This was my response to a friend who opposes the Affordable Care Act. I first sent him this story of what is happening in Kentucky, a state seeing remarkable success with the ACA despite similar demographics. Kentucky, of course, embraced the reforms as a long-overdue way to help its citizens while stimulating its economy and saving its hospitals.
I continued as follows:
Alabama is not working well, which was the state government’s goal. We have not expanded Medicaid — and note that the KY story involved the working poor, who do not have Medicaid in Alabama. The state has done nothing to curb the BCBS monopoly and it refused to create its own anti-monopoly exchange or promote the federal exchange, so BCBS remains the only significant player and controls premiums.
In Decatur we don’t have it quite so bad yet because Huntsville/Decatur Morgan hospitals are trying to provide diagnostic tests and specialized care to the uninsured, usually after a referral from the Free Clinic. (In the Kentucky story, note that diagnostic tests and specialized care were the biggest pre-ACA problems.) In talking to hospital officials, though, it is clear that can’t continue. Decatur Morgan is not breaking even; HH barely is. They are not required to provide MRIs or cancer screens or most cardio tests. All the hospital is required to do is stabilize the patient and send her home. The specialists are not required to see the uninsured patients at all, and fewer and fewer are willing to see them.
When 17% of our population has essentially no access to health care, it is inevitable that the transition will be difficult for everyone — doctors, hospitals, insured patients. Many uninsured have been struggling with untreated illnesses for years, and they will strain the health infrastructure initially. Those who have been previously denied insurance due to preexisting conditions will put upward pressure on premiums for everyone.
The transition also is difficult because the ACA is a major overhaul of a huge and complex system. There are dozens of minor changes that would make it work better, but the U.S. House does not want it to work better.
I avoid saying this publicly, but you’re a friend: For me, it comes down to my acceptance of Christ’s teachings. We have the ability to heal the sick and give them an opportunity to become productive members of society. We have the ability to treat diabetes and prevent its horrific consequences. We have the ability to alleviate painful conditions that ruin the quality of life for thousands of Alabamians. Nobody gets healthcare for the fun of it, so we are not even creating the “dependency” issues that cause our governor such consternation.
ACA has plenty of problems. Its initial rollout, as you mentioned, was a disaster. The pre-ACA status quo, however, was an affront to everything I believe in. While the vote ended up being partisan, ACA was formulated by both parties and numerous experts. Short of a politically untenable single-payer system, it’s our best shot.