7.9 percent in 2017, the first increase since the recession, and this figure is getting all the media attention. Much of the decline comes from a dip in Medicaid coverage, and as a general rule you’d expect fewer folks to qualify for Medicaid as the economy improves and poverty declines.

But Census notes that overall coverage fell one percentage point for people in families that earn 300 percent to 399 percent of the federal poverty line, and 0.8 percentage points for folks above 400 percent. “During this time,” Census notes, “the overall health insurance coverage rate did not statistically change for any other income-to-poverty group.”

These are the folks we’ve written about many times: Americans who earn too much to qualify for ObamaCare subsidies but may have few alternatives. The left’s solution is to reinstate ObamaCare’s individual mandate that forces the middle class to buy the product anyway. This shows that merely having access to insurance doesn’t mean it’s valuable.

The decline in Medicaid coverage doesn’t appear to be due to folks picking up insurance at a job, and the left is blaming the higher uninsured rate on Trump Administration policies including its rules on association health plans and short-term insurance options. But the point of association health plans is to make it easier for more small businesses to offer insurance to more workers. The rule is ensnared in court in any case.

The left is also flogging that uninsured rates are lower in states that expanded Medicaid under the Affordable Care Act than in those that didn’t. This is presented as a reason to expand Medicaid.

Yet our contributor Brian Blase notes that, according to the Census report, the uninsured rate increased from 2017 to 2018 in states that expanded Medicaid among those who earn less than 100 percent of the poverty line. That means some who are eligible for Medicaid declined to sign up. Mr. Blase and Aaron Yelowitz also explained last month in these pages how Medicaid expansion has unleashed a surge of improper enrollment by Americans who don’t qualify.

The larger point is that the only conversation the left wants to have about health care is how many Americans are insured, and that’s so they don’t have to answer for failures like Medicaid’s narrow provider networks, high emergency room use rates, and more.

Democrats running for President talk about proposals like Medicare for All exclusively as “universal coverage,” not about, say, how quickly you’ll be able to see a specialist. Having that insurance card in your wallet will be small consolation as you wait for a knee replacement allocated by political discretion.

By Patricia Older

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