Guest commentary: ‘Affordable Care’ leaves out millions

Enrollment in the Affordable Care Act health plan has begun, despite a spectacular wrestle-down in Congress that made it the object of a threatened U.S. debt default. The impasse ended with an agreement that the Department of Health and Human Services will verify the employment records of people buying health insurance on the exchanges. Applicants will be carefully cross-checked before any subsidies will be sent to the insurance companies on their behalf. These elaborate and onerous provisions were already in place before the shutdown, but some politicians still fumed that people would try to “cheat.”

It was this requirement for record verification across multiple agencies that caused the insurance “marketplaces” to crash. Politicians were obsessed with the idea that people will wrongly get government subsidies when trying to buy health insurance, when in reality, we’ve been the ones cheated by the insurance industry, with the full support of the government!

The federal HealthCare.gov website locked up almost immediately after midnight on Oct. 1, when the first 2,000 people attempted to log on to purchase insurance. Serious technical problems still plague the system.

These “glitches” are not what should concern us the most, however. What should really disturb us is that the new plan keeps the health insurance industry in the driver’s seat of the health care system.

Millions denied health care by insurance giants, politicians

The insurance industry is a discriminatory, “risk based,” private profit system. For roughly 60 years, it has excluded untold numbers of people in the U.S. from health care. A study by Harvard Medical School researchers estimated about 45,000 people die every year because they can’t afford health insurance and miss out on timely treatment.

The first enrollees in the new plan were anxious to get health care. Ten million people tried to buy health insurance the first week, which was five times more than the system was built to accommodate. They rushed forward from among the nearly 50 million people in this country who’ve been excluded from insurance, which is the gateway — and often the barrier — to health care.

An astounding 30 million people are expected to remain uninsured even after Affordable Care is in full effect. Under the new law, many of them will be “waived” from tax punishment for not buying insurance. The “waived” will be homeless people, people who’ve recently been evicted from their housing or gone bankrupt, and those who’ve had medical expenses they couldn’t pay within the past six months.

The uninsured will include those with large expenses caring for family members with illnesses, disabilities or aging. Some will be undocumented workers; among the “waived” will be young people waiting under the “Dream Act.” Although people enduring such hardships are especially vulnerable to illness and injury, they still won’t have access to health care — they just won’t be further punished if they don’t buy insurance.

As reported in an Oct. 9 Workers World editorial, 8 million people will remain uninsured because they are poor and live in states that have decided not to “expand Medicaid.” Twenty-six states have declined to expand Medicaid. Millions who would have been eligible for Medicaid coverage won’t get it.

The Southern states won’t expand Medicaid anytime soon. Those states have long refused health care for large numbers of the working poor. Not only are “leaders” in those states ideologically loath to care for their people, but their health care infrastructures are so discriminatory, defective and inadequate that it would take massive sums of money to begin their functioning under the new act.

These states have been highly restrictive in their Medicaid eligibility requirements. Their so-called community-based health care systems are few and poorly funded. If the Supreme Court had not relieved them of the obligation to expand Medicaid, their unmitigated neglect and racism would have been exposed to the world. Not surprisingly, the commercial health insurance industry is very poorly regulated in the same states that have rejected Medicaid expansion.

It shouldn’t be assumed that enrolling millions of people in Medicaid will go smoothly in Northern states, either. Medicaid has cruelly stigmatized and rationed health care across the U.S. Medicaid-eligible people practically have to beg for health care. Every state has made it difficult (or impossible) to enroll, taken punitive measures against existing enrollees, and kicked off people who needed health care, while countless people have died waiting for Medicaid.

Not only that, but people newly enrolled in Medicaid under agreements with states will probably get better coverage than those already on Medicaid. This will create a discriminatory, two-tiered Medicaid system even within the same states.

In many places across the U.S., there won’t be enough primary care providers to care for those added through Medicaid and the Affordable Care Act. This is absolutely not the fault of people who need medical care. It’s the fault of our unplanned, patchwork, private-profit, insurer-dominated health care system. Furthermore, all of us — every person in the country, young and old — deserve better medical care than what Medicaid provides.

A step in the right direction?

Some claim the new health insurance plan is “a step in the right direction” because it allows additional people to buy insurance. No question it’s helpful that parents are able to keep their young adult children on their own health insurance longer. Now, women can’t be charged more than men. It’s good that people with pre-existing conditions will be able to buy insurance without being penalized (although people over 50 can be charged up to three times as much as younger people). New provisions that are helpful should have been forced on the insurance industry long ago!

Any reforms in the new act come at a very high cost. There’ll generally be “less value” in the new insurance policies. As the ACA goes into effect, the distressing overall trend is to “equalize” health care, downward. What used to be called “good insurance” is now derisively called “Cadillac policies” and will be taxed to help finance subsidies for new enrollees. Wouldn’t it make more sense if we all could have full health care?

Insurers are still trying to avoid sick people with the new policies. They’re narrowing networks and excluding many community hospitals that have the highest proportions of sick people. Insurers are even dropping some major hospital systems from their networks if they can’t negotiate with them profitably. People living in rural areas will find they can only choose from one or two plans. Low-price policies will be available, but they’ll have very high out-of-pocket expenses and limited options. People will still suffer bankruptcy due to medical expenses because the share of costs borne by individuals and families will go up dramatically.

Is this really much of an improvement? Health care costs in the U.S. are the highest in the world, but the efficiency of our health care system is ranked 38th by the World Health Organization. Supporters of the new plan have hoped it will reduce health care cost increases, but most experts don’t believe that will happen.

The Affordable Care Act doesn’t get at the main driver of spiraling costs: the health insurance industry itself! The insurance industry has been able to make big profits even while paying high prices to the drug and device industries. They’ve been able to do this by excluding millions of people who are sick or likely to become sick. This is the terrible truth about the ACA: It was designed by insurance industry representatives to make sure the large insurers can’t lose.

There will be a $63 tax assessed on every person who enrolls in a new policy, and those funds will reimburse insurers for 80 percent of large claims. A “corridor of profit” has been built into the legislation, removing risk for insurers. It is mind-boggling that we — the public — will guarantee the profits of health insurance companies. We’ll pay them $1 trillion in subsidies over the next decade, just so they’ll allow more people to buy insurance!

Paying more: an accelerating trend

The ACA accelerates the long trend of shifting health care costs onto the public. Before the new law was put in place, government sources were already covering about half of all health costs. The new plan takes from other areas of health care to fund the new subsidies. In order to make the act “budget neutral,” hundreds of millions of dollars in cuts were made in Medicare payments to hospitals. This has already hurt people with disabilities, seniors and those on dialysis. Additional planned cuts in Medicare payments to doctors will undoubtedly affect all patients. Thousands of hospitals have already cut millions of dollars from their labor and supply budgets.

“Affordable Care” is part of a push to cement in place a highly fragmented, unequal, multitiered health care system. Working people have fought hard to keep access to health care, but the forces of capitalism are moving aggressively to drive down quality and cut access. Insurers already have their sights set on the tens of millions who’ll be dumped off employers’ policies. About 25 percent of employers have already said they’re ready to do so. The trend is for existing employer-provided policies to reduce benefits and “cost share.”

The aim of the insurance industry is to keep us divided and confused. With the Affordable Care plan, we’ll continue to be. Across the country, people will be choosing from thousands of different insurance contracts. Family members could have different types of insurance. Many difficulties will remain, such as dealing with obscure insurance provisions and limitations, the new costs, with so many people excluded.

Shouldn’t we be furious that we’re already paying enough for full, equal health care, but not getting it? We’re paying unnecessary insurance brokers to take our health care dollars and channel them to investors. This is not what we want! Our working-class morality tells us to take care of everyone. We must demand national single-payer health care. H.R. 676, “Expanded and Improved Medicare for All,” would really be “a good start.” Free universal health care for all, not dictated by capitalism, would be even better.

The writer, a retired sociologist, is a Workers World reader and an activist with the Moratorium NOW! Coalition to Stop Foreclosures, Evictions & Utility Shutoffs in Detroit.