Few issues have dominated this year’s presidential campaign more than income inequality. For Bernie Sanders it is the core message in his pursuit of the Democratic nomination. And it is one that has been picked up Hillary Clinton, who talks of reducing barriers for all Americans.
But not enough attention is being devoted to the government program that is playing an increasingly critical role in reducing inequality: the Affordable Care Act.
If anything, Obamacare has been the red-headed stepchild of this campaign. For Sanders, a single-payer advocate, it doesn’t go nearly far enough. On the Republican side, hardly a day goes by without a presidential candidate vowing to repeal the bill, sometimes on his first day in office.
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But new studies out this week indicate that Obamacare is making a life-changing difference for actual Americans. According to an analysis by The New York Times, the first full year of the ACA “brought historic increases in coverage for low-wage workers.” Immigrants saw the sharpest rise in coverage. In particular, a third of those who gained insurance are Hispanic — and two-thirds are minorities. The numbers would be higher but or the fact that blacks disproportionately live in red states that have rejected Medicaid expansion.
These are Americans who previously could not afford coverage or were restricted from purchasing even inadequate individual insurance plans because of preexisting conditions. Now they don’t have to put off seeing doctors and can have illnesses treated when they’re sick, not when they can afford it. The Times highlighted one clinic in Los Angeles that had enrolled 18,000 people since the law took effect and is now reporting “a 44 percent increase in cervical cancer screenings, a 25 percent increase in tobacco cessation therapy, and a 22 percent increase in the share of patients with controlled hypertension.”
Obviously such improvements in coverage lead to better health outcomes. But the larger impact can be seen in the pocketbook. As anyone who has never had health insurance — or who had lousy coverage — can confirm, an uninsured American is just one trip and fall, one car accident, or one bad medical diagnosis away from financial ruin.
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As another new report show, this one by the National Bureau of Economic Research, Obamacare has cut down substantially on just these types of situation. The report finds that medical debt for those covered by Medicaid expansion has dropped by between $600 and $1000 per person.
That may not seem like a lot of money for many Americans, but then again it’s hard to quantify fully the larger financial and psychological impact of medical debt. There’s a greater chance of bankruptcy; indeed, medical debt is the largest cause of personal bankruptcy. Credit scores are affected, which makes it either harder or more expensive to buy a home or car or even to rent. Medical debt, or paying huge out-of-pocket sums for medical care or prescription drugs, means falling behind on other payments. That can lead to eviction or repossession, or being forced to borrow money at often exorbitantly high rates.
Perhaps above all, it feeds the debilitating sense that there is no escape from economic misery. Planning for the future, taking a vacation, saving for college, providing for one’s kids — all of that becomes much more difficult.
A couple of years ago, a study looking at Medicaid expansion in Oregon found that those who received access to care not only saw the virtual disappearance of debilitating medical expenses, as well as less financial hardship, but were actually 30 percent less likely to suffer from depression than those who were not covered. Ironically, the study also found that health care outcomes didn’t show dramatic improvement. The biggest benefit was economic security — which, if you think about it, is the reason most people buy insurance of any kind in the first place.
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This is not to say that Obamacare is perfect. Recent news that several large insurers are leaving Obamacare exchanges suggests that a sustainable long-term business model for selling health care has still not been achieved. Obamacare subsidies are still too low, which is keeping out-of-pocket costs for ordinary Americans too high. Indeed, though the percentage has gone down, more than a third of Americans still struggle to pay their medical bills.
Meanwhile, the refusal of red state governors and state legislatures to expand Medicaid coverage to their poorest citizens should be a national source of shame. Indeed, rather than talking about repealing Obamacare or beginning a long fight over single-payer, we should shine a daily spotlight on the refusal of 19 red states to accept Medicaid monies — and the harm that this political decision is inflicting on these states’ most vulnerable citizens.
Six years after the ACA took effect, it has, perhaps more than any law passed in the previous five decades, narrowed income inequality, saved lives, and reduced financial anxiety. Imagine if the help it provides could be reproduced with paid sick leave and family leave policies, a higher minimum wage, or affordable child care.
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It’s a reminder that the tools are within our grasp to narrow the gap between rich and poor. All that’s lacking is more than one major political party that shares that goal.
Michael A. Cohen’s column appears regularly in the Globe. Follow him on Twitter @speechboy71.