What ‘Defunding Obamacare’ Really Means

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The Nation

What ‘Defunding Obamacare’ Really Means

When the fate of the Affordable Care Act (ACA) was in question, Independent Senator Bernie Sanders was no easy “yea” vote.

The single-payer, Medicare-for-All type of system that he favored was never on the table, and the final bill didn’t include a public option. He also felt the legislative process had catered too much to the interests of the health care industry which had spent over $1.4 million per day lobbying to get the bill it wanted.

But Sanders knew Democrats desperately needed his vote. He used that leverage in a successful fight to increase funding for community health centers—comprehensive clinics in medically underserved areas that provide doctors, dentists, mental health counselors and prescription drugs on a sliding-scale fee so that nobody is turned away.

In the end, Sanders helped to pass the ACA—legislation that Republicans are now so desperate to repeal that they have shut down the government and put the full faith and credit of the US in jeopardy. Yesterday on Capitol Hill, Sanders held a forum to spell out exactly what the consequences would be if Republicans were to have their way and the ACA were nixed.

He noted that “we are [still] the only country in the industrialized world that doesn’t guarantee health care to people as a right.” As a result, there are 48 million Americans without health insurance. Under the ACA, 20 million currently uninsured people will finally receive coverage (more if GOP governors get out of the way) and thousands of lives will be saved every year as these individuals no longer delay or forgo health care.

Sanders pointed to a Harvard study that estimates 45,000 people are dying each year from illnesses that arise due to a lack of health insurance.

“Nobody can come up with an exact figure, but it is absolutely indisputable that if we deny the health insurance that 20 million Americans will get under the Affordable Care Act, at the very least thousands and thousands of our fellow Americans will die,” said Sanders. “For all of those folks saying we have to repeal the Affordable Care Act, what they are doing is passing a death sentence on many of our fellow Americans.”

Ron Pollack, executive director of Families USA, a nonprofit organization that advocates for affordable health care for all Americans, said that the US Census Bureau figure of 48 million uninsured is actually low because it is tallied at a specific point in time.

“48 million is a huge number,” said Pollack, “it’s more than the combined population of 24 states plus the District of Columbia. But it does not reflect how many people are uninsured over the course of a year, [which] is considerably larger.”

Families USA used a “conservative” methodology—designed by the non-partisan Institute of Medicine—to determine how many people between the ages of 25 and 64 died in 2010 due to a lack of health insurance.

“We found that approximately 26,100 people between the ages of 25 and 64 died prematurely due to a lack of health coverage that year,” said Pollack.

He added that this breaks down to 2,175 people dying every month, 502 every week, and 72 every day.

“Every three hours a person passes away due to a lack of health insurance,” he said. He added that between 2005 and 2010, it added up to 134,000 preventable deaths.

That’s a number that resonates with Independent Senator Angus King of Maine, who shared his personal experience with health being determined by coverage.

When he was 29, married, and a father of two young children, King obtained health insurance that included a free annual physical. He decided to do it—his first physical in “ten or eleven years.”

The doctor noticed a mole on his back that turned out to be malignant melanoma.

“I thought it was a skin cancer, not a big deal, I learned subsequently that it’s a very deadly form of cancer,” said King.

He had successful surgery—the disease hadn’t spread so he didn’t have to have radiation or chemotherapy “and here I am 39 years later.”

“Had I not had that coverage and the preventive care without the co-pay, I would not be here today,” said King. “Melanoma is one of the most dangerous forms of cancer, but it’s also one of the most treatable. You catch it in time and you live, you don’t catch it in time and you die.”

King tried to make clear the scope of preventable deaths that happen every day due to a lack of health insurance.

“These deaths occur invisibly,” he said. “They occur one at a time, all over the place, and it doesn’t say in the obituary ‘died because of no health care.’ If it happened all in one town, at one time, we would be moving heaven and earth to solve this problem, if we lost anywhere from 26,000 to 45,000 [people] a year. If we lost the town of Augusta in one year, and the next year it was someplace in Colorado, or Vermont, this society would have dealt with this many, many years ago.”

The Senator noted that the US is alone in allowing this problem to persist.

“In effect as a society we are watching people die in front of us and not doing anything,” said King. “And we’re the only industrialized country in the world that has basically said, ‘Yes, we are going to allow this to happen.’”

It is that isolation among advanced nations that makes Dr. Steven Woolf, director of the Virginia Commonwealth University Center on Society and Health, say that he is “mystified” when critics of the ACA assert that we are better off without the bill.

Woolf chaired a panel earlier this year—convened by the National Research Council and Institute of Medicine—which compared US health with that of 16 other high-income countries.

“The title of our report says it all—Shorter Lives, Poorer Health,” said Woolf. “Americans rank last in life expectancy. We die earlier, and we have higher rates of disease and injury.”

He said “the US health disadvantage” cuts across the whole population—men and women, young and old, all classes, “and across multiple areas of our health.”

Woolf said that flaws in our health care system are a key reason that “American progress in health is [falling] behind other countries’.” The peer countries offer universal health care, so Americans comparatively “find care inaccessible or too expensive.”

“A basic requirement is a health care system that number one works well, and number two is available to everyone,” said Woolf. “We’ve failed on both counts under our old model, and we now have a chance to build a solid foundation…. Change is difficult, but in this case we will pay with our lives and so will our children if we don’t make a change.”

That need for change couldn’t be any clearer for Dr. Candice Chen, who works as a primary care pediatrician at a clinic five miles from the US Capitol.

“It’s in a part of DC that most people don’t ever go to,” she said.

Most of her patients receive preventive services through Medicaid. In contrast, Chen said, uninsured people first come to the clinic “after being in the emergency room or the hospital for something that was completely preventable like an asthma attack or a tooth abscess.”

She noted that the true costs of those hospitalizations are measured in missed work, school absences, and expensive treatments. But these working families aren’t coming to the clinic—or don’t always fill the prescriptions written when they do come—because they don’t have insurance and are struggling to choose between paying for food, rent, and health care.

“I find hope in a 2012 New England Journal of Medicine Study by Ben Sommers [that shows] Medicaid expansion saved lives,” said Chen. “Up to [20] lives per 100,000 adults. What that shows is that health insurance saves lives and that the Affordable Care Act can and will save lives.”

Instead of bragging about how they are repealing, defunding, or delaying Obamacare, maybe it’s time for the GOP to just tell the truth: they are denying tens of thousands of people the opportunity to live.

Greg Kaufmann

Greg Kaufmann is the poverty correspondent for The Nation and a contributor to BillMoyers.com. He covers poverty in America primarily through his blog, This Week in Poverty. Greg has been a guest on Moyers & Company, MSNBC’s Melissa Harris-Perry, NPR’s Radio Times with Marty Moss-Coane, Here & Now, The Thom Hartmann Program, Stand Up! with Pete Dominick and The Matthew Filipowicz Show, as well as various local radio programs. His work has also been featured on Common Dreams, CBSNews.com, NPR.org, WashingtonPost.com, and BusinessInsider.com. He serves as an advisor for Barbara Ehrenreich’s Economic Hardship Reporting Project.

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