The Affordable Care Act (ACA), having been upheld by the Supreme Court, contains a number of very positive features. But there are yawning gaps in its coverage of enormous proportions. When fully implemented, it will still leave 27 million uninsured, and that number could be much larger with the Court’s having made expanded Medicaid coverage optional for the states. This is undoubtedly the worst aspect of its decision. It puts at risk the main tool to expand insurance coverage to the very poor, mostly people of color. Moreover, untold numbers of the uninsured will inevitably decline to purchase insurance, despite the mandate.
Looking to the future, health care costs will continue to rise, more people will be underinsured, and those who cannot afford private insurance — or who simply refuse to buy it — will not only be deprived of health care coverage, they will have to pay a stiff fine.
At the heart of the problem is the fact that the insurance companies will remain at the core of the health care system. As long as this is the case and these companies are able to plunder hundreds of billions in profits from the system, the ACA will be severely crippled in carrying out its stated goal of providing health care coverage for all.
Health care in theUnited Statesmakes up 17.9% of the economy, incorporating some of the most profitable enterprises, as well as vital facilities and services which barely cling to life. While working people suffer and die waiting for care or through mishaps in the system, the most preposterous charges and claims reverberate in a torrent of election-year nonsense.
Underneath all the extreme rhetoric and exaggerated claims lies a free-for-all fight by competing corporate interests. Benefits to ordinary people are coincidental. The Supreme Court’s decision of June 28, 2012 on the ACA cemented health care profiteering, left union workers in an even more precarious position, and further undermined prospects of the very poor’s obtaining basic health care. Within hours of the verdict, the stock market reflected the true story.
Stocks of for-profit hospital chains shot up. With the confirmation of the individual mandate projected to guarantee a steady stream of paying customers, the value of Hospital Corporation ofAmericastocks rose 15%, while Tenet gained 10%. The commercial health insurance corporations, buoyed by the retention of the individual mandate, can now focus on whittling away the concessions they made in 2009. Pharmaceutical and medical device manufacturers held their own, already planning for the added expenses they would be incurring to help close the donut hole of Medicare Part D and insurance coverage expansion.
Drawing a Balance Sheet on the ACA
It was hoped that the ACA would dramatically expand Medicaid for most low-income folks, but the Supreme Court’s decision undermined that. The ACA pledged increased funding for community health centers – culturally competent care close to home – but this has been weakened by threats to Medicaid expansion and a variety of attacks on immigrants, with or without papers.
On the plus side, children can stay on their parents’ insurance plans until age 26. Some of the most outrageous insurance company practices are finally outlawed, like denying care for pre-existing conditions and annual and lifetime caps on benefits. Gender inequality is proscribed. The donut hole will be closed.
On the down side, there will be no real limits on what insurance companies, hospitals and drug companies charge. Those who do not have health insurance coverage one way or another will be forced to buy the insurance industry’s shoddy products or pay an additional penalty and remain without coverage. As inMassachusetts, where the ACA’s prototype was enacted in 2006, the new norm is unaffordable underinsurance.
Health care costs will continue to rise swiftly, strengthening employers’ resolve to shift costs onto workers through pushing high-deductible, low coverage plans, or by dropping health insurance altogether. Strikes and lockouts over health benefits could become more frequent and of longer duration. Workers in unions with joint union-management Taft-Hartley health and welfare plans will be confronted with more employers demanding renegotiation of terms by the end of 2013. And in 2018, the excise tax on so-called Cadillac health insurance plans will kick in, adding further burdens to those with stagnating wages.
Which Way for the Labor Movement?
Resolution 34 of the September 2009 AFL-CIO convention inPittsburgh proclaimed the goal of a national social health insurance: a single payer program. This resolution was the result of seventy pro-single-payer resolutions submitted in the pre-convention period, more resolutions on one issue than ever before in the history of the AFL-CIO. The steady growth of labor’s commitment to fundamental health care change grew from the work of the All-Unions Committee for Single Payer Health Care — HR 676.
By the time the national debate over health care took off early in 2009, nearly six hundred labor organizations in forty-nine states had already endorsed HR.676. Thirty-nine state labor federations, one hundred thirty-five central labor councils and twenty-two national and international unions stood up to be counted.
To deepen and mobilize this sentiment, the Labor Campaign for Single Payer was organized in St. Louisin January of 2009. This coalition set as its first priority the adoption of Medicare for All as a strategic goal for organized labor. That goal having largely been met with the passage of Resolution 34, the struggle now is to move from resolutions to action and to link the fight for a just healthcare system with labor’s overarching goal of driving back the threat of austerity and winning security for the working class and the entire population. This will require building labor/community coalitions across the country capable of mobilizing gigantic numbers in the streets demanding no cuts to the safety net and Medicare for All!
Following the 2010 enactment of the ACA, and in the wake of the 2010 elections, the pendulum has swung to the states. TheVermontWorkersCenter, an affiliate of Jobs with Justice, and many unions inVermontprovide the solid backbone of the movement for health care as a human right in theGreenMountainState. Built on several years of solid grassroots work, the single-payer movement inVermonttook advantage of federal funds allotted to the states under the ACA to fashion health insurance exchanges to entrench their goal of emerging in 2017 with a true single-payer system. Powerful forces are now pouring resources into the state to block this advance for health care justice or to subvert this movement into something palatable to the corporations and politics as usual.
Some unions representing those who work in health care, especially National Nurses United, are deeply involved in refashioning their industry, rejecting corporate partnerships and fighting for the highest possible standards of care. This militancy is reflected in strikes and other actions to block the erosion of access to care and threats to advances already won.
How Did Things Get This Way in the U.S.?
U.S.health care remains dominated by profiteers, and they exercise extraordinary influence in both the Republican and Democratic parties. This explains whyU.S.taxpayers spend more on health care per capita than taxpayers in any other developed country, yet we still have fifty million uninsured people, only half of whom are promised eventual coverage by the ACA. The bottom line is this: Profit rules, with the working class, one way or another, paying through the nose as a result of enactment of the ACA.
The Bush-appointed chief justice John Roberts cast the deciding vote to maintain the overall structure of the ACA. But a challenge to that structure came from 26 state governments, many of whose governors threaten to reject the expansion of Medicaid — which would make it available to those making up to 133% of the federal poverty line — even though the federal government would pay 100% of the cost for the first three years and at least 90% for the succeeding years. Their main rationale: “We need the money for education.” But instead of pitting educational needs against health care needs, the states need to demand additional funding for both, which can easily be paid for by slashing the astronomical Pentagon budget.
How many of the 26 states that brought the suit against ACA to the Supreme Court will end up refusing to implement Medicaid expansion? InMassachusetts, politicians call Medicaid the “budget buster.” We need to step up the fight for all states to sign on to the expansion, even as we intensify the struggle for a single-payer, Medicare-for-All system. Everybody in, nobody out!
The individual mandate, thought up by the ultra-conservative Heritage Foundation in the 1980s, is the most regressive way to attempt to get to universal health insurance coverage. Whether constitutional or not, it is an integral part of the “shared responsibility— shared sacrifice” mantra of the neoliberals. It was used to block single-payer inMassachusettsand on the national scene. It’s argued that the individual mandate is necessary to rope in all those who don’t buy health insurance on their own and so place a burden on everyone else. In reality, most people who don’t have health insurance are that way because they can’t afford it.
As bad as the situation for health care in the U.S. is today — and will be even under the ACA — it will be predictably far worse if Democrats and Republicans join in a “grand bargain” to impose substantial cuts in Social Security, Medicare, Medicaid and other vital safety net programs. It is widely expected that an attempt will be made to ram through such a “bargain” along the lines of Bowles/Simpson during the Congressional lame duck session in December. What’s needed is for the labor movement and our community allies to join together to do everything in our power to prevent this from happening.
This entire experience underscores the need for reforming the health care system in a most fundamental way. Let’s not forget that the Tories and Liberals did not usher in the universal health care system inCanadaorGreat Britain. It was the labor movement that led the fight to win these historic breakthroughs. Independent political action by labor in theU.S.organized in trade unions and in the community must lead the fight for a just health care system if it is to become a reality in our country. Mass action on the ground and labor campaigns wherever possible can spearhead this drive. Labor will also need to build its own party with its own demands, including Medicare for All!
Our goals and slogans going forward should include:
- Resist attacks on Medicare, Medicaid, Social Security and all other social benefits!
- Demand that Medicaid expansion be agreed to in all the states!
- Organize all health care workers into fighting unions!
- Mobilize for single-payer locally and nationally!
- SupportVermont’s grassroots efforts for single payer!
- Affiliate unions with Labor Campaign for Single Payer!
- Challenge all candidates on real health care reform!
- Run independent labor candidates!
- Prepare for a rebirth of the Labor Party!