Which way to healthcare for all?

A look at the Affordable Care Act

Whether or not history one day considers the Affordable Care Act (ACA) a victory for patients or insurance companies depends, in part, on what we do next.

The Affordable Care Act’s healthcare exchanges began selling insurance plans on October 1 — and already big insurance companies are twisting the law to make a buck. The New York Times found that companies like Cigna are offering ACA plans with small networks of doctors and hospitals in order to make a profit.

That’s just one of the contradictory effects of the new health law.

Millions get covered

The ACA has already improved insurance coverage for millions of Americans. It’s now illegal for insurance companies to deny coverage based on pre-existing conditions. Young adults can stay on their parents’ insurance until they turn 26. And the law extends Medicaid coverage to 16 million people.

These changes are a victory for patients, and they deserve our full support. Hospitals will start getting reimbursed for many patients who were uninsured until now, which is particularly important for safety-net hospitals. And yet, as we go to press, the federal government remains largely shut down because Republicans in Congress refuse to fund the law.

The profit takers

The ACA is not a panacea: it leaves for-profit corporations in charge of healthcare. And the big insurance companies are shifting many costs onto patients. The least expensive, or Bronze, plans available on the ACA exchanges require patients to pay 40 percent of their healthcare costs. And the law expects low-income families to pay 9.5 percent of their total income on premiums, not counting deductibles and other out-of-pocket healthcare expenses.

The law does nothing to stop insurance companies from denying medical procedures to those they cover. For-profit insurers will still be calling the shots on patient care decisions.

Access to care

Having insurance may not always translate into having access to care. The ACA emphasizes primary care, but many communities in our state don’t have a primary care network.

“Elite” hospitals will have every incentive to poach patients with better insurance who need expensive procedures, at the same time that the law ends the Disproportionate Share Hospital funding that many of our safety-net hospitals have relied on to help pay for uninsured patients. Safety-net hospitals are likely to struggle mightily, and more may well be in danger of closing or cutting services.

Healthcare for all

It’s simple, really. Healthcare and profit making don’t mix. And neither do healthcare and politicking. Just look at what the Republicans in Congress are doing. We need a healthcare system that cares for everyone. Vermont has started to build a not-for-profit single-payer insurance system in which everyone gets the same level of insurance coverage and care.

Dick Gottfried, chair of the New York Assembly Health Committee, is proposing similar legislation in New York. “We need publicly accountable, publicly funded universal coverage that cares as much about the poorest New Yorkers as the wealthiest because,” Gottfried said in a recent interview with NYSNA, “we would all be in the same boat.”

NYSNA has made winning this law a top priority for our legislative work. Success depends on our building a powerful coalition of patients, community leaders, and caregivers. With universal healthcare, history won’t have to debate who won. It’ll be clear: patients.