Pain But No Gain

If I sounded cynical about the health care law being upheld as constitutional by the Supreme Court on Thursday, it's because I have a pretty damn good reason to be.  The United States will remain, even after  this law is implemented, the only major industrialized country that doesn't guarantee medical insurance to everyone.

Here are the facts: Twenty-six million people living in America will still be left out of coverage.  I say "people living in America" because that includes illegal immigrants, who will account for one-fourth of those uninsured.  At best, this makes Joe Wilson, the South Carolina congressman who yelled out to President Obama in the middle of a health care speech before a joint session of Congress that the President was lying when he said his plan would not be extended to illegals, a bigger fool than he already is.  But the issue is much more complicated than stating the seemingly obvious - that non-citizens who are here illegally shouldn't get any of our benefits.  Some illegal immigrants have children born here, who would qualify for health insurance under the new law, but these children may have siblings who don't.  How does such a family proceed? How do they get health care for even one or two of them legally? 

Even if you grant that illegal immigrants shouldn't receive coverage under the Affordable Care Act, there are other problems.  Also to be considered are those who qualify for Medicaid but don't know that they qualify or even that they have to enroll by a specific deadline.  The process of enrolling is so difficult that many Americans who might qualify don't bother to do so, and while streamlining the application process in part by allowing online enrollment may help, it's worth nothing that most Medicaid recipients are poor and therefore, by definition, do not have easy access to the Internet.  Furthermore, the Supreme Court ruled that states can't be dropped form Medicaid if they don't expand Medicaid services to those just above the poverty line, and now numerous Republican state governors and legislatures have vowed not to do so.

And what of those people who make just enough money not to qualify for government assistance to buy health insurance?  You have millions of people who make just a few thousand dollars a year more than four times the poverty line ($44,680 per year), which is the maximum limit for the health care tax credit, and so don't qualify for the credit but can't afford coverage because of other expenses eating up their income.  

Anyway, this Huffington Post article on the subject by Tom Murphy explains these problems in greater detail, and I urge you to read it . . . if only so that it's clearer that the Affordable Care Act doesn't cover everyone.

So what are we left with? A law that doesn't cover everyone but could still be repealed before it covers anyone. Mitt Romney has vowed to, as President, sign a bill repealing it, and if elected, he might to get to do just that; the Republicans will likely keep the House, and they could conceivably find a way around the sixty-vote threshold in the Senate to overcome a Democratic filibuster if they win that chamber.  (Again, I call upon the Democratic Party to disband and let a real progressive party fill the gap.)  And while it's all good and fine to suggest that a future Congress could add a public insurance option or a Medicare buy-in for Americans aged 55 to 64 (two reforms that didn't make it into the current law), none of that is likely to happen even if  Obama wins a second term and even if the Democrats hold onto the Senate and somehow take back the House.

Because, when you get right down to it, we Americans are as good as guaranteeing affordable medical coverage for everyone as we are at building bullet train lines.