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If the COVID-19 pandemic has taught Americans anything, it’s surely the necessity of making sure everyone has access to decent medical care. After all, it’s not enough to make sure the affluent can be treated or receive preventive care, it’s in everyone’s best interest to see that hospitals aren’t overwhelmed when a virus breaks loose and that herd immunity is achieved through widespread vaccination to truly vanquish such a threat. Yet over and over again, we have witnessed this basic inequity for 16 months: those of means get full medical care, those who do not often suffer. This is not new. It’s a long-standing problem and a major reason why before the pandemic, Black people in the U.S. had a four-year shorter life expectancy than whites.
Thursday’s decision by the U.S. Supreme Court upholding the Affordable Care Act, which has since its passage 11 years ago sought to help close this gap between the haves and have-nots of health care, is heartening. Not just because it keeps Obamacare in place but because it did so with an exclamation point — a 7-2 ruling that even included Justice Clarence Thomas. When such a conservative court rejects the efforts of Republican states to kill the ACA (even through a technicality like the elimination of the individual mandate four years ago), it doesn’t take a legal expert to recognize Barack Obama’s signature domestic accomplishment isn’t going away. This is the third Supreme Court defense of the law; surely even the most ardent GOP opponents will give it a rest.
As of this month, an estimated 31 million Americans have health insurance either through ACA marketplaces or the law’s Medicaid expansion, according to U.S. Department of Health and Human Services data. Just as significantly, the nation saw a drop in the rate of the uninsured for much of the last decade. That’s been true not just in Maryland where the ACA has been embraced but in red states that have only grudgingly accepted ACA perks such as broader Medicaid eligibility or the requirement that insurers can’t refuse coverage because of a preexisting health condition. Yet too many Americans still lack health insurance. And during the Trump administration, there was an uptick in uninsured rates for the nonelderly from 10% in 2016 to nearly 11% by 2019.
That’s why a victory in California v. Texas is great, but building on the success of the Affordable Care Act would be better. There are still many millions of Americans whose medical needs aren’t being met under the existing program. To his credit, President Joe Biden has already made some steps in this direction, adding a special enrollment period in February while funds from the American Rescue Plan are helping make ACA coverage more affordable this year. Yet additional steps need to be taken. And it should start with GOP leadership dropping their misplaced antagonism toward the law which was, after all, a compromise that preserved private insurance instead of moving toward a single-payer or 'Medicare for All" system as liberals sought. Republican voters have benefited from the ACA. Their elected leaders are simply unwilling to admit it.
Just this year, the Maryland General Assembly approved legislation creating a pilot program targeting young adults 18 to 40 earning as much as $51,520 with subsidized coverage purchased through the individual health insurance marketplace. Lawmakers also passed a bill committing $59 million toward “health equity resource communities” to specifically address health disparities in low-income neighborhoods for the next five years. This kind of creative approach, to provide incentives and opportunities for people who may otherwise lack insurance, is exactly what is needed. Creative, smart, targeted, cost-effective ACA expansion.
Oh, it won’t be easy for certain critics to change their tune and stop referring to Obamacare as a government “takeover” of medicine or a communist plot. But then it probably also wasn’t easy for conservatives who initially opposed Social Security in the 1930s (even as nearly three dozen other countries had already adopted some form of social insurance). It was many years after the program’s initial passage that signature changes were adopted such as cost-of-living adjustments (1950) or disability insurance (1954). Social Security may need some more tweaks and better funding but it’s been generations since anyone seriously talked about doing away with that government safety net.
In his official statement, President Biden called the Supreme Court’s ACA ruling a “major victory for all Americans.” It certainly is that. But it’s also not the end of the story for providing greater equity in health care.