Upton update on ACA
Cross-posted at Alevei.
In my previous post, I wrote about Rep. Fred Upton (R-MI) and my concerns regarding his position on the Affordable Care Act (ACA), which I expressed in a letter to the congressman reprinted in that post. Here is his response:
Detail of handwritten note:
According to FactCheck.org, the Blue Cross family plan for federal employees “carries a total premium of $1,327.80 per month, of which the beneficiary pays $430.04.” The American people pick up the tab for the difference ($897.76 per employee per month). You can see the full 2012 rate schedule (pdf) for federal employee health benefits here.
I think subsidizing the health coverage of our citizens is an excellent use of public money, and I wish that all Americans could enjoy the level of coverage that Rep. Upton and I are fortunate to have at a price that is affordable for our families. I am a professor at a public university with an insurance plan that is similar to Rep. Upton’s, and my costs are similarly subsidized by my employer, the state of Michigan, although I can’t resist mentioning that the annual cost to the insured for the family plan offered by Rep. Upton’s employer ($5,160.48) is actually a tad lower than the cost to participants in my employer’s family plan ($5,228.41).
Unfortunately, as well all know, a lot of Americans who are unemployed or whose employers don’t provide insurance for them can’t afford the full, unsubsidized premiums they would have to pay to get coverage for their themselves and their families. The full annual premiums for the family plans offered by Rep. Upton’s employer and mine are nearly $16,000 apiece. He and I are truly fortunate that our employers subsidize our costs to the tune of around 2/3 of the total premium for our coverage.
Quick aside here: Another nice benefit Rep. Upton and I enjoy is that our premium contributions are deducted from our paychecks before taxes, so we even get a little tax break in the bargain without a bit of effort required on our parts, which is of course not the case for those who have to pay full price for insurance on the open market. Well, I should qualify that by saying that employees at my university on the two-person or family plan get the tax break if their covered partner is someone with whom they are in what some Republicans like to call a “traditional” marriage. Colleagues who are legally prohibited from marrying their partners have pointed out that they do not receive the same tax benefit. While I am proud that in 2008 the faculty at my institution fought for and won “designated eligible individual” (DEI) benefits so that employees in same-sex unions today enjoy the same health coverage for their spouses that we straight folks have always had, so far it is minus the tax break. 
Anyway, back to healthcare, which will continue to be out of reach for many Americans who aren’t as lucky as Rep. Upton and me if he and his friends get their way. In 2010, over 50 million Americans had no health insurance. And according to the Kaiser Family Foundation, another 25 million Americans who technically have insurance have such insufficient coverage that the results are often the same kinds of health-threatening delays in seeking care for which uninsured people are also at risk as well as excessive out-of-pocket costs. Further, according to a new study by researchers at the Bloomberg School of Public Health at Johns Hopkins University, the underinsured may also be at a significantly higher risk for adverse health outcomes than the adequately insured. Those without coverage altogether, of course, are at the highest risk for adverse outcomes.
Recently, when Senate Minority Leader and adequately insured federal employee Mitch McConnell (R-KY) was asked by Fox News anchor Chris Wallace, “What specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?” (I’m sure he meant 50 million), the well-compensated public servant from Kentucky had this response:
That is not the issue. The question is how can you go step by step to improve the American health care system? It is already the finest health care system in the world.
For him, maybe it is.
However, as Reuters reported in June, “More than 26,000 working-age adults die prematurely in the United States each year because they lack health insurance,” according to a new study by Families USA. The study found that “a record high of 26,100 people aged 25 to 64 died for lack of health coverage in 2010, up from 20,350 in 2005 and 18,000 in 2000. That makes for a rate of about 72 deaths per day, or three per hour.”
That is not the issue.
On average, says RAND health policy analyst Dr. Arthur Kellerman, who is quoted in the article, “The uninsured get health care about half as often as insured Americans.” He adds, “There is an overwhelming body of evidence that they get less preventive care, less chronic disease care and poorer quality hospital in-patient care.”
That is not the issue.
Sen. McConnell’s refreshingly candid response, making no bones about the fact that he and his party do not give a rat’s ass about the uninsured, also helps to support the assertion I made in my previous post that, despite Rep. Upton’s (somewhat disingenuous) protestations to the contrary, the zeal of Republicans in both houses of Congress to try to defeat President Obama in November far outweighs any concern that these public servants might have for the health and well-being of the upwards of 75 million uninsured and underinsured human beings in this country, a number which, by the way, is set to decline significantly over the next few years, thanks to the ACA, only not if Rep. Upton and his buddies can help it.
My position is that all Americans deserve the same quality of care, regardless of where (or if) they are employed or how much insurance or care they can afford. I consider this a moral issue. But I do not see why it is not also a position that fiscal conservatives can get behind. As CNN Money reported in 2009, before ACA, “The problem, according to health care industry experts, is that the government and those with employer-based plans will have to pick up the tab as more Americans are unable to pay their entire medical bill.”
It’s funny because that sounds a lot like what Republicans are saying now about the ACA. As NPR News reported last month, some analysts have identified Republican claims that the ACA is a way of “requiring people who already have health insurance to help pay for those who don’t” as “a calculated political tactic.” (You don’t say.)
You know, because “requiring people who already have health insurance to help pay for those who don’t” would be something totally new and different.
Never mind about any of this, then:
1. “Nationwide, the total amount of uncompensated care provided to the uninsured reached an estimated $56 billion in 2008, according to one study,” the LA Times reports. “Those costs have prompted financially strapped hospitals to rely on a complex system of shifting costs. Most of the burden falls on taxpayers, with the government providing tens of billions of dollars annually to help hospitals care for the uninsured. Privately insured Americans also pay a price as insurers raise premiums to reflect higher charges from hospitals.” (L.A. Times, 06/18/2012.)
2. “The mandate-supporting economists persuasively show that being uninsured predictably involves unavoidable commercial activity, and costs taxpayers and others money. The mandate-opposing economists dispute the extent of those effects, but this is an issue where size really doesn’t matter.” (Daily Beast, 03/25/2012.)
3. “Texas Governor Rick Perry says he won’t expand Medicaid eligibility under the health reform law because he wants to spare taxpayers billions of dollars. But many Texas taxpayers are already shouldering the burden of the state’s uninsured through higher property taxes and heftier health insurance premiums.” (CNN Money, 07/30/2012.)
4. “Private health insurance premiums are higher, at least in part, because uninsured people who receive health care often cannot afford to pay the full amount themselves. The costs of this uncompensated care are shifted to those who have insurance, ultimately resulting in higher insurance premiums for businesses and families.” (Families USA, May 2009.)
In sum, the ACA is a step in the right direction, but I think it doesn’t do nearly enough to extend coverage or to control costs. I would prefer a single-payer system, but until we get one, I fully support the ACA as a major improvement over what came before and certainly over the whole lot of nothing (and less than nothing) that we have been seeing from the GOP, which as I have suggested previously, has no incentive either to extend coverage or to limit the potential profits of its corporate overlords.
NB: The Washington Post reports that members of Congress “receive the same basic health insurance coverage as rank-and-file federal employees” but that “lawmakers also have access to other services not available generally.” These additional services, detailed in the article, are opt-in, and I don’t know whether Rep. Upton takes advantage of any of them. But as a member of Congress, he does have the option. Other federal employees do not.
 Those who follow Michigan politics know of course that the battle to protect benefits for LGBT state employees and their families is nowhere near over. For the time being we have been able to preserve benefits for same-sex couples on our campus by codifying them as Designated Eligible Individual (DEI) benefits rather than specifically as “partner” benefits. (The DEI can be a domestic partner, an elderly parent for whom the employee is primary caregiver, a grown child who is incapacitated, and so forth.)
We have also been able to hold the line for now because of (1.) our status as a union campus with a binding contract that runs through September 2014, and (2.) the Michigan Constitution’s prohibition against legislative interference in the self-governance of state universities (I mean, beyond the extent to which their budgetary spite interferes). However, the governor appoints trustees to the boards of several public universities (including mine), so it would be possible to end-run our self-governance if the current governor is in office long enough to stack the board, which will require his re-election to a second term. Additionally, collective bargaining rights for state employees in Michigan are far from secure.
BTW, Rep. Upton is not likely to be of any help with protecting LGBT rights and benefits. In the 112th Congress, he earned a score of 13% from the Human Rights Campaign, which also reports his courageous stance on the issue of marriage equality as “Unclear, Unknown or No Response.” Way to lead, Rep. Upton.