Health insurance costs have increased 20 percent in Maine, and the average paycheck hasn’t increased for most of us, despite promises to the contrary. It is important to revisit important statements when political horse-trading for votes on the tax bill were taking place in late December to gain a context around all of this.

At the time, Sen. Susan Collins, in her announcement supporting the tax bill, said she had received “an ironclad commitment” from her party’s leaders that two bills to stabilize the health care system would be brought for a vote before the end of 2017. That deadline passed with little fanfare.

Then, in late February, Collins again announced a health care fix in the latest budget bill. That didn’t happen, and with the first three months of 2018 gone by, there has been little effort to stabilize the health care system. At the glacial pace with which legislation moves in Congress, we are approaching a point where it is almost too late to implement a change before a major consequence from the tax bill takes effect.

The tax bill eliminated the Affordable Care Act’s individual mandate, removing the penalty for Americans who do not have health insurance beginning in January 2019. In less than nine months, health insurers will most assuredly increase premiums to compensate for the change in the risk pool. (Some health care subscribers are already experiencing significant increases in their health care premiums, such as in Georgia where residents experienced a 57 percent increase in premiums for 2018.) The individual mandate is there to make sure everyone is included in the health care market pool. It is no different than the mandate car owners have to maintain auto insurance coverage.

The mandate ensures a mixture of healthy and sick people are paying into the system. This avoids a scenario where only sick people use health insurance, driving up the cost to insurers to provide the insurance. This often means one or two health insurers remain in the marketplace. Fewer insurance companies offering health care mean fewer options for consumers. Fewer insurance options also mean less competition and higher premiums for those who remain in the system. That is, unless something is done to replace the individual mandate or to create a health care system where everyone pays in.

The Congressional Budget Office estimates as many as 13 million people over the next decade will lose health insurance as a result of eliminating the individual mandate, and premiums could increase 10 percent if the markets are not stabilized.

With the repeal of the individual mandate in the tax bill, we were also promised an increase in our paychecks. According to a recent poll, 42 percent of American workers say they have not seen an increase in their paychecks. For those who have seen an increase, the average increase for the lowest 20 percent of wage earners is $2.50 per week, or $60 annually.

Conversely, bronze health plans on the insurance exchanges for 2018 increased on average nationally from $476 to $561 per month, an 18 percent increase, according to the National Conference of State Legislatures. In Maine, the premium for that same bronze plan increased from $502 to $603 per month, a 20 percent increase. There will be, no doubt, additional health care cost increases in 2019.

Moreover, in an attempt to keep costs down, insurers will erode the benefit packages to include higher deductibles, higher copayments and other changes, which also means higher out-of-pocket expenses in the coming years.

These changes are significant. Increased health insurance or copayments and deductibles cause families to make tough choices in their family budgets or forego purchasing health insurance and take a risk. We’ve all read the stories of these tough choices families have made in the past. Stories of the family without health insurance who can’t let their child play sports for fear of an injury. The family member who becomes ill and incurs a medical bill that causes bankruptcy. Or the retired person who splits critical medication because she cannot afford the prescription costs and hopes half the dose will be better than nothing.

To be fair, this is a large and complex issue that Collins cannot solve alone. It will require creative thinking, tough choices and political horse-trading. But now is the time to begin to solve this problem. Otherwise, when we awake from political amnesia this time next year, many of us will be scratching our heads and asking what happened to our health care, and why is it more expensive?

Thomas Chalmers McLaughlin teaches in the School of Social Work at the University of New England in Portland.

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