America is once again facing questions of health care policy and law. Six times in the 20th century — beginning with the presidency of Teddy Roosevelt, a progressive Republican, and ending with that of Bill Clinton, a conservative Democrat — America tried to address the issue of health insurance for all people. Six times we failed. Important progress was made during the presidency of Lyndon B. Johnson, when Medicare and Medicaid became part of the U.S. health care system. For more than 100 years, the United States has struggled with health care issues, considering (and reconsidering) who should benefit and how much. The issues have only gotten more challenging over time.
Health care is a double-edged sword, in practice and in politics. On the one hand, the U.S. health care system is a complex set of policy issues that shape the daily health care realities for millions of people. On the other hand, these policies have real, immediate impacts on the lives of men and women when they or their loved ones are sick and vulnerable. People don’t think of their health care in terms of group insurance or a pool. They think of it as “my” health care. And this mindset has colored the debate for more than a century.
Health care is unlike almost every other part of American life. For the majority of Americans, it is not a product or service that we buy for ourselves. Most Americans get their health insurance through their employers, and employers are the ones who decide the plans for employees. A significant number of Americans, however, also get their health care through programs like Medicare, a federal health insurance program designed for people who are 65 or older, certain younger people with disabilities, and people with certain medical afflictions, or Medicaid, a jointly funded federal-state health insurance program designed for those whose annual income places them well below the poverty line.
It is important to remember too that, in the United States, health care is supported by both public and private funds. Public investment supports medical research, education, and infrastructure. Recognizing that medicine and health care are public investments is important to understanding the issues. It’s critical to considering whether our national obligation is to make sure health care is available to all people.
The Affordable Care Act, or ACA, signed into law under President Barack Obama in 2010 expanded the Medicaid program to include many people who are near the poverty level but not poor enough to qualify. These are usually people who are working and paying taxes but whose jobs don’t include health insurance. Nevertheless they are contributing, through their taxes, to support the infrastructure of the U.S. health care system.
Now, our legislators are seeking to repeal and replace this legislation, denying coverage under the ACA and Medicaid to more than 22 million Americans.
What do the proposed changes to Medicaid mean? In Louisiana, for example, 60 percent of the state’s children are now covered by Medicaid. Under proposed legislation, more than half of our children, some of the most vulnerable among us, would go without health insurance. At the same time, in 2016, Medicaid provided health coverage to 112,050 seniors and 227,514 persons with disabilities in Louisiana. These individuals make up just 24 percent of Medicaid enrollees, but they account for 64 percent of all Medicaid payments.
Health care is complicated and health care policy even more so. Do we need to change the Affordable Care Act? No doubt. But it would seem that, to achieve meaningful change, we must do so through a thoughtful process that allows for debate and discussion rather than simply exclude some of the most vulnerable members of society, who both have great need and little to no voice in the process.
It has often been suggested that Americans should get the same health care that members of Congress get. Another way to think about it is perhaps if our legislators had to live under the same policies they are creating for others, these decisions would be much easier to make.