Review of U.S. Health Care Law from a Human Rights Perspective




DGH Supports

Medicare for All


Many misconceptions exist, both in the U.S. and abroad, about the health care reform law recently passed in the U.S. The Patient Protection and Affordable Care Act (PPACA) implements a series of health care and insurance related provisions to take effect over years -- most by 2014. A recent report by the National Economic and Social Rights Initiative (NESRI) has published several documents that point out where this law has failed women, immigrants, and people of color.  


To briefly explain, the PPACA will extend health insurance to 32 million more Americans. Many will get insurance through Medicaid, a federal social insurance program for the poor, which will be expanded to cover all citizens and some legal residents up to 133% of the federal poverty level. The PPACA will subsidize insurance premiums for lower income individuals and families, and give financial incentives to businesses to provide health care benefits to employees. It initiates consumer protections from certain insurance company abuses such as being cut off (“rescission”) and discrimination against those with pre-existing conditions.  It will mandate that all legally residing U.S. residents obtain medical insurance, and state-based insurance “exchanges” will be established. It will establish a non-profit Patient-Centered Outcomes Research Institute to assess the relative outcomes, effectiveness and appropriateness of various treatments. Funding for community health centers and payments for primary care services will increase substantially. Cost sharing for preventive care will be eliminated, and it will also eliminate co-pays for prescription drugs for those with Medicare.


Although more people will obtain insurance once the law is fully in effect in 2014, this actually insures that more public and private funds will flow to pharmaceutical, insurance, hospital and other health care industry corporations. An estimated $447 billion in taxpayer money from the new law will go directly to the health insurance industry alone. While the PPACA creates some important consumer protections and will expand health care coverage for millions, it continues to strengthen a profit-driven and fractured approach to health in the U.S. It is far from a comprehensive system of health care for all.


Impact of the PPACA on marginalized and vulnerable groups


Under the new law, an estimated 23 million Americans will remain uninsured.  This translates to 23,000 unnecessary deaths annually, and preventable and unnecessary suffering for those who remain without access to healthcare. In addition, many previously uninsured will be mandated to spend a significant portion of their income on health care from private insurers and still may not have comprehensive coverage. On average, poor people will spend 10% of their income to cover 70% of health care expenses, with co-pays and fees still unaffordable for many  Medicaid expansion will largely be outsourced by the federal government to private insurance companies, raising concerns over for-profit abuse of Medicaaid. Federal payments to hospitals with a large proportion of uninsured and low-income patients will be lowered, limiting much needed services.


Under the new law, the health rights of women have been undermined.  Gender-based higher insurance rates for women will remain legal until at least 2017, and large employer based insurance programs will be exempt from the new PPACA provision on gender rating prohibition. Women’s reproductive rights have been eroded, as the law seriously restricts access to abortion by requiring segregation of federal insurance funds for abortion from all other medical services. This means that government funds to finance insurance programs in the PPACA cannot be used for abortion services except in cases of rape, incest, or if a woman’s life is in danger. Contraception is currently not considered a “preventive” service, so women may continue to pay for this out of pocket, despite the PPACA law that eliminates fees and co-pays for preventive services. 


Under the new law, documented immigrants are subject to the health insurance mandate upon entry to the U.S., but still face waiting periods of 5 or more years to qualify for government social services such as Medicaid. This means the large expansion of Medicaid under the new law excludes all recent immigrants. Undocumented immigrants will be unable to access state exchanges to purchase their own insurance. Nor will Medicaid (except in cases of medical emergency) or other social services be open to them. This continues a dire and inhumane practice for asylum seekers and undocumented immigrants that denies them essential health care. In addition, overly strict verification requirements for the exchanges may lead to an exclusion of many eligible applicants. 


Again, please share this information. The struggle is not over for fair, equitable, and comprehensive health care for all in the U.S.


(a similar version of this article is in press for Global Health Watch 3)