6 Steps to Improving Obamacare on its 6th Anniversary

Since 2010, many health reform advocates have described the progress made under the Affordable Care Act, and we look forward to its continued implementation in the years to come. As it enters its sixth year, let's consider the fact that this is Obamacare's last year under the Obama Administration. For this anniversary, we must urge our policymakers to take steps now and in the near future to build upon Obamacare's success:

1. Stop Suing and Repealing Obamacare
This week, the Supreme Court heard arguments for what some are calling "Hobby Lobby 2," proving that bad sequels aren't just from Hollywood. Currently, if religious organizations want to avoid the Affordable Care Act's requirement that employee health insurance cover birth control, then they must write a letter to the US Department of Health and Human Services expressing religious objection. This week, in Zubik v Burwell, a religious non-profit organization complained to the Supreme Court that writing a simple letter imposed a burden. This really happened. During National Women's History Month. Hopefully the irony is sickeningly evident, but in case it's not, I'll spell it out. When trying to access reproductive health care, women face the real burdens, almost none of which can be overcome by writing a letter. Instead of targeting birth control, let's direct our moral outrage at politicians obstructing the basic human right of health care. When it comes to the ACA, we need to get past the burdensome lawsuits in federal courts and the countless repeal-and-not-replace votes in Congress.

2. Expand Medicaid Already
This should be as obvious as not suing or repealing the law, but as of right now, 19 states are still not expanding Medicaid to include families making $28,000 per year or less (138% of the federal poverty level for a family of three). Nearly 3 million of our fellow Americans are in the "coverage gap" where their incomes are "too high" for Medicaid but too low to buy health insurance in the federal marketplace exchange. Governors and state legislatures need to put patients before politics and upgrade their Medicaid programs to cover families.

3. Fix the Family Glitch
Under the health reform law, if an individual worker can get affordable health insurance for herself from her employer, then she is not eligible for federal subsidies to purchase coverage for her family members. Over 4 million Americans are struggling with this "family glitch" where affordable individual coverage through an employer mistakenly prohibits workers' families from federal assistance to buy health insurance on the exchanges. Legislation to fix this glitch has been proposed, but Congress has yet to really act on it.

4. Add a Public Option
Since the Affordable Care Act was passed, health insurance companies have attempted to merge with each other, leaving competition and fair pricing in the dust. While the Justice Department investigates, health policy experts have expressed concern for how patients will afford care and how doctors will provide care under the crushing power of a few mega-insurance companies. Regardless of these circumstances, we must develop a public option as a source of affordable health insurance coverage for patients and as a driver for competition as big insurance companies put profits before patients.

5. Coverage for ALL Immigrants
Last year, California took a bold step to allow undocumented immigrants to purchase health insurance in the state's exchange marketplace or to enroll in Medi-Cal (the state's Medicaid program). The Affordable Care Act currently prohibits undocumented immigrants from purchasing health insurance in the federal exchange (or in a state's exchange unless the state applies for a waiver, as California is doing). Over 20 percent of America's uninsured are immigrants, some undocumented and others in an arbitrary waiting period. Immigrants' access to healthcare is being wrongly managed as a privilege, when it should be a basic human right. The rest of the country should follow California's example and extend healthcare to everyone, regardless of immigration status.

6. Demand Better Prices from Pharmaceutical Companies
In 2015, Americans spent $457 billion on prescription drugs (28 percent in hospitals and clinics, 72 percent on retail drugs). Currently, the Centers for Medicare and Medicaid Services is working on several approaches to address the rising spending and escalating prices for prescription drugs. We could stop healthcare providers from profiting off prescribing what's new and expensive, and urge them to scrutinize the efficacy of new medications compared to what has worked before. Similarly, Medicare can pay drug companies only for medicines with a proven track record of improving patients' health outcomes. These approaches are worth considering and testing, but policymakers need to act upon what 83 percent of Americans want: allow Medicare to directly negotiate with the big drug companies for better prices. Not only would this effort be fiscally responsible for the federal government, it would be morally responsible to end the false choices of whether patients pay for prescriptions, groceries, or their rent.

For over 13 million people obtaining health insurance on federal and state exchanges, and for over 15 million people enrolling in Medicaid, the Affordable Care Act has been a lifeline of support. Improved coverage for health care is a strong foundation to build upon. As Obamacare continues past the President for which it was named, Americans need to take the above health policy steps and many more to continue manifesting health justice for each other.