The healthcare aftermath of June 28, 2012: What we protected, what is missing, and what we still need to do

(Originally posted on the OccupyHealthcare blog June 28, 2012)

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Yesterday, the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA). After nearly 2 1/2 years of partisan misinformation, the Court has established the law's legitimacy.

This is an enormous step forward. The PPACA incorporates many patient protections that will reduce the profit-centered influence of for-profit insurance companies on American's healthcare. Once the law is fully implemented in 2014, insurers will no longer be able to deny insurance coverage to any American even if they have pre-exisiting medical illnesses and will no longer be able to place yearly or lifetime limits on members' benefits. Insurance companies will be required to spend 80-85% of the money members pay in premiums on providing benefits to members as opposed to salaries and administrative costs. Young adults will be able to stay on parents' insurance plans until they turn 26--meaning that they can keep necessary insurance coverage as they finish their educations or start their careers. Federal subsidies will make insurance affordable for Americans who are not offered insurance through their jobs and cannot afford to purchase it on their own. Private insurers have called the shots for too long, and restricted access to necessary care for Americans who could not afford it or who were already ill. These days are now coming to an end.

The PPACA also addresses key needs in our healthcare system. It will strengthen our primary care workforce and our community health centers. It will encourage research that is both patient-centered and evidence-based, to help patients and physicians make informed decisions about the best approaches to individuals' care. The PPACA also makes preventive care available for all without co-pays, allowing healthcare providers to detect and treat (or even prevent) chronic disease before they cause permanent harm.  The law will increase Medicaid access and will strengthen Medicare. Finally, the PPACA includes programs to explore new ways of providing (and paying for) healthcare services that are more effective, more coordinated, and less expensive.

All of these are critical patient protections and healthcare system reforms. The protections will allow us to make sure that healthcare is available with less interference on the part of insurance companies and reforms the most egregious insurance company practices. The reforms will allow us to start to move our healthcare system away from one providers are paid more for doing more care and towards a system that provides better care.  These are significant steps, and reforms that the Supreme Court has now endorsed and guaranteed so long as the Affordable Care Act is in effect.

However, the law is an incomplete step forward.  It still leaves a number of Americans lacking health insurance, and explicitly prevents many immigrants from accessing care.  The PPACA supports private, for-profit insurance companies with public money in the form of subsidies to help low-income Americans pay for insurance.  There were still be fragmented care as patients will still move between private and public insurances or between private insurers.  There is little in the law to address the high and increasing costs of pharmaceuticals and medical devices.  By building upon the flawed structure of individual private insurance companies, the PPACA cannot offer the savings inherent in single-payer systems where administrative costs are lowered, coverage and access are assured to all.  The political environment in Washington, DC would not allow for such a significant move as a single-payer system.  In fact, the law barely survived in its current form.  This does not mean that we should rest on our laurels: even with the PPACA's reforms there will be much more work to do.

We must monitor how the PPACA is enacted, and we must avoid its reforms being co-opted or weakened by special interests and the law's stubborn opponents.  Where the law does not meet its intended results, we must revise it to ensure that it will.  We must identify those who do not benefit from the law as written and work to find ways to extend the law's benefits to all.  We must continue to speak about the law's benefits and make sure that our friends, families, and colleagues understand how very important this law is.

We must be vigilant heading forward.  Although the PPACA is constitutional, congressional opponents can continue their attempts to repeal and defund the law.  Rest assured that, if they are able to, they will do just that.  The House is already planning a repeal vote on July 11. Under the PPACA, the economic and human costs of allowing millions of Americans to go without health care are finally being addressed.  We cannot afford to take any steps backwards: there is still a long road ahead.