As the year 2016 comes to an end, many Americans are worried about the future of the Affordable Care Act (aka, Obamacare). Those who want to see the Act survive the likely oncoming assault by Congress and the new Administration are mobilizing to make their repeal objections heard. They are creating or joining social media groups, attending rallies, organizing events and writing campaigns, supporting related non-profits and calling and writing their elected representatives to voice their opposition to repealing the law.

Even some non-supporters of Obamacare have concerns about a full repeal. Many have insurance because of Obamacare, and they like some of the Act's provisions such as prohibiting the denial of insurance or treatment due to a preexisting medical condition. But then there is the hardcore minority who want full repeal of the law even if it means losing their insurance coverage. And one of the main reasons for their discontent with the law is that it provides free or subsidized coverage to the non-working poor. A recent article in The Atlantic captured these sentiments when it quoted two central Pennsylvania, Trump voters:

“but everybody's gotta get out there and get a job to help pay for it.”

“I’m worried about people being willing to work hard and stopping being dependent on the government,”

These individuals want everyone to pay some portion of their health insurance and refuse to acknowledge that some people cannot. For them, not being able to pay anything for health insurance or health care is an individual defect that makes you unworthy of obtaining either. They think that only people like them should have access to insurance, and health care reform should center on making it affordable for them alone.

This repeal at any cost group is difficult to reason with because their views on who is entitled to health insurance and health care are often based on misinformation, stereotyping, and a lack of empathy. And it would be easy to write these people off as cold-hearted racists who want insurance for themselves but no one else, but then we would be ignoring the impact that workplace health insurance has had in forming our opinion about how we access health insurance.

For as far back as 1789, workers had their wages docked to pay for their health care. These schemes were designed for specific and often dangerous professions like seaman, miners and railroad workers, but soon other professional groups had insurance plans for their workers (e.g., teachers, garment workers, physicians, etc.). Then came the 1939 and 1954 Revenue Acts (Sec. 104 and Sec. 106, respectively) that excluded workplace health insurance and other benefits from taxation, strengthening the connection between work and health insurance.

So, almost from the founding of our country, there existed a link between health insurance and employment, with workers asked to pay a portion of the cost. And unlike other industrialized countries, America seems unwilling to break this link. Instead, we fiercely maintain it, even doubling down on it by making workplace health benefits even more attractive via tax policy, especially for higher paid workers.

Why Health Insurance and Health Care Should Not Be Linked To Work

There are many reasons why we need to stop thinking about health insurance and health care as a reward for working, but the main reason is that in doing so, we make health insurance and health care an issue of social class. This plays right into the hands of the health insurance and health care industry status quo. Blaming the poor for the high cost of insurance and medical care means we won't mobilize for change against them. It also keeps undesired risks from limiting their profits, as the poor and unemployed tend to be the least healthy and the most in need of health care.

As health care reform advocates band together to save Obamacare from repeal, they would be wise to address our national fixation on health insurance and health care as a reward for working.

Tags: obamacare