THE PATIENT PROTECTION AND AFFORDABLE CARE ACT

WHEREAS, it's time to reclaim the promise of high-quality healthcare—not as it is today or as it was in the past, but as it can be—to fulfill our collective and moral responsibility to provide access to all; and

WHEREAS, the promise of quality healthcare is under attack by those who demand and pursue profitization, privatization and deprofessionalization of health services; and

WHEREAS, health insurance premiums grew by 114 percent between 2000 and 2010, while wages grew by 36 percent and inflation by 27 percent, which is not sustainable; and

WHEREAS, both employee and employer premium contributions more than doubled between 2000 and 2010; and

WHEREAS, healthcare spending represented about 18 percent of our country's gross domestic product (GDP) in 2010, and is expected to reach 20 percent by 2020; and

WHEREAS, rising healthcare costs contribute to the federal deficit, through their impact on Medicare and Medicaid spending, and siphon funds that could be spent elsewhere; and

WHEREAS, a 2009 study found about six of 10 personal bankruptcies in the United States are related to medical bills. Over three-fourths of those who went bankrupt had health insurance, but went bankrupt anyway because of ongoing out-of-pocket costs, uncovered services or job loss; and

WHEREAS, our country spends more on medical care than Australia, Brazil, Canada, China, France, Germany, Italy, Japan, Spain and the United Kingdom combined, but ranks toward the bottom in terms of life expectancy; and

WHEREAS, the Institute of Medicine recently reported that the current generation of American youth could become the first generation to experience shorter life spans and fewer healthy years than their parents; and

WHEREAS, it has been estimated that over 50 million Americans under age 65 (or about 20 percent of the population) were uninsured as recently as 2012; and

WHEREAS, most uninsured go without coverage because they can't afford it; and

WHEREAS, the American healthcare system must put patient care and safety above corporate profits; and

WHEREAS, a large portion of the healthcare costs of the uninsured are passed on to those with insurance in the form of higher premiums; and

WHEREAS, seven in 10 deaths in the United States are related to preventable diseases like obesity, diabetes, high blood pressure, heart disease and cancer; and

WHEREAS, about three-fourths of our country's healthcare spending goes toward treating these preventable diseases, while only about 3 percent goes toward prevention; and

WHEREAS, reclaiming the promise of quality healthcare is about supporting health systems that are designed to keep people well, not just treat them after they become sick; and

WHEREAS, an estimated 60 million Americans lack access to primary care because there is a shortage of primary care providers in their communities; and

WHEREAS, reclaiming the promise of quality healthcare includes placing healthcare institutions at the center of the community, where they can be responsive to the needs of the community and provide access to all people; and

WHEREAS, the Patient Protection and Affordable Care Act won't solve these problems in their entirety overnight, but has already made important progress by:

• Providing insurance coverage to more than 8 million Americans;
• Ensuring that over 3 million young adults are now able to stay on their parents' insurance plan until age 26;
• Saving over $8 billion on Medicare Part D for more than 7 million seniors and people with disabilities, by starting the closing of the prescription drug "donut hole";
• Extending preventive healthcare services to over 70 million Americans at no charge in private insurance plans; and providing 27 million women with guaranteed access to additional preventive services without cost sharing;
• Ensuring that almost 18 million children with pre-existing conditions can no longer be denied coverage;
• Saving consumers nearly $2 billion as a result of an ACA provision that requires insurers to provide rebates if they do not spend at least 80 percent of premiums on care;
• Providing important incentives for provider collaboration to reduce waste and improve the quality of care, contributing to the slowest growth in national health spending in 50 years;
• Offering premium subsidies for those uninsured citizens earning up to 400 percent of the federal poverty line;
• Eliminating lifetime dollar limits on coverage for 105 million Americans;
• Eliminating insurance policy cancelations due to an application error when a family member became sick;
• Providing nearly $200 million to school-based health centers; and

WHEREAS, when making changes that affect almost one-fifth of our economy, significant issues that need to be addressed arise when translating the law into regulations. While some of these issues can be dealt with through the regulatory process, others require congressional action. Addressing the changes summarized below is vital to meet the needs of our country without causing harm to individuals:

• The transitional reinsurance and Patient Centered-Outcomes Research Institute (PCORI) fees can potentially double-tax our members as employees with employer-sponsored health insurance and as members of a welfare fund.
   
• Employers that cut hours of work below the 30-hour full-time employee standard for various part-time educators and healthcare workers and contingent faculty, so the employers don't have to offer health insurance to these employees.
   
• Shifting of industry-imposed fees to employers and workers, while health insurers stand to gain millions of dollars in revenues from the expansion of insurance to the uninsured.
   
• Only requiring employers to make single-only coverage affordable under the ACA (no more than 9.5 percent of family income), can incent bad actors to pay 100 percent for single coverage and nothing for two-person or family coverage to meet the standard. This type of premium sharing is very harmful to workers with families.
   
• The so-called Cadillac tax, which goes into effect in 2018, does not consider the wage trade-offs that workers
  made over the years to maintain our health plans, the impact of geographic living costs, or the demographic and claims costs for older, sicker workers and dependents. In addition, the tax may be applied to the 10 essential benefits that are required by the act. This is wrong-headed.
   
• The ACA's expansion of health insurance coverage is increasing the need for primary care providers. Advanced practice nurses (APRNs), including nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists, can help fill the primary care gap. APRNs have graduate education and extensive clinical training; their skills are essential to meeting the growing need for primary care, particularly in rural or medically underserved areas. APRNs should be allowed to practice to the full extent of their education and training.
   
• Multiemployer Taft-Hartley unionized funds are disadvantaged under the ACA because they are not currently eligible for federal subsidies for workers earning between 100 and 400 percent of the poverty line, while nonunion employees can get subsidized care in the healthcare exchanges. Moreover, most nonunion construction companies can drop coverage without paying a fine. This is due to a regulation that excludes employers with fewer than 50 employees from any penalty for not offering coverage. It is understood that an overwhelming majority of construction companies engage 10 or fewer employees. Without a level playing field, these employers will not be able to compete for construction and maintenance contracts with nonunion employers who shift their workers to the exchanges for care:

RESOLVED, that the American Federation of Teachers will seek to reclaim the promise that the vital, life-giving services necessary to healthy, productive lives are available to all people; and

RESOLVED, that the AFT will call on the president and Congress to eliminate the double taxation on local union welfare funds regarding the application of the transitional reinsurance fee and the Patient-Centered Outcome Research Institute fees; and

RESOLVED, that the AFT will press for regulatory and/or legislative penalties on bad employers who are cutting employees' hours of work to avoid offering them health insurance coverage; and

RESOLVED, that the AFT will support legislation that would prevent insurance, prescription drug and durable equipment manufacturer fees from being shifted to workers; and

RESOLVED, that affordability should be based on the coverage a person has under the employer's plan and not single coverage; and

RESOLVED, that the "Cadillac tax" only be applied to benefits that go beyond the 10 essential healthcare benefits provided in the act and/or cover and exceed platinum-level coverage where the plan pays an average of 90 percent of healthcare costs. Other adjustments are needed to recognize wage increases that were traded over the years, as well as geographic living costs, patients with chronic illness and plans that have high proportions of older and/or female workers. The AFT also strongly recommends that the definition of "high-risk occupation" be expanded to include nurses and other healthcare workers who provide frontline services to patients and to educators who provide services to children with disabilities; and

RESOLVED, that the AFT and its affiliates will negotiate benefit plans for members that include the full range of primary care providers; and

RESOLVED, that the AFT will call on Congress and the president to level the playing field for Taft-Hartley health and welfare funds, so they can effectively compete with nonunion employers; and

RESOLVED, that the AFT will call on Congress to put partisanship aside and work together to develop an ACA reconciliation bill that fixes problems that affect real people; and

RESOLVED, that the AFT will work to unite the voices of caregivers, patients, families and the community to reclaim the promise of quality healthcare for all people; and

RESOLVED, that the AFT will reaffirm its support and actively lobby for a single-payer healthcare system, based on expanded and improved Medicare for all.