America's much-maligned health care system is covering nine out of 10 people, a fact that hasn't stopped the 2020 presidential candidates from refighting battles about how to provide coverage, from Bernie Sanders' call for replacing private insurance with a government plan to President Donald Trump's pledge to erase the Affordable Care Act and start over.
The politicians are depicting a system in meltdown. The numbers point to a different story, not as dire and more nuanced.
Government surveys show that about 90 per cent of the population has coverage , largely preserving gains from President Barack Obama's years.
Independent experts estimate that more than half of the roughly 30 million uninsured people in the country are eligible for health insurance through existing programs.
Lack of coverage was a growing problem in 2010 when Democrats under Obama passed his health law. Now the bigger issue seems to be that many people with insurance are struggling to pay their deductibles and copays.
"We need to have a debate about coverage and cost, and we have seen less focus on cost than we have on coverage," said Colorado Sen Michael Bennet.
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He is among the Democratic presidential candidates who favour building on the current system, not replacing it entirely, as does Sanders.
"The cost issue is a huge issue for the country and for families," Bennet said.
A report this year by the Commonwealth Fund think tank in New York found fewer uninsured Americans than in 2010 but more who are "underinsured," a term that describes policyholders exposed to high out-of-pocket costs, when compared with their individual incomes.
The report estimated 44 million Americans were underinsured in 2018, compared with 29 million in 2010 when the law was passed. That's about a 50 per cent increase, with the greatest jump among people with employer coverage.
"When you have 90 per cent of the American people covered and they are drowning in their health care bills, what they want to hear from politicians are plans that will address their health care costs, more than plans that will cover the remaining 10 per cent," said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan research organization that tracks the health care system.
"When Democrats talk about universal coverage more than health care costs, they are playing to the dreams of activists and progressives ... much less to the actual concerns of the 90 per cent who have coverage today."
"This is not a system that needs a few tweaks. This is a system that needs a complete overhaul."
The president says there's nothing to worry about. Earlier this summer Trump told ABC News that he was working on a plan that would provide "phenomenal health care," protect people with preexisting conditions, and would be "less expensive than 'Obamacare' by a lot."
White House spokesman Judd Deere said in a statement that the Obama law was "sold and passed on a litany of broken promises" and now "Democrats are proposing even more radical government takeovers of our health care system."
Trump says he might come out with his new plan within months, but that passing it would hinge on his getting reelected and Republicans winning back the House in 2020 while keeping control of the Senate. That's a bit of political deja vu. Republicans controlled Washington back in 2017 when Trump, then-
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