National Nurses United

ERIN FITZGERALD N ow that the United States Supreme Court has upheld the 2010 Affordable Care Act, it���s a good time to revisit what the law does and does not do, and what���s next on the agenda for advocates of more comprehensive healthcare reform. At its best, the law will help some people who have been unable to get health coverage, primarily through the expansion of Medicaid and some of the insurance reforms, assist seniors to pay for prescription drugs, and provides important financial help for community health programs. But the law does little to control healthcare costs for families and individuals, is not universal, leaves big loopholes in the insurance reforms, and is a huge windfall for insurance companies, hospitals, and pharmaceutical corporations. Overall, the law reinforces, protects, and expands the reach of the private insurance system. Even its most progressive element, the JUNE 2012 Medicaid expansion, was undermined by the court decision allowing individual states to opt out, which could substantially reduce the law���s promise of expanded coverage. As NNU Co-President Karen Higgins, RN, who was on the steps of the Supreme Court when the decision was announced, said, ���Nurses experience the crisis our patients Opposite page: Washingcontinue to endure ton, D.C.-area NNU nurses every day. That���s the on the U.S. Supreme Court reason we will consteps the morning its rultinue to work for ing upholding Obamacare reform that is uniwas announced. This versal, that doesn���t page: RN Vickie Bryant bankrupt families or checks a San Luis Obispo leave patients in the man's blood pressure. often cruel hands of merciless insurance companies.��� That reform is called an expanded and improved Medicare for all. There are several key provisions of the ACA, most of which are to be phased in by 2014. Probably the most controversial part of the law so far has been the individual mandate, which means that those who currently have no health insurance, for example, through their employer or covered by a government-funded program like Medicare, Medicaid, or the VA, will be required to buy private insurance. Failure to comply will result in a tax (as redefined by the Supreme Court) amounting to $695 a year or 2.5 percent of an individual���s income, whichever is greater. Subsidies are supposed to be provided for people with incomes of up to 400 percent above the poverty line to buy insurance. New state health insurance exchanges will be set up to offer choices. The ACA also offers a few ���benefits��� that will add some more people to the ranks of the insured. People with incomes up to 133 percent above the poverty line will have access to Medicaid, a provision accounting for more than half of the additional people who will now have health coverage. That Medicaid expansion comes with a big caveat, however. The court allowed states opposed to the Medicaid expansion to opt out. A number of states are threatening to do so. And young adults up to age 26 can now remain on their parents��� health plans, a provision already in effect. The law bars some of the most notorious insurance abuses, including denying coverage because of preexisting conditions, recisions (dropping coverage when you become sick), and annual and lifetime caps on coverage. Insurers are also supposed to provide rebates to consumers if they spend more than 20 percent of their revenue on administrative costs. Insurance plans will also be required to include preventative care (e.g. mammograms, vaccinations, colonoscopies, physicals) with no co-pay, by 2018. Medicare will now include an annual physical and no co-pays for preventive services. And the law provides for significant increases in funding for community health centers, one of the best provisions of all, W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 13

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