• In new survey findings, 45% of respondents fear a medical event could leave them bankrupt.
  • Few seniors expect Congress to act on cost concerns.
  • Tax concerns could turn senior voters against Democrats pushing Medicare expansions.

April 15—Affordability concerns are impacting the healthcare of a growing number of Americans, according to new polling. However, there is little chance that Congress will address that issue before the 2020 election, political analysts say.

Gallup polling released this week at the Aging in America conference found extensive financial impacts on healthcare access and planning:

  • 45% fear that a major health event will leave them bankrupt
  • 21% of Republicans and 27% of Democrats have deferred care due to costs
  • 70% of Republicans and 67% of Democrats are not confident that Congress will take steps to address costs
  • 73% of seniors expect healthcare costs to increase

Mike Ellrich, healthcare portfolio leader for Gallup, said 880,000 bankruptcies are linked to healthcare costs annually, and in the last year $22 billion has been removed from long-term savings to pay for care. An estimated 7.5 million seniors were unable to pay for drugs prescribed by their doctors, with eight in 10 of those seniors saying the prescription was for a serious condition.

Additionally, one in 10 seniors did not seek care for a health problem due to costs, and 41% of those earning less than $60,000 fear they will be unable to afford basic healthcare in the next year.

Despite such concerns, 56% of seniors believe the U.S. healthcare system is the best — or among the best — in the world.

Although Ellrich questioned such beliefs in light of healthcare rankings comparing the United States with other first-world countries, such surveys’ key outcomes — such as life expectancy — have little to do with the quality of care provided and instead stem from factors like lifestyle and socioeconomics.

Outlook for federal action

Gallup respondents were not optimistic about the prospects for change:

  • 82% of seniors say the federal and state governments are fully responsible for rising healthcare costs
  • 75% of seniors say the federal government is not doing enough to ensure healthcare is affordable
  • 80% of seniors say the government is not doing enough to ensure prescription drug affordability
  • Two-thirds of Republicans and Democrats were not confident elected representatives will enact bipartisan legislation to address healthcare costs

Political and policy analysts were split on whether the 2020 election will serve to clarify and drive federal healthcare policy changes.

“Heading into the 2020 election, we’re going to see health emerge as one of the number-one issues feeding voter behavior,” said Tim Lash, chief strategy officer with West Health.

John Zogby, founder and senior partner with John Zogby Strategies, said healthcare was the leading issue in the 2018 election and is likely to be in the top three in 2020.

But Jay Newton-Small, a writer for Time, said 2020 is shaping up as the first election since 2006 where “nobody’s talking about healthcare. Very few [Democratic presidential candidates] even have healthcare platforms up on their websites yet.”

Instead, she expects states to drive healthcare policy changes in the short term.

Where healthcare policy could stall

Richard Eisenberg, managing editor and senior web editor for Next Avenue, highlighted the growing number of Medicare expansion proposals, including the recently reintroduced “Medicare for All” bill sponsored by Bernie Sanders.

But little detail has been provided about the implementation of such proposals. For instance, Sanders has not identified the costs of his proposal or any way to pay for it.

“It’s hard to imagine where you’ll get the money to pass a $4 trillion healthcare plan,” Newton-Small said.

The Medicare expansion proposals could raise concerns among seniors.

“They may fear, or they may be told to fear, that it’s going to raise their taxes,” Eisenberg said.

Zogby said President Donald Trump has reached out to senior voters on the issue and may win over a portion of those voters due to cost concerns surrounding Medicare expansions.

That outlook for Medicare expansion comes as the cost of seniors’ healthcare continues to rise, reaching an estimated $285,000 spanning the retirement years of a couple leaving the workforce this year, Eisenberg said. That’s an after-tax estimate and does not include long-term care.

“That’s why older Americans will be especially interested in what the 2020 candidates have to say about bringing down healthcare costs,” Eisenberg said. That concern likely helped Democrats take control of the House of Representatives and preserve the Affordable Care Act (ACA).

However, Eisenberg noted the low-profile failure of a 2018 Maine ballot initiative, which would have created a universal home-care benefit for seniors and the disabled, funded by a 3.8% tax on people with incomes over $128,000. The proposal failed by a large margin after it was opposed by hospitals and long-term care providers.

“We have to be careful in assuming that voters in general and older voters in particular will automatically vote for proposals to bring down the cost of long-term care and healthcare, especially if the way to do it is going to be new taxes,” Eisenberg said.

Washington state is considering a similar long-term care initiative, following Hawaii’s enactment of such a program in 2018. Washington would be the first state to use a wage tax to fund such a program.

“It would be a really huge and important initiative if it does pass,” Newton-Small said.

If Trump wins reelection, Newton-Small said, legislative changes to the ACA — “even a technical fix” — would be “very controversial.”

“If a Democrat wins, who knows,” Newton-Small said about potential healthcare payment reforms.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Tuesday, April 16, 2019