Rep. Bill Cassidy (R-LA), a physician and the current GOP front-runner to challenge Democrat Mary Landrieu for her U.S. Senate seat this November, told an annual meeting of the Louisiana Oil and Gas Association that uninsured Americans are “less sophisticated” and “less educated” people who might find the Affordable Care Act too complicated and cumbersome to take advantage of, BuzzFeed’s Andrew Kaczynski reports. The remarks came as Cassidy was promoting his own pared-down health care reform proposal that relies only on catastrophic insurance coverage and Health Savings Accounts.
BuzzFeed obtained audio of Cassidy’s comments:
CASSIDY: [My plan] I think actually reflects the reality of who the uninsured are, relatively less sophisticated, less comfortable with forms, less educated. Those are the folks that — not all — there’s a guy who goes to my church who’s uninsured, who’s middle-class but couldn’t get it because he has Type I diabetes. So it’s not all, but it is the folks who I think are going to have the hardest time reaching. […]
We were fortunate growing up in the South. The president is a community organizer. You wonder if he ever worked with a poor person… Insurance people, they will tell you that they will go to a company and an employer will pay for everything, and there are some people who will not sign up. Turns out, those are my patients. They’re illiterate. I’m not saying that to be mean. I say that in compassion. They cannot read. The idea they’re going to go on the internet and work through a 16-page document to put in their data and sign up does not reflect on understanding of who is having the hardest time in our economy.
Cassidy’s take on the uninsured doesn’t exactly line up with reality. About 18 percent of Americans are uninsured — and just under half of them have gone without insurance for at least five years, according to the Kaiser Family Foundation.
That’s not for a lack of trying. In fact, about 31 percent of uninsured adults tried signing up for Medicaid in the past five years. But most of them were rejected because states’ pre-Obamacare Medicaid eligibility requirements were often so stringent that only the poorest Americans with children could qualify for coverage.
Furthermore, more than one in five uninsured adults tried buying an individual health insurance plan within the past five years, but the majority found the plans to be unaffordable. That’s not surprising considering that the pre-ACA individual market resembled the Wild West, with nothing preventing insurers from hiking up rates for women, or people with chronic illnesses, or charging more once a policyholder got sick (not to mention the millions of people who were denied coverage due to pre-existing conditions).
It’s possible that Cassidy is referring to several recent surveys finding that uninsured Americans aren’t well-versed in insurance industry jargon or the specifics of the Affordable Care Act. But those same surveys found that Americans in general — including the insured — are only slightly less confused about those very issues as the uninsured.
In fact, most uninsured Americans who say they don’t plan on enrolling in Obamacare cite their belief that they won’t be able to afford it as their main reason for forgoing coverage — understandable considering these Americans’ past experiences with the individual insurance market. But these people are also largely unaware that half of the country has expanded Medicaid eligibility and that robust federal premium and cost-sharing subsidies are available under the ACA, particularly for lower-income people. That’s a result of persistent misinformation campaigns about the health law and the difficulty of identifying and reaching out to the uninsured — not the sophistication level of uninsured Americans.
Cassidy defended his remarks in a statement to ABC News on Thursday. “As a doctor, I can tell you that you need an honest diagnosis before you can provide the needed treatment,” said Cassidy. “It is self-evident to anyone who has worked with the uninsured, as I have for decades, that the uninsured come from all segments of society. This includes the more and the less educated. That’s exactly the point I made and make: if we seek to be truly compassionate, our policies must meet people where they are. Obamacare’s one-size-fits-all model lacks this basic measure of compassion.”