Originally published in Liberation Newspaper, April 2015
The U.S. Supreme Court recently completed hearings on a new challenge to the Affordable Care Act in the case King v. Burwell. Depending on their ruling, an estimated 8 million poor and working people will lose their current coverage—a devastating act of exclusion, which would mean new hardship and instability to poor families and communities.
Right-wing groups brought the case, claiming that the federal government does not have the power to continue to provide subsidies for insurance in states that have not set up their own health insurance exchanges. Currently, the federal program grants subsidies through its website to persons applying for insurance in those 37 states.
The appeal is based on a hair-splitting and false interpretation of the law: four words contained in the hundreds of pages of the ACA that read “established by the states.” The opponents of Obamacare claim this specifies that only states can provide subsidies. The Obama administration argues that the ACA clearly outlines throughout its hundreds of pages, that subsidies are available to every citizen in any state.
Obamacare suffers from glaring problems and limitations: the exclusion of immigrant workers, prohibitive costs and deductibles that make health insurance and access to care impossible for huge numbers, and its reliance on the profit-making model that benefits insurance and medical corporations. But it has provided minimal insurance coverage, however inadequate, to large numbers of poor and working people for the first time.
According to the U.S. Department of Health and Human Services, the uninsured rate in the United States has fallen from 20.3 percent in October 2013, when Obamacare began, to 12.3 at the beginning of 2015. (Kaiser Family Foundation) If the Supreme Court rules favorably on the appeal later this year, it is clear that millions of people would lose their health coverage and that costs would again spike out of control.
The cold-hearted cynicism of the Republican Party toward the lives and health of poor people is hard to match. Not only are they trying to eliminate these subsidies, but GOP governors have blocked the expansion of Medicaid in 22 states, even though the federal government is covering the full cost for two years.
But what most liberal writers and activists are failing to mention is that the basic design and structure of Obamacare has left it open to such attack.
Instead of fighting for universal health care as a basic and guaranteed right—either through single-payer care, “Medicare for All” or the nationalization of the health industry—Democrats ruled out such reforms. They ignored all the health care workers, scientific researchers, academics and economists who said these would be the most just, efficient and cost-effective models.
Both the Republican and the Democratic leaderships, whatever their differences, share a basic view that healthcare-for-profit, controlled by big capitalist corporations, must be protected and preserved.
That is the real bottom line. Billions of dollars in profits are earned every year by huge companies off of the sickness and misery of the population. Many people still go broke and lose their homes because of exorbitant bills from hospitals, clinics, pharmacies and other services. Millions are still denied access to quality care. While the Supreme Court ruling will have big consequences, that fundamental reality will not change.
The loyal servants to the wealthy and elite in Congress, both Republican and Democratic politicians, are playing a game where workers lose.
The struggle for true health care for all must and will continue. Those aspects of Obamacare that benefit the working class must be defended, but a whole new system is needed. A better world is waiting if we fight for it.
