The Affordable Care Act (ACA), or Obamacare for the Republicans, is the most progressive public policy initiative in the last thirty years – even when taking into account its horrendous imperfections.
The fact that too many states – especially those where there are too many uninsured – didn’t expand Medicaid by broadening the eligibility criteria, leaves too many people to continue to get their primary care or episodic care in various emergency rooms.
What do we do for the estimated 12 million undocumented immigrants who need medical care as well? Obamacare is silent on this huge segment of our population. We cannot continue to pretend the immigrants do not exist or are invisible when every Saturday we see them cutting the lawn for the middle class in suburban America.
We seem to know why the Obama administration has miscalculated when it left to the states – many of them with a conservative legislature and/or governor – to play such a big role in ensuring coverage for those who have been denied access to healthcare: their ideological bias toward the middle class.
Obamacare covers folks between 100%-400% FPL, which includes some working poor but mostly the middle class. Expanding Medicaid to include folks below 100% FPL, including single men, would have covered some working poor but also those the system has long left behind.
One of the enduring legacies of the conservative revolution that culminated with Ronald Reagan taking power in 1980 is that it becomes less and less politically correct to couch one’s political philosophy in terms of advancing the social and economic plight of the poor or working poor.
Indeed, part of today’s struggle is to seize back this power to talk about the poor and the working poor, to frame the struggle in such a way that not placing the poor or working poor at the center of everything is tantamount to accepting the ruling elite’s dicta to talk in general terms about justice and equality.
(It is even wrong to talk about equal opportunity for all: some folks, particularly African-Americans, Native Americans or most immigrants, have been left behind for too long. Some will need to be “given” more from the beginning if at the end the goal is to create a better society.)
Obamacare is here to stay. However, it is important to identify some of its flaws to make it a better law. A major flaw is that it is too expensive even after the Federal subsidy. Too many have to pay too much to get coverage.
This relates to the perception that the health insurance companies may have played a big role in influencing the Obama administration to accept all these plan options from which the consumers must choose. Just in Dade or Broward, the consumers have to select from among more than one hundred – each based upon different amounts for deductibles and co-payments, and including the ten essential benefits.
I don’t get it – a maximum of five plans should have been the way to go.
If after next year, prices do not go down, then it may become necessary to establish some type of price control. It’s a mistake to let the insurance market dictate the prices. The Obama administration, and any democratic administration thereafter, will need to revisit this health care until it morphs into something else: coverage for all.
Meantime, we all know that the Affordable Care Act – overall – may not be affordable for too many.