What Affordable Care Act?

What Affordable Care Act?

Paul Kawata, Executive Director of the National Minority AIDS Council (NMAC), sent out an email on June 27 musing about 2014 and the enactment of the Patient Protection and Affordable Care Act (or ACA). In it, he asked how we could “get ready” for ACA and how it might affect our agencies and our clients.

My question to him would be do you really think the Republicans are going to let the provisions that are supposed to start in 2014 happen? Considering the draconian and mean-spirited measures we’ve seen introduced in Congress to defund or remove any provisions of the Act that would benefit the working poor, the unemployed, the un- and underinsured, does anyone believe the ACA will ever really be what it was voted on to be, as insufficient as that is in the face of the healthcare mess we have in this country?

Mr. Kawata wonders “Why does HIV get its own separate funding? Why are we funding this single disease when there are other diseases that kill more Americans?” From my perception of a pervasive isolationism among HIV/AIDS organizations and leaders, a better question would be, why are we not joining together with those who are suffering and dying from those other diseases because they have no access to healthcare either? There is no CDAP (Cancer Drug Assistance Program) for those going through chemo or Mary Tyler Moore CARE Act for diabetics. The Community Health Centers that Mr. Kawata accuses of rejecting HIV-positive people are the very thing that many other chronic disease survivors depend on and they are being threatened and closed down more and more these days.

My point? We need to stop being territorial about our diseases. We need to stop the “us vs. them” mentality and realize that we are ALL in increasing danger of having nowhere to turn, no access to drugs or treatments, no refuge from the rip-off of insurance and the low quality of care it covers.

As a pre-existing condition, is HIV considered to be any worse than cancer, heart disease, COPD, lupus, Alzheimer’s? Seeing as HIV has now officially been termed a disability, should HIV-positive people collecting Social Security disability be considered any less debilitated than someone with MS or cerebral palsy in a wheelchair? Let’s face it—in the United States, if you have ANY serious disease and you aren’t wealthy enough to pay for your healthcare, you’re screwed!

To paraphrase Rodney, can’t we all just help each other? We can waste our time playing my-disease-is-more-horrible-than-your-disease until we’re all too weak to play anymore. Or we can sit around wringing our hands, hoping that the Republicans will let us have our puny ACA. Or we can throw out all that bullshit, join hands and voices, and start making some noise that will result in single-payer healthcare access for all. Everybody. No more Ryan White or ADAP – they won’t be necessary. No more free clinics – they won’t be necessary. No more “you can only see the doctors in the network” – ALL doctors will be in the network because there won’t BE a network. No more co-pays, deductibles, co-insurance. No more fighting over every claim with some bureaucrat who only cares about NOT paying for your test, treatments, or drugs. No more worrying about being turned away because you don’t have an insurance card – no one will need an insurance card, they’ll have a healthcare card.

Is it just that the HIV community can’t wrap its head around the idea of not having to fight tooth and nail for state and federal funds year after year? There will still be plenty to fight for – research, support services, prisoners’ rights, prevention efforts – but come on, how wonderful would it be if none of us ever had another sleepless night worrying about how to pay the medical bills or the co-pays? Who wouldn’t be for that?

So, Mr. Kawata, stop musing about ACA and start thinking about DUH, the Demonstration for Universal Healthcare, in October of 2012. Imagine millions of people, all races, genders, religions, political parties, economic backgrounds, with every disease you can think of flooding the Mall in Washington, D.C. Imagine homophobes standing with gay activists, Muslims next to Pagans next to Christians next to Buddhists, hawks and doves, Republicans, Democrats, Independents, Libertarians, Communists. Imagine HIV and cancer survivors, diabetics and anorexics, cardiac patients and athletes with arthritis, asthmatics and epileptics, people in wheelchairs and people with seeing eye dogs. Imagine all that glorious array of humanity putting aside their differences, finding their commonality, and lifting their voices together to demand the end of profit over people. And if you can’t or you won’t, if you would instead prefer to make do with things as they are, well, I wish you luck.

I’m not getting ready for ACA. I’m getting ready for DUH and the day when I and all the people who are sick in this country are finally guaranteed the healthcare we need. Unrealistic, you say? A naïve, idealistic vision? Yeah, just about as unrealistic, naïve, and idealistic as ACA covering everybody in 2014. As long as we’re dreaming, why not go for the gold?