ISPC Position Statement on the Affordable Care Act of 2010

ISPC Position Statement on the Affordable Care Act of 2010

Many of our allies in the single-payer movement believe that the ACA, while “not perfect” is “not bad;” and is, anyway, the best we can do right now. Some believe that “something is better than nothing,” or than “anything is better than what we have now.” Some see the chance to acquire health insurance, and the financial security they believe insurance represents, for the first time.

Why does ISPC decline to support a law that many people see as offering a lifeline to themselves, members of their families who have been unable to get insurance, and the businesses or not-for-profits that they work for?
 

Cost control: The law increases health care costs, and the US already has by far the most expensive health care system in the world. Health care costs ultimately come out of our pockets, whether in the form of premiums, out of pocket costs for services, or taxes. The increasing costs inevitably mean that health care becomes more and more unaffordable--that is, people cannot afford the premiums, or, after having paid the premiums they cannot afford to access care. Subsidies will inevitably not keep up with escalating costs. People will continue to go bankrupt and lose their homes because of medical expenses. 
 

Bureaucracy: The law increases bureaucracy. This has two adverse consequences: increasing amounts of money diverted from health care to administration; and bureaucratic barriers to accessing insurance and/or care that are especially intractable for the sick, the poor, and those with limited literacy or mobility. Already, people who are eligible for Medicaid, SCHIP, and other special programs are not receiving services because they cannot navigate the systems required to sign up, or because their eligibility changes frequently. In any complex system, the most vulnerable will fall through the cracks.

Universality: The law does not and does not intend to make health insurance coverage available to everyone.

Effect on employer sponsored coverage: Although people were promised that they could keep what they have if they like it, many people will be forced to keep what they have even if they don't like it. Many others will suffer loss of employer sponsored coverage; or be subjected to increased cost sharing, and have further restrictions on physicians, hospitals, and other providers. Under this law, employers are rewarded financially for dropping coverage because the penalties for doing so are less than the cost of insurance. The percentage of people in the country who have employer sponsored coverage is declining every year, and will continue to decline under this law.

Health insurance: Some policies offered on the exchanges will have an actuarial value of only 60%. This means that the policy pays only 60% of health care costs, leaving 40% to the patient in the form of deductibles, co-insurance, co-pays, and exclusions. People will be discouraged from getting care, or will be unable to get it, because of the out of pocket costs. (It is to the benefit of insurance companies to issue insurance that people can’t afford to use, because if the insurance is not used, they don’t have to pay anthing.)

Medicare: Medicare is an excellent program that has lifted many elderly people and their families out of poverty, and that provides access to care for millions of elderly people, people with disabilities, and people on dialysis. However, it is inadequate, as is inevitable for any program that a) is partially privatized, and b) segregates the sickest and most expensive patients in a risk pool separate from the healthy. Although Medicare Advantage Plans (MAP’s) will be paid less, there is nothing in the law to effectively prevent them from continuing the illegal practice of cherry-picking the healthiest seniors. (Seniors in MAP’s have lower hospital costs while they are in the plans but higher hospital costs during the year after they disenroll and return to regular Medicare--thus increasing Medicare’s costs.) Medicare pays only 80% of the cost of most services that it covers (it does not cover dental care or most long-term care, for example, and pays less for psychiatric care than for other medical care), after an annual deductible, requiring seniors to absorb these high costs out of pocket, or to buy supplemental policies that may cost more than $11,000 per year and have medical loss ratios as low as 72% compared to Medicare’s 97%. (The medical loss ratio, a term invented by the health insurance industry, is the percentage of the premium that goes to medical care as opposed to administration.) One in four seniors spent 30% of household income on medical expenses in 2003. The law does nothing to correct these problems. Furthermore, the law takes money from hospitals that care for a disproportionate share of uninsured and poor people and gives that money to insurance companies in the form of premium subsidies. 
 

Medicaid: Medicaid could have been expanded without creating the other provisions of the law. Medicaid remains, under this law, what it has always been, a program without adequate public support that segregates the poor and the disabled and underfunds their care. People on Medicaid will continue to be forced into managed care programs that do not give them access to the care they need.

Community health centers: CHC's could have been expanded without creating the other provisions of this law. CHC's will be expanded, but will continue to suffer from the inability to provide access to many needed services, especially sub-specialty care. Some areas may not be able to acquire CHC's at all because of the lack of sub-specialty support.

Women’s reproductive health: Many women will not be able to obtain insurance coverage for abortion. This includes women in the high risk pools, who are especially vulnerable to serious complications of pregnancy.  

Health insurance companies: They are the cause of our health system's failures, yet through this law they are given huge amounts of public and private money. They will spend this money on denial-management bureaucracy, lobbying of national and state legislators and regulatory bodies in order to make the law work to their advantage, shareholder profits, and inflated executive compensation.

Pharmaceutical industry: Drug prices will continue to escalate, wiping out any savings from new regulations, and subsides will be increasingly unaffordable. Patients will remain subject to formularies that may deny them access to expensive necessary drugs.

Over-all effect of the bill: The law is an insurance company bail-out. Health insurance companies add zero value to the health care system, and their products are more and more unaffordable. They need subsidies in order to continue to make a profit. This bill provides the subsidies, both by handing over taxpayers' money and by forcing people to buy a product that is worth less than its cost.

Fairness: The law discriminates against the sick, who will not be able to afford the out of pocket costs associated with expensive health care. It discriminates against providers who care for the poor and the sick, who will continue to be unable to absorb the unreimbursed costs. It discriminates against women, who earn less than men and yet have higher health care costs and therefore higher out of pocket costs (equalizing premiums for women and men does not address this discrepancy). It does not even attempt to assure the full range of necessary health care services will be available in every part of the country. The poor and disabled, and undocumented residents, remain especially vulnerable to being denied care.

What does ISPC support instead of the (misnamed) Affordable Care Act?

• Single-payer national health insurance, also called Improved and Expanded Medicare for All
• Full public financing of health care through a progressive tax, with the healthy and the wealthy subsidizing the poor and the sick; pay according to ability, receive according to need.
• Care free at the point of service.
• Health insurance companies not permitted to sell coverage duplicating that of the public plan.
• Effective cost controls, including much simplified administration, negotiation of fair prices for all goods and services including drugs, rational health system planning with capital investment according to need, and global budgets for hospitals.
• Increased investment in public health infrastructure.
• Increased investment in primary care but with access for everyone to all necessary services from prevention to specialty and long-term care to hospice care.
• National health plan card for every person, from birth to death, with no bureaucratic obstacles to access to care.
• Complete choice of physicians, nurse practitioners, hospitals, pharmacies, sand other providers.

Everybody in, nobody out. One nation, one health plan.