By Henry Melo*

In recent months, the American people have been bombarded with countless media pieces for and against Obamacare.

Democrats and their allies, who have always supported the law, felt bitterly demoralized after HealthCare.gov, the website responsible for implementing the insurance exchanges created by the ACA (Affordable Care Act), repeatedly crashed without completing people’s applications.

Republicans, who have always opposed the law (and went as far as calling it “socialist” and even used it as an excuse to defund the federal government, causing a government shutdown) suddenly felt optimistic again, and started a crusade to prove that the technical problems were in fact deeper problems of the law itself.

Nevertheless, most people just feel insecure. They know the current healthcare system does not work, but are afraid of putting all their coins on Obamacare, especially after all the bad publicity against the insurance exchanges system and the crisis regarding the people who had their current health plans cancelled against their will.

So the question that really needs to be answered is: after all the smoke clears up, will Obamacare be able to deliver its promise of providing better and affordable healthcare for millions of Americans who are currently uninsured or working miracles to pay for healthcare they really can’t afford?

The Crisis

The goal of the Obama administration was to enroll 7 million new clients for health insurance companies through Obamacare, and another 9 million through the Medicaid expansion from October 1, 2013 to March 31, 2014. They predicted 500,000 would enroll during the very first month.

But HealthCare.gov Marketplace, the website where customers were supposed to shop for healthcare, didn’t work and constantly crashed, leaving millions without knowing how to get health insurance. Far from being only a technical problem, the system failure is a consequence of the intricate complexity of a 2,000 page law, that intended to cross  -check customers’ personal information against dozens of different private insurers’ coverages, rules and prices and come up with a suitable health care plan for each person or family.

To make things even worse, the crisis was not only virtual. Over 5 million people have received cancellation letters from their current insurers announcing that their health plans would no longer be effective after January 1. The companies alleged reason was that they didn’t meet the requirements of Obamacare — something that Obama had explicitly said would not happen: “if you like your insurance, you can keep it. Period.”

As a consequence, Obama’s popularity sank to the lowest point of his time in office: 39 % approve the government, 54% disapprove it. As for the ACA, only 19% believe the quality of their health care will improve in the next year. 43% say it will get worse.

Not affordable for workers, but profitable for health care industry

The first and most important promise Obama made when he announced his “Obamacare” was that it would provide affordable health care for most people, including workers and their families. This would be done by bringing younger people, who tend to be healthier, into the system,  and their premiums would allow the insurance companies to provide less expensive coverage for older people who need more health care.

But, the problem is that the law was crafted by and for private insurance companies. Thus,  they made sure that not only the new customers will pay for the elderly, they will also tremendously increase the profits of the healthcare and pharmaceutical industry. The result is a healthcare system that is not affordable by anyone’s definition but the government’s.

According to the ACA, someone whose income is more than four times the poverty level — around $48,000 per year — would have to pay a premium of $9,000 a year and potentially another $5,000 in out-of-pocket payments. If you have to go outside your network for specialist care, you would have to pay extra for that, which is not included in the $5,000 cap. Many of the plans on the exchanges have very narrow networks, which means that if someone has a very serious disease or needs special treatment, it’s very likely that he or she would have to go outside of his/her network and spend more in out-of-pocket costs.

The other side of the coin is that insurance companies will considerably increase their profits. The will receive an obscene  $1 trillion dollars in subsidies the next 10 years, directly from the taxpayers: that’s $100 billion a year! And besides that, they’ll have around 16 million new customers in the health system. That is what Obamacare is about: increasing the profits of insurance companies and making working people pay the bill.

A California example:

Someone with a part-time, pre-tax salary of $30,000, would be recommended by the exchange to purchase the bronze plan offered by Blue Shield of California. The total cost of the monthly premium would be $512.  The person’s share would be $213, and Blue Shield would receive $298 in subsidies from the government. The person would have to pay a total of $2,556 annual premium, and $5,000 annual deductible from his\her taxes. The co-pays would have an annual cap of $6,350. Some examples of co-pays are: primary care: $60, specialty care: $70, urgent care: $120, generic medication: $19, brand medication: $50, lab tests and X-ray: 30%. It means that the total annual cost could be as high as $ 14,000 for the most affordable plan in Obamacare!

Questionable quality

Obamacare is not a universal system, meaning that it does not offer same quality healthcare to everyone and it does not cover all the expenses someone might need when they are sick.  Quite the contrary. It only offers first quality healthcare for those who can pay more, and second class health care for the rest; and it charges out-of-pocket fees for most procedures and even more for out-of-network specialist care.

The plans are divided in, Bronze, Silver, Gold, Platinum, and Catastrophic (!?), according to the customer´s income, age, family members and health condition. The better ones have higher premiums and lower co-payments and Bronze has the lowest premium and highest co-payments.

Even if they don’t admit it, insurance companies impose all kinds of limitations to plans crafted for low-income families, which affects the quality of the service offered and the range of procedures covered by the plan. In the end, the ones who cannot afford any of the plans mentioned above, will have to try and qualify for Medicaid, admittedly the health care plan for the poor.

Benefits overshadowed by problems

The main benefits included in Obamacare are : 1) Expansion of Medicaid for families with income between 138% and 400% of the poverty level; 2) Health insurance companies plans can’t deny coverage for patients with pre-existing conditions; 3) Women should have their preventive care covered, and cannot be charged more for premiums than men; 4) Companies with more than 50 full-time workers will have to provide health care for their employees (known as business mandate); 5) Children can be included in their parents plans until age 26;

These benefits were included because of important struggles and campaigns made by health workers, patients, the labor movement, and after decades of abuse committed by insurance companies and big businesses, that systematically denied the most elementary rights to workers, as to offer health care for their employees and not to discriminate women and people with pre-existing conditions.

But even now they are partial and constantly under attack. The Medicaid expansion at the state level was ruled unconstitutional by the Supreme Court, which caused half of the states to opt-out of the expansion. This will leave 8 million people that would qualify for Medicaid uninsured.

Insurance companies will not be able to deny enrollment for patients with pre-existing conditions, but that still does not guarantee that their treatment will be fully covered, specially if they require expensive exams, drugs, procedures and specialists. And in the end, customers will still be paying higher premiums and several co-pays for their plans.

The business mandate was postponed to 2015 after intense lobbying from big businesses. This will be a big break for those companies, which will save billions of dollars at the expense of their employees. On the other hand, the individual mandate, that says everyone must have insurance or pay a fine kicks in 2014. Each uninsured adult will have to pay $95, each child $47.5, and the fee increases every year. In 2015 it will be 2% of income or $325 per person. In 2016 and later years it’s 2.5% of income or $695 per person! After that it is adjusted for inflation.

The Cadillac tax is a tax that employers will have to pay on their employees’ higher-cost health plans. Despite the progressive appearance, it is in fact aimed at penalizing unionized workers, because many unions have set a priority on getting complete coverage for their members. When they’ve gone to the bargaining table, they’ve been willing to accept lower wages (shamefully!)  in exchange for health benefits. So the Cadillac tax is going to fall very heavily on these good plan — and all the more so because many union members are aging and have older families, and that tends to raise the premiums up into the so-called Cadillac range.

Undocumented immigrants are excluded

Undocumented immigrants, who make up 11.6 million people in the U.S, are explicitly excluded from participating in the insurance exchanges created by Obamacare, for being in the country illegally.

Even though they work, pay taxes, live and study here, they will have to remain uninsured, with no access to preventive health care, depending only on emergency services. And as more Americans obtain insurance that provides preventative care, the Obama administration plans to reduce reimbursements for emergency services.

The law also creates huge problems for mixed families, where some are here legally and others aren´t. Parents without citizenship, for example, may be reluctant to enroll their U.S. citizen children if it means risking deportation.

California will be the most affected state. It is home to 2.6 million undocumented immigrants, nearly a quarter of the nation’s total. 900,000 live in Los Angeles County and 400,000 in the Bay Area, according to a 2013 report by the Center for the Study of Immigrant Integration. While an estimated one in five undocumented immigrants receive some insurance through their jobs, more than half have no insurance at all, according to UCLA Center for Health Policy Research report.

Public and Free Healthcare for all!

Obamacare is a system crafted by and for the private insurance companies, who will deeply increase their profits by receiving $1 trillion dollars in subsidies and 7 million new clients who are expected to sign-up for the program.

The consequence is that instead of having access to quality and affordable healthcare when they are sick, most people will have no other alternative than buying health plans with high premiums, high out-of-pocket expenses, deductibles, and out-of-network fees, or remaining uninsured and paying an annual fine.

But what would be the alternative? How is it possible to assure quality healthcare for all?

The first thing we must argue is that health care must be seen as a human right, that every person is entitled to have access to, from birth until their elderly years, regardless of income, age, sex or any other consideration.

If that is the case, Health Care must be not only “affordable”, but Free and Universal. Every person should contribute to the health system collectively through their taxes, and that should  be enough to ensure access to all the services they need. Everything else – exams, emergency care, preventive care, specialist procedures, should be free of charge. The same health care quality and coverage should be offered to everyone.

That would only be possible through a Single-payer Public System, that is not based on profit as the main goal, but in actually providing health care. Instead of subsidizing the private industry, the government would collect the taxes and subsidize the whole system, building hospitals, purchasing equipment, hiring doctors, etc.

This is not only a question of “who pays the bill”, it´s a whole different logic of providing health care. For private companies, health care is a service like any other, that should only be offered as long as it’s profitable. The logic is: the lower the costs, the higher the profit; so they should always offer the least health care possible. The logic of a single-payer public system should be to offer as much health care as people need, even if it´s expensive, because that´s what a government should do in the first place.

This model of free and public health care was partially accomplished in Europe and Canada for many decades, especially after World War II, and only recently it has started to be dismantled by privatization. In the U.S, such a system could be easily built unifying and developing government-run programs as Medicare, Medicaid, and CHIP.

This will not be given by the Obama administration or by any back-stage maneuver of the twin parties. It can only be achieved through a working class mobilization in struggle for their rights. Building such a movement should be a top priority for socialists and progressives throughout the U.S.

* Uninsured food worker and member of Workers´Voice