“Far-Reaching Consequences”: Obamacare, Mental Illness, And Guns
After years of delays, the Obama administration has released final regs aimed at implementing 2008 legislation requiring “parity” in insurance coverage of mental illness, as Jackie Calmes and Robert Pear of the New York Times report today:
The rules, which will apply to almost all forms of insurance, will have far-reaching consequences for many Americans. In the White House, the regulations are also seen as critical to President Obama’s program for curbing gun violence by addressing an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders.
Remember gun violence?
In issuing the regulations, senior officials said, the administration will have acted on all 23 executive actions that the president and Vice President Joseph R. Biden Jr. announced early this year to reduce gun crimes after the Newtown, Conn., school massacre. In planning those actions, the administration anticipated that gun control legislation would fail in Congress as pressure from the gun lobby proved longer-lasting than the national trauma over the killings of first graders and their caretakers last Dec. 14.
But there’s another big piece of the puzzle that is necessary to make sure mental health benefits are available to the people most at risk of committing acts of violence: the Affordable Care Act. As Harold Pollack explained in a major article in the March/April 2013 issue of the Washington Monthly, the ACA’s Medicaid expansion alone is a really big deal for people with mental illness and/or addictions who are prone to violence:
Why do so many people at risk—many of them young low-income men—fail to receive appropriate mental health services? The most important single reason is this: most are categorically ineligible for Medicaid. These men are not custodial parents. They are not veterans. They have not (yet) been diagnosed with federally recognized disabilities. Many get into trouble because they have serious drug or alcohol disorders. Since 1996, substance use disorders are no longer qualifying conditions for federal disability programs….
This will begin to change in 2014. That’s when the ACA will start providing subsidies that will eventually reach thirty-three million Americans without health insurance. An estimated sixteen million will eventually be covered by expanded Medicaid to low-income Americans with incomes below 138 percent of the federal poverty line. That number will include the hundreds of thousands of mentally ill men cycling in and out of places like Chicago’s Cook County Jail and sleeping on grates in cities from Washington, D.C., to Seattle. For the first time, nearly all of these individuals (undocumented immigrants are the big exception) will gain access to regular health care. Moreover, if the law is properly implemented, these same individuals will gain access to mental health services that can reduce their propensity to commit violent acts.
So if you want some very good news about the impact of Obamacare, and some very bad consequences if it fails to be fully implemented, there you are.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 8, 2013
“What Really Matters”: Don’t Knock Obamacare Until You Try It
There has been a steady drumbeat of news stories about health insurance companies informing customers that their policies will be dropped or that they will face steep rate increases due to requirements of the Affordable Care Act.
This has opened the door to fair criticisms that President Obama wrongly stated that people would be able to keep their current insurance policies if they are happy with them, as this isn’t necessarily the case. However, the real question for individuals facing rate hikes or dropped coverage is whether there are insurance options provided through the exchanges, mandated by the new law, that these people would actual prefer, thanks to some combination of lower prices and more generous benefits. Obamacare might cause some to lose their current policy, but it also might provide them with options they would prefer. That is what really matters.
People should remember that the program provides subsidies for lower income individuals and families. At least in states that have accepted the very generous federal contribution, Obamacare also expands access to Medicaid. For many people who currently lack insurance, a group of people who tend to be poorer, Obamacare insurance policies will be free or relatively cheap.
The initial implementation of Obamacare has not gone smoothly. The key problem is website difficulties faced by people who are attempting to see just how much a plan will cost them, and whose attempts to actually sign up for a policy have been thwarted. We will see if these problems are fixed in a timely fashion, and whether other serious problems crop up.
But the program, as designed, is intended to lower prices for the vast majority of people on the individual insurance market, as well as to open it up to people who previously have been denied affordable coverage because of pre-existing medical conditions. Optimistically, increased competition could even lower prices for employer-based health plans.
Admittedly, such optimistic predictions might not come to pass. Over the next several months we will get a better idea of how many people manage to enroll, whether their coverage is adequate, and whether their overall medical costs, including premiums and out of pocket costs, fall. We might ultimately declare Obamacare a failure, and if that happens we should figure out a better way to expand access to affordable health insurance and care.
Despite the rhetoric from many conservatives, Obamacare isn’t the way most self-described liberals would reform our health care system. It is needlessly complicated, not guaranteed to reduce overall medical costs significantly and its subsidies, while significant, are too stingy. People with lower middle class incomes will still likely find the premiums to be a budgetary strain. At the very least, liberals would have included a government run “public option,” a Medicare-like program that would have competed with the private insurance.
But problems aside, people who are currently navigating the private insurance market –both those without health insurance currently and those who might be receiving scary policy and price change letters from their current insurance companies — should make sure to see just what their Obamacare options are. They might be pleasantly surprised.
By: Duncan Black, USA Today, November 5, 2013
“An Obvious Problem”: Chris Christie Needs Republicans To Have A Terrible 2014
I wouldn’t say that New Jersey Governor Chris Christie is the presumptive frontrunner for the Republican presidential nomination in 2016—though, like Ross Douthat, I’m not sure who could beat him—but it is true that he is the official candidate of the GOP establishment. And, with a reelection coalition of Republicans, Democrats, young people, Latinos, and African Americans, Christie stands as the only potential presidential nominee that can claim a credible path to victory.
It doesn’t come as a surprise, then, to learn that his rivals are already throwing shade in his direction. NBC News has a good round-up of the Republican presidential contenders who have opened fire on the New Jersey governor:
Even after the disaster of the shutdown and Ken Cuccinelli’s loss in the Virginia gubernatorial race, the operating assumption of right-wing Republicans is that success will come when conservatives take a doctrinaire approach to their ideology. The available evidence makes clear that this isn’t true—Ted Cruz, for instance, won his election, but he underperformed Romney—but this doesn’t matter to either the GOP base or lawmakers like Cruz.
This poses an obvious problem for Christie. Insofar that his message of electability has any chance of resonating with Republican primary voters, it will be because they have given up the quest for purity, and are desperate to win, which means that, for Christie, the best thing that could happen is for Republicans to have a terrible 2014. If the GOP continues down its path of extremism, and loses its shot at capturing the Senate as a result, Christie has perfect ground for making his pitch.
Unfortunately for him, the more likely outcome is that Republicans do pretty well. The combination of a sluggish economy and voter discontent will hurt incumbents, which threatens the Democratic majority in the Senate and precludes the party from making real gains in the House. And a GOP base that does well—or even okay—in next year’s midterms is one that doesn’t have much interest in Christie’s message.
By: Jamelle Bouie, The Daily Beast, November 7, 2014
“Another Banker Scam”: Can Wall Street Buy Redemption?
Goldman Sachs churns out enormous profits from its high-rolling, casino investment schemes, while also churning out fat paychecks for its top executives. They literally sack up the gold, even as their speculative gambles have wreaked havoc on our real economy.
But, finally recognizing that their public approval rating has sunk lower than mad cow disease, Goldman’s banking barons now want you to know that they feel your pain and are eager to “give back” to the people. So — ta-da! — they’ve transformed themselves into philanthropists, having goosed up the bank’s foundation in order to flash their “charitable side.” Goldman’s chief of staff noted that “people said we weren’t doing enough” to address the gross inequities created by Wall Streeters, so they’ve turned their foundation into the fourth-largest corporate charity in America. In an orchestrated show that the New York Times dubbed “reputation redemption,” the bank’s charitable arm doled out $241 million last year, including grants to women in developing nations and small-business projects here in the U.S.
That sum would be impressive, except for a couple of ugly hickies on it. First, the foundation spends an unseemly amount on slick videos and PR efforts to extol Goldman’s new “generosity,” diverting philanthropic funds from altruism to corporate promotion. One Goldman banker, who’s appalled at the self-congratulatory splashiness, said of the charity: “It’s run as if it’s a Broadway show.”
Second, $241 million sounds like a lot — until you see that the financial empire’s income last year topped $34 billion. Do the math, and it turns out these “bankers with a heart of gold” actually allocated less than one percent of Goldman’s income to its widely ballyhooed beneficence.
How pathetic. Even poor people put these multimillionaires to shame, regularly donating 3.2 percent of their meager incomes to charity. Trying to buy redemption on the cheap is just another banker scam, but why aren’t we surprised that they would even view charity as a self-serving hustle? After all, on Wall Street, it’s assumed that anything can be bought and sold — from fraudulent investment packages to congress critters.
It’s no surprise, then, that the wizards of Goldman Sachs assumed they could purchase an image makeover, convincing us gullible rubes that they’re not just a pack of malicious, money-grubbing narcissists, but at heart, are huggable bankers who want nothing more than to serve humanity. Hence, the Goldman Sachs Foundation spreading a few of its millions hither, thither and yon in a flashy show of charity designed to mask the bank’s voracious ethic of greed.
But whom do the Goldman Sachers think they’re fooling? By putting a pittance of their billions into charity, they’re merely updating the old PR shtick attempted a century ago by the billionaire robber baron, John D. Rockefeller, who went around in public passing out dimes to a few children in the vain hope of buffing up his sour public image. But, worse, Goldman’s sly executives are not even donating their own dimes! It’s the shareholders’ money that these bankers are doling out. Worse yet, it’s also our money. By ours, I mean that Goldman’s so-called “gifts” are deducted from the income taxes the bank owes, thus, shorting America’s public treasury of funds that We The People need for schools, roads, parks, clean water and other essentials to advance our society’s common good.
Also, what is “charitable” about funneling $375,000 into one of Bill Clinton’s show-and-tell PR events? This donation by Goldman’s foundation went to Clinton’s Global Initiative conference in September, allowing the banking giant to plaster its brand on the event, including being the “host” of a panel moderated by Chelsea Clinton. Come on, that’s not charity — it’s advertising.
The more Wall Street bankers try to purchase morality, the less they have. We don’t want their false “charity” — we want honest accountability for their destructive greed, and we want a restructured, decentralized and ethical banking system based on fairness and common decency.
By: Jim Hightower, The National Memo, November 7, 2013
“Voting For Governor Is One Thing, For President, Another”: The Wrong Election Takeaways From Christie’s Win, Virginia, and More
The conventional wisdom on New Jersey: Huge Chris Christie win sets him up to steamroll his way to the Republican nomination in 2016, proving that a more mainstream conservative can win in a blue state. The conventional wisdom on Virginia: Ken Cuccinelli’s stinging loss in a purple state in an off-off-year election against Terry McAuliffe, a flawed Democratic candidate, shows not only that he was too extreme but also that Virginia is inching its way into the Democratic column. As the Times put it in its headline, “McAuliffe Win Points to Virginia Changes.”
Well, God invented conventional wisdom so people like me could beat it down. In New Jersey, Christie doesn’t emerge from his victory nearly as strong as he appears to. And the Virginia outcome isn’t really very strong for Democrats, especially down the ballot. No, I’m not buying into the right-wing spin that Cuccinelli’s narrow margin of defeat really represents some kind of loss for Obamacare. It does not. What I’m saying is something different. But let’s start with Joisey.
Barbara Buono, Christie’s Democratic opponent, volunteered for a suicide mission when she agreed to run against him. Surfing on an ocean of media hagiography, Christie seemed unbeatable just when it was time for Democrats to declare themselves. Buono couldn’t raise money, couldn’t attract much media, couldn’t get anyone to believe she could make it close, let alone win.
In such a circumstance, a lot of voters just mentally write that person off. Most people don’t care passionately about politics. Most people care…some. When they look at a race and see someone who looks as if she’s going to get clobbered, they just decide they’re not voting for her, in the same way they might decide they’re not going to let themselves get too invested in the idea of Rutgers knocking off Florida State in a fantasy matchup.
So Christie got a lot of those votes. He got high percentages from Latinos (around half) and blacks (21 percent). Does it mean he’d get them running for president? No way. Indeed, the exit poll result that showed Hillary Clinton beating him 48-44 demonstrated Christie’s national weakness, at least against her. Think about it. On the night of his greatest triumph, a smashing 22-point win, exit poll respondents walked right out of the booth and said, “For president? Are you kidding me? Hillary all the way!”
About 2 million votes were cast Tuesday. We should perhaps be careful about reading too much into exit polls, but the results suggest that running for president against Clinton, Christie, who corralled nearly 1.25 million votes Tuesday, would give back about 370,000, or roughly 30 percent of them. That sounds about right to me.
People make different calculations voting statewide and nationally. Massachusetts voters, for example, have often elected Republican governors in recent times, but they would never let a Republican get within 20 points of winning the state in a presidential election. New York had a Republican governor in George Pataki not all that long ago; Connecticut had one just recently; Pennsylvania has one right now, and Michigan, and Wisconsin, and Maine, and New Mexico. Likewise, a few red states where Democrats haven’t been winning many presidential votes lately (Kentucky, Arkansas, West Virginia, Montana) have Democratic governors. News flash: People can distinguish between voting for a governor and voting for a president.
The Clinton exit-poll number, the 61 percent of Jersey voters who backed a minimum-wage hike that Christie had vetoed, and his basically nonexistent coattails suggest to me that he will have a hard time winning his own state in 2016, especially if he does a little pandering to the right between now and then, as he’ll surely have to. I don’t deny that he is a skillful politician. What I do deny is that a blowout gubernatorial win under these circumstances means much of anything about the presidency three years hence.
As for Virginia, I mostly come away from that race shocked that someone as divisive and reactionary as Cuccinelli could get 45.5 percent of the vote. His tally, combined with the Libertarian guy’s 6.6 percent, suggests that Virginia is still fairly red. I was also staggered that Cuccinelli beat McAuliffe among white women by 16 points. Surveys before the voting indicated that McAuliffe was much closer than that among white women.
Of course, a presidential-year electorate will be different. It will be younger, more black and brown, and so forth. I would think Clinton, if she were the nominee, could beat Christie there with a large enough “on-year” turnout. But if 46 percent of Virginia is willing to vote for that little reptile Cuccinelli, a die-hard caucus in that state is going to put up a fight. I don’t see McAuliffe’s win as the “bluing” of Virginia. That’s going to take one more presidential election, and it may well be that only Clinton can do it.
Finally, it’s lots of fun to watch the sparring between Republicans about why Cuccinelli lost. The establishment types say the party should have nominated someone more mainstream, while the Tea Partiers blame the establishment for abandoning Cuccinelli too soon. The truly enjoyable thing about this fight is that both arguments have enough of a grain of truth in them to keep the quarrel going on into next year. So let the Tea people keep launching their cannonade, and let the establishment overrate Christie. That’s about as good an ending as this election could have had.
By: Michael Tomasky, The Daily Beast, November 7, 2013
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