The achievement of national health reform was a long time coming. We knew for decades that the system cost too much and, more importantly, threatened the fundamental human dignity of those left on its sidelines. It was as far back as 1945 that President Harry S Truman urged Congress to take immediate action.
It took 11 more presidents and 65 more years to pass health reform. The politics only got harder, as the recent Patient Protection and Affordable Care Act proved. Now opponents of reform are making a lot of noise about how to scale back, change or repeal the law altogether. A lot of this noise has been amplified by the recent mid-term election, which some are interpreting as a mandate to rid the books of health reform. Yet an Associated Press poll shows that just 39 percent of Americans surveyed after the election support efforts to repeal or scale back health reform. Fifty-eight percent would rather make more changes in the health care system or leave the law alone.
Still, for some advocates, particularly those who have spent years if not a lifetime pushing for universal health care, it may seem like the battle we thought was at least partially won is now beginning anew. There is no doubt that health reform needs to be explained and promoted so that it can be understood and, eventually, more broadly accepted as a much-needed step in the right direction.
Until then, it is important to keep some perspective on the noise around us. As a ministry, our priorities for health reform as spelled out in CHA's Vision for U.S. Health Care have not changed. Our insistence that the health care system protect life and serve everyone has not changed. And our position on laws and regulations affecting providers and patients did not shift because the balance of power in Congress did.
A few important things to keep in mind as we move forward and continue to implement the Affordable Care Act:
- Reform is the law of the land. While those opposing health reform in the House of Representatives likely have the votes to overturn the Affordable Care Act, the Senate has more votes in favor of keeping it in place. Even if the Senate could somehow muster the votes to pass repeal, it would not survive the president's veto pen. The next president, meanwhile, would likely face pushback for repealing provisions that expand access and have therefore become popular.
- Most of the attacks on health reform are politically motivated, and most of them are inaccurate or false. Perhaps the most frequently repeated myth is that reform amounts to a government takeover of health care. This could not be further from the truth. When the Affordable Care Act is fully implemented, the vast majority of people in the U.S. will still get their coverage from a private health insurance carrier — and they will choose which one it is.
- The law is not perfect but the framework of health reform is sound. Necessary improvements represent the best path forward. The Affordable Care Act establishes a basic foundation on which our country can build and allows states to set up their own system to best serve their residents.
- Threats to defund the reform law are authentic but can be managed. Using the power of the purse, members of Congress opposed to enacting health reform may attempt to starve it of funding. This requires our continued advocacy to prevent. With the Senate sure to serve as a roadblock to many defunding efforts, the threat of insufficient appropriations is just that. Meanwhile, the Department of Health and Human Services has issued and will continue to issue regulations and guidance that put the Affordable Care Act into practice.
- Education and dialogue are more crucial now than ever. Our ministry has a powerful message and a credible voice when it comes to the nation's health care system and serving its most vulnerable persons. We must continue to engage our communities around this issue, describe how our current system is unsustainable and remind one another that reform is a lifeline to the uninsured and to those who fear losing coverage or outpacing limits that soon will be a thing of the past.
We should also remember the slew of reasons that reform was necessary in the first place — as well as the world to which we would return if the Affordable Care Act were upended:
- Staggering numbers of uninsured. A recent report from the Centers for Disease Control and Prevention estimates that nearly 59 million Americans went without health insurance coverage for at least part of 2010. That represents more people than the combined populations of New York, Pennsylvania, Florida and Ohio.
- Out-of-control cost growth and no incentives to pay for quality so that outcomes improve while expenditures decline.
- Insurance companies restricting access to health insurance through pre-existing condition exclusions and high premiums, limiting needed care and rescinding coverage when a given patient or condition costs too much.
- Limited efforts to coordinate care, especially for those with chronic conditions. As it stands, the U.S. spends more per person on health care than any country in the world but is ranked 37th by the World Health Organization in terms of performance.
"It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy …Comparisons also reveal that the United States is falling farther behind each year," concluded a Jan. 14, 2010, article in the New England Journal of Medicine.
- An unfair burden on employers, some of whom have limited or stopped providing health insurance coverage because of cost. This burden on employers also leads to reduced global competitiveness because companies elsewhere in the world do not pay for their workers' health care.
MAKING OUR CASE
Public opinion polls continue to show that about half of the American public supports reform. Among the half that doesn't, some think it should have gone even further, and most support the central tenets of the law — no pre-existing exclusions, Medicaid expansion, coverage for all children, small business tax credits and many more.
Our decades-long quest to secure health reform is far from over. As we work to implement the Affordable Care Act, we need to make certain that it continues to align with our principles and values. As mission-based organizations that keep our communities healthy, we can also help inform the people we serve and the political leaders who serve us.
Health care reform was and is a moral imperative. It is also a practical, economic necessity. Now, instead of pleading for reform, we are working hard on behalf of its effective enactment. A fairer, stronger health system is no longer a dreamy hypothetical. It is the path carved by the Affordable Care Act.
Health reform is the law. Don't forget how significant and real that is.
JEFF TIEMAN is senior director, health reform initiatives, Catholic Health Association, Washington, D.C. Write to him at firstname.lastname@example.org.
Copyright © 2011 by the Catholic Health Association of the United States
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