Doctors in white coats marched in the rain from Freedom Plaza near the White House to Capitol Hill in Washington, D.C. on March 22, 2010 to show support for health reform and to ask the Senate to do likewise. I was one of those doctors, drenched but undeterred. We represented thousands of health care providers in organizations like the National Physicians Alliance, Doctors for America, and the American Medical Student Association, just to name a few. But more than anything, we represented millions of our patients nationwide. Our march in the rain was nothing compared to the arduous journeys that patients and families suffered in the broken American health care "system" (or lack thereof), losing their lives, their fortunes, and their dignity. The next day, March 23, 2010, the Patient Protection and Affordable Care Act was signed into law.
There are plenty of reasons to celebrate what Obamacare has accomplished over the past five years. My Top 5 lists those reasons that might be overlooked but are paramount to building health justice in America:
5. Caring for your health won't cost you your wealth.
For the first time in 50 years, people are not double-checking their pocketbook before they decide to go to the doctor. According to the Commonwealth Fund, back in 2012, there were 80 million working age adults who reported at least one cost-related problem accessing needed health care. Last year, there were 66 million. Thanks to a lot of the provisions in the Affordable Care Act, 14 million people did not delay health care because they were worried about the cost of care. Similarly, millions of people are having less problems paying medical bills. Clearly there are still too many Americans facing the false choice between preserving their health and preserving their wealth, but Obamacare is reversing this tragic trend.
4. Women are people, not "moral hazards" for health insurance companies.
Insurance companies are no longer allowed to use gender when they determine rates for plans, meaning women no longer pay more for their health insurance just because they are women. A full range of preventive services are covered, saving lives and strengthening the health of millions: prenatal care; breast cancer and cervical cancer screening; contraceptive counseling and prescriptions; breastfeeding counseling and support services; and intimate partner violence screening and counseling. Just as importantly, these services are covered at no extra cost to women, thus eliminating the financial barrier to better health outcomes for individuals and communities. To the misogynists who whine about having to pay for these services they will not use, I want to remind them of the simple principle of risk pooling. For example, there are hundreds of thousands of lesbians paying insurance premiums so hundreds of thousands of men can be treated for erectile dysfunction or prostate cancer. The point is that we all pay a little so none of us go broke from illness. "United We Stand" is real, not just rhetoric.
3. Obamacare helps you if you're red or blue (but especially if you're red?).
People living in Republican counties are benefiting from Obamacare, and sometimes they benefit more than people living in Democrat counties. Before the health reform law was passed, 18.5 percent of people living in Republican counties were uninsured. As of October 2014, that number decreased to 13.1 percent. The ongoing progress of the Affordable Care Act in parts of the country that oppose President Obama demonstrates the foolishness of playing politics with this law. Kentucky proves it: in one year, the uninsured rate dropped from 20.4 percent to 9.8 percent.
2. Medicaid deserves a medal.
A critical part of the successful enrollment of the uninsured in Kentucky and many other states is the expansion of Medicaid. Depending on where they live, families struggling at or below 138% of the federal poverty level ($33,465 for a family of four) may or may not have access to health care under Medicaid. The District of Columbia and 28 states opted to extend this lifeline, and now over 7 million Americans have the basic human right to see a healthcare provider when they need one. Sadly, many states are still putting politics before patients, and there are 4 million Americans stuck in the "coverage gap." Earning $10,000 per year as a parent is not enough to buy insurance on the federal exchange, but it may be "too high" of an income to be eligible for Medicaid in states refusing to expand the program. This injustice must end because it perpetuates the notion of healthcare as a privilege, not a right.
1. Implementation of the ACA advances civil rights.
First, remember that of the total US population, 17.1 percent are Latino-Americans and 13.2 percent are African-Americans. Prior to the enactment of the Affordable Care Act, minorities made up a disproportionate number of the uninsured, working at low-income jobs, where employers do not offer health insurance. However, thanks to Obamacare and Medicaid expansion in DC and 28 states, we are seeing significant improvement in the rate of uninsurance for minority communities: for Latino Americans, the uninsured rate fell from 41.8 percent to 29.5 percent. For African Americans, it fell from 22.4 percent to 13.2 percent. The job is not over. In the coverage gap mentioned earlier, the danger and injustice of lacking health insurance falls disproportionately on minority communities. 24 percent of the 4 million people in the coverage gap are Latino-American and 26 percent are African-American. As long as governors and state legislatures continue to resist the Affordable Care Act and Medicaid expansion, these injustices will persist.
My hope in sharing this Top 5 list is that we see the Affordable Care Act as a cause for celebration and a call to action. Health care is a human right and fundamental for a moral society. The ACA and its many provisions are important steps on our journey to health justice, a path that requires all of us (healthcare providers, elected officials, public health experts, and "ordinary" people) to do our part for our fellow Americans.