US health care is rife with high costs and deep inequities, and that’s no accident – a public health historian explains how the system was shaped to serve profit and politicians

  A few years ago, a student in my history of public health course asked why her mother couldn’t afford insulin without insurance, despite having a full-time job. I told her what I’ve come to believe: The U.S. health care system was deliberately built this way.

  People often hear that health care in America is dysfunctional – too expensive, too complex, and too inequitable. But dysfunction implies failure. What if the real problem is that the system is functioning exactly as it was designed to? Understanding this legacy is key to explaining not only why reform has failed repeatedly, but why change remains so difficult.

Preventive care is free by law, but many Americans get incorrectly billed − especially if you’re poor, a person of color or don’t have a college degree

  Even though preventive care is supposed to be free by law for millions of Americans thanks to the Affordable Care Act, many don’t receive recommended preventive services, especially racial and ethnic minorities, and other at-risk patient groups.

  The Affordable Care Act exempted preventive services from patient cost-sharing for large chunks of the population. This means that if you receive preventive screening and have private insurance, including through the ACA Marketplace, there should be no copay at time of service, and you shouldn’t get a bill later on. Easy enough, right?

Free preventive care under the ACA is under threat again – a ruling exempting PrEP from insurance coverage may extend nationwide and to other health services

  Many Americans breathed a sigh of relief when the Supreme Court left the Affordable Care Act in place following the law’s third major legal challenge in June 2021. This decision left widely supported policies in place, like ensuring coverage regardless of preexisting conditions, coverage for dependents up to age 26 on their parents’ plan, and removal of annual and lifetime benefit limits.

  But the hits keep coming. One of the most popular benefits offered by the ACA, free preventive care, is under legal threat again by Braidwood Management v. Becerra – originally Kelley v. Becerra. The Braidwood plaintiffs are a mix of individuals and business owners who object to purchasing insurance that covers preexposure prophylaxis – or PrEP – a medicine that is almost 100% effective in preventing HIV infection. One of the plaintiffs claimed that PrEP “facilitates and encourages homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman” and that his religious beliefs prevent him from providing insurance that covers PrEP.

The Medicaid coverage gap requires permanent closure

  Inequities and disparities in U.S. health care access have had insidious impacts on communities for centuries and will require robust and long-term action to remedy. As of March 2020, 13 million people had gained Medicaid coverage in states that implemented the Affordable Care Act’s (ACA) Medicaid expansion. However, in 11 of the remaining states that have not expanded the program, 2.2 million people are stuck in the “coverage gap”: Despite having incomes below the federal poverty level (FPL), they do not qualify for Medicaid and are also ineligible for financial assistance for marketplace coverage. As a result, millions of low-income individuals—who are disproportionately Black and Latino—are unable to access the coverage they need.

The next attack on the Affordable Care Act may cost you free preventive health care

  Many Americans breathed a sigh of relief when the Supreme Court left the Affordable Care Act (ACA) in place following its third major legal challenge in June 2021. This decision left widely supported policies in place, like ensuring coverage regardless of preexisting conditions, coverage for dependents up to age 26 on their parents’ plan, and removal of annual and lifetime benefit limits.

  But the hits keep coming. One of the most popular benefits offered by the ACA, free preventive care through many employer-based and marketplace insurance plans, is under attack by another legal domino, Kelley v. Becerra. As University of Michigan law professor Nicholas Bagley sees it, “[t]his time, the law’s opponents stand a good chance of succeeding.”

What the American Rescue Plan says about President Biden’s health care priorities – and what they mean for you

  As millions of Americans receive COVID-19 vaccines, the Affordable Care Act just got a booster shot of its own.

  After 11 years of existential threat and months after an argument before the Supreme Court, the ACA has been strengthened under President Joe Biden’s American Rescue Plan, the US$1.9 trillion economic relief package. This means greater access to health insurance at lower costs for millions of Americans.

Four myths about the public option

  The idea of a public option for health insurance has become increasingly politicized. Insurance companies, the pharmaceutical industry, and powerful hospital systems—all groups that profit from the status quo—are attempting to stir up fears about a plan that would actually help American families. In reality, a public option would lower costs, save American families money, and allow private insurance plans to continue to compete. The public option also remains a popular path for reform with growing support: A recent survey shows that 2 in 3 voters support a public option. In this column, the Center for American Progress sets the record straight on what a public option would do and discusses four common misconceptions about the plan.

Conservatives backed the ideas behind Obamacare, so how did they come to hate it?

  The Affordable Care Act is back before the U.S. Supreme Court in the latest of dozens of attacks against the law by conservatives fighting what they now perceive to be a government takeover of health care.

  Yet, in an odd twist of history, it was Newt Gingrich, one of the most conservative speakers of the House, who laid out the blueprint for the Affordable Care Act as early as 1993. In an interview on “Meet the Press,” Gingrich argued for individuals’ being “required to have health insurance” as a matter of social responsibility.

The Trump administration treats seniors as expendable

  Amid a pandemic in which seniors have been disproportionately infected and killed, the Trump administration and its allies continue to fail at protecting seniors’ health care access. By downplaying the COVID-19 pandemic and failing to act, and discounting the impact of the coronavirus on seniors with preexisting conditions, the Trump administration and its allies are letting down older adults and those who love them. Meanwhile, the administration continues to push for repeal of the Affordable Care Act (ACA), which would cause seniors’ out-of-pocket premiums and prescription drug costs to soar, and to punt on prescription drug pricing reform. In the middle of a historic health crisis, the Trump administration has left seniors behind.

If Obamacare goes away, here are eight ways your life will be affected

  More than 10 years after its passage, the Affordable Care Act once more hangs in the balance. There have been plenty of near misses before, including previous Supreme Court appearances and Congressional votes. Yet in the wake of Justice Ruth Bader Ginsburg’s death, this time around Republicans may finally be successful in undoing the Obama Administration’s signature achievement. Hearings before the Supreme Court are scheduled to begin on Nov. 10 on whether a change in tax law makes the ACA unconstitutional.

While the U.S. is reeling from COVID-19, the Trump administration is trying to take away health care

  The death toll from COVID-19 keeps rising, creating grief, fear, loss, and confusion.

  Unfortunately for us all, the pain only begins there. Other important health policy news that would ordinarily make headlines is buried under the crushing weight of the coronavirus. Many have not had time to notice or understand the Trump administration’s efforts to wreck health care coverage.

How states are combating Trump’s ACA sabotage

  Following his failure to legislatively repeal the Affordable Care Act (ACA), President Donald Trump and his administration have waged a campaign to undermine and sabotage the landmark health care law. The administration has employed numerous strategies, including expanding access to short-term junk plans; eliminating cost-saving reinsurance programs; and cutting enrollment outreach funding. The Center for American Progress Action Fund (CAPAF) has been tracking these efforts to undermine enrollment, force coverage loses, and increase the cost of care for millions of Americans.

  The Trump administration and congressional Republicans delivered a blow to the ACA in its repeal of the act’s individual coverage mandate, which was included in the 2017 Tax Cuts and Jobs Act. With that provision of the law repealed, Texas Attorney General Ken Paxton, along with 19 other Republican state attorneys general, sued the federal government, arguing that the remainder of the law would now be unconstitutional. In 2018, a federal district court judge sided with the plaintiffs, ruling the ACA unconstitutional in a decision that is now being appealed to the 5th U.S. Circuit Court of Appeals. The fate of the ACA remains uncertain the near future, as the case is likely to reach the U.S. Supreme Court regardless of the 5th Circuit’s decision.

Joseph O. Patton: Montgomery should pass on Artur Davis

Editor's note: This article was published in the Capital City Free Press on January 26, 2015. It has been updated to reflect Artur Davis qualifying as a candidate for mayor of Montgomery, Ala. The Montgomery Municipal Election is scheduled for August 27, 2019.

  Just when I foolishly believed I had washed the foul political aftertaste of Artur Davis out of my mouth, he's uncorking another bottle of his trademark bitterness, shameless opportunism, and ego-tripping.

  Last week, Davis qualified as a candidate for mayor of Montgomery along with 11 other candidates. It will be an open seat as Todd Strange is not seeking reelection. Strange spanked Davis and three other candidates in 2015, garnering enough votes to avoid a runoff. But which version of Artur Davis this happens to be would be anyone's guess....

Attack on the ACA: Undermining protections for LGBTQ patients and language accessibility requirements

  The Trump administration is proposing to undermine strong and clear protections against discrimination in health care by giving health care providers, pharmacy benefit managers, and insurers a license to discriminate against LGBTQ people and many others. The existing rule implementing Section 1557 of the Affordable Care Act (ACA), also known as the Health Care Rights Law, was promulgated by the Obama administration in 2016 after a rigorous six-year process. The rule characterized discrimination based on sex stereotyping and gender identity as impermissible sex discrimination under the law. It also prohibited insurance providers using the marketplace from discriminating against protected characteristics, provided strong language access and notice requirements, and established many other critical patient protections.

Conservatives are using the courts to attack health care for all Americans

  Conservative state officials, in conjunction with the Trump administration, have launched an all-out attack on health care in the United States. They have brought a suit to overturn the entirety of the Affordable Care Act (ACA), which would have serious consequences for nearly every American who has health coverage, whether through their employer, the individual market, Medicare, or Medicaid. And they found a partisan judge who proved willing to ignore the rule of law and help them advance their political agenda through the courts.

Efforts by anti-choice advocates to redefine and limit contraception

  The U.S. Supreme Court’s 1973 landmark decision in Roe v. Wade was a critical step forward for women’s equality, establishing vital, constitutionally protected privacy rights that enable women to access abortion services. However, the ruling also became a target for anti-choice politicians and advocates to organize around. Since the Supreme Court’s decision, these groups’ attacks on abortion access have become an everyday reality that reproductive health advocates, providers, and patients must face. From targeted regulation of abortion provider (TRAP) laws to mandatory waiting periods and biased counseling, there is a well-organized and widespread effort to limit a woman’s ability to make decisions about her own reproductive health when it comes to pregnancy.

Conservative myths about Medicaid

  Access to health insurance in the United States is one of the most hotly debated issues in the national discourse. Prior to the implementation of the Affordable Care Act (ACA), 44 million Americans lacked health insurance, including many low-income nonelderly adults who did not fall within traditionally covered Medicaid eligibility groups, including pregnant women, disabled adults, and low-income children. Since the ACA went into effect in 2013, 11.9 million newly eligible people have gained coverage through Medicaid in states that chose to expand their programs. In addition to producing better health outcomes, Medicaid expansion has resulted in new enrollees having access to quality care without the threat of financial turmoil.

Sam Berger: Three ways that states can stop ongoing health care sabotage

  This past year has seen a sustained federal attack on state insurance markets. Congress repeatedly sought to repeal the Affordable Care Act (ACA) and significantly cut funding for Medicaid. While these efforts proved unsuccessful, President Donald Trump and his allies in Congress were able to repeal the individual mandate in the regressive tax bill they passed at the end of 2017. And the Trump administration has taken a number of steps to drive up costs and drive down coverage, including by halting billions of dollars in federal payments that help keep people’s deductibles and co-pays low and by directing agencies to seek ways to increase the number of substandard plans in the insurance marketplace without adequate consumer protections.

The Trump premium tax will increase premiums up to $2,500 next year

  Since he entered office, President Donald Trump has taken numerous steps to sabotage the Affordable Care Act (ACA) by driving up costs and driving out insurers. With the failure of ACA repeal in the U.S. Senate, Trump has threatened to accelerate his efforts. In particular, by undermining enforcement of the ACA’s individual coverage mandate and threatening to stop billions of dollars in cost-sharing reduction (CSR) payments that help lower consumers’ deductibles and copayments, Trump will significantly increase 2018 premiums.

Senate repeal bill will increase average costs for exchange enrollees by $2,294

  Now that the Congressional Budget Office (CBO) has released its score of the Senate’s Better Care Reconciliation Act (BCRA), it is clear why the Senate majority worked so hard to keep the text of the bill a secret. The truth is now out: an estimated 22 million people would lose coverage under the BCRA compared to the ACA.

  But the people who would lose coverage are not the only ones who would be worse off. Many Americans who kept their insurance would still face higher costs under the BCRA. For the average marketplace enrollee in 2026, the BCRA would raise their total costs, including net premiums plus cost-sharing, by $2,294.