The Affordable Care Act improved health care a lot, and continues to help people – but here is a NOW article from 2010 explaining at what price it came, and also reiterating a more efficient and less costly solution – single payer.
Originally posted on the national NOW website and in the National NOW Times, at http://www.now.org/nnt/spring-2010/health.html
Although Republican lawmakers did all they could to derail health care reform (including using the abortion issue as a political football), the Patient Protection and Affordable Care Act finally passed after a grueling process of deal making and compromises. Had it not passed, inside-the-beltway pundits were poised to declare President Obama virtually irrelevant; instead, they pronounced the law a major victory for him. But some of the compromises made to ensure passage will have far-reaching, damaging impacts on women. NOW and its allies are already gearing up to “reform the reform” and repeal the Hyde Amendment, which was used to justify the anti-abortion provision.
NOW has advocated for a single-payer health system since the 1990s. Unfortunately, the new law is based on our flawed and expensive system of private health insurance. Under the law, everyone must have insurance, with a few limited exceptions and penalties for those who do not purchase coverage. The roughly 70 percent of people who have insurance through their employers will stay in those plans, for the most part. Unfortunately, it’s not a universal reform: 23 million people, one-third of whom are undocumented immigrants, won’t be covered.
Still, it is an important advancement that 32 million low- and moderate-income people who were previously uninsured or under-insured will have access to affordable insurance. The new law will expand Medicaid eligibility; provide government subsidies to moderate-income individuals and families who cannot afford premiums; make tax credits available to small businesses as well as exchanges where they can find affordable policies; and improve Medicare financing and the prescription drug benefit. Equally important is the allocation of $11 billion more for professional training and doubling the number of community health centers. Soon, high-risk insurance pools will be available to persons with pre-existing health conditions who have been denied coverage, and parents may keep adult children on their family plans until age 26.
Additional good news: insurance companies will no longer be permitted to deny coverage due to pre-existing conditions or because of health conditions arising from domestic violence. Maternity coverage may not be excluded, and screenings and preventive wellness measures are guaranteed with no cost sharing. The new law also contains an anti-discrimination clause that prohibits insurance companies from refusing coverage on the basis of race, religion, national origin, sex, disability and other factors.
These advantages came at a steep price: a sweeping anti-abortion provision, punitive anti-immigrant provisions, continued discrimination on the basis of age, and abandonment of a meaningful public option or other pathway to a single-payer system.
NOW and its allies successfully beat back the infamous Stupak-Pitts Amendment, which was crafted by the Catholic Bishops and aimed at eliminating coverage for all abortion care. While the measure passed the House, the Senate tabled it — but in the end a watered-down version was added to the Senate bill at the insistence of Sen. Ben Nelson, and that version became law.
According to the George Washington University School of Public Health, this provision achieves the goal of Stupak-Pitts (albeit over a longer time frame): elimination of all private as well as public coverage of abortion care. One in three women will have an abortion in their lifetime — but unless this provision is repealed, millions of women will lose the abortion coverage they currently have, as insurance companies will eventually conclude it’s not worth the law’s regulatory hassle to cover this common and necessary medical procedure.
The harsh restrictions on the ability of immigrants to access health care can only be termed shameful. Permanent, legal residents must wait five years before being eligible for assistance such as Medicaid; and undocumented workers aren’t even allowed to use their own money to purchase health insurance through an exchange. These provisions are not only inhumane but also counterproductive, in that they will put upward pressure on overall health care costs.
The law also explicitly permits age rating, the practice of imposing higher premiums on older people. This has a disproportionate impact on women, whose incomes and savings are lower due to a lifetime of systematic wage discrimination.
Unfortunately, the single-payer approach that NOW supports did not get a fair hearing, and a public option was not included in the final law. However, Senate Majority Leader Harry Reid (D-Nev.) has promised a separate floor vote on a public option, and the new law does contain an opportunity in 2017 for states to experiment with alternative health care systems. NOW’s state and local chapters will be organizing for single-payer as the most efficient and least costly solution.
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