We're about to begin year four of open enrollment under the Affordable Care Act or Obamacare. There's widespread agreement that the system, as written, cannot survive. But no agreement on how to fix it. And questions about whether any of the solutions politicians are proposing would do the job. Today, millions of Americans are left guessing about not only what's next but what's now. It's thrown us into a state that one of our favorite and most accurate analysts has dubbed "Zombiecare." And that's today's cover story.
Sharyl Attkisson: Are Americans required, with the ways things are today, to buy health insurance in 2018?
Robert Laszewski: Maybe they are,and maybe they aren't.
That's only the beginning of the lack of clarity surrounding America's current health care status.
Sharyl: As far as you know, is Obamacare still the law? Or what's the future about? Do you have any idea?
Stephanie Walker: No.
Sharyl: Is Obamacare still the law? Do you have to buy insurance? Like, do you even understand what's going on right now?
Kristian Anderson: I think it's just been really unclear coming from the White House.
Kim: There's no clarity as to what is going on and, like, they don't make the public knowledge easily accessible for people.
Clarence: I think we could explain it somewhat. I know it's a disaster. I think most of us do. It's been a mess for 50 years, and they haven't helped it any.
Our best shot at sorting things out is by consulting Robert Laszewski, an insurance industry adviser who's been incredibly accurate in his analysis,from the precarious beginnings of Obamacare. It's been seven and a half years since President Obama signed the Affordable Care Act into law.
Robert Laszewski: The law technically says that you have to have health insurance. If you don't have health insurance, you will pay a fine. But the Trump administration has told the Internal Revenue Service, who is in charge of collecting the fines, that when people file their tax returns, if they refuse to say whether they have health insurance or not, the IRS should not pursue them. You technically have to pay it. Your accountant's probably going to tell you, you technically have to pay it, but it's not being enforced.
Sharyl Attkisson: If nothing happens, nothing major to change what we call Obamacare, what happens to it?
Robert Laszewski: You know, I kind of call where we are with Obamacare now Zombie Care. I mean, it's just going to stumble along. A zombie's the walking dead. So, Obamacare is still there, it's still walking around. It's still selling health insurance plans to people. But it has no chance in its present form of ever offering affordable and attractive health insurance. And more and more people are just exiting it and going uncovered because they can't afford it.
Sharyl Attkisson: Is Trump correct that the plan that just failed, sort of partial reform and replacement, will be passed in January, February, or March?
Robert Laszewski: No, no. We've got two problems here. First of all, Democrats and Republicans aren't anywhere near close enough to each other to get anything done. For Democrats, the Holy Grail is not going backward on the insurance protection reforms and the Medicaid expansion. For Republicans, the Holy Grail is to go backward on the Medicaid expansions and loosen up the insurance protections. So, Democrats and Republicans are never going to agree here.
Sen. Bernie Sanders: Today, all of us stand before you and proudly proclaim our belief that health care in America must be a right, not a privilege.
Sharyl Attkisson: Can you describe in an easy sentence or two what single payer means?
Robert Laszewski: Single payer health insurance plans such as the one Bernie Sanders is proposing would have the insurance company become the government for everybody.
Bernie Sanders: Under Medicare for all, the average American family will be much better off financially than under the current system, because you will no longer be writing checks to private insurance companies.
Robert Laszewski: Bernie Sanders calls it 'Medicare for all.' And that's an accurate and simple description.
Sharyl Attkisson: Sounds like a good idea in some respects.
Robert Laszewski: It sounds like a great idea, and Bernie Sanders says that it if we do Medicare for all, people's premiums will be less. They'll likely not have deductibles and co-pays, or they'll be much less than they are. It assumes that if we just pay the Medicare fee schedule to doctors and hospitals, cost will come down dramatically, premiums will come down dramatically and deductibles will come down dramatically. The biggest lobbies in Washington, DC are doctor and hospital groups and pharmaceutical companies. They all spend more money than anybody else lobbying in Washington. So how long do you think it would take for them to lobby much higher reimbursement rates from the government? And they would just come back to the piggy bank every time they needed money. So, we would have a program that didn't cost less and didn't have lower deductibles and co-pays. It would be a mess.
Sharyl: President Trump talked about being able to sell insurance across state lines and that being a good practical solution, at least in part.
President Trump: The time has come to give Americans the freedom to purchase health insurance across state lines.
Sharyl Attkisson: What's your view of that?
Robert Laszewski: Selling insurance across state lines and association health plans, are the two dumbest ideas that have ever come out of Washington, DC and healthcare policy. And what they are is they're back door cherry picking ideas. You bring this plan in stripped down it attracts the healthy people out of the existing pool, drives the prices up for the people in the state domicile pool. You've just rearranged the deck chairs in the Titanic. That's all you've done.
Sharyl Attkisson: It seems like most of the solutions are oriented towards things that don't address the base cost of health care.
Robert Laszewski: Well Wonder why our healthcare costs are so high? The healthcare establishment has been getting unlimited dollars from government, from employers, from consumers. They built this incredible infrastructure now that's very expensive. And the only way we're going to make healthcare more affordable is to deal with all this infrastructure we've got and get it to an efficient place.
Sharyl Attkisson: How are we ever going to make the healthcare infrastructure dial itself back?
Robert Laszewski: We're going to have to do it over many years. In the private sector and the public sector, we're going to have to put them on a diet. It really is the prices we charge. We're going to have to, in real terms, ratchet those back so that hospitals and doctors understand there's going to be less money in the years to come.
Sharyl Attkisson: Here's the problem, I haven't heard of any proposal in Congress to address that.
Robert Laszewski: There isn't a single proposal to address that. They're not even talking about it.
Sharyl Attkisson: Why?
Robert Laszewski: Because if you start talking about taking money away from hospitals and doctors; They are the single largest lobbies we have in Washington, DC, the pharmaceutical industry, the hospital lobby, the American Medical Association, all the provider associations. No lobby is stronger. These are incredibly politically powerful forces. They just keep sucking more of your money.
Meantime, he says, the Zombiecare form of Obamacare stumbles along.
Robert Laszewski: Obamacare has had some significant successes and some significant failures. Obamacare is working pretty well for the lowest income people who qualify for Medicaid in the 31 states that have expanded. So they've got comprehensive health insurance. You've got low income people being able to afford pretty good health insurance plans, because they're so heavily subsidized. But the middle class is just getting clobbered, both because they face huge deductibles and huge premiums. And the premiums are just going to go up. I mean, we're going to see premiums go up in 2018, typically, another 15-20 percent. In many states, we're seeing 50 percent rate increases.
We recently heard from Sen. Lindsey Graham on the Republican's latest attempt at Obamacare replacement, which failed. We asked Independent Senator Bernie Sanders for an interview to explain his concept of single payer health care, but he didn't respond.