National Nurses United

Up to 31 million will remain uninsured more than 48 million people are currently uninsured. A new study in Health Affairs estimates that, even after full ACA implementation, as many as 31 million will still be without coverage. That starts with the 14 states and counting who are opting out of the expansion of Medicaid. That's a consequence of the Supreme Court ruling last June which blocked the ability of the federal government to sanction states that reject the Medicaid expansion, even though the federal government will pay the full cost of the expansion through 2016, and 90 percent afterwards. The result is 3.6 million more to come of the most poor and medically underserved people in some of the states with the highest percentage of uninsured, such as Texas, who will be left without health coverage while the states give up $8.4 billion in federal payments for healthcare services, according to a new Rand Corporation report. Others will lose their employer-sponsored coverage due to ACA taxes on employers or the provision excluding dependent coverage for small businesses that enter the health exchanges. Finally, add in all those who, despite the fine or access to subsidies through the exchanges, will still find the price tag for insurance premiums and the out-of-pocket costs too daunting, especially in a recession that still has not ended for millions of people. The wellness scam "wellness" programs are on the rise, encouraged by the ACA which offers premium discounts to participating employees. These programs enable businesses to penalize workers with higher premiums or other co-pays for "unhealthy" habits like smoking or factors like high blood pressure or cholesterol levels. However, health disorders may derive from chronic or genetic conditions and economic factors that have a disproportionate impact on the poor, who have less access to healthier diets or gyms. Wellness programs make insurance unaffordable for some workers, and "keep the sickest workers from affording the care they need," as has said Alan Balch, vice president of the Preventive Health Partnership, an alliance of the American Cancer Society, the American Diabetes Association, and the American Heart Association. The cost reductions also fall far short of the hype. The federal government apparently buried a report it mandated for the ACA from the Rand Corporation on wellness programs which showed the overall savings are, at best, modest. Whatever cost savings are realized, a University of Arizona researcher told the Washington Post, "doesn't necessarily come from health improvement, it comes out of the pocket of employees with health problems." Undermining union workers and contracts traditional labor union health plans offered to members, known as "Taft-Hartley Plans," will not be eligible to participate in the health exchanges. As a result, participants in such plans will not be eligible for subsidies to cover premiums or out-of-pocket costs. Yet, non-union employees will be able to receive subsidies for purchase of health insurance, giving them an advantage over unionized employees. 18 N AT I O N A L N U R S E Nurses and other workers are increasingly in battles with employers, such as Sutter Health, who are demanding elimination of coverage for part-time employees and citing the ACA as their pretext. Unionized workers, many of whom have secured improved health benefits in exchange for reduced pay increases or other collective bargaining gains, will also be disproportionately harmed by the "Cadillac tax" as well as the incentives to employers to replace full-time workers with part-time or temporary staff. Self-rationing on the rise with its weak controls on insurer pricing practices and hospitals and provisions that encourage cost shifting and high-deductible plans, the ACA provides little relief for those who postpone needed care because of the high price tag. Nurses now regularly see patients who forego medical treatment or diagnostic tests they've been prescribed. A Kaiser Foundation survey last July found 52 percent of men and 64 of women delay or skip healthcare. An early June 2013 survey by the Centers for Disease Control and Prevention found that 20 percent of Americans last year said their families had difficulty paying for healthcare services, including physician visits, hospital procedures, and medications within the prior 12 months. Delayed care results in less containment for the spread of infectious diseases and more people ending up in emergency rooms after postponing needed care. ER visits and the ER as the point of entry for hospital admission have been on a big upswing, a worrisome trend for the increased pain and suffering of patients and overall health expenditures. New barriers to care if massachusetts is the political model of the ACA, the industry model is Kaiser Permanente, through its integration of the roles of insurance company and medical provider with its network of hospitals and clinics. As ACA implementation nears, Kaiser has stepped up practices to keep patients out of or reduce time in "high-cost" facilities. These include: ■ Restricting hospital admissions by methods such as holding patients longer in the ER for observation rather than admitting them ■ Delaying medical appointments (Kaiser just received the second-largest health plan fine in California history for failure to provide timely mental health treatment) ■ Premature discharge of patients home, where the care burden falls on family members, especially women. 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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