Flawed Affordable Care Act Needs Fixing

Health care for all has been a goal for the U.S. bishops for almost a century. Yet despite the apparent Supreme Court victory June 28 for the Affordable Care Act (ACA), the nation still does not have health care for all.

Most glaring is the lack of protection of the unborn, because the ACA allows use of federal funds for elective abortion. Rather than protecting children in utero, the health care law endangers them when it takes the unprecedented step of authorizing federal funds to subsidize health plans that cover such abortions. In addition, with the Health and Human Services mandate to coerce employers and employees to pay for female sterilization and contraceptives, including abortion-inducing drugs, children in utero are endangered more than they were before. When the ACA allows federal funding of abortion in various provisions, it contradicts longstanding federal policy in all other health care laws, such as Medicaid, Medicare and the Federal Employees Health Benefits Program.

The Affordable Care Act also excludes undocumented immigrants from the new health care exchanges, even if they simply want to purchase insurance with their own money. This is a cut-off-your-nose-to-spite-your-face action, given that the ACA can’t work unless as many people as possible buy into the system. The stance also drives up health care costs for all of us because undocumented immigrants who cannot purchase insurance will be forced to seek medical care in the more expensive emergency room setting. For some, politics requires you fight against undocumented immigrants everywhere, despite the fact that about 11 million of them have become part of the fabric of America, holding jobs, paying taxes and making the economy work.

Some people will benefit from the Act. People with pre-existing medical conditions cannot be discriminated against, a merciful outcome. Young people can stay on their parents’ insurance until they are 26, certainly good now when post-college does not automatically mean a good job with insurance benefits. The exchanges will help working families who don’t have insurance through their employers. Uninsured poor people will be helped by the Medicaid expansion if their state pursues the expansion, which the Court’s ruling has now made optional.

But the bill is significantly flawed and the Administration and Congress need to face this when they stop popping champagne corks celebrating an apparent victory.

1.    ACA allows use of federal funds to pay for elective abortions and for plans that cover such abortions, contradicting longstanding federal policy. This law can be fixed by amending it to bring it into line with other health care legislation, for example by passing the Protect Life Act (HR 358) that the House has approved.

2.    ACA fails to include necessary language to provide essential conscience protection, both within and beyond the abortion context.  This has been illustrated in dramatic fashion by the HHS mandate to force religious and other employers to cover sterilization and contraception, including abortifacient drugs. Most of the conscience problems are problems of omission, because the act does not include protections of conscience that other federal programs have. This law can be fixed also by amending it to bring it into line with other health care legislation, by enacting the Respect for Rights of Conscience Act (H.R. 1179) supported by a majority of the House and a near-majority of the Senate.

3.    ACA fails to treat undocumented immigrant workers and their families fairly, leaving them worse off by not allowing them to purchase health coverage in the new exchanges created under the law, even if they use their own money. Congress could easily change this.

Getting nearly universal health care is a first step. Now Americans need to get it right. This flawed Act needs fixing.