Kim Palchikoff: Obamacare can be fixed. Here’s where to start

As an Affordable Care Act participant, I expect last month’s long-awaited court ruling will have some serious consequences for me. The problem is, I have no idea how.

There have been many rulings on the ACA’s legitimacy, including by the U.S. Supreme Court in 2012, since it became law in 2010. Politicians and other opponents of the ACA, also known as Obamacare, have been trying to “repeal and replace” it since its inception.

These complicated court rulings affect me — and all Americans who rely on the ACA for their health insurance. Unfortunately, they’ve done nothing to help us plan for our health-care future.

Here’s the skinny on the latest ruling: After hearing arguments last July, a three-judge Appeals Court panel agreed with a lower court in December that the ACA’s requirement compelling all Americans to obtain health insurance —or pay a fine — was unconstitutional.

Fortunately, they didn’t agree that because of this, the entire law was unconstitutional, which is what the lower court was arguing.

Following its decision, the court of appeals sent the ACA back to that same lower court for further review. It’s widely expected that ultimately the Supreme Court will vote on it again.

For those us who rely on Obamacare, this years-long game of court hopscotch has been a nightmare, in part because I’m one of Nevada’s 1.2 million residents who lives with a pre-existing condition. I know what it’s like to live without health insurance. It can be petrifying.

It’s probably the most important federal law to affect my life, in no small part because of my mental illness, bipolar disorder, which means I will regularly see a costly psychiatrist for the rest of my life. Health insurance companies hate people like me. Many people with a serious mental illness spend many expensive nights in mental hospitals.

Patients with mental-health issues often have other medical issues as well. In 2011, researchers from the National Institute for Mental Health found that on average, Americans with major mental illness die 14 to 32 years earlier than the general population because of their poor health. They are more than twice as likely to smoke cigarettes and more than 50 percent more likely to be obese than the rest of the population. People with major depressive disorder are at higher risk for cardiovascular disease and stroke.

We also know this: untreated mental illnesses in the U.S. cost more than $100 billion a year in lost productivity, according to the National Alliance on Mental Illness.

I agree with many others who believe that instead of condemning and attacking Obamacare, politicians should work with public health officials to improve it and our health-care system in general.

There is no shortage of ideas on how to fix Obamacare, and these are some of my favorites:

Allow people to sign up for Medicare starting at age 55. This would help private insurance by taking higher-cost clients out of their pool. Medicare could negotiate lower prescription drug costs, a big expense for many people. Other government programs, such as Medicaid and the Veterans Administration, are allowed to negotiate and do so successfully. There’s no reason Medicare cannot do the same.

The government could offer higher subsidies to insurance companies, including those serving high-risk populations, so they wouldn’t have to raise prices as much. They could reduce the amount of deductibles.

Have the government subsidize medical education, so new doctors aren’t saddled with enormous debt upon graduation. Maybe more of them would go into primary care, which is a lower-paying field of medicine than other medical specialities but one of the most needed.

The enormous profits associated with American medical care is a big issue. I knew a wealthy businessman who owned three hospitals in the Los Angeles area. He often talked about the huge sums he made off of desperate, sick people, especially those in the last stages of life, when his hospitals bankrupted families desperate to save their loved ones at any cost.

In his later years he regretted his former line of work, and embraced the notion of socialized medicine, or what is now being called single-payer option. I don’t think it will ever materialize in America, but it’s something to think about. No one thought that Obamacare would see the light of day, and here it is.

I have friends in Canada and Europe in both private and public health-care systems. It’s normal for them. When I lived in Europe during my 20s, I spilled boiling water on my hand one morning, which resulted in large, second-degree burns. I rushed to the nearest emergency room. The doctors there took care my injury, free of charge. No insurance was required, no money ever exchanged hands. I never received a bill. Their only concern was my hand.

Back in Nevada, Gov. Steve Sisolak signed Assembly Bill 170 last spring that guarantees health coverage to Nevadans with pre-existing conditions regardless of any federal law. But I’m a skeptic. A lot of states pass largely symbolic legislation that gets trumped by federal laws.

For now, the future of Obamacare is still a waiting game. More courts, more decisions. With the Supreme Court stacked with a conservative majority, who knows what will happen to me, thousands of Nevadans and millions of Americans who rely on government subsidies for our medical care.

The uncertainty of it all leaves me feeling helpless and more than a little nervous.

Kim Palchikoff can be contacted at


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