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Red States seek to gut the Affordable Care Act and make Blue States more like them.

Red States seek to gut the Affordable Care Act and make Blue States more like them.

In this timely piece from the LA Times we learn about two working mothers, one in California and one in Texas, and their very different health care experiences thanks to the Affordable Care Act’s expansion of Medicaid to low-income adults, or lack thereof, in their states. The California mum (Jenny) whose state enthusiastically embraced the ACA, has health coverage which kicked in last year when she was hospitalized from a severe infection. Texas on the other hand opted out of the Medicaid expansion and the Texan mum’s (Courtney) experience reflects that fact; without health coverage she’s not able to afford asthma inhalers nor dental treatment for a broken molar she received in a domestic dispute. Courtney’s been living on Orajel, she says.

In fact recent research has concluded that the Red States who refused Medicaid expansion suffered a higher mortality rate among near elderly low-income adults compared to states that expanded the program. The result is that the states who opted out likely sustained almost 16,000 avoidable deaths during the period studied. 

The fate of the ACA now rests in the hands of an ideologically extreme right-wing Supreme Court (SCOTUS) in California v Texas stemming from an effort by Texas and 17 other Red States joined now by the Trump administration to overturn the ACA. (The result will not be known until next year). It’s difficult not to see this as anything other than a continuation of an expanding war on Blue States who typically provide their citizens with more and better services. It’s bad enough that Texas and the others demonstrate such a studied unconcern for the health and well-being of their own residents, but it’s truly reprehensible that they’re driven to seriously damage that of low-income people in the rest of America. Apparently, Texas politicians will not rest until Jenny’s experience in California mirrors that of Courtney. Misery really does love company it seems.

And if Republicans win the November election, we can be assured that any chance of a meaningful replacement for the ACA in the event that SCOTUS throws it out will be just as dead as those 16,000 people who died prematurely. Nor should we forget that if the law falls, all who enjoy private health insurance will once again be subject to caps on their coverage, prohibitions on pre-existing conditions and the other means of victimization in the tool bags of the insurance companies. 

All of which is a strong reminder that the sooner we crush the GOP at the ballot box, the better it will be for our collective welfare.

GOP’s selective outrage on display with VA scandal.

GOP’s selective outrage on display with VA scandal.

Over at Vox.com, Ezra Klein puts the current Veterans Administration healthcare scandal into much needed perspective by wondering why there isn’t similar outrage over the 4.8 million Americans who fall into the Medicaid gap because their GOP governors and/or legislatures have refused that program’s expansion under Obamacare – an expansion paid for 100% by the federal government for the first three years and 90% thereafter.

Of that 4.8 million, about 250,000 are poor veterans. Their situation is far more precarious, as Klein points out, than that of veterans caught up in the VA’s care backlog.  However long and outrageous the wait times may be for VA care, those eligible for it at least know that quality care will come eventually.  Veterans not eligible for VA care but eligible under the Medicaid expansion who happen to reside in one of the 24 states which have opted out can expect no relief, no help. For them it is not just a delay in care that is at issue but its complete absence.

So where is the outrage for the almost 5 million souls affected, particularly from those Republicans and conservatives who are practically frothing at the mouth over the VA revelations? We know the answer from the din of silence, and it’s not difficult to figure out why. There’s political mileage to be made out of the VA’s problems even though they’ve been a long time building. But the lack of coverage for those in the Medicaid gap is the GOP’s exclusive shame and the less said about it the better.

No one would argue that our wounded veterans don’t deserve the very best care we can provide. But why stop there? It’s not a zero-sum game, after all? We can show our concern for both vets and the uninsured working poor can’t we?

Klein provides the roll of shame of states which have refused the Medicaid expansion and the total number of people in each who would be eligible, together with a separate figure for vets. It’s nothing short of a disgrace and as a civilized society we should be every bit as outraged over the plight of those in the Medicaid gap as we are over the VA’s deficiencies.

The 2014 midterm elections need not be a disaster for Democrats

The 2014 midterm elections need not be a disaster for Democrats

Conventional wisdom has it that the Democrats are in for a drubbing in the 2014 midterm elections. After all, polls show that Obama’s approval rating is at or near its lowest point in his presidency. The generic question of which party you will support in the next election now favors Republicans. And Obamacare may yet yield further frustrations in the New Year, particularly if computer glitches with the “backend” processing of enrollees on Healthcare.gov lead many to believe they have coverage when they do not.

Nevertheless, Democrats have a prospective domestic policy agenda that could help to confound CW – if they can summon the wisdom, courage and energy to push it forcefully.

For the 2014 campaign, Democrats can present their overall vision as one that maintains and even strengthens the social safety net for all Americans, increases the hourly wage of our lowest-income workers, and seeks to boost an already improving economy while simultaneously improving America’s international competitiveness. Key features:

A strong push to increase the minimum wage. Polling shows a strong majority of Americans support an increase in the minimum wage. The president has proposed a national raise to $10.00 an hour. Some cities are considering an increase to $15.00 an hour, as one municipality in Washington State (SeaTac) has already done. Fast food workers have staged nation-wide demonstrations in support of higher pay for workers on minimum wage. With so many low-wage workers struggling to make ends meet without resorting to government assistance, it’s an issue whose time has definitely come.

Extending long term unemployment benefits. Republicans may face a backlash to their unwillingness to include such an extension in the budget deal concluded recently by Democratic Senator Patti Murray and GOP Congressman Paul Ryan. GOP reasoning that losing their benefits will provide a necessary kick in the butt for these unfortunates to find jobs is contradicted by most of the available evidence. Lack of effort is not the problem; studies show that employers are less inclined to hire the long term unemployed. The public’s sympathies, not to mention the genuine pain that will be inflicted on up to 4 million unemployed Americans over the next several months if this federal program is not extended, make this a compelling issue for Democrats.

Switching to offense on the Affordable Care Act. Whatever its initial travails, the ACA is starting to settle down and show its promise. About 2 million Americans have enrolled in private insurance plans through Healthcare.gov or state websites thus far, and more have signed on directly with insurance companies. An additional 4 million have enrolled in Medicaid in the last few months mostly under the ACA’s expansion but also including some who qualified previously but never enrolled. There is reason to believe that many more will enroll before the enrollment period expires on March 31st. Republicans, meanwhile, not only lack a health care reform plan of their own but are doing everything they can to impede the only one on the table. Most egregiously, 25 GOP dominated states have deprived 5 million of their own low-income workers of an opportunity to be covered under an expanded Medicaid. This can only work to the detriment of the GOP. Whether it comes quickly enough to help Democrats is an open question; but the latter at least have something substantive to argue for, whereas Republicans are left to do what they do best – nothing. Unless carping, bemoaning and obstructing is viewed as doing something.

Beyond these three issues, it’s past time for Democrats to produce a progressive tax reform bill that addresses the disproportionately favorable treatment received by the rich that has characterized tax legislation since Ronald Reagan. While raising rates for wealthy individuals, particularly on unearned income, such a bill could lower corporate tax rates significantly while ensuring that profitable corporations actually pay taxes. If President Obama is serious about making income and wealth disparity the defining issue of his second term, this is a good place to start.

Finally, Obama and Democrats need to push much harder for a significant investment in our crumbling infrastructure and to restore cuts to science and technology research spending. Not all debt is created equal; the benefits of investments in infrastructure, science and technology and education will more than justify borrowing the money to pay for them, a lesson Republicans never fail to grasp.

The contrast between an agenda such as this and a GOP one that consists primarily of destroying health care reform, not raising taxes on even the mega rich and slashing programs for the poor and middle class in their phony crusade for fiscal rectitude, is one that Democrats should not be shy of drawing in 2014.

GOP’s deep unseriousness on deficit clearly displayed in Ryan Budget

GOP’s deep unseriousness on deficit clearly displayed in Ryan Budget

The first thing that needs to be understood is that the new budget proposal from Congressman Paul Ryan is not a serious document in any way. Rather, it is a GOP political manifesto, a document that clearly states what today’s GOP stands for and where it wishes to take the country. And it shows how unserious the GOP is about reducing our deficit and the national debt since the plan includes no new revenue and is all about cutting government programs – its real, indeed only priority.

The budget is even more harsh on the poor and middle-class than the last one since its putative purpose is to balance the budget in 10 years. In practice, if enacted it would almost certainly tank the economy and increase America’s poverty rate over its already unacceptably high level, thereby negating any financial benefit from cutting government programs.

The Ryan budget repeals Obamacare, keeps the sequester cuts on discretionary spending which would disproportionately hurt the poor and middle-class, and would actually increase reductions on domestic spending by allowing the defense budget to rise by $500 billion above the caps imposed by sequestration. It would reduce Medicaid by $750 billion over the decade and block grant it to states. It would lower taxes on the wealthy and on businesses.

Ryan’s budget would voucher Medicare but is careful to exclude seniors enjoying its current benefits and those over 55, an act of hypocrisy that is as breathtaking now as when it was first proposed. After all, if giving seniors a voucher is such a great idea from which they will benefit by exposing them to the wonders of the free market in healthcare insurance and save the country money to boot, shouldn’t we start it, like, now? Oh wait! We need to keep all those selfish old white voters in the GOP column come election day and they really don’t want Medicare messed with, at least not for them.

The budget completely ignores the fact that we just had a national election in which Ryan himself along with his ideas played a prominent role. His side lost, big time. But as far as Ryan is concerned it’s: Election? What election?

And the plans for Medicare and Medicaid demonstrate the sort of ignorance and blinkered, ideologically-driven thinking that has become the hallmark of today’s GOP. Despite the preponderance of studies that show both programs are more efficient and cost effective than the private insurance industry, and would be more so if the congressional GOP would allow them to negotiate with the pharmaceutical industry on the price of drugs, the Ryan/GOP budget plan pushes the poor and the future elderly into the vagaries of the private sector. If anyone is in any doubt regarding the lack of cost effectiveness and efficiency of the private health system in this country, they should read Steven Brill’s comprehensive report in Time: “Bitter Pill: Why Medical Bills Are Killing Us”.

The Ryan/GOP budget plan will go nowhere. That’s why Democrats were put on the earth. But it does do two things. It shows to those not yet clued in how far to the extreme right the GOP has moved in the last decade, something that may finally hurt them enough in the next election, even in the heavily gerrymandered House. But it also lays out an initial, albeit, outrageous negotiating position from which they can move left just enough, from uber extreme to merely extreme, to claim the mantle of compromise while still doing immense harm to the country. Obama, whose negotiating skills leave much to be desired since he starts in the middle and then moves further right, could learn a lesson or two.

The people of this nation, despite our differences, will soon need to make a clear choice between two distinct visions of America’s future because we can’t continue to lurch perpetually from one budgetary crisis to the next.

The first believes that while a thriving private market system is essential, so is a supportive and complementary government that regulates and softens the edges of capitalism, provides a firm safety net from its vagaries and provides a boost to the nation’s competitiveness by funding scientific and medical research, and building an infrastructure fit for the 21st century and beyond.

The other sees government as an impediment to, if not an outright enemy of the people and the free market, believes the poor and those struggling to make ends meet should largely fend for themselves, that massive income disparities are a good thing and that unfettered capitalism is the path to prosperity for all, or at least the ones who deserve it.

In a nutshell Democrats believe we should strive to be more like Scandinavia. Republicans aspire to take us back more than a century to a place that doesn’t exist any longer but we’d end up looking a lot like Mississippi today. You choose.

The Lack of Universal Healthcare Hurts US Productivity and Competitiveness

The Lack of Universal Healthcare Hurts US Productivity and Competitiveness

Both the United States and the United Kingdom have struggling economies in the wake of the Great Recession with high unemployment rates and levels of economic insecurity. But consider this: In the UK if a worker loses or changes his job, his access and that of his dependents to that nation’s universal healthcare system remains the same no matter what. And he will never be billed a penny for any medical treatment he or his spouse or his children receive.

Contrast that with his American counterpart. Assuming that he is fortunate enough to work for a company that even provides health insurance, he is always vulnerable to the possibility of out-of-pocket medical expenses not covered under his plan. (Medical debt is the single biggest cause of personal bankruptcy in America. 62% of personal bankruptcies are the result of medical expenses, and 78% of them had some form of medical insurance.)  If he loses his job he also loses his health insurance. And to get covered under a new insurance plan will be difficult if not impossible if he or a dependent family member has a significant pre-existing condition.

The Affordable Care Act will ameliorate some of the most egregious features of the private health insurance market and the gaps in coverage. However, Republicans are committed to repealing the law. Medicare and Medicaid provide medical coverage for the elderly and very poor but both programs are under assault from the GOP under the pretext of reducing the budget deficit.

In an economy that is struggling for air many companies are saddled with burdensome overhead to provide health insurance for their workers. For example, it’s been estimated that healthcare costs add up to $2,000 to the price of a car made in Detroit. It’s no accident that US automakers have plants in Canada where wage rates are comparable but they don’t have the same burden of worker health costs. And these adverse effects on our industrial competiveness are by no means limited to the auto industry.

The current argument over entitlement spending misses the point. The fragmented nature of the American non-system of health care coverage is the problem not Medicare and Medicaid. The private insurance industry, with its inordinately high administrative overhead compared with, say, Medicare, has proven to be as inefficient and ineffective at slowing medical inflation as it is at providing affordable insurance to the poor and ailing elderly. That is why Medicare and Medicaid exist in the first place. Cutting the benefits or eligibility of these entitlements, therefore, as the GOP wishes will simply shift costs to those least equipped to assume the burden.

A universal health insurance system to share the cost as well as the benefits as widely as possible makes both moral and economic sense. Just ask the people of every other advanced nation in the world.