American Healthcare: Lacking, with Exception of Congressional Healthcare, Beyond the Reach of Low Income Citizens

The recent Democratic debate exposed some of the continuing problems we, here in America, have with making health care accessible to all. Our solutions over the years have not only been the most expensive, they have also delivered the least. Let's take a look.

There are currently seven major government health care programs —

• Congressional Healthcare Program,
• Medicare,
• Medicaid,
• State Children’s Health Insurance
Program (SCHIP),
• Indian Health Service (IHS)
• TRICARE, an enormous and complex health care system that includes, but
is not necessarily limited to:

▸ TRICARE for Active Duty Members and their Dependents,
▸ TRICARE for Reservists & Guard Members and their Dependents,
▸ TRICARE Overseas Programs
▸ TRICARE for Retirees
▸ TRICARE for Children Ages 18-26,
▸ TRICARE Dental Benefits
▸ TRICARE Pharmacy Benefits
▸ TRICARE Vision Benefits
▸ Transitional Health Benefits for Recently Separated Service Members
• Veterans Health Administration

These seven major government health care programs serve members of Congress, older persons, persons with disabilities, low-income mothers and children, active-duty military personnel and their dependents, Native Americans and Veterans.

The Congressional Healthcare provides care for members of Congress and their family members.

Prior to January 1, 2014, Members and congressional staff participated in the Federal Employee Health Benefit (FEHB) program, like other federal employees. With the passage of Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) requirements changed. Members and congressional staff now receive employer-sponsored insurance (ESI) through a plan or exchange created under the ACA. This is probably one of the reasons the Republicans hate the ACA, so much. More later on the ACA.

Members of Congress and staff members are able to enroll in anyone of the plans offered, and the government will contribute a generous 72%, not to exceed 75% of any given plan’s premium.

In addition, OPM administers a Flexible Spending Account (FSA) program for eligible members and staff. Members of Congress also qualify for some medical benefits that ordinary federal workers do not. They (but not their families) are eligible to receive limited medical services from the Office of the Attending Physician of the U.S. Capitol, and they are also eligible to receive care at military hospitals. For outpatient care, there is no charge at the Washington, D.C., area hospitals (Walter Reed Army Medical Center and National Naval Medical Center).

Three of these programs—Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP)—were devised for groups for whom the health care market has historically failed to work because of the members' high health care needs and low socioeconomic status.

The remaining three programs—DoD TRICARE, VHA, and IHS—serve particular populations with whom the federal government has a special relationship-- military personnel and their dependents, veterans, and Native Americans.

These federal government health care programs serve more that 100 million citizens at a cost of more than $500 billion annually. In addition, each of these programs has its own bureaucracy to oversee their day-to-day operations.

It 1986 Congress also enacted the Emergency Medical Treatment & Labor Act (EMTALA). EMTALA's purpose is to ensure public access to emergency services regardless of ability to pay. Since its enactment, EMTALA has become the de facto national health care policy for the uninsured. The program has created severe financial stress on emergency departments across the nation, forcing closure of many because of EMTALA’s unfunded mandate.

In 2010 the Affordable Care Act (ACA) was enacted by Congress. The Republicans renamed it "Obamacare” and convinced many that it was a failure. Since the ACA’s inception, the Republicans have tried unsuccessfully 30 or more times to repeal all or part of the ACA.

Hillary wanted to build on the ACA, while Senator Bernie Sanders wants to move to a "Medicare for All" single payer program that would cover EVERY citizen from the moment of conception to the moment they pass away.

The ACA offers numerous benefits, such as, but not limited to, an end to denial of coverage based on pre-existing conditions, but the ACA also depends on expansion of the Medicaid program to cover the poorest citizens among us. Unfortunately, 24 states have refused to expand Medicaid, depriving more than 5.7 million people of health insurance coverage.

Do the math. If we were to expand Medicare to cover every citizen, as Bernie Sanders is calling for, we could abolish the Congressional Healthcare Program, Medicaid, SCHIP, TRICARE, IHS and EMTALA, and we could save hundreds of billions of dollars. Money that could be applied towards funding the proposed single-payer “Medicare for All program.”

Which would you prefer?