When it comes to providing access to medicines, and access to healthcare overall, we in the U.S. can do much, much better than the Affordable Care Act.
First, let’s give credit where credit is due: the Affordable Care Act represents an improvement in the shameful state of affairs that preceded it. Thanks to the ACA’s expansion of Medicaid and subsidies in health insurance “Marketplaces,” millions of people now have coverage that did not have it before.
As for access to medicines, the expanded population of insured people and the ACA’s narrowing of a drug coverage gap in the Medicare Part D program are credited with playing key roles in reducing the percentage of U.S. adults who report not taking prescribed medicines.
But the ACA has not fixed our broken U.S. healthcare system. Far from it.
There are still more than 28 million Americans not covered by insurance. In our law school clinic, we still see families who are blocked from needed care and medicines because they cannot afford even ACA-subsidized premiums, because high deductibles make their insurance unresponsive to their needs, or because they are locked out of the ACA due to their immigration status.
These massive coverage gaps will continue as long as the ACA does, because the law perpetuated the foundational flaw in our healthcare system. Healthcare in the U.S. will never be broadly effective and affordable as long as we stay wedded to a system that features massive accommodations to corporations who profit off of sickness. The ACA preserved and even expanded the toxic roles of drug companies, as well as investor-owned insurance companies and for-profit healthcare providers. All of these corporate sectors take advantage of guaranteed markets and “customers” who have little or no ability to make informed choices about what they purchase.
The unique U.S. system of using healthcare to guarantee corporate revenue is weighing down the ACA, so it is now seeing rising premiums that continue to put its coverage beyond the reach of many working families.
To be sure, the replacements for ACA that seem likely to be proposed by a Republican-led Congress will make the situation worse, not better. But the dark cloud of ACA repeal talk includes a distinct silver lining. Plans to scrap the ACA have fueled a strong response in favor of healthcare for all. That response has included faith groups issuing passionate statements and calls to action.
That is exciting stuff, because our only way out of this mess is through determined activism. But it is important that the current campaign avoids being a veneration of the flawed ACA. Instead, the rallying cry should continue to demand recognition of healthcare as a human right and universal coverage in a form such as “Medicare for All.”
Universal coverage, which is only feasible if we limit the leeching roles played by for-profit healthcare corporations, enjoys strong support from the U.S. public. It even forms the basis for the healthcare statements from our new President (“We’re going to have insurance for everybody.”)
We can do far better than the ACA, and the path to that better system starts with the continued public pressure for healthcare—including access to medicines--for all.
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