Obama's health reforms: millions still uninsured

When US President Barack Obama signed the Patient Protection and Affordable Care Act into law on March 23, he said: “Today after over a year, today after all the votes have been tallied health reform has become the law of the land in America … Our presence today is remarkable and improbable with all the punditry, all the game playing in Washington … We are a nation that faces its challenges and accepts its responsibilities … Everybody should have some basic security when it comes to their health.”

What he failed to mention is that rather than fixing the ingrained and fundamental flaws in the US healthcare system (an expensive mess that accounts for 16% of US GDP, twice the proportion of the GDP of other developed capitalist countries), he merely put a shoddy patch on the problems — and essentially gave a giant handout to the big US health insurance companies, the five biggest of which recorded profits of US$12.2 billion in 2009.

Unlike with the single payer Medicare system in Australia which provides all residents with free public hospital care, most people in the US receive their health insurance through their jobs. If they are not provided insurance as part of a salary package (because they either work too few hours or are in a low paying job), then often their only option is to either pay for it out of their own pocket, often to the tune of hundreds (or even thousands) of dollars a month or go without.

The US version of Medicare is only available to those who are over the age of 65. Those on extremely low incomes are sometimes eligible for a program called Medicaid, which is administered by individual states, but it is severely underfunded and those users who can access it face problems finding doctors who accept it as payment. There were nearly 45 million people on Medicaid in 2008, while in the same year there were 47 million without any health insurance in the world’s richest nation. It is estimated that 22,000 deaths in 2006 were directly linked to the fact the deceased didn’t have health insurance, according to an Institute of Medicine study.

One of the biggest flaws of the legislation enacted by Obama (aside from the fact that it wasn’t proposing a single payer system) is that an estimated 23 million Americans will still be without health insurance in 2019 according to a Congressional Budget Office (CBO) estimate, even after the final reforms come into effect in 2014. Another estimated 32 million who wouldn’t otherwise have health insurance will be eligible for a tax credit or a federal subsidy to help them buy insurance. Despite the outburst from South Carolina Representative Joe “You Lie!” Wilson during Obama’s September address to both houses of Congress, “illegal” immigrants within the US will not be eligible to purchase health insurance and they represent nearly a third of the pool of uninsured.

Once the entire legislation comes into effect, insurance companies will no longer be able to drop people from their rolls just because they have gotten sick. Those with “pre-existing conditions”, which can range from cancer survivors to those who simply suffer from hay fever, can no longer be excluded from buying insurance. There will be no caps on the amount of spending for healthcare services and insurance companies will be required to spend at least 85% of all premiums on healthcare services — up from a low by some companies of only 67 cents for every premium dollar. Young adults will be able to remain on their parent’s health insurance plans (if they have them) until their 26th birthday without having to attend college or meet other qualifying criteria.

These modest reforms, while long overdue, are just a stop gap. As medical doctor Margaret Flowers wrote on the Physicians for a National Health Program website, “We want health CARE reform. Health insurance reform makes no sense … If we want real reform, it isn’t going to be pretty. It can’t be brought in through the back door or by tweaking. We will have to take on a very powerful industry that currently owns the White House, Congress and the media.”

To get even Obama’s meagre measures passed was a heavy lift given the complicated US legislative system, a Republican party hell bent on derailing any reform at any cost and the insurance lobby’s hold on both the Democratic and Republican parties. According to the Washington Post, the healthcare lobby “set records from January to March [2009], when health-care firms and their lobbyists spent money at the rate of $1.4 million a day”.

Initially intended to be voted on mid-2009, the legislation was held up by various Congressional committees. During the August Congressional recess, town hall meetings were hijacked by an organised, frenetic and loud mob of those opposed to “Obamacare”. Most of these opponents were whipped into a frenzy by the lies peddled by the health insurance industry itself through fake grassroots organisations like Americans for Prosperity, FreedomWorks and other rent-a-crowd groups.

Former vice-presidential candidate Sarah Palin did her bit via her Facebook page by writing, “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.” Elected representatives joined in the frenzy, with Senator Chuck Grassley famously saying “We should not have a government program that determines if you’re going to pull the plug on grandma.”

Despite the fact it was very clear early on in the process that Republicans were not willing to have a genuine conversation about the legislation, the Obama administration time and again tried to court Republican votes with generous concessions. Negotiations were started not with a single payer system on the table, but the so-called Public Option — a government run and administered plan that people would have the option to purchase on the open market, just like any other insurance plan. The difference here is that there would be no million-dollar bonuses or high executive salaries and no one would be considered too “high risk” to buy in.

Over time even that got watered down to only people without insurance would be eligible to buy in and individual states would have the option to “opt out” of the program, denying their residents any choice at all. As we have seen, the lack of choice was extended to the entire nation when the legislative dust settled. The administration has faced heavy criticism from the left of the party for making it clear early in the process that it was not fazed if the public option were included or not as it was more vital to get something, anything, passed before the 2010 mid-term Congressional elections for maximum Democratic Party gain.

At the start of the legislative process, a meeting was brokered between those on both sides of the abortion debate (probably the biggest rallying point for social conservatives within the US) that the status quo would not change regarding abortion and its funding throughout the country — meaning the barriers set down in the Hyde amendment regarding no federal funding of abortion, except in cases of rape, incest or imminent maternal death would remain in place.

Enter conservative Democratic Representative Bart Stupak, who was convinced there was an abortion funding loophole in the legislation — a loophole that existed only in his own mind. He was, however, able to convince some 40 other members of Congress that such a loophole existed and they needed to vote for his amendment to the House of Representatives version of the health reform bill. (The Senate version of the bill, which was the more conservative of the two and what was ultimately signed into law, considered a similar amendment but did not proceed to a vote.)

That Stupak was even able to bring such an amendment to the floor of the House for debate was seen as an affront to a woman’s right to choose — a supposed central tenet of the Democratic Party platform. The reason he was permitted to do so by the party leadership was meant as a gesture to ensure passage of the overall legislation. Members of the congressional pro-choice caucus saw it for what it was — throwing women’s healthcare under the figurative bus to score political points.

While Stupak ultimately relented from his campaign to further restrict access to abortion, a legal medical procedure throughout the US since the 1973 Supreme Court’s Roe v. Wade ruling, the language in his amendment would have made it illegal to cover abortion services for any woman using a federal subsidy to buy health insurance. These women would have either had to purchase an insurance rider specifically to cover abortion or pay for it out of their own pocket.

The Department of Health Policy at the George Washington University Medical Center concluded the amendment would have had a flow-on effect to the coverage of abortions for all women, because it would encumber the ability of private insurers to market supplemental coverage and possibly deny coverage for other procedures if a relationship between those procedures and abortion exists — a strong possibility if the abortion is needed due to other serious maternal medical issues.

US filmmaker Michael Moore, who directed arguably the single greatest critique of the US healthcare system with his film Sicko, explained his frustrations to Democracy Now daily TV/radio news program host Amy Goodman in an interview on March 23, “I’ve been pretty vocal about this. This bill was never about universal healthcare. It, you know, did a couple of good things that could have been done anytime, I guess, like ending the pre-existing condition rule for children. It doesn’t end it for adults for four years, so you can rack up another, you know, probably 20,000 to 40,000 deaths in the meantime from people who otherwise would have received help had we truly gotten rid of the pre-existing condition thing for all citizens. But six months after the bill is signed by Obama, kids will be able to get coverage from a private, profit-making insurance company. The larger picture here is that the private insurance companies are still the ones in charge … I don’t know why they’re so upset this week, because this bill is going to line their pockets to an even greater extent.”