POL­I­TICS OF PEO­PLE’S HEALTH

BioSpectrum (Asia) - - Bio Edit - Milind Kokje Chief Ed­i­tor milind.kokje@mmac­tiv.in

The US Se­nate’s re­jec­tion of ‘skinny re­peal’ of Af­ford­able Care Act (ACA), pop­u­larly known as ‘Oba­macare” is not merely a po­lit­i­cal is­sue. The de­feat is very nar­row. Still, it is em­bar­rass­ing for the Trump ad­min­is­tra­tion as the Pres­i­dent Don­ald Trump had made the re­peal of Oba­macare and its re­place­ment with a new sys­tem a pres­tige is­sue. No won­der, he tweets on de­feat, ‘3 Repub­li­cans and 48 Democrats let the Amer­i­can peo­ple down.’

The fact that the three Repub­li­can sen­a­tors vot­ing against and de­feat­ing the Repub­li­can leg­is­la­tion, which sought to re­peal only some part of Oba­macare, in which Repub­li­can Pres­i­dent is in­ter­ested is surely a po­lit­i­cal is­sue, no doubt. But there is much more into the de­feat that goes be­yond the pol­i­tics. This is a se­ri­ous so­cial is­sue too. The re­peal of the for­mer Pres­i­dent Obama’s health­care re­form law would have left 22 mil­lion poorer ci­ti­zens without health in­sur­ance. They were cov­ered by the in­sur­ance due to a pro­vi­sion in ACA com­pelling the busi­nesses with more than 50 em­ploy­ees to pro­vide health in­sur­ance and of­fered sub­si­dies to make cov­er­age more af­ford­able.

Oba­macare had showed pos­i­tive re­sults as cen­sus bu­reau fig­ures showed that from 2014 to 2015 the per­cent­age of Amer­i­cans without in­sur­ance fell from 14.2% to 9.1%, the drop of 5.1% was largest. Still, it was sought to be re­pealed.

In­ter­est­ingly, the bill for re­peal­ing was de­feated on the back­drop of news re­ports that health in­sur­ance pre­mi­ums would in­crease by 20%. The Con­gres­sional Bud­get Of­fice has es­ti­mated that this would re­sult in 15 mil­lion more Amer­i­cans be­com­ing unin­sured next year alone. Repub­li­cans were op­posed to the ACA right since it was in­tro­duced in 2010 by the then Pres­i­dent Obama, who had made this as one of his ma­jor elec­tion plank. They had in­ten­tion to re­peal it and voted sev­eral times to re­peal the law even when Obama was still the Pres­i­dent. But they could win the vote then and they could not do it even af­ter the change of ad­min­is­tra­tion. Ear­lier, just four months back Pres­i­dent and House speaker Paul Rayan had to can­cel the vot­ing in the house on the Amer­i­can Health­care Act, re­peal­ing and re­plac­ing ACA, as they re­alised that they lacked ad­e­quate num­ber of votes to pass the bill. That time also there was op­po­si­tion from two groups of Repub­li­cans.

The de­feated bill, called the Health­care Freedom Act, would have ended the re­quire­ment that most peo­ple have health cov­er­age, pro­vid­ing the man­date to in­di­vid­u­als. It would have also freed large em­ploy­ers from pro­vid­ing cov­er­age to their em­ploy­ees. One good point was it would have in­creased gov­ern­ment grants to community health cen­tres.

Though ACA is con­sid­ered to be the big­gest over­haul of the health­care sys­tem in US, it is also true that all is not well with ACA. It re­quired some changes with the chang­ing times. The gov­ern­ment could in­crease sub­si­dies given for in­sur­ance pur­chase to bring down the cost or in­crease the min­i­mum in­come limit to re­ceive sub­si­dies since af­ford­abil­ity is an im­por­tant is­sue. Some more pol­icy changes could also be con­sid­ered than to re­peal the law.

In­stead of find­ing out what changes are needed in the ACA and working for them, at­tempts were made to strike it down as per the poll prom­ise, ob­vi­ously for po­lit­i­cal rea­sons. Thus, though the is­sues in­volved in the sub­ject are much be­yond pol­i­tics, pol­i­tics is surely in­volved in it. But in­stead of pol­i­tics in peo­ple’s health, the de­feat of the re­peal in Se­nate should be con­sid­ered as an op­por­tu­nity for the Repub­li­cans and the ad­min­is­tra­tion to make changes in the ACA to make it more ef­fec­tive than re­peal­ing it.

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