PHOTO/STEVE RHODES
ATLANTA, GA — Rollout of the “market-place insurance exchanges” created by the Affordable Care Act (ACA), so-called Obamacare, begins October 1 with the bulk of ACA implementation set for January 1, 2014. It’s a two-edge sword. On the one hand, Americans with incomes between 100% and 400% of poverty (that’s an annual income between $11,500 – $45,690 for an individual and $23,500-$94,000 for a family of four} can buy private health insurance and qualify for a federal subsidy to offset some of the cost of that insurance. The less you make the higher the subsidy. On the other hand, the mandate to buy private health insurance backed up by federal subsidies is a prop for the very industry that has left over 50,000,000 uninsured. It’s the fox watching the hen house.
The never-ending policy debate about the good and bad of the ACA has obscured the strategic political substance of the structural changes occurring in healthcare.
First is the economic integration and consolidation of the healthcare delivery system. Subsidized by public funds, electronic medical records and Medicare industry-setting reimbursements that are broadly based on patient outcomes, have been introduced. Conditions of living in poverty, food scarcity and limited access to comprehensive and compassionate healthcare are not factored into ‘outcome’ based healthcare. These changes are accelerating the closure of countless small community hospitals, ‘safety net’ hospitals, clinics and rural healthcare institutions.
Second is the failure of 17 states to expand Medicaid, with Southern States at the forefront of reaction. The Supreme Court’s ruling on the ACA reinforced states rights by permitting states to decline Medicaid expansion even with the Federal government paying 100% of the cost for three years. The most dispossessed section of the working class surviving below 100% of poverty will remain uninsured in states refusing Medicaid expansion. To add insult to injury is the exclusion of undocumented workers from any access to health insurance, public or private and the five-year waiting period for ‘documented’ immigrants.
The scope of these changes are felt throughout the working class. Multi-employer union contracts that cover their workers between periods of employment are at risk. UPS is dropping spousal coverage to 15,000 of its non-union workers who qualify for insurance from their own employer, thus requiring a family to pay twice for coverage. More employers will use the excuse of the “mandate” to further erode employment-based insurance. Public employees and pensioners are painfully aware of how vulnerable their access to healthcare has become.
The time is now to confront this massive governmental support for corporate healthcare.
A strategic response can build critical class unity by elevating the program of those with no ties to a corporate agenda or their political parties. Medicaid must be expanded! The undocumented cannot be ignored. A united working class agenda for equal, comprehensive compassionate and publicly distributed healthcare based on need, not on degrees of income or identity differences, is necessary now to win healthcare for all!
