Health care costs a major concern for voters ahead of midterms

Geoff Bennett:

The midterm elections are closing in, and once again, health care costs, including loss of insurance coverage through the Affordable Care Act, are at the center of a political debate.

According to national data, enrollment in the marketplaces created by the ACA dropped by roughly three million people this year. That's mainly due to the expiration of enhanced federal tax credits last year. And it's leading to an average premium payment surge of 114 percent for many enrollees.

This week, Vice President J.D. Vance announced plans to cancel coverage for nearly 760,000 more people who get insurance through Obamacare, citing claims of widespread fraud.

J.D. Vance, Vice President of the United States: We expect that most of these people are fraudulently enrolled. But we're going to do some additional verification on about 419,000 people. We're going to make sure that they're, first of all, legal residents of the United States of America.

And, second of all, we're going to make sure that they actually meet the income threshold requirements in order to receive these Obamacare benefits.

Geoff Bennett:

For more on what this could mean for those relying on Obamacare for coverage, we're joined now by Larry Levitt, executive vice president for health policy at KFF. That's a nonprofit health policy research organization.

Thanks for being with us.

Larry Levitt, Executive Vice President For Health Policy, KFF:

Thanks for having me.

Geoff Bennett:

So when Vice President J.D. Vance says this move will save taxpayers $2.2 billion, and it's all aimed at rooting out abuse, what evidence is there that thousands of people were improperly enrolled?

Larry Levitt:

Well, I think the reality is that there is fraud in the Affordable Care Act or Obamacare marketplaces that is mainly perpetrated by rogue insurance brokers who are either signing people up against their will or counseling people to mislead about their income or circumstances.

And I think the administration's efforts to root out this fraud are legitimate. But at the same time, as you said, millions of people have lost coverage due to the expiration of the enhanced premium tax credits at the end of last year. So there is fraud, and the administration is taking efforts to eliminate that.

At the same time, millions of people, real people, are also losing their health insurance.

Geoff Bennett:

Is there an appeals process for people who have been dropped from their ACA coverage? How does that work?

Larry Levitt:

Yes, there is.

I mean, these are people who lacked a Social Security number or proof of their immigration status on their applications or on the federal data systems. And they were given 30 days to -- after being notified by their health insurer to confirm their details.

Now, we all know we all let mail pile up. We don't necessarily follow through on things. So these people got dropped, but they will have an opportunity to get back on if they legitimately are eligible for health insurance coverage.

Geoff Bennett:

We know that health care costs are a major concern ahead of the midterm elections. And according to KFF polling this summer, it found that 51 percent of voters say it's extremely important for candidates to address this issue.

What is putting the most pressure on household budgets right now? Is it premiums, deductibles, prescription costs, all of the above?

Larry Levitt:

Well, if you even back up a little bit, I mean, we have asked people, when you say the cost of living or economic concerns are your biggest worry, and no doubt that is what is on voters' minds. Health care and gas prices are the two household expenses that people are most worried about.

So it's not surprising that people want candidates to be talking about health care costs. And it really is all of the above. And it's not just people getting coverage through the Affordable Care Act. It's people in employer plans. That's over 160 million people. They're seeing their premiums go up. They're seeing their deductibles go up.

And that that's putting a crunch on household budgets. I mean, people are going into medical debt. There's over $200 billion in medical debt that Americans are holding, or they're cutting back on other household expenses.

Geoff Bennett:

What's making employer-sponsored coverage more expensive? What's driving that?

Larry Levitt:

Well, people blame their insurance companies, and there is certainly plenty of blame that could be put on insurers for the problems people have in the health care system.

But the reality is, insurance companies are not the only problem here, and, in fact, they're not the biggest problem. The vast majority of the reason that health insurance premiums are going up is that health care expenses are going up. Health care prices are going up. And that is mainly hospitals.

I mean, hospitals have driven 40 percent of the increase in health care costs in recent years. I mean, the hospitals are merging, they're getting bigger, they're raising prices, and that's a big reason health care costs are going up.

Geoff Bennett:

So, what then is a viable solution?

Larry Levitt:

Yes, that's what elections are for, right...

Geoff Bennett:

That's true.

Larry Levitt:

... to see what the solutions are going to be.

And the parties are far apart. I mean, we started talking about this health care fraud that the administration has been emphasizing. In many ways, Republicans and Democrats are talking past each other. I mean, Republicans are talking about fraud.

That certainly can increase federal government costs, but rooting out this fraud is not going to help people struggling to meet their household expenses, and including health care costs. Democrats are putting forward a wide range of proposals. Progressive Democrats are arguing for Medicare for all, a government system that would cover everyone.

Moderate Democrats are talking about more incremental steps, restoring those premium subsidies that expired at the end of last year, restoring the over $900 billion in Medicaid cuts that Republicans passed last year, capping hospital prices.

And if Democrats win the house or even win the Senate as well, President Trump will still be in the White House. They may be able to get some things done, but they're not going to be able to implement their entire health care agenda.

Geoff Bennett:

Larry Levitt, executive vice president for health policy at KFF, thanks again for your time this evening. We appreciate it.

Larry Levitt:

Thank you.