Congress Explores Pathways to Universal Health Coverage

WASHINGTON — The House Education Subcommittee on Health, Employment, Labor and Pensions recently met to discuss possible pathways to affordable, universal health coverage for Americans. 

“Simply put, the steps taken in the American Rescue Plan made coverage more attainable for millions — and these reforms have saved lives. While the U.S. has made progress in terms of coverage over the course of the past decade, millions of Americans remain uninsured or underinsured,” said Rep. Mark DeSaulnier, D-Calif., chairman of the subcommittee, during the hearing.

A typical American household pays $8,975 a year for health insurance, according to a study from The Motley Fool, a private financial and investing advice company. 

Data also shows that the yearly average Americans spend on health care is more than twice the average in the world’s 35 most advanced economies.

DeSaulnier said in California, there is a public option known as the Contra Costa Health Plan, which is a collaborative effort among commercial insurers and Kaiser Permanente, which keeps health care prices low and quality high for those who are enrolled in the plan in the San Francisco Bay Area. 

For the past two years, a public option has also been available in Washington state that allows residents purchasing their own policy on the state’s health insurance marketplace to sign up for the public option instead.

Washington residents who receive a lower income may also qualify to receive subsidies that lower health care costs.

So far, Washington state has seen low enrollment numbers in these plans and has experienced difficulty in getting hospitals to participate in the public option plans. 

Robert Reich, who served as the secretary of Labor under former President Bill Clinton and is currently the chancellor’s professor of public policy at University of California at Berkeley, said during the hearing that there could be a limited version of the Medicare for All plan rolled out at the federal level. 

The plan proposed by Reich would allow insurance costs to remain the same but be paid through taxes rather than by individuals directly.

Under Reich’s suggested model, the government would reimburse insurance companies which he said would allow for lower administrative expenses and drug costs. Economists from the University of Massachusetts Amherst provided a report which estimates a 10% reduction in costs under a Medicare for All plan. 

“The administrative costs for private for-profit health insurance are substantially higher than the administrative costs of what might be called Medicare for All … You’ve got one third of nurses’ time, for example, looking at billing, and you’ve got all sorts of marketing and advertising costs,” said Reich.

“We see in private for-profit health insurance more and more of consolidation, which means more and more market power to drive up these costs,” said Reich. 

The U.S. spent $4.1 trillion on health care in 2020, according to the data from the Department of Health and Human Services. Although that accounts for nearly a fifth of the gross domestic product, still 30 million Americans remain uninsured. 

“We are not getting nearly our money’s worth. If we have 30 million people who are uninsured — have no health insurance at all and they don’t have any preventive care — even those who do have insurance are paying copayments and deductibles that are so high that they are deterred from seeing doctors. That means that they’re not getting the preventive care they need, which is driving up the total costs,” said Reich.

Despite the proposals and findings presented by Reich, not all members at the hearing thought that the Medicare for All plan was the best solution to reducing health care costs for Americans. 

“We should be promoting policy solutions that expand the ability for employers to continue offering high quality health coverage for their employees,” said Rep. Tim Walberg, R-Mich., during the hearing. 

“I would encourage [the committee] to take up the Association Health Plans Act legislation I have offered with Republican leaders on this committee, that would lower health care costs for hundreds of thousands of small businesses, employees and sole proprietors,” said Walberg.

In light of the ongoing labor shortage, Walberg said employers should recognize that survey data shows 75% of Americans say that health care coverage played a role in their decision to accept their current job. 

Walberg said the Association Health Plans Act would equip small businesses with more resources and bargaining power to get on the same playing field as large employers through an association health plan or AHP. 

In 2018, the Department of Labor finalized a regulation to enable association health plans to escape Affordable Care Act market rules.

At the time, the Congressional Budget Office projected that these new AHPs would cover as many as four million people by 2023, half a million of whom would have been uninsured.

In March 2019, a federal judge invalidated the pathway and the Department of Justice appealed the decision during appellate court hearings in November 2019.

The AHP that formed as a result of the rule, mostly through local chambers of commerce, provided comprehensive coverage to consumers, according to research from the U.S. Chamber of Commerce, who expressed disappointment at the court’s decision.

In 2021, President Joe Biden issued an executive order that revoked the previous executive order under the Trump Administration for the DOL to issue the AHPs regulation.

Biden also tasked the DOL to review all existing regulations and consider whether to suspend, revise or rescind any regulations which may be inconsistent with the Affordable Care Act.

In the meantime, the courts have granted the Biden administration a motion to pause the appeal while the DOL considers further agency action. 

“Expanding AHP really would reduce inflationary pressures,” said Walberg.

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