Transcript Slide 1

NESRI
National Economic and Social Rights Initiative
Why the New Health Reform Law
Fails to Meet Human Rights Standards
Anja Rudiger
Human Right to Health Program, NESRI
The Human Right to Health
Governments have an obligation
to respect, protect, and fulfill
our “right to a system of health protection which
provides equality of opportunity for people to enjoy the
highest attainable level of health.”
International Covenant of Economic, Social and Cultural Rights
(legal interpretation, General Comment 14)
Recognition of the Human Right to Health
 Universal Declaration of Human Rights (Article 25) *
 American Declaration on the Rights and Duties of Man (Article 11) *
 Convention on the Elimination of All Forms of Racial Discrimination
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(Article 5) *
International Covenant on Economic, Social and Cultural Rights
(Article 12)
Convention on the Elimination of All Forms of Discrimination Against
Women (Articles 12 & 14)
Convention on the Rights of the Child (Article 24)
Convention on the Rights of Persons with Disabilities (Article 25)
*The U.S. has committed to these Declarations and Conventions
What is the Human Right to Health?
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The human right to health entails the right to a system of health
protection.
Everyone has the right to enjoy, on an equal basis, a variety of
facilities, goods, services, and conditions necessary for the
realization of the highest attainable standard of health.
This includes access to appropriate health care, and to the
underlying social determinants of health, such as adequate food,
housing, and healthy occupational and environmental conditions.
Health Care is a Right, not a Commodity
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Health care is a human right, not a commodity. Commodities are
restricted to those who sell and purchase them, with sellers seeking
to make a profit and consumers limiting their demand based on
price.
As holders of a right we are entitled to health care. We are not
consumers who choose to buy or not to buy care.
The human right to health care confers an obligation on the
government to respect, protect, and fulfill this right. This includes
holding the public and private sector accountable for meeting
human rights standards.
Human Rights Reality in the U.S.
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Human Rights Principle:
 Everyone has an equal right to get the health care they need.
 This requires a health system that works to protect people’s
health, guaranteed by the government.
Reality Check:
 People in the U.S. are denied their right to health care.
 Market imperatives take precedent over social goals.
 Profit-making trumps meeting health needs: in 2007 alone, the
five largest insurance companies made a combined profit of
around $12 billion, while up to 101,000 people die
unnecessarily each year.
 Those who are wealthy, healthy, white, male, young, or
employed have better access to care, and better health
outcomes, than poor people, people of color, immigrants and
women.
The Human Right to Health Care
as a Catalyst for Change in the U.S.
No legal or political recognition of the right to health care in the U.S.
No universal health care system
Poorer health outcomes and higher private health expenditures
How can human rights advance policy and practical change?
Tools for Human Rights Advocacy
Legal advocacy: use international law, comparative law, and reports to
treaty bodies
Policy advocacy: advocate for the human right to health and for
human rights principles and standards to guide policymaking
Organizing: unify movements through the normative framework of
universal rights
Components of a Human Rights Campaign
Shifting the discourse: from a commodity to a rights frame 
recognizing health care as a public good
Changing policy: from market-based insurance to a publicly financed
and publicly administered health care system at state and national
levels
Changing practice: from local paralysis to community-led actions for
local human rights zones
Changing law: amend state constitutions, anchor human rights in state
and local laws and regulations, ratify treaties
Human–rights based health reform goals
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Commodity, privilege, charity  human right  universality
Market competition, private purchase  public good, risk & income
solidarity  equity
Personal responsibility  collective responsibility and government
obligation to ensure everyone can exercise their rights
accountability
Solidarity is needed to achieve this – both in our political struggle
and in the way we should pay for our health care
Why the New Health Law
Fails to Meet Human Rights Standards
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Market-based approach: care is a commodity that is bought and sold
Expansion of for-profit insurance: mandates people to buy a
product from an industry incentivized to maximize profit, not care
Stratification: separate tiers for different categories of people
receiving different levels of care
Health care rationed according to ability to pay, age, geographical
location, employment and immigration status
Failure to pool all health risks, fully cross-subsidize costs, and
guarantee access to care according to people’s health needs.
Human Rights Principles
Health facilities, goods and services must be accessible,
available, acceptable, and of good quality for everyone,
on an equitable basis, everywhere in the country.
 Universality
 Equity
 Accountability
UNIVERSALITY
in Health Insurance Reform?
Human Rights Strategy:
Including Everyone in a Universal, Unified System
The New Law’s Strategy:
Improving Market Management through
Competition and Choice of Private Insurers
Does the New Law Meet
Universality Standards?
 Everyone should have guaranteed access to health care,
without discrimination or exclusions.
≠ 23 million people will remain uninsured.
≠ Exclusion of those who can’t afford coverage and, in addition,
those who can’t afford to use their coverage.
≠ Requirement to buy an insurance policy is not a right to receive
care: coverage may not fully pay for care (as little as 60% of the
cost, not including co-pays) nor cover all needs (e.g. dental care).
≠ Expanded coverage is not matched with more doctors, esp. for
Medicaid patients (reimbursement rates not raised permanently).
≠ Exclusion of immigrants (5-year bar to Medicaid/Medicare;
undocumented barred from buying coverage in the Exchanges).
 Everyone should have access to care based on their health
needs, not their ability to pay. Cost must never be a barrier to
care.
≠ Public subsidies for the purchase of private insurance for those
earning under 400% of the federal poverty line (FPL). Yet costs
will continue to remain high: At 250% FPL premium payments will
amount to 8.05% of a person’s annual income, plus co-pays,
deductibles and out-of-pocket costs. At 400% FPL ($43,000)
subsidized premium payments will be 9.5% of income ($4,115),
out-of-pocket costs can reach up to $4,147 per year, and co-pays
and deductibles will be 30% of the insurance plan’s value.
≠ Out-of-pockets costs of up to $5,950 per year ($11,900 families).
≠ Older people may have to pay up to 3 times more for coverage.
EQUITY
in Health Insurance Reform?
Human Rights Strategy:
Providing Free, Pre-Paid Care as a Public Good
The New Law’s Strategy:
Subsidizing Private and Safety Net Coverage
Does the New Law Meet
Equity Standards?
 Disparities in access to care should be eliminated.
═ Specific provisions on racial health disparities: improvements to
language & cultural access, data collection, workforce diversity
≠ Different groups of people will get different coverage (amount,
type, price of insurance) and therefore different access to care.
≠ Disparities in access to reproductive health for women will be
exacerbated.
≠ Disparities in access for immigrants will be exacerbated.
≠ Many geographical disparities will continue, as it is up to states
how to set up Insurance Exchanges.
 Publicly financed care should be strengthened and expanded
as the strongest vehicle for guaranteeing equal access.
═ Medicaid expanded to everyone with incomes up to 133% FPL
(except many immigrants) but low payments to doctors continued.
+ Additional funding for community health centers
≠ No “public option”, no Medicare expansion
 Entrenchment of private insurance as principal funding
mechanism for health care by creating millions of mandated
customers. No lever for government to ensure that health needs
are prioritized over market incentives.
ACCOUNTABILITY
in Health Insurance Reform?
Human Rights Strategy:
Ensuring Accountability to the People
The New Law’s Strategy:
Increasing Security for Insurance Policyholders
Does the New Law Meet
Accountability Standards?
 Private companies and public agencies should be held
accountable for meeting the populations’ health needs.
═ Improved “consumer protections” through stricter regulation of
insurance companies (no medical underwriting, minimum
benefits, grievance and appeals mechanisms).
≠ No premium price controls, only reviews.
≠ No elimination of insurers’ incentives to limit and deny care.
≠ Permits interstate sales of insurance policies which may lead to a
race to the bottom.
≠ No full employer mandate to provide coverage or pay for public
programs.
Health industry is accountable primarily to private interests (e.g.
shareholders).
What Reforms Would Meet
Human Rights Principles?
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A publicly financed and administered health insurance plan for
everyone, guaranteed and continuous through life.
 principle of universality
Equitable public financing system with contributions based on ability
to pay, not on health care use  principle of equity
A democratic health care reform process that does not silence the
majority of the population who sees health care as a human right
 principles of participation and accountability
Next Steps for Human Right
to Health Care Advocates
 Monitor and report impact of reforms on different communities,
using human rights principles and standards.
 Support local efforts for the human right to health care (e.g.
universal health care zones, possibly with community health centers
as the hub, preserving public hospitals etc.).
 Support state-based campaigns for universal health care, such as
state single payer bills in California, Vermont, Minnesota,
Pennsylvania, etc., and constitutional amendments for the right to
health, e.g. in Montana.
 Use local and state actions as a basis for a national human right to
health movement with an advocacy focus on a Medicare for All type
system that is publicly financed and publicly administered