March 23 marks the two-year anniversary of the Patient Protection and Affordable Care Act (PPACA). Its passage culminated an extraordinary two-year debate over healthcare policy that helped to launch new movements for healthcare justice and challenged labor and other social movements to think strategically about what it would take to win universal, affordable, guaranteed healthcare for everyone in America. During these debates, the AFL-CIO declared that, “Whatever the outcome of the current debate over healthcare reform in the 111th Congress, the task of establishing healthcare as a human right, not a privilege, will still lay before us.” Today, we call on all of labor to rededicate itself to this principle.
PPACA will extend Medicaid coverage to millions of low-wage working Americans. It will provide subsidies that will allow millions more to purchase private insurance and will attempt to regulate some of the most outrageous practices of the private insurance industry. But, as many Americans already know, the right to purchase healthcare insurance is not the same thing as the right to healthcare.
As an advocate of a single-payer, Medicare-for-All solution to the healthcare crisis, the Labor Campaign for Single Payer never was under any illusions that PPACA could be anything more than a stepping stone on the path to healthcare justice. At the time of its passage, we predicted that, “The healthcare system that will emerge from this legislation is unstable and financially unsustainable. It is headed for crisis, perhaps even before it is fully implemented in 2017.”
Already, these predictions are being borne out. A recent study by the Congressional Budget Office (.pdf) shows that there will be 4 million more uninsured people in 2017 than originally estimated, leaving close to 10% of all Americans without health insurance (down from the current 20%). The same report estimates that 5 million will lose their employer-provided coverage by 2017.
Even the widely-reported “good news” in the CBO Report—that the 10-year net cost of PPACA will be $50 billion less than originally estimated—is not because the CBO has determined that coverage costs are going down (they are actually going up by more than $50 billion). Rather, it is because they now estimate that the government will collect nearly $100 billion in additional penalties and taxes from employers who opt to drop all medical coverage for their workers.
Nor has the Bill inspired much public confidence that, on the whole, people will be better off under PPACA. In fact, after two years of exposure to its provisions, only 41% of Americans hold a favorable view of the law. While much of this may be due to a concerted right-wing misinformation campaign, it is important to point out that Medicare has also been subjected to similar attacks yet still enjoys overwhelming public support. The public’s continued skepticism about whether PPACA will make a real difference in their ability to get affordable healthcare for themselves and their families is no doubt related to the complexity of its provisions and well-founded suspicions that profiteers will find ways to game the system.
On March 26, the Supreme Court will begin holding three days of hearings on the constitutionality of PPACA. Some single-payer supporters are hopeful that a ruling against PPACA will advance their cause. However, it seems unlikely that a Court that has ruled that corporations are people will provide support to the principle that real people have a right to healthcare. In reality, a Court ruling against PPACA would very likely be a setback for the social insurance model which frames the entire healthcare debate.
Many will use the occasion of PPACA’s two-year anniversary and the opening of the Supreme Court hearings as an opportunity to celebrate a flawed and partial solution to a healthcare crisis that has touched nearly every American family. We, in the Labor Campaign for Single Payer urge that we use this anniversary to rededicate ourselves to the principle of healthcare justice. The labor movement must not stop fighting until we have removed healthcare from the bargaining table and made it a right for everyone in America.