Americans Lose Insurance Under Trump; Private Payers Delay Coronavirus Testing

Adding insult to injury, Donald Trump helped more Americans lose their health insurance before the coronavirus pandemic started putting hundreds of thousands of Americans in the hospital:

The ranks of the nation’s uninsured continued to grow last year, even before the arrival of the coronavirus pandemic that’s devastated the economy, new federal data show.

Nearly 30 million Americans went without health coverage at some point in 2019, up by roughly 1 million from the previous year, according to new U.S. Census Bureau data. The figures show continued losses in health insurance under the Trump administration, slightly eroding coverage gains made following passage of Obamacare a decade ago.

…Health insurance experts say President Donald Trump’s efforts to undermine Obamacare have contributed to the growing number of uninsured, though it’s hard to say how much could be attributed to his administration’s policies. The experts say Trump’s expansion of short-term health plans and elimination of the unpopular individual mandate penalty have weakened the law’s health insurance marketplaces.

Their concerns are echoed in the census data. Even though more people enrolled in employer-sponsored insurance last year, the number of people buying direct coverage, including Obamacare plans, declined by 0.3 percentage points. Medicaid, the health care program for low-income people, also saw a 0.7 percentage point decline, even as Medicare enrollment grew [Susannah Luthi, “More Americans Lacked Health Insurance Last Year—Even Before Pandemic Hit, Census Reports,” Politico, 2020.09.15].

By the way, our Medusan tangle of private insurers is getting in the way of an effective national testing regime to control the pandemic:

…We’re dominated in the United States by three, four big commercial labs, and they have the logistics. No. 1, you have to have contracts with all the insurers to bill in our kind of crazy, fragmented system. So part of the lunacy of our testing system is the lunacy of our health care system.

…When I visited the Broad, that institute was doing 3,000 tests a day. Today, they hit 60,000 tests per day supporting colleges, universities, nursing homes that need testing. And they’re continuing to do it with a next-day turnaround time. I have spoken to labs in California, in Minnesota, in Alabama that are bringing on similar levels of capacity but don’t have those interconnections. What did the Broad do? Well, for colleges and universities, you don’t have to set up the billing system so that you can get it from the insurers. The universities and colleges are paying for it out of their own pocket. The Broad’s costs are about a third of what the current going rates are. You know, usually the cost of processing a test is about $100 plus $50 to $80 for the logistics around that. They’re charging $35 for test processing. And I’m seeing even lower costs that the other labs are willing to bring onboard if we make these interconnections come into place [Dr. Atul Gawande, interviewed by Mary Louise Kelly, “How the U.S. Could Solve the Coronavirus Test Mess,” NPR: All Things Considered, 2020.09.14].

Single-payer, faster cheaper tests. A virus kills 195,000 Americans in seven months (World War II needed four years to kill 292,000 Americans), and we can’t adopt some simple national health payment policies to wage war on this enemy. It’s as if the Japanese bombed Pearl Harbor and President Roosevelt told us that instead of nationalizing production and deploying the United States Armed Forces, he wanted private workers to buy their own bazookas and scoot across the Pacific in their fanboats to take down Hirohito.