By Sarah White, nurse practitioner

Millions of people breathed a sigh of relief today as the Supreme Court found in favor of Obamacare in a challenge to the plan’s federal subsidies. Despite severe shortcomings, Obamacare brings desperately needed health insurance to millions of people who have previously gone without. From January to September 2014 alone, the number of uninsured people dropped by 11.4 million.

This step forward was a result of struggles over decades, as working people, community organizations and unions fought for high quality, affordable healthcare.

Since its passage, Obamacare has come under repeated attack by the right wing. This most recent case before the Supreme Court threatened the health insurance of people in states that refused to set up insurance exchanges.

Now that Obamacare is upheld, however, 35 million people in the US remain uninsured and people who purchased plans on the exchanges can still face bills up to 40% of their income, with some deductibles as high as $5,000. The number of people underinsured has actually risen to 23%, up from 12% in 2003. It’s clear, health insurance doesn’t equal access to healthcare. Further, high quality plans, bargained for by many unions, will also face steep taxes causing businesses to attempt to shift that tax bill onto the backs of workers.

Meanwhile, the real bloated cost problems lie in the insurance companies’ profits and overheads. Private insurance companies operate with a 23% overhead, compared to Medicare’s 2%.

While Obamacare is a start, we need to implement improved Medicare for All, providing free, high quality healthcare to all. Socialist Alternative wants to tax the super-rich to fund this plan. We support Medicare for All, as a first step towards fully socialized medicine. Prior to the passage of Obamacare, there was a movement in this direction. It was built up through struggles over decades, as working people, community organizations and unions fought for high quality, affordable healthcare. The more progressive aspects of Obamacare were a reflection of this movement.

Two Wings of Profit Driven Interests at Odds

During his 2008 campaign for president, which immediately preceded the negotiation for Obamacare, Obama received a record $20 million in campaign donations from the healthcare industry. Insurance companies bought their influence in the process, thereby protecting their profits. The result? Obamacare forces people into the arms of insurance companies, while using taxpayer money to subsidize the coverage. The Democrats defend the profits of the insurance companies and hope to benefit politically from the support of those who gained health coverage.

Even with insurance companies’ profits strengthened, the right wing isn’t satisfied. But corporations are divided: on the one hand, insurance companies have made huge profits from Obamacare, while employers who have to pay a small share of the cost of coverage, rebel against the tiniest cut to their profits. The Republican Party’s opposition to Obamacare is driven by the opposition of these employers. Further, some corporate politicians fear that working people in the US will see Obamacare as a starting point to demand what people around the globe fought for and in a number countries won: universal, high-quality healthcare for all.

What Was at Stake in King v. Burwell?

King v. Burwell, brought by lawyers from the Koch-funded American Enterprise Institute, threatened to drastically undermine Obamacare. The suit challenged the federal government providing insurance subsidies in states that didn’t set up health insurance exchanges. If the justices would’ve ruled against the Obama administration, the federal subsidies that make health insurance affordable would be withdrawn and 6.4 million people would be priced out of their healthcare coverage, primarily white lower middle class workers in Southern states.

But the problems wouldn’t have stopped there. These insurance schemes rely on a pool of healthy people to pay for the care of the sickest. With a mass exodus of insured people out of the pool when people can’t pay their premiums without federal subsidies, insurance companies would likely raise rates on those left which will only exacerbate the problem, leading to what’s known as the “Obamacare death spiral.”

Truthfully, many Republican politicians are probably also breathing a sigh of relief because the drastic consequences of upholding the suit could have become a political liability for them in 2016.

Profits Get Better Care than Patients

Even with the favorable court decision today, one thing is clear, we need a better system. Unions that organize health care workers should lead the way, mobilizing to defend working families from attacks like King v. Burwell and fighting for a universal health care system for all.  Like all serious gains for working people, this will require mass mobilizations and facing down the entrenched opposition of key sections of the ruling elite.

An alternative to corporate politicians in the pockets of big business is also needed. Bernie Sanders’ presidential campaign, and his call for single payer health care system, is gaining momentum. The tremendous echo his campaign is receiving is a sign of support for an improved healthcare system, and the energy for his candidacy can be used to put improved Medicare for All back on the agenda! Sanders refused to run as an independent and, despite the huge impact his campaign is having, faces almost certain defeat in the Democratic Party primaries. Worse, he vows to throw his support to Hillary Clinton in the general election if she is the party’s nominee. Working people, activists and unions should refuse that: the demand for health care for all, in itself, should be a reason not to hand over support to Hillary Clinton’s campaign. Sanders and the movement behind him should push beyond the limitations of the Democratic Party, and campaign independently, all the way to the general election with a fighting working class platform including improved Medicare for All!

• Defeat all attacks on Obamacare by the right wing! Extend medicaid expansion to all 50 states.
• Tax the super-rich to fund improved Medicare for All.
• Take the pharmaceutical and insurance companies under public, democratic ownership to reduce costs, improve quality and put the needs of working families over the greed and profits of a few.