First step for the Right to Health Care in the US?

March 23, 2010

On Sunday night, after more than a year of debate, the U.S. House of Representatives passed Health Care Reform legislation. No, the bill was not the one that most human rights advocates wanted to see. And yes, there will be plenty of work to do to ensure that the right to health care is fully met in the United States. But the fact that the Patient Protection and Affordable Care act will soon become the law of the land marks a recognition of how poor our current “profits-before-patients” health care system really is.

Human rights advocates now have their work cut out for them at the federal and state levels to make sure that 2010 marks the beginning of a way out – towards a system where no one is denied care based on an inability to pay and where the government is held accountable for making sure that the system works.

Earlier this month, Amnesty International published Deadly Delivery: The Maternal Health Care Crisis in the USA, which finds that despite spending more per person than any other country on health care, the U.S. ranks behind 40 other countries when it comes to women dying in pregnancy or child birth. The report documents barriers to access in the provision of maternal health care around the country.

Among the horror stories in that report is the case of Starla Darling, a 27-year-old who was close to her due date when she learned that the Ohio cookie plant where she had worked for eight years was going to be closed down and that her health insurance would expire just three days later. Faced with the prospect of paying thousands of dollars in medical bills, Starla asked her caregiver to induce labor two days before her insurance was set to expire. Ultimately, Starla had to have a C-section. To add insult to injury, the insurance company denied her claim as it was so close to the end of her employer-provided insurance coverage, and left her with nearly $18,000 in medical bills. (Robert Pear reported Starla’s story for The New York Times.)

Starla’s story – and those of hundreds like her – are indicative of a larger problem. Private insurance companies use a business model that relies on not providing care. Those who need to access health care are a cost to insurance companies, and like any business, they work to minimize their costs and maximize their profits.

The legislation does impose some limits on the power of insurance companies to say “no” when patients need care. Open discrimination against people with pre-existing conditions and women will be illegal when the law takes effect. The legislation also includes measures – particularly the expansion of government insurance for the poor (Medicaid) and more funding for Federally Qualified Health Centers– that will improve access for poor and marginalized communities.

But according to the Congressional Budget Office, at least 20 million will remain uninsured even after passage of this bill. And the additional regulations on insurance companies – while a needed first step – do not go far enough to ensure that patients – and not profits – are the primary concern of our health care system. One could even say that the legislation as it stands right now – with a requirement that every individual purchase insurance but no limits on the profit margins or compensation levels of insurance companies – entrenches the profit-first model. If the U.S. is to join other developed countries in guaranteeing quality health care for all, this is a model that must be questioned in the years ahead.

As documented in Amnesty International’s report, Deadly Delivery, these reforms alone will not end the maternal health care crisis in the US, because of systemic flaws that extend well beyond a lack of health insurance.  A coordinated, systematic and comprehensive approach to maternal health care is needed to address the myriad obstacles standing in the way of women getting the care they need.  Discrimination in the health care system, a lack of nationally standardized guidelines ensuring that the health care provided is safe, and inadequate funding for existing programs are among the many problems faced by women that have not yet been adequately addressed in the current health care reform effort.

President Obama and the Congressional leadership should get some credit for the positive aspects of this bill. We should also be reminding them that we still have a long way to go to fully respect the right to health care and the right to maternal health. An Office of Maternal Health – based within the Department of Health and Human Services – would be a good step towards ensuring that health care for women and mothers is universal, equitable and accountable.