With a critical election approaching, millions of Americans who buy health insurance on the Affordable Care Act exchanges are getting smacked by sticker shock this week: premiums for benchmark Silver plans will rise an average of 25% next year.
The publicity around the 13 million exchange customers obscures an even bigger problem. When measured against inflation, family coverage premiums for 156 million Americans who get insurance from their jobs are growing faster than they were in the five years before the law. In response, employers are shifting premium costs to employees and hiking copays and deductibles.
Whether covered on the exchange or on the job, 43% of insured Americans say it is difficult or impossible to afford their deductibles, and medical expenses have driven more than 11 million Americans into poverty. New Republican proposals to tax job-based benefits will make it worse.
Why hasn't this been fixed? Too many "experts" think costs are out of control because we use too much health care. The solution? "Skin in the game" -- make us all pay more so we use less.
Unfortunately, these "experts" have it all wrong. Americans already have the second highest of-pocket costs in the world and we visit our doctors and go to the hospital less often than people in other countries.
The problem isn't us, it's the prices we pay to health care corporations that are becoming so powerful they can charge whatever they want. New studies show that we pay an average of nearly $1,900 more for the same services in places dominated by one hospital system than in areas with real competition. And every few months, another scandal like EpiPen reminds us that drug companies are so powerful they can also dictate prices.
Rather than take on these powerful corporations and fix the ACA, the Republicans have decided that we really are the problem. Speaker Paul Ryan's "Better Way" budget proposes a punitive tax on employer-based health insurance to try to force us to pay even more and use even less.
This isn't the first try to tax health care. The ACA included a 40% excise tax on so-called "Cadillac" health care plans. But the tax didn't target Cadillac owners - it would affect the people who clean your hotel room, prepare your in-flight meal, feed your college students and serve your drinks at the casino. They're members of our union: low-wage workers, almost all women, who have sacrificed literally billions of dollars in wage raises over the past thirty years so they can build some of the best, highest-quality and most affordable family health care in America.
Our members spoke out last year and convinced Congress to delay the Cadillac tax, and they've gotten Secretary Clinton to pledge a full repeal. The odds are good that this tax will go away early next year.
But just as one tax scheme fizzles out, another pops up. This time, the taxes are tucked into Speaker Paul Ryan's "Better Way" budget. His plan would raise the cost of employer-sponsored benefits of 156 million Americans and further discourage employers from offering decent, affordable health insurance. It's an even worse idea than the Cadillac tax and we need to stop it cold.
The ACA has provided health insurance to millions of people, given hope to people with pre-existing conditions and made insurance fairer for women. So of course the Republican mantra "repeal and replace" is just another phrase for stripping coverage from millions of people and turning corporate health care monopolies loose to charge even more outrageous prices.
But let's be clear - the ACA is broken and needs major fixes. Congress and the new President have to get rid of the idea that ordinary Americans are the problem and stand up to the billion-dollar industries that put ever-higher prices on our health. There is a lot of work to do to fix the ACA, but step one isn't complicated: Don't tax our health care.
D Taylor is General President of UNITE HERE International Union, the 270,000 member union for North American hotel, food service and gaming workers. UNITE HERE's non-profit health benefit funds, operated in partnership with industry, are widely recognized as leaders in innovative delivery system design, quality-driven purchasing and patient education.