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True health care reform will only happen in the United States when everyone who needs to can access the health care they need and want, without restrictions based on ideology and misogyny. To this point, complete reproductive rights are critical for the realization of true health care reform. These rights have not been in more jeopardy since the verdict in Roe v Wade, and later Planned Parenthood v Casey.
The passage of the latest attack in Texas on abortion - SB8 - prove the protections of Roe v Wade are in serious jeopardy. In the almost 50 years since the Supreme Court decision which declared abortion a matter of privacy between a pregnant person and their doctor up to viability of the fetus - usually 22-24 weeks of gestation - Congress has failed to codify these protections into federal law. Those opposed to the protections of Roe have worked to maintain the status quo while they worked to put Justices on the Supreme Court who oppose the Roe verdict. Since 1973, the Supreme Court’s decision in Roe v Wade has maintained that women have the right to privacy in their reproductive choices under the Constitution and that states could not impose undue burdens on women seeking an abortion has been deemed the law of the land. And since 1973, issue groups, religious organizations, and ideological lawmakers have worked to erode that right by preventing access to health clinics, impairing access to birth control, passing laws that determine when and how a woman may decide to carry a pregnancy to term or not, and providing decision power and even visitation rights to rapists whose criminal assault resulted in an often unwanted pregnancy. Women and child-bearing people have become secondary to the potential life of a fetus, yet no social safety net for the care of the product of these pregnancies have been reinforced. In fact, these same actors have worked to reduce any potential help to mothers following the birth of a child. The fetishization of the fetus has led us down a dark and dangerous road, that is yet again under attack from a new case that will be ruled on by the Supreme Court this spring. This case refers to the constitutionality of a new Mississippi law that would prohibit abortions after 15 weeks of pregnancy, significantly before viability that is outlined in Roe v Wade. The State of Mississippi has asked that the Court overturn Roe in its entirety. In anticipation of the Court ruling the Mississippi law constitutional, the Texas governor signed into law a prohibition of abortion after 6 weeks, well before most child-bearing people even know they are pregnant. Above and beyond other ‘heartbeat bills’, this “... bill turns the reins over to private citizens — who are newly empowered to sue abortion providers or anyone who helps someone get an abortion after a fetal heartbeat has been detected.” Further misinformation about pregnancy abounds as media outlets continue to call these ‘heartbeat bills’, when at 6 weeks there is no heart or circulatory system existing in an embryo. In 2021 alone, there were more anti-abortion laws introduced in states than in all of 2011 - the last year with the most proposed legislation to reduce access to reproductive care since the Roe decision in 1973. Laws passed have required invasive ultrasounds for women seeking an abortion, criminalized the act of performing an abortion, restricted access to contraception, prevented abortion after a incorrectly termed ‘fetal heartbeat’ is detectable, and one law even removes the right to an abortion from a state constitution. We are also seeing lawmakers blur the line between contraception - medications that prevent pregnancy - with those designed to terminate pregnancy, and discussing banning coverage of birth control from Medicaid programs. In 2021, as in every previous session since 2013, a Congressional bill has been introduced that would codify the protections delineated in the Roe v Wade decision. This bill, The Women’s Health Protection Act, would “protect a person’s ability to determine whether to continue or end a pregnancy, and to protect a health care provider’s ability to provide abortion services.” On September 24th, the House passed this bill and it now sits in the Senate. Without the passage of actual legislation on the federal level that will codify the rights confirmed in the Roe decision, states controlled by those who seem to believe, as Monty Python posited, that ‘every sperm is sacred,’ will continue to pass more and more restrictive legislation aimed at reaching the Supreme Court to challenge the findings in both Roe, and even Griswold, which determined that women had the right to access contraception. Without the passage of real federal legislation, women of color will continue to be disproportionately impacted by anti-abortion and anti-contraceptive laws. Women will no longer be able to make decisions about their own bodies, at least as far as current laws permit. Those who are lower or even middle income who live paycheck to paycheck will continue to be unable to access the care they may desire and need. There seems to be a substantial number of especially state-level legislators that want to bring back the days of women as chattel, while ignoring that much of our national economy is dependent on women they refuse to acknowledge as having the rights laid out in our Constitution - the rights of life, liberty, and the pursuit of happiness. Without full access to reproductive rights - access to no-cost contraception, the ability to terminate an unwanted or dangerous pregnancy, the ability to terminate a pregnancy resulting from rape or incest, the ability to terminate an unviable pregnancy, the ability to choose a tubal ligation during a C-section, the ability to have a hysterectomy without being asked if a woman truly understands the implications of the procedure -- even if it is medically necessary -- those rights will remain out of reach for over half of Americans. What can you do? Call your Senators and urge passage of the Woman’s Health Protection Act. Join with other grassroots advocates in one or more of several organizations fighting for reproductive rights. Some groups include Planned Parenthood, NARAL Pro-Choice America, and Men4Choice. There are also state and local organizations. Many Indivisible chapters have subcommittees focused on Choice. If you live in a state with abortion clinics, consider volunteering to help women and others seeking treatment there. Learn what you can do counteract false information being spread about abortion and reproductive rights. Without full reproductive rights with no interference from the government, we can never have true health care reform in this country.
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Health care reform can only be truly realized when we address all of the issues that touch on it. One area that must be addressed is gun violence and the epidemic of carnage it is causing in American society. Nationally we often focus on the deaths caused by gun violence, or more often, only those shootings that are categorized as “mass shootings,” where four or more people are killed or injured. This narrow focus causes us to disregard the total costs, both monetary and physical, of the uncontrolled and virulent obsession of firearms in this country. According to a study published in the Journal of the American College of Surgeons, injuries from gun violence costs the U.S. health care system $170 billion a year. Surgeries alone account for $16 billion. That doesn’t take into account those who did not need major surgery between the years of 2005 to 2016. Any victim of gun violence is automatically entered into the fellowship of those with ‘pre-existing conditions,’ which, if the Affordable Care Act’s protections are ever removed, would mean insurance companies could once again refuse to cover future needed medical and rehabilitative care stemming from the injury. Victims of gun violence must also deal with the mental anguish of becoming a victim, not to mention the potential of PTSD, and even survivor’s guilt if they survived a mass shooting where others did not. These require potentially years of mental health care, and the associated physical manifestations that can develop from mental illness and stress. Family members of both survivors and those who died from gun violence also incur medical costs for mental health and associated physical manifestations. According to Dr. Peyman Benharash, an associate professor-in-residence of surgery and bioengineering at the David Geffen School of Medicine at the University of California, Los Angeles, who worked on the report, "It's very important to put it in perspective that this entity is quite economically burdensome," he said. "If you're looking at prevention vs. treating a gunshot wound from an economic standpoint, it would make sense to invest in anti-violence interventions that can reduce assaults that are often preventable." According to Everytown for Gun Safety, the cost of gun violence during the time of Covid-19 is even higher. They projected the total cost of gun violence at $280 billion for taxpayers, families, communities, survivors, and employers - above and beyond simply the costs related to health care. They go on to break this down:
Our current health care system comprises an estimated one fifth of our economy. According to the Health System Tracker, in 2019 health spending in the U.S. reached $3.8 trillion. Numbers for 2020 are lower in many cases, due to the impact of the Covid-19 pandemic. Using the numbers above, addressing gun violence could help reduce our health care costs by 4.5-5%, and reduce total costs to us all by upwards of 7 percent. While it may seem an insignificant amount in comparison, that is $200 billion that could be used in other areas that we desperately need to address, like education, infrastructure, clean air and water, climate change mitigation, food security, social justice reform, justice system reform, immigration reform, and more. Financial figures are one thing, but not the most important consideration. The sheer number of potential world changers we lose every day in this country, those who could have led us toward a better future for all, is a national tragedy and disgrace. For a nation that claims to value life, those lawmakers and voters who constantly wave the banner that life is precious, we have a long and sad record of meaning only some lives matter. We won’t even get into the fact that the 2nd Amendment contains a second section that includes the phrase ‘well regulated;’ that is for another day. In 2020, according to The Gun Violence Archive, over 43,000 people in the U.S. were killed by guns - 19,000 by others and 24,000 by suicide. The total number of people shot who survived is over 39,000. In 2021, over 20,000 people were killed, excluding suicides, and the U.S. saw 693 mass shootings. What can you do? There are several grassroots organizations working on gun violence prevention. Some advocate for the elimination of firearms, others for stronger regulation and laws - as with health care reform, there is a wide tent of advocates. Some groups to check out include Newtown Action Alliance, Moms Demand Action for Gun Sense in America, March for Our Lives, and Giffords Law Center to Prevent Gun Violence, Each of these groups have local and state-based groups, as well as national agendas. There are other groups, but this is a good start. Find one and get involved. If we really are serious about reducing the costs of health care in the United States, then we must get serious about gun violence prevention now. If we are committed to true health care reform, we must advocate for gun violence prevention, too. 
2021 has been exhausting. We have all had so much to handle, had to pivot, adapt, and adjust every single day. As the year comes to a close, there are some significant achievements to keep in mind and goals to set for 2022: 
But we are far from done. There are many areas that we will need to work on together to push for more health care reform. 
Thank you.These achievements were possible due to you speaking out and being involved. Making calls, attending town halls, signing petitions, writing letters, talking to friends and family, and staying informed are critical for us to eventually realize a comprehensive, universal, affordable, accessible, high-quality, and truly equitable health care system for all. 2021 also saw significant advances for us here at ACA Consumer Advocacy. Our 501c3 was approved. We joined with new coalitions working to effect change in our health care system by bringing consumer voices to the table, held online discussions on getting vaccinated and getting enrolled for 2022, and we began a new project looking at the importance of lifting up numerous social justice issues to achieve comprehensive health care. We have big plans going forward and are glad to have you along on the journey. If you can, any support is greatly appreciated to help us reach our goals.  There is still time to #GetCovered for 2022. In most states, enrollment by January 15th will get you an affordable plan that begins on February 1st. With new laws, new subsidies are available to more people. Go to www.healthcare.gov and check your options today. The truth is we can't do our work without you. Thank you.
In the 2020 election, health care was listed as one of the most important issues to voters. The COVID-19 epidemic has further highlighted the myriad problems and deficiencies in our current health care system. Recent polling shows Medicare for All (or some sort of single-payer reform) is supported by 55% of voters, almost 7 in 10 support some sort of public option, and nearly 8 in 10 adults believe prescription drug costs are too high. Time and again voters have spoken that health care reform is critical to improving our way of life. Even with this overwhelming support for reform, we have had to fight tooth and nail in each election to maintain what progress that has been made. The will of the people continues to be stymied by voter suppression, gerrymandering, and a political system that continues to give the minority of the population - frequently those with the most wealth and large corporate lobbies - more power than the majority. We saw the impact of elections and our election system in 2016, when those who had worked for a decade to weaken and overturn the Affordable Care Act won the majority in Congress and almost succeeded in repealing the law. Just one single vote in the Senate is all that prevented the protections of the ACA from being taken away. In twelve states, elected officials continue to deny health care access to millions by refusing to expand Medicaid and legislating requirements that very few can meet to qualify for unexpanded Medicaid coverage. Without meaningful protections and reforms to our election system, we must continue to remain on the defensive, as we have since the passage of the Affordable Care Act - the most impactful and significant health care legislation passed in close to 50 years. The fact is if we do not have free and fair access to the polls for each and every eligible voter, we can forget any meaningful health care reform in our near future. We can have the best legislation that would guarantee universal health care, but it will mean nothing if we cannot elect people who will pass it. The 2020 election was historic in many ways, no more so than holding the record for the largest number of votes cast in an election in American history. Yet as soon as the last ballot was counted, it became clear that the strategy of those who supported the last administration - the same people who tried to repeal the Affordable Care Act - was to prevent such a large turnout from ever happening again. Through lawsuits and legislation, from the federal level to the county, conservative politicians have advanced new and undemocratic restrictions, chipping away and rolling back protections afforded Americans under the Voting Rights Act. Decades of gerrymandering have left us a situation in which districts have been drawn that minimize the votes of over one half of our country. Further, the attacks on the idea of free and fair elections by the far right and supporters of former President Trump continue to undermine the confidence in what we have touted as the strongest democracy in the world. Elected officials preemptively questioning the outcome of elections, declaring fraud if they do not win, and perpetuating the idea that our voting system is rife with fraud are all endangering the future of our nation. We are in serious danger of losing our representative democracy and with it the chance to further meaningful health care reform. This is not hyperbole. If members of a single political party are able to decree that those vote for their opponents are not eligible to vote, or make voting so difficult for huge swaths of our nation, particularly voters of color, low-income voters, those who need to vote by mail easily, those with disabilities, we will no longer have a representative government. When elected officials can choose who can and cannot vote, our democracy dies. The idea of elected officials determining who can vote is not new, and this is far from the first time members of one political party have worked to undermine our Constitution and the rights it guarantees. But that doesn’t make it right and we cannot allow it to happen. Following the Civil War and the assassination of President Lincoln, rights that had been confirmed by the 14th Amendment were undermined by his successor and white Southerners of the time. The implementation of Jim Crow laws, while still saying the right to vote existed for men of color (not women), prevented millions of Americans from determining their future and those of their children. Immediately following the Civil War, we had African Americans elected to state legislatures and Congress, but within a generation, that was no longer so. The idea of representative democracy means that every vote matters. Black votes matter, women’s votes matter, Latinx votes matter, indigenous votes matter, immigrant votes matter, votes of the poor and disadvantaged matter, the votes of college students matter, the votes of disabled Americans matter - every vote matters. They should and we should make sure they do. We must make sure they do if we want a chance at a comprehensive health care system that everyone can afford and access. The desperation of a minority to cling to power has never been more stark than with the release of the most recent census data. Many preliminary reports state that, for the first time, Caucasians are not the largest growing demographic in this country. The time of so-called minorities outnumbering or even equaling the number of those of European ancestry in the United States - or at least how they are counted - has arrived. And with it, those committed to the long-standing white male power structure they have worked so hard to maintain are more committed than ever to keep their power. If we stand by as a growing minority in our nation, at the behest of outrageously wealthy benefactors, continue to rollback the hard won advancements that Americans have fought and died for, we will be abandoning the path towards that more perfect union, and turning our backs on the ideals of life, liberty and the pursuit of happiness for all. We will finally in fact be a nation where corporations and a small group of ideologues focused on acquiring all the wealth they can run roughshod over the majority of the population that they no longer represent. If they succeed in disenfranchising sizable blocks of the American electorate, we will be looking at the end of America as a nation with a representative government. Equal voting rights are central to any other issue each of us holds dear. They are absolutely critical if we want meaningful health care reform that results in a comprehensive, universal, affordable, accessible, high-quality, and equitable health care system. If voters can not choose who will represent them, who upholds their values, we will not see progress. The so-called ‘Great American Melting Pot’ will continue to scorch. To be health care reform advocates, we must also support and advocate for true voting rights nationally and at the state level.  We believe that so many issues are connected with true health care reform.
If you do, too, show it with a shirt! Since 2016, ACA Consumer Advocacy has been fighting to preserve and expand the availability of affordable health care in America. Our mission is to achieve truly comprehensive, universal, health care reform and educate and activate members of the public impacted by health care to advocate and work with lawmakers to achieve it. However, as the last few years, the last decades, the last century have shown us, improved access to healthcare is, like so many other parts of our shared life, meaningless if it is not available to each and every one of us. At ACA Consumer Advocacy, we are committed to fighting not only for the continuation and improvement of the Affordable Care Act (ACA), we are fighting for the ability of all Americans to live a full and dignified life with access to health care as a key component of that life. While we will continue to seek protection of, access to, and expansion of the ACA, we will be examining in depth the areas in dire need of improvement that touch on our existing healthcare system. It is not enough to demand healthcare reform without also acknowledging how our society has continued to provide separate and unequal care that falls on clearly delineated lines of race, gender, religion, wealth, and more. We can no longer afford the luxury of saying we only support single-payer health care, or a public option, or health care for immigrants, or permanent protections for medical history (pre-existing conditions), or prescription cost reduction. True reform means so much more than that. True health care reform means that we sincerely believe in what our Declaration of Independence says — that every person is endowed with the unalienable rights of life, liberty, and pursuit of happiness, and that we are committed to making it real in our lifetime. It means that we acknowledge that health care means clean water, clean air, the ability to live without fear, the ability to earn a living wage, and the ability to vote in elections. It means believing that these things and more are basic human rights and working to truly make them a reality — to finally fulfill the promise of our nation for all. It means that none of us have the luxury of being single issue voters or advocates and ignoring tangential issues. It means we must lift up all issues, while having a main focus, and finally realize the nation we can be. Over the next few months, we will be looking at issues that impact our health care system, and how we can and must lift up those issues and address them as we pursue comprehensive health care reform in the United States. Please join us, participate in the conversation, and let’s work together to realize a comprehensive, universal, accessible, affordable, high quality, and equitable health care system for all.  We believe it's all connected. Get a shirt and show you do, too.
As you may have heard, the U.S. Supreme Court has dismissed California v Texas, the case aiming to overturn the ACA. The Court decided 7-2 that the plaintiffs in the case were not harmed by the zeroing out of the individual mandate penalty, meaning the case cannot stand. Which is a roundabout way to say - THE ACA REMAINS THE LAW.
This is the third time the Court has upheld the ACA as a law. ACA Consumer Advocacy enthusiastically applauds this decision. From the beginning, the case was deemed spurious by legal scholars on both sides of the aisle. The health care protections put in place by the passage of the ACA will continue to stand:
Now is a time to celebrate, take a deep breath, and then refocus. There is much to celebrate in the ACA, but there is also much to fix and improve. We are committed to the full realization of comprehensive, universal, affordable, accessible, high-quality, and fully equitable health care for all and look forward to working with you to achieve that. Remember, if you or someone you know needs health insurance, there is a special enrollment period going on now at www.healthcare.gov. Thanks to the American Rescue Plan, those who did not qualify for premium subsidy assistance before now do, and those who had received subsidies are eligible for more. If you are enrolled on the federal exchange, check www.healthcare.gov, click on 'change of life' and access your new subsidies, or even change your current plan. If you were waiting to enroll because of the court case, now is the time to get covered! Thank you for all you do to make the world a better place, and let's keep going! Dear President-Elect Biden,
Congratulations on your campaign and your successful election. The grace and integrity you modeled during this pivotal election, the humanity you displayed at every turn, and the hope you proffer are sorely needed in our nation today. Another thing we sorely need is a reexamination of what the health of our nation means. Are we simply referring to a broken health care system that provides different levels of care based on geographic location and economic status? Do we refer to the strangle-hold of restrictive networks that determine who will receive the best care and who will receive mediocre services, if any at all? Do we refer to the finally acknowledged scourge of endemic racism in our health care system? Do we, as a nation, believe in being able to live a life of respect and dignity, or are we okay with too many of our friends, neighbors, and families having to scramble to make a living — working multiple jobs just to maintain a roof over our heads, food on the table, and basic necessities for our family? The fact is, too many of our neighbors must focus too much of their lives on simply surviving. This precludes many of us from being full participants in our society. If all of one’s energy is focused simply on surviving day to day, what energy is left to pay attention to what is going on all around us? This is not a new phenomenon in our country, nor in human history. Forcing the majority of the country to spend their time merely surviving allows those in power to do as they will. Those who have been called variously lords, robber-barons, the wealthy, the 1%, have free reign to make decisions that will benefit themselves instead of working toward a better society for all. Throughout history, we have seen that when more people have access to true prosperity — the ability to earn a living wage, to have time left at the end of the day to join in with neighbors and friends in social activities, to spend quality time with family, and to not constantly worry about how far their next paycheck will extend, the happier and more prosperous the society. That means those at the top of the socioeconomic ladder benefit along with the rest of the population. But we, as a nation, have strayed from that path. One of the reasons people romanticize the 1950’s is that for many — but by no means all — it was a time of prosperity, comfort, and security. Due to social contracts laid down 20 years prior, we saw more people able to work good-paying jobs, have a home, and send their kids to quality schools that taught critical thinking, civics and humanities. People had time and energy to create and maintain relationships with their communities, and people had access to health care that would not put them in the poor house. As the disparities among our cubby-holed society began to be more evident — as fully half our country began to demand the same type of life that many envision when we talk about the idyllic suburban life of the 1950s and was portrayed so romantically on the big and small screens, we allowed those who wanted to maintain the status quo — who feared being less than or equal to those we have, from our founding, decided were less than human — to keep dividing and separating our fellow citizens. There were many advances made in the 1960s, but also many missteps and critical errors made. Those who do not take the central teaching of most religious creeds to heart — that we are all made in a deity’s image or that we are all children of Man and none is higher than the other — fought back believing that equity is a pie that is diminished by allowing others a part of it instead of seeing it as a banquet to which all bring more flavor and experience. We saw communities come together to provide that which they were shut out from — stable housing, access to food, education, reading programs, voter registration, medical care, and even protection from persecution. For too many, this could not stand, and groups like the Black Panthers were vilified and ground down yet again. We saw the rise once more of those who profit from suffering. A sad remnant of those who profited from the perversity that is slavery gained more and more leverage and power to pursue their goals: profit above all and workers as simply a means to an end for the altar of wealth and power with bigger platforms and more money to influence elected officials. We saw the institution of for-profit medical care. We saw the monetization of our neighbors’ suffering. We saw articles describing the values of the elements that make up the human body say the total was about $600 seemingly taken as a challenge by those for whom shareholders’ gains rule everything. We began a path forward that exponentially exploited the vagaries of the human body and the things that can go wrong with it to benefit the bottom line of those who saw suffering as potential profit. As a nation we continued to listen to some elected leaders and influencers and allowed ourselves to believe that instead of us being part of a greater whole, all that matters is what we as individuals could get as quickly as possible. How far we could rise up the corporate ladder no matter who we stepped on to get there. How many shiny objects we could obtain, and if they break, throw them out and get more. We began to believe that the economy really was the Dow Jones report and the stock market and if it was going up, even as wages stagnated and in too many cases began to decline, all was well. Later we allowed the national tragedy of 9/11 to further erode our rights and allow those who sow dissension in pursuit of their own power to further divide us. They insisted we believe that there were those among us who were ‘others’ and not like us. No more were we the Great Melting Pot that celebrated the different ingredients that those from other countries, cultures, religions brought to our shores and made a more glorious whole. No — we stopped trusting anyone who was different no matter how small the difference. We allowed tribalism to exceed citizenship, stopped actively teaching our children how to think critically because all that mattered was how well they tested and toed the line. We vilified those who had the audacity to stand up and say this was not right until finally, many of the nation said this is enough, and elected a new leader who reflected that idea. With the new direction of leadership under President Obama, we finally saw changes to move us as a nation forward. Not all the way by any means, but a beginning. With that administration, we saw the blossoming of the belief that health care is a human right. That people should not go bankrupt trying to overcome illness, or trying to afford medication for chronic conditions. That insurance companies should not be able to use a person’s medical history to determine if they will be covered. That the insurance industry could not charge women more for the same coverage simply because they are women and no longer would pregnancy be labeled a ‘pre-existing condition.’ No longer would insurance companies be able to limit the benefits people have paid for on an annual or lifetime limit. No longer could insurance companies retroactively cancel an insurance plan when one got sick. No longer would the intrinsic value of a human life be subject to the same vagaries, repackaging, and monetary manipulation as the mortgage industry utilized prior to the Great Recession — or so we thought. That was the goal. Even then, we saw the country divided horrifically. But through perseverance, determination, and yes, compromise, the Patient Protection and Affordable Care Act was finally passed. It was by no means perfect. There was a much more comprehensive bill in the House that would have addressed many of the issues we have discovered over the past 10 years with the final bill. But at last our country as a society and our lawmakers had taken the next step forward to join other nations around the globe in the truth that health care is a human right. No, it was not perfect. Much of the law was predicated on letting the market determine prices and how competition would prevail. The initial goal of a public option was scrapped. Letting the market determine pricing for premiums, deductibles, hospital and medical fees, and more, saw health care go from being 1/6th of our nation’s economy to 1/5th in the space of 2 years. But it was not meant to be perfect. It was meant to be the next step on the path laid down by President Roosevelt, and later President Johnson. The path toward a more equitable society. There are many things that need to be improved, which have come to light the past 10 years. Things like the family glitch — if a family member has access to health care through their employer, their family must use that insurance and not the exchanges, regardless of whether it is affordable for the family. The ‘fiscal cliff’ which is the cut off for federal subsidies for those enrolling on the exchange, which has priced many Americans, especially older ones and those within tens of dollars of the cut-off limit, out of the exchanges and access to health care. The lack of choice of insurance carriers in some counties across the country has limited the loudly championed idea of competition. It is hard to trumpet the benefits of market competition when there is no competition to bring down prices. The continued purchase and consolidation of medical providers — especially the influx of private equity firms who see health care as an easy profit market and have no care for the people seeking treatment and help — have led to persistent decline in affordability and accessibility in health care. The purchase and closing of hospitals, especially rural hospitals and those in low-income communities of color, have reduced the availability of care to too many across the nation. The continued idea that health care is not a right, but a commodity to be exploited is further dooming our population. The ACA’s passage saw a decline in medical bankruptcy, but those numbers are climbing again. The implementation of PBMs (Pharmacy Benefit Managers), initially touted as a way to reduce the cost of prescription drugs, has led to further layers of bureaucracy and less ability of physicians to ensure their patients can receive the medications that have been prescribed. When the ACA was passed, you famously said this was a “Big F-ing Deal.” You were oh so right. Now is the time — past time frankly — for the next step. Too much of the law’s implementation is dependent on who the administration is and who is put in place as Secretary of Health and Human Services. Many fixes have been passed by the House, yet blocked by the Senate. Executive Actions have been used by the current administration to whittle away what could not pass Congress. Civil rights protections for the LGBTQ+ community, immigrants, women, and other minorities have been curtailed. Advertising for Open Enrollment and educational services to help people get covered have been slashed. Too many in this country live in states whose lawmakers chose spite over the well-being of their residents and refused to expand Medicaid. But the health care of the nation cannot be seen as a piecemeal issue. We cannot afford as a nation to continue to compartmentalize what constitutes equitable health. Just as our medical system has become more and more focused on specialities of different systems in the human body — essentially ignoring the whole for the sum of its parts — so has our society and government compartmentalized what a healthy member of our society needs. It is more than access to an affordable health insurance plan, it is more the metal levels on the exchanges. It must include access for all residents to affordable, comprehensive, quality health care as needed and available locally. It must also include food security, affordable quality housing, real education for all, family leave protections, living wages, affordable comprehensive childcare, and affordable higher education. It means severing insurance from employment and making it available to all — regardless of whether they work for a large employer or have their own start-up. This need not mean an attack on unions and what they have striven for — their very successes could serve as a baseline going forward. It must mean that those in rural areas and those without access to transportation are as equitably served as those in wealthy urban areas. It must mean that medical professionals are permitted to treat their patients and not have to beg an insurer who has never met the patient to approve the care needed. It means insurers cannot require the prescription of medications that do not meet the need simply because of cost. And it must include the Congress passing an expansion of medical residency openings at hospitals across our country, especially in a time of an international pandemic. Further it means a review of our patent law system, and a review and modification of our monopoly laws. It means making broadband access available across the country, and it means making the COVID-19 vaccines — all of them — available free of charge and taking the vaccines to the populations who may not be able to travel to receive them. It means an embrasure of the idea that #OurHealthIsNoOnesCommodity. It means the demilitarization of our police system, the end of the idea that people in power — be it law enforcement, corporations, or everyday citizens — have the right to take or endanger the lives of fellow citizens with impunity. It means that workers’ rights are more important than shareholders’ stakes and corporate compensation plans. It means embracing the idea that melanin is not a determinant of the worth or value of a life. It means taking to heart that faith, national origin, primary language, and ancestry do not determine one’s predetermined place in society. It means addressing the institutional racism of our justice system, and ending the idea of for-profit prisons and the inherent oppression this process engenders and promotes. No one person can achieve all of this. Indeed no one leader should. But a strong, successful leader can start us back down the path to an equitable nation. There are millions of Americans waiting to help, both at the legislative and grassroots level. Guide us, let us know what you need. Listen to us who have been in the trenches and have lived with the positives and negatives of the original ACA. We know perfection is rarely obtained. We know that real solid compromise means that while all sides are somewhat unhappy, progress has been made. Together, we can move our country forward toward a more perfect union and improve the physical, emotional, and societal health of our nation. Originally posted on Medium While it’s easy to understand how focused we all are on November 3rd and the election, there is another important date that might have slipped your notice. With all of the news about the election, the Supreme Court hearings, and of course, COVID-19, it could be easy to forget about November 1st, the day that Open Enrollment on ACA exchanges begins.
The ACA Still Exists You may be surprised to hear open enrollment is still happening, since the news is full of stories saying the ACA is at risk, and it is. There is a lawsuit seeking to overturn the ACA scheduled to be heard by the Supreme Court just one week after election day. However - and this must be repeated - the ACA is not dead yet. No matter what decision the Court renders, it’s important to understand the schedule of the Court. Traditionally, the Court hears oral arguments of cases on their docket in the fall, and then renders its decisions in the spring or early summer, ending their session in June. This is critical to understand for a number of reasons:
Don’t Forget to Enroll! Open Enrollment Begins November 1st In spite of the challenges of the ACA, this year’s Open Enrollment is more important than ever. Americans are continuing to lose jobs, and by extension, their health insurance, as COVID-19 infections continue to rise. In most states, the dates to enroll are November 1 through December 15. Some states with their own exchanges have extended enrollment periods. While some state exchanges offered a special enrollment period to residents who’ve lost their employer-based insurance due to COVID-19, the federal exchange has repeatedly refused to do so. Many people aren’t aware that losing employer-based insurance is considered a life change which makes them eligible for a special enrollment period to get insured. According to the Kaiser Family Foundation, upwards of 27 million Americans may have lost health insurance during this pandemic. While some of those have been able to enroll in their state-based exchanges, and others may have qualified under Medicaid Expansion if their state opted for that, potentially millions of others need to enroll and this is the time to do it. Unfortunately, the ACA’s advertising and education budgets have been slashed by over 90%, leaving the program largely unable to promote itself. Without that promotion, many Americans lack a clear understanding of how and when to enroll for the coming year. Therefore, it is up to each and every one of us to make sure our friends and family know that the exchanges open on November 1st. At a time when so much is happening, and healthcare is such an important issue, make sure the word of mouth gets out there. Healthcare Is On The Ballot This November, it is vital that we both vote and enroll in the ACA. Make your voice heard, both at the ballot box, and among your neighbors and loved ones, letting them know the exchanges are open. This election will have a massive impact on a great many things, including, obviously, the ACA. A strong enrollment period, showing the government just how many people depend on the ACA for their healthcare, has never been more important. To find help to get enrolled near you, go to the Get Covered America Connector. Or log onto or call healthcare.gov. Your health and the health of your friends and family is too important to let this pass you by. Originally posted on acasignups.net as a guest post titled "Why Are We Waiting for the Federal Goverment to Offer Comprehensive Testing and Contact Tracing?"
In almost the middle of June 2020, with over three months of an international pandemic behind us, over 100,000 Americans and more around the world dead from Covid19 and its complications, what are we waiting for? We know that our administration has done everything possible to impede the facilitation of needs and resources to our country. Special interests are running rampant, price gouging is the norm, government agencies have been scooping up supplies from states that are desperately needed, and the GOP controlled Senate is more focused on packing courts with unqualified ideologues than with passing bills to assist Americans financially affected by the pandemic. It feels like much of the progress we’ve made as a society, the labor reforms people fought and died for, the governmental regulations meant to ensure our safety and our ability to trust that the medicine we take or the food we eat is safe, it feels like those hard fought battles are being rolled back faster than we can even register our outrage. Companies are still selling unreliable coronavirus test kits with no real oversight, and untrustworthy results. After years of fighting for better pay, suddenly minimum and low-wage workers have been deemed “essential,” yet have seen no pay raise, while many of their employers dragged their feet on creating safer conditions for workers, only acting when strikes and public outrage forced their hands. Many of these workers, due to delayed and insufficient economic assistance are forced to make a choice: work, and face the possibility of becoming sick and spreading infection to their family, or potentially losing their income and home. Millions of others have lost their jobs, with unemployment higher than any time since the Great Depression. In Texas, Ohio, and across the country, lines for food banks have stretched for miles as many Americans can no longer afford to feed their families. All while the president tweets increasingly incoherent and dangerous tirades, and those in his administration find ways to profit from a disaster, if not of their own doing, then one greatly magnified by their greed and incompetence. Because of our continued insistence in linking healthcare to our employment status, millions of Americans find themselves not only out of work, but now without insurance in the middle of a pandemic.. Those in states that refused to expand Medicaid have essentially three choices: see if they qualify for an expensive COBRA plan to continue their existing plan, especially if they have already met their deductibles for the year, attempt to navigate the complicated maze of enrolling in an ACA exchange, or simply go without insurance at all. These millions of Americans must make this complicated choice while the administration works to overturn the Patient Protection & Affordable Care Act (ACA) - their opening arguments before the Supreme Court are due in mere weeks. So - what are we waiting for? Seriously. Why are we still waiting for the federal government to fix this? To guarantee enough testing, to make sure there are enough treatment centers, especially in rural areas of our country. Why are we waiting for a cohesive contact tracing system, for more PPE, for anything else to trickle down from the top, especially when it seems the administration has moved on from talking about the current healthcare crisis? We have seen some modest improvements in some areas of the country, but it is not enough, it is not comprehensive, and we are starting to see more outbreaks due to states easing their lockdown rules. The fact is, we can do this together. States are already working together in regional coalitions. Nonprofits and grassroots organizations are doing their best to fill in gaps. Imagine if we all worked together to address the issues we now face with this pandemic. Every county in this nation has a health department. Many of these are stretched now - and frankly most of the time - but the fact remains that they represent the best place to build a nationwide effort focused on using local programs to do the contact tracing that is needed to open our country. They remain the best central base to make sure testing can be done in rural and underserved urban neighborhoods. A partnership made up of local county health departments, states, federal funds, and private funds and donations can be made to work. County health departments make the most logical place to create dedicated mobile health units that can function for contact tracing, testing, as well as primary care. Rather than inefficient and slapdash responses to a crisis, we could take this time to build a method of delivering dedicated, routine, regular primary care to those who need it, but can’t get it. Dedicated, routine, regular primary care. What about the tech answers being bandied about - why not wait for the next cell phone app to do the tracing for us? In too much of this country, cellular networks are insufficient, and internet connections are spotty at best. Many of the communities most in need are comprised of people without the money to buy a smartphone. Once again, those most in need would be left behind. This must be done in a non-profit, non-private, non-profit motivated manner. This is not something that we, as a nation, can afford to rely on private medical conglomerates to do, or to abdicate our responsibilities to private equity firms looking for the next quick profit venture. We cannot afford to exclude anyone based on insurance networks or being uninsured. These clinics must be available to everyone regardless of their insurance status. Medicare, Medicaid, private insurance, ACA exchange plans, underinsured, uninsured - everybody must have access. Who will staff them? We have millions of health care professionals - from doctors to nurses, technicians, administrators and more - currently out of work, at the height of a national pandemic. Many were laid off from medical staffing firms at the beginning of the pandemic so as to protect the profit margins of the private equity firms that own them. Others were laid off as clinics that were deemed non-essential were closed. A report from the American Academy of Family Physicians estimates the closure of upwards of 60,000 family clinics by June, impacting over 800,000 workers. We can get these trained experts back to work at the same time we expand necessary healthcare across the country.. This whole system can be run out of the county health offices that already exist to handle this crisis. There have been significant advancements in logistical technology over the last several years. That same technology can be used to implement effective, quick, and thorough testing and contact tracing. There are foundations and donors looking to give money to programs that can make a difference, so let’s use them. We have too many different groups focused on reinventing the wheel rather than looking to existing models around the world for guides on how to build a functioning system. Rather than relying on profit-driven corporations to build proprietary walled gardens, we could be building a universal system, one that works with and for every person in America, regardless of income. Once up and running, these mobile healthcare facilities can be utilized for community contact tracing and testing, a response to the pandemic that we desperately need. Later, as this crisis is brought under control, we can continue to fund this program in order to offer real primary care facilities that go to the people in need, those otherwise unable to travel to perhaps distant medical centers. If we can create a regular schedule, making appointments, offering school physicals, vaccinations, maternal and prenatal care, and providing chronic care monitoring, we can create relationships and extend care in areas that are chronically underserved. Not only will we keep those without primary care physicians out of the emergency room, but by extending healthcare into these communities we can improve overall health by addressing chronic conditions and providing preventative care to those who need it most.. To meet the long-term demand for doctors and nurses a program like this will create, we need more than just money. We will need Congress to open up the caps on residency openings in this country in order to train the numbers of primary care physicians this country will need long after we get through this pandemic. In addition, pressure must be brought to bear in order to stop the repeated attempts to slash the funding of Medicare and Medicaid, the programs we rely on to pay for these residency positions. Building on the success of the Teach for America program we can introduce a similar initiative that will allow medical students to work in underserved communities to pay off their medical school expenses. This would give our young doctors and nurses valuable practical and personal experience in treating patients in need. Our nation’s healthcare system faces challenges on so many fronts, with so many things in need of attention that we can feel paralyzed by how much there is to do. Unfortunately, the cost of the status quo has grown too high to be allowed to continue. By focusing on a community based solution that can be built into a nationwide network, we can get started on the mountain of challenges in front of us, while laying the groundwork for a continued and necessary way to treat the most vulnerable among us. This is something we can do now to make real change and have a positive impact on the lives of millions. The health of millions, and of the nation, rests on our resolve to act now. “…An eligible employer-sponsored plan is affordable for a related individual if the portion of the annual premium the employee must pay for self-only coverage does not exceed the required contribution percentage…” (Federal Register, Feb 1, 2013. 78-22, p. 7265)
Once upon a time I was an enrollment assister in rural West Virginia, helping community members get signed up for ACA-compliant health insurance coverage. I have hundreds of success stories under my belt, and hopefully not as many failures. Most frequently, I can say with confidence, those failures could be attributed to the family glitch. Most Americans have never heard of the family glitch unless it has affected them personally. Actually, even if they’ve experienced this glitch, they may not understand what it is. It’s complicated, but important to understand when you’re parsing through all the new ACA-fix bills circulating out there. A family glitch fix is essential to allowing more people to access affordable health coverage. I’ll start with an example: Maria comes to me hoping to purchase a subsidized Marketplace plan for her husband who is a stay at home dad. She is working a full time job making $53,000/year. Maria has coverage through her employer for $175/month (about 4% of her income). However, to add her husband to her plan it would cost her $575/month (about 13% of her income) which she cannot afford. At $53,000/year for a family of 3, Maria’s husband should qualify for a healthy tax credit to help him pay for his coverage. So what’s the glitch? In this case, Maria’s husband is not eligible for a tax credit to help him pay. Here’s why: An individual may not receive a tax credit to purchase Marketplace coverage if s/he has an offer of affordable employer-sponsored insurance coverage (ESI). “Affordable,” in 2019, according to the ACA/IRS, means the total cost of self-only premiums must equal no more than 9.86% of an individual’s total household income. “Self-only” is the key term. While Maria’s ESI cost for her family is well over 9.86% (at 13%), the cost of her self-only coverage is well under 9.86% (at 4%) and is thus deemed affordable. Therefore, her husband has an offer of “affordable” ESI and is not eligible for a tax credit. How can this be? Turns out, it’s not a glitch. The IRS and the GAO have decided to interpret the law in such a way so as to cut costs. Fewer people eligible for tax credits means less money the government has to dole out. It all comes down to the interpretation of the phrase “required contribution.” Because the law states that the required contribution, as it relates to the individual mandate, will be calculated based on self-only cost, the IRS determined that “required contribution” as it relates to tax credit eligibility should also be calculated based on self-only cost, though the law does not explicitly state this. Two to four million people are stuck in the glitch, with no options for affordable coverage. Back in 2014, Senator Al Franken first introduced the Family Coverage Act to fix the family glitch. His bill went nowhere because of concerns over- you guessed it- cost. But here we are in 2019, with a plethora of ACA-fix and health system reform ideas filling our inboxes and bungling our brains. Most notable, for the sake of this issue, is HR 1884: The Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act, better known in health policy circles as ACA 2.0 thanks to the unsurpassable Charles Gaba. The upside is it passed the House in May, which is quite a feat given previous pushback. The down side is, well, Mitch McConnell will never let it come to a vote in the Senate. It is also worth it to check out Senator Sherrod Brown’s (D-OH) reintroduction of the Family Coverage Act, introduced in June, which specifically targets the family glitch. This bill would allow families to access Marketplace tax credits if the cost of employer-sponsored family coverage is greater than 9.86% of income, providing access to affordable coverage to millions of individuals. So, what is there to do if you have found yourself in the family glitch? The hard answer is “not much.” Here are some true but maybe unhelpful answers:
What you should actually do:
The “family glitch” is essentially health policy jargon, so families may have experienced this without even realizing. They just know that the ACA hasn’t helped them, and they are owed an explanation. Let’s educate, enlighten, and demand change for those who deserve access to affordable health insurance coverage. |
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