Grassroots Advocacy

by Karl  Schwartz

Springfield Township, Riegelsville, PA

Grassroots advocacy is defined as public pressure  - most often directed to our elected representatives - for the purpose of affecting needed changes in policy that affects our lives.

Oct 2016
What is behind the rise of our health care insurance premiums?

With the candidates focused on the character and fitness to be President, very little time has been given to compare health care policies that existed before and during the implementation of the Affordable Care Act (ACA/ Obamacare).   

I have been a patient advocate for more than twenty years.   I’m writing to share my perspectives and related information about the ACA -- a complicated subject.  I’ve done my best to be concise (I beg your forgiveness in advance) - but there are many moving parts and sides to health care policy.

1)      The dominant factor driving the cost of our premiums is the rising cost of medical services and products – especially new medical technologies.

On this AETNA has reported an alarming trend that the expected health care spending in the US will be $4.8 trillion in 2021, up from $2.6 trillion in 2010, up from $75 billion in 1970.

Further, in the Financial Projections report (below), the Medicare Trustees note that “medical technology changes have been the dominant growth factor of medical care costs"

It is not the domain of the ACA to set prices on drugs and other medical innovations.   Under current patent law the companies can charge ANY price they wish.  (The EpiPen price hike scandal was masked until the deductibles rose.) 

Notably, experts have counseled Congress that it needs to authorize Medicare to negotiate the cost of prescription drugs and medical technologies as is done elsewhere in the world.  However, there has been no movement in this direction.

2)      Resent events show that ACA has decreased the profits of the insurance companies. 

Prior to ACA, health insurers realized record profits (while 2.7 Million Americans lost coverage). Today some insurers (such as AETNA) report losing money – (while 21 million Americans have gained coverage). 

The ACA has helped to contain profits by requiring insurers to offer similar plans (Bronze, Silver, Gold) on the marketplace exchanges and compete with price.  Also, insurer profits cannot exceed what is taken in by more than 20% because of the ACA 80/20 rule.

3)      ACA provides an Ethics framework that insurance companies must follow.

Prior to ACA if you or a loved one had a serious preexisting condition the insurer would reject the application.  It could also raise your rates (pricing you out) if you developed a medical condition later on (a formula for record profits).

4)      With ACA 21 million Americans have gained health care insurance. 

This was made possible by subsidies that can help persons with lower incomes afford the health insurance premiums.  With ACA Mom or Dad can address conditions before they get serious, and avoid advanced debilitating medical conditions so they can continue to provide for their families.

Also affecting enrollment were the ACA mandate and related penalties.  So why does the law require me to purchase health insurance coverage?

NAIC: National Association of Insurance Commissioners explained:  "The key goal of the health care reform law is to ensure that nobody can be denied coverage or be priced out of coverage due to a health problem.  If you allow people to wait until they have a health problem to purchase insurance, the health insurance market simply will not work. Eventually, there would be a small number of very expensive choices for everyone.

What was the enrollment trend before ACA? 
In 2007 it was reported that 2.7 Million Americans lost coverage.

That trend contributed to the rise of premiums as "the uninsured consumed more than $50 billion in uncompensated care, the costs of which are passed through health care institutions to insured Americans.”;

5)      Insurer can no longer sell the public “junk” policies.

The ACA has set minimum standards (such as no life time caps and limits on out-of-pocket expenses).  These standards protect us from bankruptcy that was previously common as a result of medical debts. 

Prior to ACA in 2007:  “62.1% of all bankruptcies were medical. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance.”;

Our health insurance premiums are still rising and the real reasons need to be acknowledged before they can be addressed.  Notably, according to the Brookings Institution (report below), our premiums would have been higher today (while affording us less protection) without ACA.

In closing, the issues are somewhat more complicated than what I’ve noted above (such as the need for younger persons to buy into ACA in order to decrease the median per-person cost of healthcare). The next Congress and President must address the true drivers of health care costs and work together to shape ACA so it maintains the ethical standards touched on here.

Stating the obvious: we, the people, are the primary stakeholders in public policy decisions! 

… To make the medical system sustainable some special interest groups (doctors, drug companies, etc.) will have to make less money.  But each policy proposal that could help to achieve that goal will be considered a threat to a different special interest group - who are well organized and can effectively lobby Congress to oppose it. 

It’s painfully evident that we have an information crisis:

Presently we receive mainly misinformation in political ads amid an avalanche of conflicting sound bites in the reporting of news.  The news stations are funded by ads, are ratings based, and loath to present facts that may sometimes offend half their audience. 

… For example, a good many people still believe the ACA is government provided health care. It is not.  Few appreciate that ACA regulation of the private insurers cannot fix prices or control the cost of medical services.

To save our democracy and fix how public policy is debated, we urgently need the FCC to require that news stations give some time to comprehensive coverage and debate on critical policy issues on the public airways. Such credentialing (as we do for contractors, teachers, doctors …) should be required for a station to call itself a NEWS service.

Karl Schwartz
Riegelsville, PA


·         AENTA report: Facts about rising cost of health care  
expected spending in US will be $4.8 trillion in 2021, up from $2.6 trillion in 2010, up from $75 billion in 1970

·         Roberts, Woods, Johnson Foundation, 2011
What are the biggest drivers of cost in U.S. health care? 

“Significant factors driving growth in spending are medical technology, obesity and low productivity gains in health care.”;

·         NEJM, 2010, Buying Health Care, the Individual Mandate, and the Constitution:

"… the uninsured consume more than $50 billion in uncompensated care, the costs of which are passed through health care institutions to insured Americans. Moreover, medical expenses not covered by insurance are one of the leading causes of bankruptcy in the United States ...

·         Brookings Institute, 2016, Center for Health Policy

·         Medical Bankruptcy in the United States, 2007:
Results of a National Study

"62.1% of all bankruptcies in 2007 were medical; ... Most medical debtors were  well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. "

·         American Society of Clinical Oncology, 2009 Guidance Statement:
The Cost of Cancer Care 

The United States spends approximately 16% (more than $2 trillion) of its gross domestic product on health care.4 Because the growth in health care spending exceeds that of the overall economy (approximately 6% to 8% v 4% to 6%),5,6 the proportion of our economy devoted to health care continues to increase and is expected to reach nearly 20% by 2017.

·         Review of Assumptions and Methods of the Medicare Trustees’ Financial Projections

“Medical technology changes have been the dominant factor growth of medical care costs"

·         Why is HealthCare so expensive? - Consumer Reports

higher health care costs mean higher health insurance premiums for everyone. It’s Health Insurance 101: Insurance is about pooling risk. That’s a good thing because it protects you against unexpected costs—but companies have to collect enough in premiums to pay for members’ health expenses. The higher the expenses for the risk pool, the higher the premiums for everyone—even if you received little or none of that care.

·         Committee for a Responsible Federal Budget
The Trump plan reviewed


Guidelines for Effective Grassroots Advocacy

Your issue must resonate with the public. Thus, success will require public education - for example raising awareness of the consequences of inaction, both long- and short-term.

Your issue requires validation by experts in the field, such as by environmental experts and independent scientists.

You should try to anticipate and answer opposing arguments proactively. Use Blogs, Op Ed.

It's vital to maintain your credibility. To document what you say, and to know what you don’t yet know.

It's important to be both respectful and persistent, even with your opponent. Radical action,  or using poor language, or being wrong can cause valuable allies to abandon you.

A petition that shows a sizable % of voters favoring your position provides evidence that you have a public consensus. (You must describe also your survey methods ... random samples are most persuasive)

Many small actions (calls, letters) are essential … add up.  This is the primary mechanism by which change is achieved. This is how our representatives measure public concern (and his or her chances for re-election). Even the best arguments require this kind of support.

Make it as easy as possible for your supporters to communicate their concerns in different ways to different groups.  (media, Op Ed, directly to representatives,  regulatory agencies, experts, related non-profits). Provide form letters,  addresses to write to, websites, phone numbers, email , signs, and so on.

Provide easy access to your talking points and references to the evidence that supports your issue.

It's important also to arrange face-to-face conferences with leaders and your elected representatives – phone calls, letters and emails alone can easily be discounted in our busy world.

Know your subject!  Read the literature from the most credible sources ... and provide concise arguments, emphasizing the benefits or action and the consequences of inaction.

You must be clear about what you want to achieve, what you're asking for - and why.

Ask for Help! Network. Call. Meet. Form coalitions!

Give credit to those who help you.

Create a website to document and publish your concerns, findings - a central place to refer people to, and tell people how to help.