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Quiet the storm brewing in health care

By Sen. Mark R. Warner (D-VA)

Even before the coronavirus outbreak began, a storm was brewing in our health care system. Under the Trump administration, the number of uninsured Americans has steadily increased from the record lows seen following the passage of the Affordable Care Act. Thanks to the administration’s efforts to undermine the health care law, combined with political resistance to Medicaid expansion in many states, the uninsured rate climbed up and up. According to new data from the CDC, nearly 31 million Americans lacked health insurance on the eve of the pandemic.

Then the coronavirus hit. Of the more than 40 million Americans out of work due to the pandemic, an estimated 27 million have also lost their health insurance. Today we face record rates of Americans lacking health insurance precisely when demands on our health care system are greatest. 

The consequences of this policy failure will be severe, and the damage will not just be felt by those uninsured Americans who contract coronavirus. This will hit state budgets, cash-strapped hospitals and American families — who will likely see the financial strain on our system reflected in higher insurance premiums.

Unfortunately, this is not even the worst-case scenario. Having failed twice to overturn the Affordable Care Act in Congress, the Trump administration is currently leading a lawsuit that would overturn the health care law in its entirety with no plan for replacement. The Supreme Court is expected to rule on the case this fall, precisely when public health experts warn we could face a second wave of COVID cases. If successful, the Trump administration lawsuit would dismantle health coverage for millions of Americans and protections for the millions more who have a pre-existing condition.

To be clear, this legal challenge to the health coverage and protections that millions of Americans rely on represents the entirety of the Trump administration’s plan to address the health coverage crisis we now face.

The administration should immediately withdraw this lawsuit that threatens to disrupt our entire health care system in the middle of a pandemic. But merely avoiding this impending disaster is not nearly enough. We need to dramatically and quickly expand coverage for those Americans out of work due to the coronavirus, as well as for those Americans who lacked insurance before the crisis began.

First, we must expand and strengthen Medicaid. More than 380,000 Virginians have already gained affordable coverage through our expansion of Medicaid. As unemployment increases, states will see a further influx of individuals eligible for Medicaid coverage. Congress should provide states with additional funding, tied to unemployment rates, to help address this influx. In addition, we should pass legislation I’ve introduced called the SAME Act, which would make sure states such as Virginia that were late to expand Medicaid get their fair share of federal funding. 

Second, Congress should help workers who have lost their employer-provided insurance regain that coverage through the COBRA program. To offset the high cost of paying for an employer-sponsored plan without employer support, the federal government should temporarily help cover the costs until it is safe for workers to return to work.

Third, the Trump administration must re-open the Affordable Care Act health care exchanges so uninsured individuals can immediately enroll in health care coverage. Congress should also enhance tax credits to help more Americans afford this marketplace coverage.

These are three ideas that can and should be enacted in the next round of coronavirus relief legislation. While the legislative solutions I’ve described are not a cure-all to structural problems in our health care system, they would quickly help millions of Americans regain coverage during this critical moment.

With unemployment and uninsured rates at record highs, the combined economic and health care crisis we face cannot be ignored. The solutions I’ve described would allow us to get millions of Americans covered as quickly as possible, using the tools that are already available. We should implement them before it is too late.

Mark Warner represents Virginia in the U.S. Senate.



Coronavirus exposes gig workforce left behind

By Sen. Mark R. Warner (D-VA)

It took a global pandemic for Congress to finally, tentatively wake up to major flaws in America’s social safety net. Sitting in negotiations for the third coronavirus relief, known as the CARES Act, I remember as my colleagues began to acknowledge that the U.S. unemployment insurance program failed to cover millions of workers who make a living as independent contractors, freelancers, “gig workers,” and self-employed entrepreneurs.

The “contingent workforce” has been around for decades, long before internet platforms like Uber, Airbnb, Postmates, and Taskrabbit enabled the rise of the “gig economy.” According to the Bureau of Labor Statistics, independent workers make up around 10% of the workforce—approximately 16 million people. But, that doesn’t take into account those who supplement traditional jobs with income on the side or millions of workers in the service and agriculture industries who often work jobs that don’t offer reliable benefits. We know that the majority of service sector, part-time, and low-wage workers in America don’t have access to healthcare, paid leave, or a telework option through their employer.

For years, I’ve been telling anyone who would listen that our system was increasingly leaving millions of workers behind. But, it took the prospect that millions of Lyft drivers, hair stylists, truck drivers, freelance designers, handymen, and other independent workers could be stuck with no income and no safety net to fall back on in the middle of a pandemic for Congress to act.

Fortunately, Congress recently took a first, if temporary, step towards correcting this gaping hole in our unemployment insurance program. The bipartisan coronavirus relief package Congress passed contains the most dramatic expansion of unemployment insurance in decades, finally extending benefits to independent workers, the self-employed, as well as part-time workers who’ve had their hours cut. 

This expansion of eligibility is an important step, and one that Congress should look to make permanent in a financially sustainable way – supported by employer contributions – once this crisis is over. But, unemployment insurance is only one piece of our social insurance system. 

Even before we began to feel the economic consequences of the coronavirus, gig workers were sounding the alarm that their lack of access to paid sick leave could create a potential threat to public health, where sick workers would be forced to choose between their health and a paycheck. At the beginning of this pandemic, I called on the largest gig worker platforms to provide paid sick leave for drivers getting treated, quarantining, or caring for a loved one with COVID-19.  I am glad that several companies stepped up to provide this assistance for their workers before it led to a public health emergency. But as recent organizing by gig workers has demonstrated, paid leave for sick workers is just the tip of the iceberg.

Recognizing the public health challenges facing workers in other fields who lack these benefits, Congress temporarily expanded paid leave to some workers as part of the coronavirus response. But millions more still lack paid sick leave, and the temporary nature of these coronavirus relief programs mean the cracks in our system will open right back up when this crisis is over.

Congress should not simply wait until the next economic calamity to swoop in and try to catch these millions of Americans who have been failed by our social safety net. While our first priority must be weathering this crisis, our recovery must include structural reforms that guarantee a social safety net to every American.  To do that, we must find a way to ensure access to our entire system of social insurance, including healthcare, unemployment insurance, paid leave, workers’ compensation, skills training, tax withholding, and tax-advantaged retirement savings. 

We need to move towards a portable benefits system that allows Americans of all walks of life to pay into package of benefits that can follow them from job to job or gig to gig. The program doesn’t necessarily have to come from the federal government—labor unions, technology firms, state, and local governments, or consumer-employer partnerships like New York’s Black Car Fund may be part of the solution.

I’ve proposed a portable benefits pilot program that would empower states, local governments, and worker advocate non-profits to experiment with these ideas, and I am hopeful that we can include this bipartisan proposal in future coronavirus relief legislation. We need to patch the holes in our social safety net now, not when the next crisis hits.

Sen. Mark R. Warner, a Democrat from Virginia, is a former technology entrepreneur and Governor of Virginia. He serves on the Banking, Budget, Finance, Rules and Intelligence committees.