The Urgent Need for Healthcare Reform NOW
- T Michael White MD FACP
- Jan 6
- 3 min read
David Emory Lippman MD ABIM DipABLM
“It is health that is real wealth and not pieces of gold and silver.” - Mahatma Gandhi
Monday, January 6, 2025
Dear Mr. President, Honorable Members of Congress and Distinguished Staff and Fine Citizens,
I am an internal medicine physician who has worked with the underserved for nearly 25 years. I was the medical director of a free clinic in Owensboro, Kentucky, for five years. In 2005, I moved to ECHO, a federally qualified healthcare center in Evansville, Indiana, becoming medical director the following year. Every day I am confronted with the problems of health coverage in America.
One of the largest tax breaks delivered by the Biden administration came through the Inflation Reduction Act. I believe many Americans are unaware of just how large the impact of this act has been on the cost of monthly health insurance premiums under the Affordable Care Act. According to the Kaiser Family Foundation, the average monthly premium for an individual on the exchange was $605. However, this cost is largely reduced for many individuals by the government. The average premium paid by an individual after the “Advanced Premium Tax Credit” (a government subsidy) is actually $111.[i] That is, the government saves the average individual nearly $500/month or nearly $6,000/year. Further, there was a significant subsidy enhancement effected by the Biden Administration under the Inflation Reduction Act. Because of the subsidy enhancement, many more individuals have taken advantage of the ACA during the Biden Administration. The number of people receiving care through the ACA has nearly doubled in less than 5 years, from 11.3 million in 2020 to over 21.4 million in 2024.[ii]
The primary issues driving the new Congress are extending the prior Trump-era tax cuts and working on immigration reform. These can both be expensive endeavors (the former alone has a cost of up to $4 trillion over 10 years[iii]), and there is a strong desire for more tax cuts. It is likely that a great deal of this expense could be borne by increasing premiums for individuals and families covered by the Affordable Care Act. A quick back-of-the-envelope calculation estimates that the government subsidies to the ACA ($6,000 for 21 million individuals) total over $125 billion a year.
It is my belief that many who are receiving ACA coverage are simply not aware of the significance of this government subsidy. If these subsidies are curtailed, premiums could increase dramatically and make such coverage simply unaffordable for many. Those affected could feel very vulnerable as they face the potentially devastating cost of healthcare. It could lead to widespread anger and frustration among the public. Further, these 20 million individuals are mostly of voting age and, if they feel that healthcare is a necessity for their own life, may vote largely on this issue.
I think it would be wise for politicians of both parties to take this issue very seriously at the present moment. Dr. Mehmet Oz, who was picked by President-elect Trump to run the Centers for Medicare and Medicaid, has previously advocated for a Medicare Advantage Plan for All.[iv] Although I personally am disgusted by the apparent billing practices of current Medicare Advantage plans (regarding this issue, I strongly recommend the Wall Street Journal article “Insurers Pocketed $50 Billion From Medicare for Diseases No Doctor Treated”[v]), I do believe that, for the well-being of our population, the idea of a Medicare Advantage Plan for All should be discussed.
I personally favor a Medicare For All or public health insurance option, but as the Democratic presidential nominee would not support either in 2020, I do not see any possibility of that happening now. By drastically increasing the pool in the Medicare Advantage plans, the cost for all Medicare Advantage plan members could be reduced. Further, it could allow portable insurance coverage for individuals who lose their jobs. Lastly, such a plan may work to promote healthy behaviors like increased walking, smoking cessation, improvement in sleep, increased social connection, and weight loss, thereby potentially reducing the cost of future healthcare expenses.
Regardless, healthcare and how to pay for it for our citizens is an issue I believe our country needs to face, and we need to face it now.
Respectfully submitted,
David Emory Lippman MD ABIM DipABLM
Copy to: We The People at fixingushealthcare.com
[i] https://www.kff.org/affordable-care-act/state-indicator/marketplace-average-premiums-and-average-advanced-premium-tax-credit-aptc/?currentTimeframe=0&selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
[ii] https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/
[iii] https://www.americanprogress.org/article/permanently-extending-the-trump-tax-cuts-would-cost-4-trillion-over-the-next-decade/
Dr. Lippman thank you for your insightful paper. Your experience qualifies your comments as insightful and highly relevant and truthful. The potential will exist for essentially any universal US health care system to provide opportunities for fraud be it Medicare advantage or medicare alone. Yet, as you note, universal coverage may promote opportunities for incentivizing Personal health behaviors. Importantly, there will be a role for strong oversight of each company who takes on the role or providing care for a share of the American Populace and keen monitoring of those entities to prevent fraud, or inappropriate billing will need to be clearly demonstrated on a very regular basis. If you have specific thoughts on the best way to do…
Very well said, Dr Lippman. I would also like to point out that the Obamacare Plans are not first dollar coverage either - the premiums are only the beginning of the costs born by individuals insured by these plans. Even with the reduced premiums, these families can be one hospitalization away from financial ruin. If the premiums increase for these families for whatever reason, what is barely possible now would likely become impossible for many. Thanks for your thoughtful and accurate analysis of the situation!
Thank you Dr. Lippman. The access and affordability issues are clear. The timing is now. TMWMD