The psychological drivers shown by Maslow’s Hierarchy of Needs is a key to why affordable health insurance is a red-hot policy issue.
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To understand why access to affordable health insurance has suddenly emerged as a red-hot policy issue, look beyond politics to the deepest roots of human psychology.
To political insiders, “health insurance” has become a kind of abstraction, a source of endless arguments over what policy tweaks will somehow cause health system problems to magically dissolve. But having good health insurance is actually something that connects, if only subconsciously, to one of the core motivators of human behavior. After fulfilling basic physiological needs like food, water and shelter, what next dominates all our efforts, according to Maslow’s Hierarchy of Needs, is the need for safety.
Health insurance keeps us safe. Or as an Austin barbershop owner whose brain cancer diagnosis required months of expensive care colorfully characterized his Affordable Care Act Marketplace insurance to KFF Health News, “It saved my ass.”
That attitude, if not the language, likely resonates with anyone who’s experienced illness. It’s no coincidence that politically savvy Democrats dubbed their health reform legislation the Patient Protection and Affordable Care Act, while equally savvy GOP detractors invariably refer disdainfully to the ravages caused by “Obamacare.” (My favorite piece of you-can’t-vote-against-this legislation, mandating minimal postpartum hospital stays, was The Newborns’ and Mothers’ Health Protection Act of 1996.)
The Tiff Over Tax Credits
According to the Center on Budget and Policy Priorities, the enhanced ACA tax credits due to expire at the end of the year, which are targeted at those with modest incomes, are helping more than 20 million people afford health coverage. The center cautioned that “premium costs will more than double on average if enhancements expire.” A pre-election, Forbes.com examination of premium hikes by major publicly traded health insurers found that 20-25% price hikes were already common, while there were also reports of premiums doubling or even quadrupling.
Perhaps not surprisingly, the ACA marketplace subsidies are widely popular among all segments of the population, even though they are staunchly opposed by most Republican leaders. A KFF Health Tracking Poll conducted just before the midterm elections that saw a wave of Democratic victories found that three-quarters of the public said Congress should extend the health insurance subsidies. Three in four political independents and half of all Republicans joined 94% of Democrats in that opinion.
Senate Majority Leader John Thune (R-SD) is among those who have vigorously opposed a tax credit extension, agreeing as part of a deal with Democrats to reopen the government that he would simply schedule a vote on their renewal. House Speaker Mike Johnson (R-TX), however, has made clear he has no plans to do the same, while President Trump similarly opposes a subsidy extension.
TrumpCare
Still, though President Trump brushed off concerns over the general state of the economy in a post-election interview with Fox News, calling reports of growing inflation and other problems a “con job by Democrats,” the political potency of health insurance worries triggered a response. On Truth Social, the president proposed that ACA funds be diverted from “money sucking Insurance Companies” (also known as “BIG, BAD Insurance Companies”) and sent directly to consumers to purchase their own health insurance.
Among the many actuarial problems with that oft-suggested idea, as noted by the Center for Economic and Policy Research, is that individuals with health problems would face sharply higher premiums than those who are healthy. Moreover, even if the total amount of federal money now going to Obamacare was available to individuals, government checks would amount to just $170 a month, while in 2024 the average premium for an individual on the ACA marketplace, according to KFF, was $540 per month.
The pitched political battle over health insurance has also highlighted the longstanding – and to my mind, bizarre — controversy over whether health insurance saves lives and, if so, how many. A post-election,Washington Post article noted that this issue “has fueled political debate and stumped researchers for decades, but new studies point to an answer.” The article ably summarizes more than a decade of both political arguments and academic research, examining why health insurance didn’t seem to affect mortality and why new evidence shows that it does, particularly “among adults older than 45 and, to a lesser extent, younger adults.”
Leaving aside for a moment common sense and lived experience (or what the academics would call “real world evidence”), consider that latest conclusion about health insurance benefits in the context of a recent study by the Centers for Disease Control and Prevention. Researchers found that approximately 6 in 10 young adults, 8 in 10 midlife adults and 9 in 10 older U.S. adults report one of more chronic conditions “which are costly and major causes of death and disability,” including diabetes, heart disease, cancer and stroke.
Safety
Small wonder that the basic human instinct for safety and survival has made care affordability – what health insurance promises to those who buy it – a health policy issue whose urgent political importance, as ACA subsidies near expiration, dwarfs all others.
The centrality of affordable health insurance also provides a lesson for those of us concerned about issues such as care safety and quality. It’s important to remember that you can’t worry about whether your treatment was good or bad, appropriate or inappropriate, sensitive or not to your needs as a “consumer,” if you’re really sick, but can’t afford to access care at all.
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