By Robby Stern
PSARA has a long proud history of supporting a single payer health care system. We advocate expanding eligibility for Medicare to include everyone in the U.S. At the same time, we were and are very active in supporting the reforms in the Affordable Care Act (ACA) as an important step forward in health care reform.
On the other hand, a significant number of single payer advocates – our political allies and in some cases, our members- were disappointed with the Supreme Court decision. They hoped that a decision striking down the law would lead to a genuine battle for single payer as the only rational option to our dysfunctional health care system. We need not debate these differences among friends. At least for now, the ACA is the law of the land.
One of the complex challenges we face is to support the progressive pieces of the ACA and assist in the fight for progressive implementation of the act while we also develop a strategy for moving the ball down the field toward the goal of single payer health care for all.
Some of the progressive advances in the ACA that are already being implemented prior to full implementation in 2014 include:
- Children up to age 26 staying on their parents’ health care plans.
- No exclusion of children up to age 19 for pre-existing conditions.
- No life time limits. This positively impacts 2.4 million WA residents including 580,000 children who were subject to life time limits.
- No cancellation of coverage after a patient gets sick.
- Bars patient co-pays for many preventive services including preventive services in Medicare.
- Gradually closing the donut hole over a period of years.
- Sharply limiting what insurance companies can take from premiums as administrative costs. A much higher percentage of premiums most go to actual care or quality improvement.
In 2014, there will be a very large expansion of coverage in Washington including an additional estimated 500,000 uninsured being brought into Medicaid and an additional 300,000 being able to receive federal subsidies to purchase health care coverage. Additionally, pre-existing condition exclusions will be absolutely barred under all circumstances. 2014 is also when the individual mandate kicks in.
This very imperfect law fails to achieve universal coverage and also keeps in place a private insurance system that either must be more heavily regulated (like France) or eliminated. Meanwhile, the law is under vicious attack by the right wing. They seek to repeal the law or thwart its implementation.
To quote Paul Krugman, “What was striking about the anti-reformers is their cruelty. It would be one thing if, at any point, they had offered any hint of an alternative proposal to help Americans with pre-existing conditions, Americans who simply can’t afford individual insurance, Americans who lose coverage along with their jobs. But it has long been obvious that the opposition’s goal is simply to kill reform, never mind the human consequences. We should all be thankful that, for the moment at least, that effort has failed.”
The fate of the progressive reforms embodied in the ACA, the fate of future reforms and the make up of the next Supreme Court rest on the outcome of the 2012 elections. The PSARA Government Relations Committee has initiated a conversation about how we can both defend and support progressive implementation of the ACA and, at the same time push forward the goal of a single payer health care system.
Vermont has led the charge by passing a single payer health care system for Vermonters. They built a broad and effective political movement based on the value that “health care is a human right”! They engaged in a three year intensive grassroots human rights organizing campaign. They helped elect a Democratic Governor who was clear and stalwart in his support for a single payer system and they held elected officials accountable to keep their campaign promises to support single payer.
Organizers of the Vermont victory are now saying to the rest of the country (much as we in Washington said to progressives around the U.S. when we passed the first minimum wage indexed to the cost of living) that the ability of Vermont to ultimately succeed depends on the ability to win victories in other states. We have been told that there will be Congressional legislation introduced to make it easier for states to establish their own single payer systems. Clearly, the chances of such legislation are tied to the 2012 election.
PSARA does not have the organizational capacity to lead the fight for single payer health care in our state or nation. But we do have the capacity to make a mighty contribution to the effort. We have a large core of savvy and devoted activists who have been and will continue to be an asset to any single payer campaign. Many battles on many fronts lie ahead. One battle we are in for the long term is the fight for universal, affordable, quality health care coverage for all!