The ACA Stands: Poor People Left in the Dust

I’ve written most of this in advance of the expected Supreme Court ruling on the Affordable Care Act (ACA).  Instead of going into great detail about what the ACA will do (been there, done that), here’s my synopsis:  the ACA, after being riddled in the womb with bullet holes by Republicans and Corporate Interests, had its best part amputated shortly after birth by the Court. 

The Justices said they didn’t read the whole thing, but they must know the law has a deadly infection—private for-profit health insurance.  No matter what else is in it, we can’t save healthcare reform until that infection is cured.  So they found a way to let it live, including all the elements that profit the insurers, but they cut out the only part that would have helped poor adults get desperately needed care—the Medicaid Expansion. 

That was the only version of the ruling I hadn’t prepared for, ironically.  I should have known.  States can still participate and get the federal money, but they won’t be required to do so.  This is especially bad news for Alabama, with our long-standing habit of leaving federal Medicaid dollars on the table so we can give tax breaks to the rich corporations.  Will we take it during the initial period, when it is fully federally funded?  I have my doubts but hope I’m wrong. 

President Obama once wanted something better.    I believe in my heart our President still dreams of a day when we will have real healthcare reform—quality, affordable medical care for every one of us.

I’ve written most of this in advance of the expected Supreme Court ruling on the Affordable Care Act (ACA).  Instead of going into great detail about what the ACA will do (been there, done that), here’s my synopsis:  the ACA, after being riddled in the womb with bullet holes by Republicans and Corporate Interests, had its best part amputated shortly after birth by the Court. 

The Justices said they didn’t read the whole thing, but they must know the law has a deadly infection—private for-profit health insurance.  No matter what else is in it, we can’t save healthcare reform until that infection is cured.  So they found a way to let it live, including all the elements that profit the insurers, but they cut out the only part that would have helped poor adults get desperately needed care—the Medicaid Expansion. 

That was the only version of the ruling I hadn’t prepared for, ironically.  I should have known.  States can still participate and get the federal money, but they won’t be required to do so.  This is especially bad news for Alabama, with our long-standing habit of leaving federal Medicaid dollars on the table so we can give tax breaks to the rich corporations.  Will we take it during the initial period, when it is fully federally funded?  I have my doubts but hope I’m wrong. 

President Obama once wanted something better.    I believe in my heart our President still dreams of a day when we will have real healthcare reform—quality, affordable medical care for every one of us.

We can’t afford to take much time for regrets.  We need to push, harder and more effectively, for Expanded, Improved Medicare for All.   How can we learn from this experience, quickly, to do better next time?  I have a few lessons to suggest.

Votes Count.  Even though we didn’t get to directly vote for constitutionality or for the Justices, we did elect the Presidents who appointed them and the Legislators who confirmed them.  We had a part to play in letting the ACA stand and in this blow to the poor.  The Republicans have a number of ways to continue finishing off the rest, and you can be sure they’ll do their darndest.  We are only going to get as good as we vote for.  For Court appointees, our votes can affect what happens to our country for decades to come.  There is no excuse for taking your right to vote lightly.  Contrary to the Randian/ Libertarian fear about being made to support the public good at the “point of a gun” and despite serious corporate influence on policy-making, we the voters still have a say.  Use it.

Emergency relief measures are not a substitute for real reform, but they matter.  It may still take us awhile to get the national health insurance program we need.  In the meantime, it is the right and decent thing to enact some stop-gap help for those in the worst straits.  The ACA has a few of those left, mainly coverage of young adults and prescription coverage for Medicare.  But to cut out mandatory coverage for the poorest poor adults is a travesty.  If the Court could finagle around to change the “penalty” for the individual mandate to say it really meant a “tax”, they could have found a way to save this part.  We didn’t have to wait for a more comprehensive solution to do this basic act of humanity.  We wouldn’t wait to give pain medicine until after a broken leg is fixed.  At the same time, we should not get confused and think pain medicine will repair the problem.

Unless we get conservative buy-in, we will fail.  We aren’t likely to have a Democrat controlled Congress in the near future, even if we re-elect Obama as I hope.  If we did, and we rammed a single payer bill down the opposition’s throat, they might not notice their lot had improved in time to prevent sabotage of a new system.  We need to spend more time studying how to enlist the good parts of conservativism – decisiveness and unyielding dedication to a cause, for instance (thank you, Chris Mooney), and communicate with our brethren in their own language.  We can help bring out their better natures, and they have some skills we need.

Quit Compromising.  Surprised, after what I just said?  We have made a huge error in confusing persuasion with negotiation. We need bipartisan buy-in at the grassroots level, not a bipartisan solution in Congress.  Unless we become fiercely devoted to the goal of real healthcare reform, to the point we will absolutely not compromise our principles, we are always going to wind up being the patsy.  My husband loves the Bible quote “because you are lukewarm, and neither hot nor cold, I will spit you out of my mouth”. Come on, people!  Get some fire.  We can do this.

Remember why it matters.  I haven’t got much choice here—I see the consequences of our current healthcare system right in my office, every day, in ways that range from frustrating to tragic.  The father who quit bringing his children for checkups because he knew he had a deductible  in his grandfathered policy and was too embarrassed to say he couldn’t pay. The child who suffered terrible itching for weeks from eczema, waiting for insurance to authorize his prescriptions, because they insisted he try the things that had already failed before he could get what had already worked before. The working and uninsured mom who chose to spend her limited funds on her family’s food and shelter, who would have qualified for the Medicaid expansion.  Who, when  I asked “are you ok?” broke down sobbing because she was so tired of pain, for months, but it couldn’t be cured in a trip to the ER and the free clinic here didn’t have a specialist to help her. 

All the numbers you hear about have faces.  Remember that.  We cannot forget why, whether we are tired of working on this or whether we really have time to do it, we have to keep going.  Until we fix the problem. 

It will be tempting to get caught in a sort of righteous jubilation  here—it looks like we won something big.  I would have had more sympathy for that if the poor hadn’t been shamefully hung out to dry.  Let’s don’t go there!  We have work to do.  Medicare for All or bust!