June 2012, Week 5


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Fri, 29 Jun 2012 20:00:37 -0400
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SCOTUS Rules. What Happens Next?


Labor for Single Payer

Yesterday's Supreme Court decision that substantially
upholds the Affordable Care Act (ACA) was widely
praised by the national labor movement. "Working people
won a resounding victory," proclaimed SEIU President
Mary Kay Henry as she thanked President Obama and the
members of Congress who supported the ACA.

Likewise, AFL-CIO President Rich Trumka declared
himself "pleased and relieved." However, he also stated
that, "We have no illusion that the destination has
been reached, and we are more committed than ever to
the hard work necessary to achieve our dream of quality
health care for all." One "indisputably constitutional
solution," Trumka suggested, would be to "allow
Americans of all ages to buy into an improved Medicare

The National Nurses United (NNU) took a longer-term
perspective. Co-President Jean Ross pledged that NNU
would step up its campaign for a reform that would be
based on "a universal program based on patient need,
not on profits or ability to pay. That's Medicare for

"Medicare is far more effective than the broken private
system in controlling costs and the waste that goes to
insurance paperwork and profits," adds NNU Co-President
Karen Higgins. "[I]t is universally popular, even among
those who bitterly opposed the Obama law. Let's open it
up to everyone."

Most single-payer advocacy organizations used the
occasion of the Supreme Court decision to focus on the
inadequacies of the ACA. Healthcare-NOW! points out
that there will still be 26 million uninsured and that
the ACA, "Embeds private, for-profit insurance in the
system's core, allowing them to continue to profit and
game the system at our health's expense."

"Contrary to the claims of those who say we are
'unrealistic,' a single-payer system is within
practical reach," says a statement signed by eight
leaders of the Physicians for a National Health
Program. "The most rapid way to achieve universal
coverage would be to improve upon the existing Medicare
program and expand it to cover people of all ages."

In Vermont, the Vermont Workers Center (VWC) sees the
decision as a "vindication of Vermont's own path toward
a human-rights-based universal healthcare system."
Declaring that "Vermont can lead the way," the VWC
contrasts the ACA's mandate to "buy health insurance as
a commercial product" with Green Mountain Care's
treatment of healthcare as a "public good to all,
financed through tax-based contributions."

Vermont Senator Bernie Sanders--the only U.S. Senator
who is a current sponsor of single-payer
legislation--echoed these sentiments. While expressing
support for the Supreme Court decision and the ACA, he
asserted that, "the real solution to America's health
care crisis is a Medicare-for-all, single-payer system.
Until then, we will remain the only major nation that
does not provide health care for every man, woman and
child as a right of citizenship."

"I am proud that Vermont is making steady progress
toward implementing a single-payer system," he added.
"I hope our state will be a model to show the rest of
the nation how to provide better care at less cost to
more people."

Where Do We Go From Here?

The most immediate consequence of the Supreme Court
decision will undoubtedly be political. Pundits are
already calling it a momentum changer in the
presidential campaign. Indeed, Republicans, with their
call to "repeal and replace," appeared disoriented and
mean-spirited. For President Obama it was a triumphal
day as he decreed vindication for his vision that, "In
America, no illness or accident will lead to a family's
financial ruin."

The jury is still out, however, on what effect this
decision will have on the actual healthcare that
Americans will receive under the ACA as well as its
effects on the long-term prospects of the fight to make
healthcare a right for everyone in America. Certainly,
a more sober assessment of the healthcare realities
faced by most working Americans and their families
would show that we are a long way from President
Obama's aspirational vision.

Many have also expressed concern that the structure of
Supreme Court decision may set the stage for future
judicial challenges to the social insurance model. The
Court refused to anchor the ACA's individual mandate in
the Constitution's "commerce clause." This is the
clause that has been used to justify nearly every piece
of social legislation--from the right to join unions to
the food stamp program--since the New Deal. While
having no material effect on the implementation of the
ACA (the Court ruled that the mandate could be enforced
under the constitutional power to tax), this new
interpretation, coupled with the Court's apparent
assertion that the federal government cannot force
states to comply with all of the provisions of
state-administered programs such as Medicaid, could
indicate that the Court would be willing to countenance
a broader attack on social programs. The Labor Campaign
for Single Payer has repeatedly affirmed that, to win,
our fight must be part of our broader fight to defend
and expand the social insurance model.

Coming at the end of a Supreme Court session that was
especially cruel to the labor movement, it is perhaps
to be expected that there would be some celebration at
what was widely seen as a defeat of labor's worst
enemies. But this must not detract us from the urgency
to prepare for a renewed assault on employer-provided
healthcare benefits. At a recent strategy meeting of
the LCSP Steering Committee and Advisory Board, we
heard from union leaders from around the country who
are seeing the writing on the wall. Public employee
benefits are under the gun in nearly every
jurisdiction. Union Benefit Funds, often the gold
standard in employer-funded healthcare, are facing
threats to their very survival as ACA regulations
impose new mandates while new state insurance exchanges
potentially draw off their youngest and healthiest
participants. And the 2018 "Cadillac Tax" is beginning
to look more and more like a "Chevy Tax" as continued
healthcare inflation will trigger this penalty on the
hard won benefits of millions more union members than
originally predicted.

What Happens Next?

The Affordable Care Act is now indisputably the law of
the land. This will create new conditions and new
challenges. Many millions will undoubtedly benefit from
increased access to healthcare and regulation of the
private insurance industry. Many millions more will
find out that the right to buy health insurance is not
the same thing as the right to healthcare. States will
be required to set up healthcare exchanges by 2014 and
state-level innovation--including state single-payer
reforms--will be barred until at least 2017 (although
President Obama did re-affirm his support for efforts
to move that date up to 2014).

Certain things won't change, however. Healthcare will
still be treated as a commodity and a profit center
rather than as a human right. Millions will continue to
be denied access to basic healthcare. Costs will
continue to rise two, three, even four times faster
than our wages while quality deteriorates. Employer
provided healthcare will continue to go the way of
defined benefit pensions and healthcare fights will
continue to be the biggest cause of strikes, lockouts
and union busting.

The labor movement has no choice but to fight on for
healthcare justice. And we in the Labor Campaign for
Single Payer vow to re-dedicate ourselves to this fight
to remove healthcare from the bargaining table and make
it a right for everyone in America. We believe that it
is labor's historic responsibility to lead this effort
and we will not rest until it fulfills this mission.

Statement by AFL-CIO President Richard Trumka on the
Supreme Court Health Care Decision 

June 28, 2012


We are pleased and relieved that the Supreme Court has
upheld the constitutionality of the Affordable Care
Act.  Today's decision means that we can continue
moving full speed ahead to implement and build upon the
Affordable Care Act.  We have no illusion that the
destination has been reached, and we are more committed
than ever to the hard work necessary to achieve our
dream of quality health care for all.

With this decision, more than 105 million Americans
will continue to benefit from the elimination of
lifetime limits and the coverage of preventive services
without cost-sharing, and more than 6 million young
adults will remain covered by their parents' health
care plans.  Seniors will continue to save money on
prescription drugs as the Part D donut hole closes over
the next eight years; already over 5 million seniors
have saved $3.7 billion on prescriptions in 2010 and
2011.  And insurance companies will not be able to deny
coverage due to pre-existing conditions, charge women
more or drop coverage for those who get sick.

To assure that 33 million Americans will be able to
obtain health care coverage through the exchanges and
Medicaid beginning in 2014, all states, including those
that waited for this decision to be issued, must now do
their job and act without delay.  We are troubled by
the Court's decision limiting the ability of the
federal government to encourage states to extend
Medicaid coverage to certain lower income individuals,
and it would be unconscionable for states to refuse to
extend that coverage, using today's decision as a

The Affordable Care Act is our first step in expanding
health care coverage, improving care and beginning to
get control of health care costs.  We will need to
build on the achievements of the Act, Medicare and
Medicaid in order to fix our broken health care system
and advance along the path to a more equitable and
cost-effective system.

We believe the way forward is to build on the
Affordable Care Act reforms that strengthen Medicare's
historic leadership in containing health care costs,
without cutting benefits.  A simple indisputably
constitutional solution is to allow Americans of all
ages to buy into an improved Medicare program.  We
believe every baby in America--whether rich or
poor--deserves the same standard of quality care, and we
will keep moving forward until we make this a reality.

We cannot afford to go backward, but that is what Mitt
Romney and the Republican leadership in Congress would
do.  Their prescriptions would not expand coverage or
control health care costs.  Instead, they would shift
costs to working families, retirees and the states.

The election this November provides a clear choice
between the President, who has stood for fairness and
for working men and women, and Romney, who urges
repealing health insurance protection for working
families. We stand with the President.

Contact: Josh Goldstein (202) 637-5018


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