An article that appeared on huffingtonpost.com detailed the fight over the health care reform bill, and made the case for improving, not repealing and replacing, the Affordable Care Act.

Below is a segment from the piece, authored by Heide Castañeda, Associate Professor in the Department of Anthropology at the University of South Florida; Jessica Mulligan, Associate Professor of Health Policy and Management at Providence College; and Mark Schuller; Associate Professor of Anthropology and Nonprofit and NGO Studies at Northern Illinois University. They write:

“Wendy and Rich, a white working-class couple from Crystal River, Florida, signed up for Affordable Care Act (ACA, or “Obamacare”) coverage last year primarily because they wanted to avoid paying the penalty. ‘We weren’t against it,’ Wendy recalls. ‘We just thought we were healthy.’

Circumstances changed.

Now at 61, Rich can’t work anymore. A few months after they enrolled for coverage, his kidneys failed. Wendy, who used to work in food service, only works 20 hours a week since her operation to remove a bone spur. She is 56.

Both Rich and Wendy have ‘pre-existing conditions,’ but are currently guaranteed health insurance through one of the signature components of the ACA. That coverage is now at risk.On May 4 the U.S. House of Representatives very narrowly passed (217 to 213) a measure to replace major parts of the ACA. While it faces an uncertain future in the Senate, the American Health Care Act (AHCA) of 2017 kept alive Republican efforts to repeal the ACA after an initial failure months earlier.

…

The AHCA does not fix the health care system, it makes it worse. For all its flaws, Obamacare at least acknowledged that it was in the government’s interest and responsibility to ensure access to basic health care. The U.S. is the only economically advanced nation that doesn’t have universal health care. When the Congressional Budget Office released its estimates last week, it became clear just how vicious and partisan the bill was designed to be, rather than in the interests of the American people. It will leave 23 million more people uninsured by 2026 than if the ACA were to remain in place.

Other organizations, including mainstream and even conservative groups have conducted their own analyses. The nonpartisan Kaiser Family Foundation examined the potential impact of the AHCA on people with pre-existing conditions, like Wendy and Rich, as well as its effect on premiums and deductibles for consumers. According to their projections, premiums will rise for lower income and older enrollees. States will also have the ability to waive certain consumer protections like the essential health benefits package and community-rated pricing for those with pre-existing conditions. The American Medical Association declared to Congressional leaders that the AHCA is critically flawed. The American Association for Retired Persons, to whom Republicans appealed in their attacks on the ACA, also opposes the AHCA.

Meanwhile, as efforts to repeal and replace have finally found footing in Congress, public support for the ACA is soaring, reaching its highest point in February since the law’s passage in 2010.

Given this public support for the ACA, why does it continue to be the Republican’s main target, and only legislative “success” in the new administration? Two central interests seem to be tax cuts for the wealthy, and a devolution – “deconstruction” – of the federal government, in favor of states’ rights. Both have been consistent themes of the radical right’s agenda since the Civil War and Civil Rights.

There are alternatives. While a single-payer system remains the most efficient and equitable option, there are many paths to universal coverage. There are models for universal coverage that have varying degrees of private insurer participation (Germany and the Netherlands, for example). Our conversations need to expand. The AHCA simply leads to less comprehensive coverage, fewer people with insurance, and no progress made to control our skyrocketing health costs beyond selling people coverage with higher deductibles that covers less.

Because of its focus on state-level decision-making, this is where the fight is being waged right now, by organizations such as the Florida Policy Institute [emphasis added], Florida CHAIN, and Protect Our Care Illinois. To resist a disastrous AHCA in our future, voters need to be sure the deliberation process is visible and consequential for legislators from their home states. Similarly, state leaders should insert themselves into this conversation, especially those from states that expanded Medicaid and have the most to lose.

For now, Wendy is in limbo, and very nervous. ‘If Trump gets rid of the ACA, he will kill my husband.'”

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