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Next Steps for Health Care Reform

The Affordable Care Act paved a path to expand health care coverage, improve care and begin to get a handle on out-of-control health care costs. However, America’s broken health care system can’t be fixed without more fundamental changes, building on the achievements of the Affordable Care Act, Medicare and Medicaid. Our country must keep moving forward toward a more equitable and cost-effective health care system and never go backward.

No Going Backward

Numerous attempts have been proposed in Congress to undo the progress that America has already made toward a more equitable and cost-effective health care system, including:

Repeal of the ACA or Its Key Provisions.  The AFL-CIO will oppose repeal of ACA, which would deny health care coverage to 32 million people, increase the deficit by over $1 trillion in the second decade, eliminate the ACA’s protections against insurance company abuses, and derail reforms that hold promise for making our health care system more cost-effective.  The AFL-CIO will also oppose repeal of the key provision that requires insurance companies to spend at least 80 to 85 percent of your premium dollars on health care instead of excessive profits and CEO pay.

  • Replacing Medicare with vouchers.   Medicare’s guaranteed benefit must not be replaced with vouchers to purchase private health plan coverage, which would force seniors to spend more for health care and increase overall health care costs.
  • Raising the Medicare eligibility age.  The Medicare eligibility age must not be increased from 65 to 67 would increase overall health care costs and require seniors and other payers, including businesses and states, to spend more.
  • Increasing Medicare cost-sharing.  Proposals to increase required co-payments or deductibles for Medicare or to restrict supplemental coverage offered through Medigap policies would simply shift costs to seniors and lead some seniors to forgo necessary care.
  • Taxing health benefits.  Reducing or eliminating the tax exclusion for employer-provided insurance would result in reduced coverage and higher out-of-pocket costs for working families and would lead many employers to drop health coverage.
  • Cutting Medicaid funding or eligibility.  Cutting federal funding for Medicaid or allowing states to restrict Medicaid eligibility would increase the number of uninsured and underinsured and exacerbate the fiscal crisis states are still suffering due to the economic crisis of 2007-2008. 

Moving Forward: Toward a More Equitable and Cost-Effective Health Care System

Numerous proposals would continue moving America forward towards a more equitable and cost-effective health care system. These include:

  • Aggressively implementing the Affordable Care Act.  The 2010 health care reform law should be implemented to provide as much help as possible for working families.  The interests of working families must be the guiding principle as state health insurance exchanges are established and other key decisions are made to implement the act. One key decision involves the Medicaid expansion to provide coverage for everyone with income below 138 percent of the federal poverty line, and states should adopt the expansion, taking advantage of the significant federal funding available.
  • Bargaining with employers to contain health care costsBecause we cannot afford to wait for Congress to act, AFL-CIO unions will continue working with employers through the collective bargaining process to adopt a wide range of cost containment techniques.
  • Allowing Medicare to negotiate prescription drug prices.  Medicare should be given authority to negotiate over drug prices, as the Veterans Administration already does, which would lower the cost of prescription drugs.
  • Increasing drug rebates to Medicare.  Drug companies should be required to pay rebates to Medicare equal to those paid to Medicaid for single-source drugs and drugs for low-income beneficiaries. 
  • Making it easier to reimport prescription drugs.  Proposals to facilitate the re-importation of prescription drugs would provide working families with some relief from excessively high drug costs because the prices charged for drugs made here are often lower in other countries.
  • Creating a public health insurance option.  Employers and individuals of all ages should be allowed to buy into a public plan—the equivalent of Medicare, but with comprehensive coverage—which would reduce health care premiums by 5 percent to 7 percent and drive cost-saving payment and delivery reforms throughout the U.S. health care system.
  • Enacting “Medicare for All.”  The 2009 AFL-CIO Convention passed a resolution supporting the social insurance model of health care reform, such as "Medicare for All,” and will continue working with Rep. Jim McDermott (D-Wash.) and Sen. Bernie Sanders (I-Vt.) to enact legislation that would provide a social insurance model for health care reform that is progressively financed and provides a single high standard of comprehensive care for all.

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