Tomorrow, millions of Americans will find out how much healthcare will cost in their state marketplaces as the Exchanges begin enrolling new customers. On the eve of that event, Dr. Atul Gawande writes about the forces lined up to oppose healthcare reform. The essay, which appears in the newest issue of the New Yorker, quite rightly compares those who are fighting the Affordable Care Act to those who, so many years ago, tried to block the Civil Rights Act. In each case, conservatives refused to recognize a basic human right.
Gawande is not worried that Republicans will succeed in stopping the Affordable Care Act. Already, the reform is rolling forward on the ground, affecting peoples’ lives. Even if the extreme right wing of the Republican party manages to shut down the government tomorrow, the legislation is largely funded through mandatory appropriations that cannot be curtailed through Congressional Nevertheless those who are blinded by rage can do great harm.
Who Will Be Hurt? –Paul Sullivan’s Story
Gawande opens his essay by reminding us of who will suffer—Americans like Paul Sullivan. “Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn’t have health insurance. ‘I should have known better,’ he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.”
Under the ACA, this would never happen. His out-of-pocket spending would be capped at $6,350–as long as he signed up for insurance. (If he earned less than $45,650, the cap would be considerably lower.) This is how the legislation helps even those who are too wealthy to qualify for a subsidy. They are protected against financial ruin.