Reflections on our Work

After a relaxing day of walking on the beach and taking a run though the Gulf Breeze nature pathway, I decided to take a few minutes and reflect on the experience of helping people enroll in health care in Escambia County, AL. On the whole, I am very satisfied with our trip. We talked with scores of people, small business owners, and locals attending a rogue carnival about the upcoming Open Enrollment deadline. We spoke with about 20 people or families and helped at least 10 of them select a plan that they could afford. The five of us (with me and Lauren) worked with Bama Covered and joined the group of over 27,000 trained assistors who have helped people navigate the Marketplace.gov website.

Me setting the table for dinner at the beach

Our efforts this week seem to have paid dividends. The White House just announced that over 6 million people have enrolled in a plan, which isn't quite equal to the goal of 7 million people that was set this past summer. Still, there are a lot of people in the United States who will live measurably better lives because they don't have to worry about getting stuck with unreasonable hospital costs if something happens to them. And what's better, almost 2 million of the people who have enrolled did so within the last two weeks, and experts predict that the recently-announced extension will allow at least a half million more people to find a plan that works for them. In Alabama, one of the states that did not choose to extend Medicaid and does not have a state-based exchange, 41 percent of the people who were found to be eligible for plans enrolled in one (as of March 1). I am curious to see what effect the final push in March has on this number.

The work that students from Montevallo did this week is important and should be commended. However, seeing them talk with people has also given me a new perspective on health care legislation in the United States. My major takeaway from this week is that the Affordable Care Act does make the lives of some people better, but it does only a little to alleviate the acute need for justice and fair access to health care in our country. And the problem on the surface is the Medicaid Gap. As I and several other students have talked about before on this blog, we had multiple conversations with people who are completely helpless. They are unable to find jobs or unable to work, yet they receive just enough federal assistance to not qualify for Medicaid, and thus they cannot realistically afford health care. It was awful to walk people through the application process (people who have jobs even) and hope with them that there would be something they could afford. There's no worse feeling than having to share all of your information with a stranger and hope but later realize that the only plans you qualify for cost more than 50 percent of your income. All we could tell these people was that we were sorry and we hoped our legislators would change their mind.

It's important to phrase this dilemma in terms of real numbers, and it's worth comparing Alabama to Kentucky, a state that did choose to expand Medicaid and does have a state-based exchange, which makes it easier for citizens to purchase plans. In Kentucky, about 33 percent of people who were eligible for a marketplace plan purchased one (as of March 1). This is a lower rate than Alabama, but far more people in Kentucky are being insured. 222,448 people were deemed to be eligible for Medicaid, whereas in Alabama, only 17,980 were. Kentucky's is the highest percentage of the overall state population in the United Sates that receives some form of health care because of the Affordable Care Act, I believe. Alabama is not the worst, but it has one of the more substantial gaps in coverage.

The second thing I take away from this trip is that the Affordable Care Act is a misalignment of priorities. Many people who desperately need health care cannot afford it, while those individuals, especially those who work for large corporations and profitable small businesses and make a semi-good living, can now receive good health care coverage. I don't begrudge such people health care coverage, but I think it's important that we not lose sight of what's actually happening in the United States: the Affordable Care Act is letting many corporations and businesses off the hook for fairly compensating their employees and providing them quality health care. Instead, these businesses are allowing the government to subsidize their operations by stepping back and requiring their employees to purchase independent plans from Marketplace.gov. American taxpayers effectively foot the bill for the operating costs of Wal-Mart, Target, Trader Joe's, and other retailers while these corporations get to pocket massive profits. Of course, the ACA has anticipated this and has levied fines for businesses that can but won't offer health care, but it's unclear as to how or to what extent this will be monitored.

We experienced this first-hand on our trip when one of the students talked with a woman who works at a large chain drug store retail chain. She is not full time, but often works over 30 hours per week. That store offers her a private health plan, but it is completely unrealistic, considering how little money she makes each month. But this chain drug store company refuses to offer something reasonable, especially now that they know more and more people will be able to afford a plan with the Marketplace. The problem is, however, that even in the Marketplace, the only people who can afford plans are those who make much more than minimum wage.

Ultimately, I think that every state will expand Medicaid and accept the provisions of the Affordable Care Act, and this will lead to more people getting to have access to health care, which is good. However, it won't solve the other fundamental problem here: private health care providers will continue to get rich as they funnel billions of dollars from the government, and access to health care will still be uneven and inconsistent. To answer the question that we posed on this blog, I will continue to monitor health care legislation, and I will continue to maintain that our only option in the United States is to adopt a single payer system.

I don't think that our work with Bama Covered was for naught. Don't get me wrong. In fact, it has opened my eyes to the way that the Affordable Care Act is effecting all of us. But it's also affirmed my conviction that we need to have a single payer system. I've often casually advocated for causes like Single Payer Action, and now I will do so even more.