National Nurses United

Bad Medicine On closer look, the biggest health reform of our lifetime does little to rein in healthcare corporations and insurers. Instead, it shifts even more in costs onto workers who can't afford it and, at the same time, threatens the practice of registered nurses. BY C H A RL E S IDE L SON he one-year anniversary of the Supreme Court ruling upholding the Affordable Care Act (ACA) provides a good moment to take stock of the impacts of the law. While the ACA does limit several abuses endemic to a private insurance-based system and will increase access to health services for some, the law's fundamental flaws become more apparent daily as its full implementation next January nears. Despite its insurance market reforms, the ACA falls short on the key areas of access, cost, and quality. It is not universal, leaving up to 31 million uninsured, not affordable for many with its still high out-of-pocket costs for individuals, and it promotes changes that undermine nurses' ability to provide safe, therapeutic care. At its best, the law does provide real relief to those most disadvantaged by the present system, especially people with preexisting and medically expensive conditions who are assisted by the law's requirements eliminating annual and lifetime caps on coverage and a mandate that insurers must be willing to sell insurance policies to everyone. The law also promised the expansion of health coverage for millions of additional low-income Americans who would become eligible for Medicaid, enabled young adults up to age 26 to remain on their parent's health plans, and reduced the "donut hole" in prescription drug coverage for Medicare recipients. T 16 N AT I O N A L N U R S E However, the ACA concurrently reinforces a corporate medical model that elevates profits over care, offers no meaningful reform of treatment denials by insurance claims adjustors, and, in perhaps its biggest defect, places the burden of cost cutting on workers while providing incentives for care delivery models that have ominous implications for nurses and patients. Nurses, who on a daily basis care for those abused and abandoned by a callous corporate medical system, understand the need for a more systemic transformation of our healthcare system to one based on patient need, not ability to pay. The ACA is not that fundamental reform. The critical flaws start with the glaring decision of how it proposes to reduce healthcare expenditures. The shakiness of the law is evident in continuing concessions to big businesses—such as the latest one granting a oneyear delay to employers with 50 or more workers to provide coverage or pay a fine—that will likely have a variety of ripple effects in the law's implementation. It's all a reminder that single-payer reform is the only permanent solution to our healthcare mess. The Achilles heel: Who bears the burden for cutting costs? from the outset, the Obama administration ruled out the most effective mechanisms to reduce costs by a) refusing to consider a single-payer alternative that guarantees universal coverage combined W W W. N A T I O N A L N U R S E S U N I T E D . O R G JUNE 2013

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