"Of all of the forms of inequality, injustice in health care is the most shocking and inhumane." -- Martin Luther King Jr., addressing the Medical Committee for Human Rights in Chicago, 1966
On Feb. 21, Americans celebrated both the birthday of Martin Luther King Jr. and the second inauguration of President Barack Obama. While King never publicly supported a political party or endorsed a candidate during his lifetime, it's hard to imagine that the revolutionary leader would not have seen the election of Obama as a watershed moment in American civil rights. Further, Obama's Patient Protection and Affordable Care Act will allow millions of Americans to have access to the health coverage they need, bridging the inequality gap illustrated in King's quote. Extending access to health care represents a healthier society, and also embodies meaningful civil rights legislation. But does the Affordable Care Act fulfill King's prophetic legacy?
Signed into law by Obama in March 2010, the Affordable Care Act set in motion the expansion of a nationwide insurance system, intended to extend insurance to about 33 million people. This will be accomplished primarily by expanding state Medicaid programs and by providing subsidies to many lower- and middle-income individuals to buy private insurance. The Affordable Care Act also represents a controversial, but significant legislative achievement of Obama's first presidency -- a goal that Democratic presidents had unsuccessfully pursued for 75 years.
The centerpiece and the most contentious part of the Affordable Care Act is the so-called individual mandate. Beginning on Jan. 1, 2014, individuals will be required to obtain health insurance coverage meeting the federal government's "minimum coverage requirement" or face tax "penalties." An annual tax "penalty" of $95, or up to 1 percent of income, whichever is greater, will be imposed on individuals that do not meet the minimum coverage requirements. In the years thereafter, the penalty will gradually increase, based on a percentage of taxable income and adjusted to cost of living. However, if an individual does not want to buy health insurance and is willing to pay the tax, there is nothing further the government may do.
Another key provision is the substantial expansion of Medicaid, the needs-based federal- and state-financed health insurance program for the poor and people with disabilities. Under the current Medicaid provisions, coverage varies slightly from state to state, but all states are required to cover pregnant women, children under 6, school-aged children, elderly individuals with disabilities and working parents who meet minimum threshold requirements based on the annual federal poverty level (FPL). Beginning in January 2014, individuals under 65 with income below 133 percent of the FPL will be eligible for Medicaid. The Affordable Care Act will also cover pregnant women and preschool-aged children 122 percent below the FPL, and school-aged children 100 percent below the FPL. Most controversially, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver.
Arguably, the principles outlined in this legislation provide greater equality in the health care sector, which aligns with King's views. This monumental legislation, however, will still leave an estimated 30 million poor, working and young Americans uninsured. In July, the Supreme Court determined that the federal government cannot force states into implementing the Medicaid expansion by withholding all federal Medicaid funds. Consequently, states may decide whether to opt into the Medicaid expansion. Several states have expressed their intention not to do so.
In states that reject the expansion, individuals who fall below 133 percent of the poverty line, but above the state's Medicaid threshold, will not be eligible for any health care coverage made available by the Affordable Care Act, including federal subsidies to buy health insurance. Ironically, this will create coverage gaps for the states' working poor and childless young adults -- the people that health care reform was designed to help from its inception. As an advocate for disadvantaged Americans, King would take most issue with this disparity.
King was not one to stay quiet. And if Americans today want to close these inequality gaps with the Affordable Care Act, they will have to take King's call to action and service.
Alexis Parks Anderson is a law student from Bakersfield with a passion for the environment and health care. She lives in Washington, D.C.