ACA needs “patients and subscribers” movement

The New York Times reported in a recent survey article that the expanded Medicaid provisions of Obamacare (Affordable Care Act) are already having a profound effect on the lives of poor Americans. “Enrollment in private insurance plans has been sluggish, but sign-ups for Medicaid, the federal insurance program for the poor, have surged in many states.”

Here in West Virginia, we have some of the shortest life spans, highest poverty rates, oldest median ages, worst educational investments, and most dangerous work and industrial environments in the country. Still, the strength of the Medicaid demand has surprised officials, with nearly 100,000 people enrolling so far.

Many of the people with incomes higher than 138 percent of the federal poverty level, but who are now signing up for private insurance through the new insurance exchanges, had some kind of health care coverage before. However, as recent studies cited by the Times have found, most of the people getting coverage under the Medicaid expansion were previously uninsured, and many have never had insurance before. Already, nearly 40 percent of West Virginia’s 246,000 uninsured citizens are newly covered.

While enrollment in expanded Medicaid is surging, sign-up for private insurance through the exchanges is lagging. Let’s face it: a worker making 25,000 dollars a year, selecting the “bronze” – or cheapest – plan will have to pay $400 a month in premiums and is subject to nearly $2,000 a year in deductibles. This burden is subsidized slightly through tax refunds at year-end, if there is any tax, and is supposed to lessen after 2015, but remains month to month a difficult if not insurmountable cost barrier.

In addition to unreachable premiums and deductibles for not a few workers, enrollment has also lagged due to outright sabotage of the exchange launch in W.Va. was organized and driven by tea party/Republican forces, including the State Attorney General Patrick Morrissey. Federal funds for training navigators and community assistants were boycotted and stalled with threats of lawsuits and other onerous duties.

Thus few insurers have signed up to participate – negating the “competition” premise (and benefit) which was advanced from the beginning of the Obamacare debate as a defense of a private insurance over a single-payer, Medicare-for-all approach to national health care.

Providers, insurers, and patients are also feeling the rising pressures from a shortage of resources, and back-end bureaucratic confusion, in the face of rapidly increasing loads and demands. Official figures are not available this soon, but an informal survey of Jefferson county, W.Va. doctors and nurse providers reveals long shifts by doctors and nurses, big backlogs, and disarray processing paperwork. Furthermore, getting compensation to providers is slow to non-existent; getting approval for procedures, treatments, and drugs in the new system faces other hurdles where rules implementing legislation have not yet been written; patients in under-served areas are facing three-month appointment delays.

If ever there was a circumstance that cries out for mass self-organization, it is here and now among both Medicaid and new exchange-based patients and subscribers. They need collective and individual representation in this massive and complex health care system that is emerging. Brother Trumka, sign me up!

Photo: Jobs with Justice/Flickr