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New Orleans       Breaking away from a meeting with our new tenant organizers at a table in front of Publix grocery store in the Buckhead neighborhood of Atlanta, I had to find a place quiet enough to talk to Rosemarie Day about her take on expanding universal healthcare on Wade’s World . Walking down an alley fifty yards away, some of the restaurants were still not open for the day, so I found myself perching everything on top of a garbage receptacle, hoping it would work.

And, it was worth it!  We needed to see where he Affordable Care Act was going next, which made Day’s book, Marching Toward Coverage:  How Women Can Lead the Fight for Universal Healthcare, very timely.  Day had been there and done that as former chief operating officer for the Massachusetts Health Connector, which had been the model and precursor of the national legislation.  Before we talked about the prospects for extending coverage, we were hearkened by the news that in a hearing before the US Supreme Court Chief Justice Roberts and Justice Kavanagh had both seemed to signal that they saw the issue of the individual mandate before the court has one where severability would apply, meaning that even if they found one piece, even a fundamental one, constitutionally flawed, the act would still survive.  Day’s cut on this was that a simple legislative fix might work, even one that lowered the individual mandate penalties to only one-dollar.

Day’s call was for women to lead the charge for universal care, but she saw Biden’s public option as progress compared to where the ACA had been left.  There were other fixes that Biden could make to restore attacks on the ACA by the Trump administration.  Capping the deductibles closer to $3000 as Massachusetts had done and providing more generous incentives in the marketplace would also allow the ACA to get closer to the 95% plus range Massachusetts had achieved.  I hoped that would allow lower waged workers to not be blocked from the marketplace incentives by the play-pretend skinny plans with exorbitant deductibles offered by many employers of essential workers.

We agreed that the pandemic seemed to put wind in the sails of reform.  Day believed that heighten recognition of the need for more investment in public health would now be a major factor.  I hoped that the fact that an estimated 14 million had lost employer provided coverage due to layoffs and job losses in the pandemic depression would also point the way to a more robust federal health support.

The marketplace is also more inviting during the current enrollment under the Affordable Care Act.  Kaiser estimates that the cost of benchmark plans had fallen by 2%.  According to Get America Covered, a nonprofit advocate, two-thirds of customers on HealthCare.gov can find a plan for $10 a month or less.

Who knows if Day is right that women can lead the fight, but for sure someone has to step up, so why not women?