Oh look, the Affordable Care Act still isn’t affordable

I’ve repeatedly lodged my opposition to the Affordable Care Act on the grounds that it does nothing to actually improve access to health care in the United States — it’s more about health insurance reform than actual shifts in health policy. Yes, more people in the US have health insurance. Yes, insurance plans are no longer allowed to drop people for developing significant health conditions, nor are they allowed to discriminate during enrollment. Yes, transgender care is covered for more people under Obamacare. But this is nowhere near the universal health care that would be both more efficient and more comprehensive.

Some individuals may have benefited under Obamacare, which is undeniably good, but it’s still the wrong thing for our country, and people need to stop calling it ‘health care reform.’ One particularly poetic illustration of what Obamacare hath wrought came out of a Kaiser Family Foundation study conducted earlier this year to examine how well the programme fared in its first year of active deployment. The organisation was interested in Obamacare’s affect on quality of life, specifically when it came to the users of California’s health insurance exchange, Covered California, which, as we know, is a complete and utter clusterfuck.

What they found is quite interesting, and it put rather a pin in the bubble of the ‘Affordable’ Care Act. According to their research, 44 percent of people in California on the health insurance exchange were having difficulty paying their premiums, and were in fact finding that their financial security was negatively affected by the burden of buying health insurance — the health insurance the government mandates that they purchase in order to avoid paying fines. Adults on subsidized Obamacare, specifically designed to meet the needs of low income people who can’t buy insurance on the open market, can’t buy their supposedly affordable health insurance.

Kaiser also found that people who had been insured before, and through private insurance, didn’t have this problem. In other words, forcing a bunch of low income people to buy health insurance inevitably created a significant cash crunch for them. This was precisely the outcome I and many critics predicted, and it’s a telling testimony to how Obamacare is likely to fail, and why it’s flailing even now.

There are a number of things to pick apart here. One of the first things we know is that prior to having insurance, many low-income people experienced health problems that they didn’t address, because they couldn’t afford to. This included substantial health issues which, left untreated, compounded into emergencies that required expensive and serious treatment. Having insurance theoretically reduces these expenses by allowing people to get into the doctor’s office earlier and to access better treatment options. In this sense, those premiums can pay off, though of course many people are simply paying into a risk pool and don’t use those benefits very much, beyond, possibly, gynecological care for those who need it, since annual exams are now provided free of charge for those on exchanges.

However, this leaves out two important issues. One is the premium itself. When you are on a very limited budget and you’re used to paying nothing for health care — and scrambling when you absolutely need it — even a reduced premium is too much. If you calculate the way you use money down to a handful of dollars every month, a very real experience for many low-income people in the US, you can’t afford an additional hundred dollars or even less for basic insurance. Moreover, insurance only covers so much, and with those premiums people also need to address copays, deductibles, and services that aren’t covered, like off-label drugs and surgical procedures some may consider ‘optional.’ These all add to the cost burden of retaining that supposedly so glorious insurance.

In California, these problems are particularly acute because of the extremely high cost of living in the state. Obamacare and Covered California are being used by service workers, by the people who struggle to survive while propping up the lives of the rich. They’re already enduring incredible hardships to take care of themselves and their families, from living in substandard housing and relying on food banks and charities for support to working multiple jobs in order to bring in enough money to survive. To be poor in California is to be sentenced to a really difficult life, even with pushes to increase the minimum wage and commitments on the part of companies across the state to ‘make things better’ for their employees — even as they do sneaky things like cut everyone to half time to avoid paying benefits, like Blue Bottle Coffee did.

Covered California was supposed to address the problem of health care affordability in the state, but organisers of the programme and Obamacare at large refuse to acknowledge that what they’re really doing is finding more ways to funnel funds into the market of insurance companies. Insurers have no incentive to provide broad-spectrum coverage to their members, and forcing people to buy coverage doesn’t actually make it any easier to access health care. People on Covered California plans report that it’s hard to find in-network doctors and get the care they need. They say copays are too high and necessary medications are being blocked. What they’re saying is that they face the same status quo they did before, only now they have to pay a useless monthly premium on top of it.

In a medical emergency, Covered California could be a huge benefit — but for many, the month to month expense of retaining insurance just isn’t functionally possible.

Image: We Love Obamacare, LaDawna Howard, Flickr