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Health Care - Making Progress

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You rarely see headlines such as "Federal Food Aid Saves Millions," or "Unemployment Insurance Rescues Homeowners" or "Social Security Ends Poverty for the Aging." Government programs that work don't make news. So when you hear news about the Affordable Care Act, it is usually about the glitches, the dislocations or the disappointments. While certainly not welcome, they are to be expected -- such things happened when prescription drug coverage was added to Medicare -- but it often means that stories on what when wrong with the ACA are wildly out of context. We need to focus on where we were, where we are now and where we need to go to finish repairing the nation's broken health care system. The lives of millions -- especially women -- depend on it.

Rewind back to 2009. Our nation's health statistics were dismal. We ranked 17th among nations despite our national wealth. While we boasted of our high quality care in leading hospitals, our cutting-edge treatments and our impressive research efforts, the system was broken. Why? Because millions were left out of that picture -- more than 45 million, according to estimates. Those people had no health insurance. Conservatives and liberals alike pointed to the consequences. The uninsured were 25 percent more likely to die each year. Uninsured children were five times more likely to have an unmet need for medical care and 70 percent more likely to lack needed care for asthma, ear infections, sore throats and other common problems. Uninsured adults were 33 percent less likely to get a routine physical and 25 percent less likely to visit a doctor for an illness.

The effects of statistics like these -- and there were plenty more -- were felt throughout society in many ways -- greater absenteeism, disability, lost wages and reduced productivity, as well as more school absences and poorer classroom performance. Unpayable medical bills were a leading cause of individual bankruptcy. As long as ten years ago, the Kaiser Family Foundation study found that those without health insurance cost society $125 billion annually -- to say nothing of the morality of putting the health and lives of millions of low-income people at risk.

Even when people had insurance, it was often woefully inadequate. Health insurance companies charged large monthly fees for substandard individual policies with huge deductibles. Pre-existing conditions were usually excluded, gender discrimination was rampant and young adults were kicked off their family policies at 18.

Not only were women subject to discriminatory rates, but none of the preventive services women typically need were required. That is no longer the case. Now most private insurance must cover contraception, domestic violence screenings, Pap tests and mammograms, among other important care and life-saving screenings that many women used to forego due to cost. A key new required benefit is maternity care -- excluded by 87 percent of individual market insurance plans in 2009. In other words it is no longer a pre-existing condition to be female.

It now appears that more than 7 million people have signed up for insurance in the marketplaces created by the ACA -- and more will have that chance during the next open enrollment period beginning November 15. Nine million more bought ACA-compliant policies directly from insurance companies. Medicaid has expanded in 27 states, including DC, to include 4.5 million of the working poor. Considering the open hostility to implementation, even including attempts to make the cooperation of state employees with the new program illegal, that is a very good beginning.

But a glaring hole remains -- the failure of 24 states to expand Medicaid to cover 6.4 million of the working poor, more than 3 million of whom are women. Funding Medicaid would not only save lives but actually boost state economies. Despite the fact that initially 100 percent of the cost of expansion will be paid by the federal government, gradually phasing to 90 percent after three years, states have still refused to offer this coverage option. These states offer no alternatives either. Given the fervent tone of anti-Obamacare rhetoric, it will take time for the positive reality of the Affordable Care Act to become obvious to voters. Those of us who care about our fellow Americans must give this process a vigorous shove through advocacy, education, mobilization and lobbying at the state level.

There are surely many things left to do to improve our nation's health, from eating better and exercising more to ensuring there are enough primary care doctors, efficient delivery of care everywhere and more widespread use of use of information and medical technology. But first the desperation of so many not yet reached by the Affordable Care Act must be ended. Our health care system was scandalous enough when people in need had nowhere to turn. Now that legislation is on the books and solutions are at hand, the deliberate decision by those in office to deprive their neighbors of access to life-saving care is immoral. It's time for a good news headline -- "US Achieves Universal Health Care Coverage." And we can make it happen.