The Supreme Court is about to render a decision that could cost you your access to health care.
The case, King v. Burwell, challenges the tax subsidies that help millions of people to pay for their health insurance in the 34 states that allow the federal government to run their insurance marketplaces. Its basis is that the Affordable Care Act has wording that can be construed to read that only states that run their own marketplaces are entitled to federal tax subsidies -- the assistance that millions of Americans need to be able to afford health insurance.
The "basis" of the lawsuit has nothing to do with the intention of Congress, and everything to so with denying people access to care simply because some people are angry that a Democratic president and Congress managed to pass the Affordable Care Act.
This shouldn't even be a political matter, but it has become one, and people's lives are at stake. Before the ACA became law, some 45,000 people died prematurely every year from lack of access to health care, and in this country, insurance is access. The emergency room only has to stabilize patients, which is why my son died instead of getting the care he needed. This isn't the fault of he ER staff; the ER just isn't set up to do the kind of care people need for early diagnosis of cancers and chronic disease management.
It's estimated that 13 million people could lose their ability to pay for coverage. That includes me. I live in North Carolina, which has not set up a marketplace and has not expanded Medicaid. As of the end of July, my husband will have Medicaid, but I still have two and a half years before I get Medicaid, and I have chronic depression and asthma. I need access to care, just to manage my chronic illnesses. Without management, all chronic illnesses get worse. That's one reason people without health insurance die at greater rates than people with insurance.
Republicans in Congress said they would have an alternative to the ACA ready to go if the Supreme Court invalidates the tax subsidies, but the decision is due in the next couple of weeks and Congress has nothing, nor does there appear to be any urgency to do something.
The decision could be a mixed bag, according to an attorney I know who specializes in health care matters. It could be complex, and so I won't know what it means until I speak to her unless it's a straightforward rejection or a straightforward affirmation of the subsidies.
A lot of us have worked hard for a very long time to increase Americans' access to care. I was writing about it as a newspaper reporter almost 25 years ago, before President Clinton was elected in 1992 with the promise of reform.
This would be a huge step backward, but it might be a reason to pass Medicare for everyone -- a single-payer system that would cover everyone, no matter what their income.
In every other developed country, health care is seen as a basic human right; here it is seen as a way to make money, and if you can't contribute to the profits, you die.
In Indiana, a woman is sent to jail because she had a miscarriage.
In Texas, a lawmaker crafted a bill that would force women carrying nonviable fetuses to carry them to term. The bill passed, but was recalled because of a technicality.
Former Florida governor and now presidential candidate Jeb Bush's spokesman says he would de-fund Planned Parenthood if he is elected.
Here in North Carolina, women now have to wait 72 hours before they can have an abortion.
Across the country, states have passed laws that require doctors to recite scripts filled with inaccuracies and outright lies before they can perform an abortion.
But there's no war on women's reproductive rights.
I felt compelled to rejoin NOW after the Hobby Lobby decision last year that allows businesses to decide whether their health insurance coverage will include birth control.
Women's health decisions should be off limits to politicians, but we have seen in the last several years renewed attacks on the right of a woman to decide her own future.
Pharmacists can refuse to fill birth control prescriptions if they have a religious objection in the name of "religious freedom."
Well, what about a woman's freedom to make her own decisions about how many -- if any-- children she will have and when she will have them? Birth control is legal, and any woman has a right to have that prescription filled. A pharmacist who refuses to fill the prescription should be fired on the spot. Let him open his own pharmacy and not carry any contraceptives. Women then will be free to shop where they can get what they need.
Abortion is legal, too, and women need to be able to make that choice, whether or not it is the choice you would make. My son was at risk of a number of birth defects and I was advised to have an abortion. I CHOSE not to. Then, 33 years later, our broken health care system stopped his beating heart.
Until you're willing to join the fight for universal access to quality health care, you're just another anti-life extremist in my eyes.
That statement may disturb some people, but you can't call yourself pro-life if you don't support all lives.
When you de-fund Planned Parenthood, you deny health care to low-income women, especially in states that have not expanded Medicaid.
When you deny a woman access to birth control, you ought to be ready to take responsibility for what happens. You can't take away women's choices and then say they're responsible for what happens.
If you look at the blue line of the graphic above, you'll see the Affordable Care Act hasn't spent much time in the positive zone. The lies and rhetoric of opponents have kept its image negative for most of the five years since its signing,
But people are gaining some experience with it now, and more see it as a good thing than bad, at least for now.
Yes, there are problems with the law, the biggest one being that insurance and pharmaceutical companies are raking in the profits. Generic drug prices are skyrocketing, and insurance companies are paying less of the cost, on average. This year, one of the drugs I need has gone from $25 a month to $80.
Still, those of us who get subsidies to enable us to afford insurance coverage can breathe easy. My asthma won't keep me from being covered. My son would have been able to get insurance despite his "dirty" history of being born with a less than perfect body. It would have saved his life.
Too many people think we have fixed our system with the Affordable Care Act, but we still have a long way to go. Even with insurance, many families can't afford the deductibles and co-pays and so don't get the care they need until their condition becomes serious -- and far more expensive to fix.
Millions still don't have access to care because 22 states have refused to accept Medicaid expansion, and 17,000 die every year the same way my son did -- deaths that are preventable if we care enough to offer care before it's too late.
Remember, too, that the ACA's low approval ratings include those of us who think the law didn't go far enough. We still have nowhere to go but the health insurance monopoly. They have no competition and therefore too much power. Way too much power.
At the very least, we need a public option. Let me buy into Medicare. I want to be part of that single-payer system, as do a lot of other people.
Instead of denying access to care, let's expand it.
And let's be certain our legislators know we're not done fixing health care.
Those in power in Raleigh like to pretend the Affordable Care Act was never passed. They labor under the misguided notion that it will go away and that the voters of this state agree with them.
The argument that allowing people access to health care is the moral thing to do has no effect on these lawmakers. I know because I have spoken to many of them who refuse to acknowledge the plight of people in their districts.
"They can go to the emergency room," is the most common response.
But the emergency room only has to stabilize someone, I tell them. But they've already moved on to their next argument.
"We can't afford to take care of everyone."
Yes we can. It's actually much cheaper to manage a chronic illness than it is to treat complications.
But they don't hear that because they've moved on to the lie about how broken Medicaid is in North Carolina. I can try to tell them our state's Medicaid was a national model until they cut funding. But they've moved on to another talking point.
A few times, I have asked legislators who professed to be Christians who Christ might have denied care, but they argue that "God helps those who help themselves," implying that the poor are lazy, even though most of them work. According to Families USA, a national health care advocacy nonprofit, 59 percent of those eligible for expanded Medicaid coverage work.
Many who are unemployed are ill or disabled. Others have lost jobs since the economic meltdown, and have been left behind in a recovery that has added mostly low-wage jobs.
I can't imagine that they believe most of these broken and disproved talking points, so their motivation appears to be sheer meanness.
And although Gov. McCrory has made some noises suggesting he might want to expand Medicaid, he signed the law giving the legislature the final say. He can't expand it on his own and he knows it. Perhaps he's trying to appear moderate in advance of the 2016 election, but for most of us, I think it's too little, too late.
Meanwhile, as the legislature plays its game of pretend, real people are suffering and dying. Between five and eight human beings are dying every day in North Carolina. Estimates of the annual death toll range from about 1,500 to 2,800.
These deaths can be prevented, but the legislature continues to deny Medicaid expansion to the people of this state. We can talk about the money and jobs, but as the mother of a young man who died from lack of access to health care, it's the lives that matter the most to me, even if they don't matter to the people who are supposed to be representi.
This was me on Monday, reminding the press that the statistics we presented as reasons to expand Medicaid coverage in North Carolina were not just numbers. Every one of those estimated 2,880 deaths in North Carolina each year from lack of access to care has a face.
Seven years ago Monday, Mike asked me to play the "dead kid card," but to do it with class, to not sue anybody. So, I told him I would advocate for access to quality health care for every human being. Every. Single. One.
This was a news conference to publicize the results of the People's Grand Jury, indicting the governor and legislative leaders on charges if willful and reckless disregard for human life.
As the jury foreperson, Vicki Ryder, read off the charges, each preceded with, "Guilty," my friend Lila and I wept. Lila has a number of serious medical problems and no access to health care. She could die before anyone does anything for her. Just like Mike did. Just like 2,880 North Carolinians did last year. Just like five to eight North Carolinians do every single day right now.
As I relive the last days of my son's life -- as I do this time every year -- my hear breaks for the families who share my pain, five to eight more of them every day in this state alone.
We went to deliver copies of the indictment, along with the scientific backup for everything we said during the grand just sessions, but Senate Leader Phil Berger wasn't in. House Speaker Tim Moore wasn't in. And we were told no one was in the entire wing of the statehouse where the governor's office is.
The Statehouse security guard told us no one was there. So, Jamie Sohn -- the woman Gov. McCrory gave cookies to last year -- decided she wanted a tour. Since the Statehouse is open to the public, the guard had to let us on, one by one, as we said we wanted to take a tour.
We went to the wing where the governor's office is, and we heard voices. Since no one was supposed to be there, we feared someone must have broken into the building and two people went to see what was going on.
Turns out the security guard lied to us. There were employees there and we handed one of them the packet before the security guard came over and threatened to arrest us.
Hey, I've been arrested before. I'm not afraid. We asked the guard why he had lied to us and he just kept telling us to get out or be arrested.
After we went outside, the chief of the statehouse police came over to tell us ever so kindly that we had no business in that section of the building.
I reminded him he and everyone in that building works for us, the building is ours and we have a right, guaranteed by our state's constitution, to speak to elected officials. Several of us were arrested and our cases thrown out because that right is guaranteed to us. We weren't insisting on occupying the governor's office; we simply wanted to drop off a packet, and we have a right to do that.
I'm tired of the political games they're playing while people are dying every day. I have no patience for the bullcrap anymore.
Yesterday was a little better. I got to thank my legislators, who have introduced bills into the state House and Senate to expand coverage to all North Carolinians.
But when we went to deliver 43,000 signatures on petitions asking the governor to work on Medicaid expansion, we again were stopped at the front desk. I stayed outside because I probably would have gone inside again and stood outside the corridor where the governor's office again and once again hollered, "Hello! Hello! We have something for the governor. We the people have a delivery!"
Seven years ago today, Ian was born. That's Janet's nephew. We were worried he would be born while Janet's mother was here saying goodbye to Mike, but she got to see him before she took off from Albany for Asheville. Six days after Ian entered the world, Mike would leave it.
These politicians don't give a damn about the grief their policies cause, but I do. I can't save Mike, but I can try to save the people who are still here, people like Lila and Crystal, who has cervical cancer and no access to care. Both of these women are tired of fighting, tired of being in pain and tired of being treated as though their lives don't matter.
I'm tired, too. I'm exhausted and sad as I'm forced to relive my child's final days.
If these anti-life politicians think I'm giving up and going away, they had better think again.
Seven years ago yesterday, I brought my son home to die.
He had a chemo appointment in the morning and he needed to gain two pounds before it. Before we left the house, he said to me, "Mom, I'm ready for this to be over."
But when we got to the appointment, he stepped on the scale and he had lost another pound.
"I tried," he said to me. He was near tears. He wasn't as ready for it to be over as he had thought.
Dr. Hurwitz came in to talk to him and tears welled in his eyes as he said, "You're a good person, Mike. You don't deserve what's happening to you. I wish we could have done more."
It was such a change from his doctor in Savannah, who had been downright nonchalant in his delivery when he gave up on Mike two years earlier.
That afternoon, we packed a few belongings into my car and brought Mike to my house so I could care for him.
For two years, James had changed dressings, cooked, paid bills and otherwise done everything Mike needed so he could at least pretend he had some level of independence.
But I wanted to take care of my son now, and James was fine with that.
Today was the day hospice came and ordered a hospital bed and walker. James and Janet came late that afternoon because they wanted to be close to Mike and to help.
I remember the nurse interviewing Mike for intake.
"Do you use drugs or alcohol?"
"When did you stop?"
"Eleven years ago."
And what was your drug of choice?"
I could see on his face he was going to be a wiseass.
She looked up, shocked. I could tell he loved her reaction.
"I was whatcha call a garbage head," he said. "It didn't mater what it was as long as it got me high."
I relive these moments every year at this time as I count down the days of his life to the end. It feels as raw now as it did then.
I'm going back and forth on Facebook today with his friend, Christian, remembering what a jackass he was and how he could take the worst of things and turn them into a good laugh. That was one of his finest qualities.
Christian reminded me of the time Mike and I were in Walmart getting him some groceries. When we got to the checkout, Mike asked for a candy bar. I could tell by the tome of his voice he wasn't really looking to get a candy bar -- he had something more jackassy in mind. So I said no.
"But I have cancer," he said loudly. "I might die!"
The woman at the cash register glared at me and the woman behind me bumped me with her cart.
I stated them both down and said, "Cancer, schmancer. No candy."
When we got out into the parking lot, Mike doubled over laughing. "Oh, man, that was so great!" he said. "We need to go back and do that again."
"I can never go back into that store," I said. "Those people wanted to string me up."
Today, seven years ago, we got Mike settled in and comfortable. We had just 13 days left with him.
In June, the US Supreme Court will decide the fates of millions of Americans as they decide whether a poorly worded sentence in the Affordable Care Act means the federal government can't offer subsidies on the state marketplaces it operates.
To me, it could mean the loss of my health insurance because I can't afford coverage without the subsidy.
According to Families USA, the lawsuit is about a clause that states subsidies will be available in marketplaces “established by the state.” What they're trying to say is that Congress never meant to extend premium tax credits to those of us in states that didn't set up their own marketplaces. They claim Congress intended to induce states to run their marketplaces by withholding tax credits from people in states that opted not to do so. - See more at: http://familiesusa.org/product/how-king-v-burwell-could-affect-health-insurance-under-obamacare#sthash.j4YSLcza.dpuf.
I live in North Carolina, where the legislature has tried to pretend the law never passed. We have failed to expand Medicaid, so a half million people here have no access to health care because their incomes are below the federal poverty level. We didn't set up a marketplace. The NC Institute of Medicine and activists tried, but the legislature shot it down.
I heard a legislator say, "We ain't gonna take part in any of that bill that we don't have to."
The first Supreme Court challenge to the law left it mostly intact, but the court ruled that since Medicaid is an opt-in program (only six states participated at first; the last state to sign on was Alabama in the mid-1980s), the expansion also must be opt-in. Most Republican-led states opted out, although a few leaders decided to do what was best for the people of their states.
Now the subsidies in marketplaces operated by the federal government could be overturned, and in states like mine, the response won't be to build our own exchange; it will be to let people like me die.
I am 62 years old and I have asthma. If I can't see a doctor to manage my illness, it will get worse.
I have tried my best to talk sense into legislators who vote against the best interests of the people they're supposed to be serving. A few will meet with me, but most won't. They send their health care advisory people to meet with me -- or more accurately, they send their people to tell me I don't matter. My son didn't matter. Only the ability to score political points matters.
If the Supreme Court rules against the American people again, I do see hope for a single-payer system to come from it, but it's not likely to happen in my lifetime unless we can boot the anti-lifers out of office and install people who care about their constituents more than their corporate overlords.
If I lose my subsidy, perhaps I'll move to a state that has its own marketplace, but most people can't do that. Our best option is to work toward a system that will give all people access to affordable, quality health care.
I was astounded last night to hear an apparently well educated man tell me he was surprised to learn that Medicare is a single-payer system.
He was not one of the few people who attended the screening of "The Healthcare Movie" here in Asheville; he was waiting for his daughter to finishing a voice lesson in the church where we were showing the movie, and we started talking about health care.
I mentioned that Medicare is one of the most successful single-payer systems in the world, that it's one of the most efficient systems, and one of the most popular. Wait times for elective surgery are less than many other places, and satisfaction rates are extremely high.
Opponents of health reform have been very successful in painting single-payer as socialized medicine, but that's a lie. Socialized medicine is what Great Britain has. The government owns and operates the health care system, which has better health outcomes than our own for-profit system.
No health care system is perfect, but our country has one of the worst health outcomes of any system in the world, and that's because it's operated for profit and it leaves a large percentage of people with less than optimum health care. In fact, it still leaves millions with no access to health care at all, and even with the Affordable Care Act, an estimated 17,000 people are dying each year because of lack of access to care.
In the 1950s, Canada's health care system was pretty much the same as ours. Then, province by province, the system changed over to single-payer. At first, doctors were hard-core opponents, but as the system developed, they got on board. They were being paid the same as before, and the payment was far more reliable. No one was telling them something wasn't covered. There were no co-pays, no co-insurance. In fact, most Canadians have never heard those words. All they know is that they have access to high quality care and it's covered by their taxes.
Here, nearly a million people file for bankruptcy each year based on medical bills, and 78 percent of them have insurance.
That never, ever happens in Canada.
And that thing you hear all the time about how Canadians hate their health care system? That's an out-and-out lie. People in Canada love their system. They know they can go to the doctor or the emergency room and get care immediately if they need it, and then they can concentrate on getting well because they don't have to worry about bills.
When medicare was signed into law 50 years ago this summer, it was supposed to expand gradually to cover everyone. That never happened, thanks to lobbying by for-profit businesses. In fact, in the run-up to the passage of the ACA, the money spent on fighting it amounted to $1.4 million every single day.
It's time to take control of our health care system, and we can only do that by voting for legislators who will work to expand access in spite of the money offered to stop it.
We have to shout down the liars with the truth, and we can't rest now just because we got something passed.
We are not done fighting for health care. In fact, we have a long way to go.
In the case before the US Supreme Court called King vs. Burwell, an unfortunate order of words in the Affordable Care Act could lead to millions of Americans losing access to health care.
The case will decide whether the marketplaces operated by the federal government on behalf of states that didn't set up their own are eligible for the government subsidies that allow the majority of us to afford insurance.
I know I wouldn't be able to afford insurance without the subsidies, and I have asthma, so without insurance, I could die the same way my son did.
Up to 13 million working Americans could lose access to affordable health insurance, and premiums will triple for tens of millions -- all because of a single sentence in the where the wording could be misinterpreted.
This isn't the intent of the lawmakers, nor would most rational people think the law should be interpreted to say the federal government can't offer subsidies in marketplaces it operates.
This is just the latest in a long line of attempts to sabotage the law and take us back to a time when 45,000 Americans died every year from lack of access to health care -- that's one every 12 minutes.
As it is, some 17,000 Americans are dying each year because they live in states where legislators have refused to take the federal money to expand access to care through Medicaid to millions of low-income working Americans.
That's right, 88 percent of people who would be newly eligible for coverage through Medicaid are working. One-third of them have two full-time workers in the household.
But those who oppose expanding access to health care are claiming people have no right to care. It's perfectly OK with them to allow tens of thousands of people to die, just so they can score a political point.
I've gotten e-mails asking me to sign a petition asking the justices to think about the lives at stake here, but I have no intention of signing it. For one thing, public opinion means nothing to them, not should it. They are appointed for life because they are supposed to be above politics and public opinion. Unfortunately, some of the current justices are not above politics and will twist the law to meet their own political agendas, and it doesn't matter what the death toll looks like.
At this time seven years ago, we were waiting for my son to die. His time with us would end on April 1, 2008, all because he couldn't get access to the care he needed.
I can only hope the Supreme Court justices decide to land on the side of life this time.
I was right.
North Carolina's governor has turned his back on a half million uninsured constituents and decided he won't pursue an expansion of Medicaid, which would close the insurance gap and allow all of those people access to health care.
In this case, I hate being able to say I told you so, but there it is.
He's waiting to see the results of a lawsuit now before the U.S. Supreme Court that would remove the insurance premium subsidies paid to consumers who buy health insurance through the federal-run marketplaces.
If the Supreme Court rules that the intent of Congress (to help lower- and middle-income people buy insurance) was not the intent of Congress because of unintentional wording, millions of people will lose their coverage. I know I will because my husband and I can't afford to pay the full premium.
Maybe I'll die the way my son did, unable to gain access to the health care I need.
I don't understand what the lawsuit has to do with expanding Medicaid to cover almost everyone in or near poverty (where it now covers almost no one who is between ages 19 and 64), except that I think he hopes it will boost his street cred among the far right.
Other conservative states have seen that expanding access to care through Medicaid has saved lives -- and money. When people get the care they need, it saves much more expensive emergency care later.
Gov. McCrory says he's worried about bureaucratic hassles, but what's he's really worried about is the reaction from the far right. He's afraid he'll anger them so much he won't get their votes and will lose the 2016 election.
Instead of being concerned for human life, he is concerned for his own political life.
To me, that is the epitome of immorality.