What do we know and not know about the Affordable Care Act? Plenty.
We know it’s helping families by keeping young adults on their parents’ policies, and it’s helping individuals by eliminating exclusion from insurance plans because of preexisting conditions. We know it creates options for middle class wage earners who benefit from marketplace exchanges offering a range of plans. And though public dialogue may at times be heated, the ACA has put new energy into the healthcare conversation. There are considerable issues to talk about, so this is good.
However, we don’t know whether the conversation will successfully transition from talking about who has an insurance card to what real health means and where it comes from. The ACA is silent on a wide array of topics that contribute to health and the economic mobility generally associated with better access to healthcare.
We don’t know whether more states will eventually expand Medicaid to care for the poorest part of the population. We don’t know whether the exchanges will eventually work as smoothly as intended after a seriously rough start.
Questions swirl, but this one thing we know: There will still be gaps in coverage.
Using the Church Health Center’s uninsured patient population as an informal case study, it’s clear to us that more than 60 percent of our patients will see no change. The Affordable Care Acts makes no difference to them. Because Tennessee did not expand its Medicaid program—and most states opted not to—our low-wage patients still do not qualify for this form of healthcare assistance. Yet neither do they qualify for subsidies for the cost of premiums. In a backward logic sort of way, the people with the least income were left off the charts. Hopefully the state will clarify this soon.
And even with the availability of plans that cannot exclude applicants because of preexisting conditions, the working uninsured are still choosing between paying for insurance premiums or essentials like food and housing.
When the exchanges first opened, I was encouraging one patient to explore the possibility of a simple plan that would cost about $150 a month. It seemed to me it would give her some good coverage. She responded by essentially daring me to find $150 in her monthly budget that had somehow escaped her attention. While insurance was available to her now, whereas it had not been previously, she still couldn’t pay for it.
I used to hear from people who assumed that after the Affordable Care Act took effect, there would be no need for faith-based health ministries like the Church Health Center.
That couldn’t be further from the truth.
A more accurate assumption is that in order to remain relevant in the context of the Affordable Care Act, we need to stay on the job. We can’t let up.
I offer these two words as touchstones for our efforts going forward.
1. Nimbleness. We can’t be encumbered by loyalty to old ways of doing things. The Church Health Center is constantly seeking to innovate with the goal of improving health. None of us should be waiting to see what state or federal governments will do about healthcare. It’s up to us to dig in and find ways to bring real change at the local level.
2. Community. The government can’t buy love, yet we know that love improves health. Faith communities reflecting the love of God have an enormous opportunity to care for their communities and address not only clinical health needs, but also the socioeconomic factors that contribute to inequitable health access and outcomes. Love God and love your neighbor, the Scriptures tell us. Healthcare reform starts with changing how we look at health not as a card or pills or office visits, but as how we relate to each other, from individual relationships to matters of injustice too long ignored. At every level, people of faith can raise their voices and bring change. The Affordable Care Act hasn’t changed that fundamental truth.