I was wearing a hospital gown and trying to ignore the stirrups I would soon be placing my feet into when I found out about the Supreme Court’s health care decision. I found out about it by text (3 texts, actually) before I heard about it through the news. My boss (the head of a middle judicatory) texted, “Health care law affirmed! Hallelujah!” A seminary friend texted “Court rules 5-4 in Obama’s favor!” And my favorite text was the text from a Missionary Baptist colleague of mine in Oakland who wrote, “Yeah don’t you love it when the right thing prevails? Now let’s get single payer health care!”
I love that third one because I think of it as the “already but not yet” text. The Patient Protection and Affordable Care Act, or PPACA (nicknamed “Obamacare” by critics before people actually knew what the content would be), includes a few provisions you’ve probably already heard about. It allows young adults to stay on their parents’ insurance until they’re 26. It expands generic drug options. It increases the income level for people to qualify for Medicaid. By the year 2020, it seeks to eliminate the “Medicare gap.” It eventually eliminates pre-existing conditions as a reason people can’t get insurance. It eliminates spending caps by insurance companies, so that people will get as much care as they need in a year. It requires companies of over 50 people to provide health care to their full-time employees. And it requires people to purchase insurance starting in a couple of years. (The argument here is that if all barriers to accessing health care are removed, people need to participate in the health care system—otherwise people would only get health coverage once they got sick, breaking down the system that relies on people paying in when they don’t need services so that there are resources when people DO need services.)
So what would Jesus think about health care? As a pastor and preacher, what might I say about this from the pulpit? I live in a city with twice the national unemployment rate (and in some neighborhoods, that rate can reach 45%). I thought this would cause me to become more strident in the way I understand politics, justice and God. And yet, it often complicates my analysis, because there turn out to be more “least, last and lost” folks than I used to track. Perhaps that’s why the theological lens of the already and the not yet matters so much to me: there’s never a moment when we can solely dwell in the “We have arrived; God is here; we are delivered,” because simultaneously, we have sisters and brothers longing for and praying for deliverance. And even health care becomes an already-not-yet moment for me in this community.
So while my initial instinct was to dance around in my paper gown in the doctor’s office (which might have proved awkward had my doctor walked in right then), my enthusiasm has been tempered. I find myself caught between two stories which represent the already and the not yet of the PPACA. The first is a story a friend of mine posted on facebook. A woman was in DC walking down the street when she heard a scream, and turned around to see a young woman jumping up and down with utter joy. “The Supreme Court upheld the health care legislation!” she shouted. “Did you work hard to get that legislation passed?” the passerby asked, trying to understand the level of enthusiasm. “No,” responded the young woman; “I just have lupus.” Already, there is hope for people with pre-existing conditions who could not get access to health care. The other story is shorter. “How are you feeling about the health care verdict,” I asked an activist friend of mine the day the news rolled out. “Eh,” she responded. When prompted, she said, “I’m just tired of liberals conveniently ignoring the people whose needs won’t get met. Today’s decision doesn’t provide health care to a single undocumented person, to a single Dream Act youth.”
Not yet have we created a system where the people who do the hardest work in our country, and without whom our economy would grind to a haltcannot get the health care they need, even though migrant farm workers (exposed to high levels of pesticide) have high rates of cancer and day laborers are often placed in dangerous work environments that risk their wellbeing on a regular basis. In Oakland, I know of one organization, Street Level Health, that does not require some form of identification for the purpose of medical care, and they are not allowed to receive state or federal funds for that reason. I received the news of the Supreme Court decision while sitting in a paper gown in my OB-GYN’s office at Kaiser. When I checked in that day, I was told that since my annual cancer screening was preventative, I didn’t have a co-pay. (That’s part of the PPACA.) I have health care because my part-time job at the middle judicatory knew I needed it and made sure that was part of my contract, since my church can’t afford to cover me.
I already have much for which to be grateful. I’m better off than a lot of friends (and congregants and colleagues) whose health insurance is praying to God that they don’t get sick, because their jobs don’t or can’t provide the same insurance that I get, or because a pre-existing condition stops them from accessing affordable insurance. And I am so grateful to my Missionary Baptist colleague for allowing me to celebrate the already on behalf of my brothers and sisters whose lives will be safer and healthier and less fearful. (“Yeah don’t you love it when the right thing prevails?”) And I am even more grateful to him for reminding me of the not yet. (“Now let’s get single payer health care!”) What would Jesus think? I suspect he would think, “I am here not for the well but for the sick.” And he would promptly turn his attention to his brothers and sisters living in the not yet.