Ten years ago, on March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. Health care had been a pivotal issue during the 2008 presidential election and the ACA delivered a massive overhaul to a failing system.
Unfortunately, even though the bill was modeled on a plan by the Heritage Foundation, a right-wing think tank, in order to garner GOP support, not one Republican supported this legislation. The polarized partisan vote that passed this bill was just the beginning of what would become a decade-long fight, waged by the GOP to dismantle a policy that delivered some major improvements to the health care system.
Now, on the ACA’s 10th birthday, we find ourselves battling an unprecedented coronavirus pandemic with a system that has left millions uninsured and hospitals under-resourced. How did we get here, and what can we do now to protect our people during this public health crisis?
After an admittedly rocky launch, the ACA did indeed increase the ability for 20 million Americans to get health insurance at an affordable cost. Working people were able to receive federal subsidies (financial help) to help pay for monthly insurance premiums and out-of-pocket costs. They could keep their kids on their policies till they were age 26. Insurers could no longer refuse to cover or charge more for people with pre-existing conditions and they were mandated to cover essential health benefits including maternity care for all enrollees.
Many more people with low incomes would be eligible for coverage under the Medicaid program, which was greatly expanded under the ACA with the federal government picking up 100% of the bill for the first three years, and never covering less than 90% in perpetuity. Community health centers were given billions in funding to also serve the needs of the working poor. One of the more controversial aspects of the law, the individual mandate, a provision that made it mandatory for everyone to carry insurance or be penalized was immediately challenged and went all the way to the U.S. Supreme Court. The National Federation of Independent Businesses v. Sebelius Supreme Court decision upheld the individual mandate, but made the Medicaid expansion (one of the key provisions to achieve health equity) optional, leaving it up to the states to decide.
The North Carolina General Assembly, under Republican leadership, has continually rejected Medicaid expansion, leaving hundreds of thousands of Tar Heels uninsured, and leaving billions in federal dollars on the table. The consequences of not expanding Medicaid have been enormous, leading to suffering and financial instability for individuals and communities. Without the additional federal funding, rural hospitals continue to struggle financially, and some have been forced to close important departments or even shut down completely. Across the state, working families find themselves unprotected in the health coverage gap, ineligible for Medicaid and unable to afford insurance. Meanwhile, the leadership of the legislature has reacted to efforts to expand Medicaid — efforts marked by through sustained advocacy, the telling of heartbreaking personal stories, and the presentation of well-researched facts and figures — with indifference and inaction.
In the ensuing 10 years, the U.S. Congress has tried to repeal the ACA 70 times, and the ACA ended up back in court once again over the individual mandate, in the Texas v. U.S. case. Late last year, the Fifth Circuit Court of Appeals found that the individual mandate was unconstitutional but did not uphold the decision from the lower court that the entire law was unconstitutional. The ACA is therefore headed back to the Supreme Court.
Now North Carolina is facing the coronavirus pandemic with the equivalent of one hand tied behind its back. The failure to close the health coverage gap has left hundreds of thousands of North Carolinians who are working high-contact, public-facing jobs, like food service or child care, without health insurance or paid sick leave, making them vulnerable to both contracting the virus and also unintentionally spreading it. Rejecting the important federal Medicaid match dollars for the last 10 years has left many hospitals and clinics struggling financially and unprepared for the increased utilization that will be necessary during this public health crisis.
In this moment, North Carolina needs bipartisan cooperation among our elected leaders to create an emergency response that fits the enormity of the health and economic crisis we are facing. Immediately expanding Medicaid is an essential first step, bringing in much needed financial resources for our hospitals and clinics and protecting all North Carolinians by giving health coverage to uninsured Tar Heels who need it.
However, this pandemic has exposed far greater issues with America’s fragmented, for-profit health care system that will need to be addressed sooner rather than later.
How effective is employer-based insurance when millions are laid off during a public health crisis? How can a country effectively contain a pandemic when 87 million people are either uninsured or underinsured? How have deductibles, co-pays and other out-of-pockets costs kept people from seeking the care that they need, when they need it? How has fear of medical debt impacted people’s decisions to pursue treatment? As the United States looks for solutions to deal with this unprecedented moment, it is time to explore ways to create a truly universal health care system that controls costs and covers everyone.
Click here to learn more about efforts urging Sen. Phil Berger and Rep. Tim Moore to take immediate action to expand Medicaid.
Please join us for a virtual gathering of Tuesdays with Tillis on March 24, 2020, to talk about health care policy during coronavirus. You can find the Zoom info here.
Rebecca Cerese is the Health Engagement Coordinator for the North Carolina Justice Center’s Health Advocacy Project.