"Less is more" works in architecture, but not in health care. With ideas floating around in Washington to cut back on health care coverage, Illinois should do what it can to protect its residents.
In July, Gov. JB Pritzker signed the Healthcare Protection Act. The law prohibits "step therapy," which forces patients to undergo less effective treatment before they're allowed to get the treatment doctors recommend. The law also bans prior authorization for mental health coverage and junk insurance, which can be cheaper but has gaping holes in coverage.
But there are other looming challenges for Illinoisans and people around the nation.
At the end of next year, for example, the enhanced subsidies for the Affordable Care Act, also known as Obamacare, are scheduled to expire. If that happens, according to the Center on Budget and Policy Priorities, a typical 60-year-old couple making 405% of the poverty level would see marketplace premiums go up by about $17,500 a year.
Without the enhanced subsidies, the Congressional Budget Office estimates, ACA enrollment will drop from 22.8 million in 2025 to 15.4 million in 2030. That's a lot of people who will lose their health insurance.
And just on Dec. 20, Congress dropped from a reauthorization bill an overhaul of pharmacy benefit managers that would save people money. Pharmacy benefit managers negotiate drug prices with pharmaceutical companies and help determine what medications are covered by insurance firms. The bill also dropped a measure that would have prevented a 2.8% Medicare payment cut starting on Jan. 1. The cut means payments to doctors will go down even as costs continue to go up.
There are many flaws in today's health care system. Many people are angry, for example, about how they sometimes can't get health care because an insurance company denies payments — through a "preauthorization process" — for the treatment doctors prescribe. Many people also are upset about "automated denials of coverage," in which algorithms instantly deny claims for medical services without an actual person looking over a claim.
And then there are the high co-pays in some circumstances that price all-important — even life-saving — medications out of people's reach, even those who are fully insured.
No wonder the nonprofit social science research group FrameWorks Institute reports "70% of Americans believe that people in power are rigging the system to benefit themselves at the expense of the rest of us."
Because of shortcomings in the existing system, about half of adults nationwide struggle to afford health care. One in four adults say in the past year they have skipped seeking health care because of the cost. One in five say they have not filled prescriptions also because of the cost. On Dec. 6, Gallup and West Health reported Americans’ opinion of health care has declined to a 24-year low.
But in today's political climate in Washington, the big upcoming battles appear likely to be over protecting what people already have as some lawmakers look for cutbacks to help pay for extending provisions in President-elect Donald Trump's tax cuts geared to the wealthy. Those provisions are scheduled to expire at the end of 2025.
Proposals to undercut private health insurance, weaken the ACA, cut back on Medicaid and undercut Medicare have been floating around. Snake oil mongers likely will be trying to sell those ideas as ways to improve the health care system. Instead, those concepts would make things worse.
Unfortunately, comparatively little time was devoted to discussing these issues in the recent presidential campaign. People did not get to hear a robust debate over what is truly needed to improve health care and what would simply line the pockets of those who run the system while ordinary people are left worse off.
State lawmakers need to continue looking for ways to shield Illinoisans from poor-quality health care. And voters should educate themselves on what any new proposals really mean and put all the pressure they can on Washington to demand a better — not worse — health care system.
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