“How The Right Wing Is Killing Women”: Far Right Ideology Is Trumping The Health Needs Of Millions Of Americans
According to a report released last week in the widely-respected health research journal, The Lancet, the United States now ranks 60th out of 180 countries on maternal deaths occurring during pregnancy and childbirth.
To put it bluntly, for every 100,000 births in America last year, 18.5 women died. That’s compared to 8.2 women who died during pregnancy and birth in Canada, 6.1 in Britain, and only 2.4 in Iceland.
A woman giving birth in America is more than twice as likely to die as a woman in Saudi Arabia or China.
You might say international comparisons should be taken with a grain of salt because of difficulties of getting accurate measurements across nations. Maybe China hides the true extent of its maternal deaths. But Canada and Britain?
Even if you’re still skeptical, consider that our rate of maternal death is heading in the wrong direction. It’s risen over the past decade and is now nearly the highest in a quarter century.
In 1990, the maternal mortality rate in America was 12.4 women per 100,000 births. In 2003, it was 17.6. Now it’s 18.5.
That’s not a measurement error because we’ve been measuring the rate of maternal death in the United States the same way for decades.
By contrast, the rate has been dropping in most other nations. In fact, we’re one of just eight nations in which it’s been rising. The others that are heading in the wrong direction with us are not exactly a league we should be proud to be a member of. They include Afghanistan, El Salvador, Belize, and South Sudan.
China was ranked 116 in 1990. Now it’s moved up to 57. Even if China’s way of measuring maternal mortality isn’t to be trusted, China is going in the right direction. We ranked 22 in 1990. Now, as I’ve said, we’re down to 60th place.
Something’s clearly wrong.
Some say more American women are dying in pregnancy and childbirth because American girls are becoming pregnant at younger and younger ages, where pregnancy and birth can pose greater dangers.
This theory might be convincing if it had data to support it. But contrary to the stereotype of the pregnant young teenager, the biggest rise in pregnancy-related deaths in America has occurred in women 20-24 years old.
Consider that in 1990, 7.2 women in this age group died for every 100,000 live births. By 2013, the rate was 14 deaths in this same age group – almost double the earlier rate.
Researchers aren’t sure what’s happening but they’re almost unanimous in pointing to a lack of access to health care, coupled with rising levels of poverty.
Some American women are dying during pregnancy and childbirth from health problems they had before they became pregnant but worsened because of the pregnancies — such as diabetes, kidney disease, and heart disease.
The real problem, in other words, was they didn’t get adequate health care before they became pregnant.
Other women are dying because they didn’t have the means to prevent a pregnancy they shouldn’t have had, or they didn’t get the prenatal care they needed during their pregnancies. In other words, a different sort of inadequate health care.
One clue: African-American mothers are more than three times as likely to die as a result of pregnancy and childbirth than their white counterparts.
The data tell the story: A study by the Roosevelt Institute shows that U.S. states with high poverty rates have maternal death rates 77 percent higher than states with lower levels of poverty. Women with no health insurance are four times more likely to die during pregnancy or in childbirth than women who are insured.
What do we do about this? Yes, of course, poor women (and the men who made them pregnant) have to take more personal responsibility for their behavior.
But this tragic trend is also a clear matter of public choice.
Many of these high-poverty states are among the twenty-one that have so far refused to expand Medicaid, even though the federal government will cover 100 percent of the cost for the first three years and at least 90 percent thereafter.
So as the sputtering economy casts more and more women into near poverty, they can’t get the health care they need.
Several of these same states have also cut family planning, restricted abortions, and shuttered women’s health clinics.
Right-wing ideology is trumping the health needs of millions of Americans.
Let’s be perfectly clear: These policies are literally killing women.
By: Robert Reich, The Robert Reich Blog, May 12, 2014
“The Human Consequences”: Cost Of The Medicaid Expansion Rejection In Lives As Well As Dollars
The more research that is done on the human toll of denying people health insurance, the easier it is to place a price in lives as well as dollars of decisions like that made by nearly half the states to reject the Medicaid expansion provided for in the Affordable Care Act. At Politico Magazine (in a piece given the wonderful, Celine-esque title, “Death on the Installment Plan”) Harold Pollack of the University of Chicago utilizes the findings of last week’s study on the lives saved by RomneyCare in Massachusetts to make some suggestions for those that might be saved by making Medicaid available to more non-elderly adults:
As a matter of fiscal policy, [rejecting the Medicaid expansion] makes little sense. The federal government would initially cover 100 percent of the costs. Its share will gradually drop to 90 percent over the coming years. Over the next decade, the federal government will cover more than 95 percent of the Medicaid expansion’s total cost. Edwin Park of the Center on Budget and Policy Priorities notes that the ACA raises state expenditures on Medicaid and the Children’s Health Insurance Program (CHIP) by only 1.6 percent, when compared with what expenditures would have been in the absence of health reform.
Even the above figures overstate states’ true fiscal burden, since these federal dollars would cover many services such as mental health care, public hospital services and services to the correctional population that would otherwise be supported by states and localities. Medicaid expansion is a significant economic stimulus to the states that have adopted it. Even in deeply conservative states such as Texas, the expansion is strongly supported by the medical community, hospitals, cities and localities and other key constituencies.
Texas and other huge states like Florida are leaving tens of billions of dollars on the table. When asked to give an accounting of themselves, officials offer flimsy justifications to evade two obvious realities: First, Republican politicians do not want to embrace the centerpiece domestic policy achievement of the Obama presidency. Second, many of these same politicians display conspicuously tepid concern for the wellbeing of the expansion’s most obvious beneficiaries: poor, nonwhite, politically marginal residents of their own states….
Nearly 5 million low-income Americans are income-eligible for Medicaid under the ACA, yet live in states that now reject the Medicaid expansion. Within this rather small but critical low-income population, that same one-per-830 estimate [made in the Massachusetts study] implies that almost 5,800 people will die every year as a result of being left uninsured. That’s only an estimate. It may overestimate—or underestimate—the true human consequences. In my view, there’s no escaping the fact that partisan opposition to the ACA is costing thousands of actual human lives every year.
That’s a hell of a toll for scoring an ideological point.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 12, 2014
“GOP Governors Hurting Their Own”: The Latest Plot To Undermine Obamacare And Prevent Millions From Enrolling In Medicaid
It’s actually quite easy to explain. The reason why 19 states have refused to expand Medicaid has nothing to do with the cost — the federal government would cover the full cost of the expansion for the next two years, then 95 percent of the cost thereafter. It definitely doesn’t have anything to do with a lack of need for such a solution. This, as with the refusal to establish health care marketplaces (exchanges), has everything to do with Obama Derangement Syndrome — Republican governors who refuse for a variety of cheap political excuses to attach their names to Obamacare. By doing so, they’re hurting their own people, including Republican voters by numbers into the hundreds of thousands per state.
The Affordable Care Act originally mandated that all states expand Medicaid eligibility from 100 percent of the Federal Poverty Level (FPL) to 138 percent of FPL. In other words, the government had previously established an income threshold for what constituted poverty: below the line and you’re considered poor and therefore eligible for certain safety-net benefits; above the line and you’re more or less on your own. But Obamacare raised the poverty threshold to qualify for Medicaid coverage, thus expanding Medicaid nationwide — until the Supreme Court ruled against that part of the law in 2012, allowing states to opt out of the expansion.
That’s a massive problem.
4.8 million Americans have incomes higher than the 100 percent threshold, so they don’t qualify for Medicaid without the expansion, but they don’t earn enough to qualify for health insurance premium subsidies through the marketplaces. The ACA was written with a nationwide Medicaid expansion in mind so the law’s premium subsidies only kick in where Medicaid coverage was supposed to leave off, after 138 percent of FPL. Hence the coverage gap.
In Kansas alone, home of climate and science denier Gov. Sam Brownback, there are 77,000 residents trapped in the coverage gap. 77,000 people who have no choice but to go without insurance and medical care, all because Brownback refuses to touch Obamacare with a 10-foot pole, either because of his raging ODS or because he and his fellow red state governors prefer to sabotage the law or both.
By the way, Medicaid expansion in Kansas is supported by 59 percent… of Republicans. Republicans! It’s supported by 72 percent of all voters.
In Georgia, there are around 400,000 residents in the gap, and no sign that Gov. Nathan Deal will participate in the expansion in spite of the fact that 54 percent of Georgians support it. 400,000 is a lot of people, and they’re being denied insurance in order for Deal to prove his quality to the extreme flank of his party.
In fact, Brownback and Deal are so maniacal about blocking the very popular expansion of Medicaid, they’re each lining up to sign recently passed legislation that would block future Democratic governors from expanding Medicaid without the approval of the solidly GOP state legislatures in each state.
In other words, GOP lawmakers have taken steps to guarantee that many of their poorest residents will remain uninsured under the health care reform law, no matter what happens in the gubernatorial election.
Georgia Gov. Nathan Deal (R) and Kansas Gov. Sam Brownback (R) both oppose Medicaid expansion. They both look likely — if not quite certain — to win re-election in November. That should make the bills passed by their respective state lawmakers unnecessary, but they seem intent on guarding against even the remote possibility of a Democratic governor.
Actually, the possibility of Democratic victories aren’t as remote as Talking Points Memo reported. Polls in both races are neck-and-neck, with PPP showing a slight advantage for the Democratic challengers to Brownback and Deal, Paul Davis in Kansas and state senator Jason Carter (grandson of former President Carter) in Georgia. And there it is: a possible explanation for the laws.
This is how far they’re reaching to stymie evil, evil Obamacare. Not only are they refusing to create state-run exchanges, oddly ceding state power to the federal government, but they’re refusing to allow the expansion of Medicaid, even though they don’t have to spend a penny to do it — worse, they’re passing laws that will prevent others from doing it, too. It’s yet another way to sabotage the law in a long list of plots to undermine it.
So, what are the consequences?
On Wednesday, the Orlando Weekly published the explosive and infuriating story of Charlene Dill, a struggling, 32-year-old mother of three who collapsed and died on a stranger’s floor late last month. According to Weekly reporter Billy Manes, Dill suffered from a treatable heart condition. She also fell into what policy experts call the Medicaid coverage gap–a hole the Supreme Court punctured in the health safety net when seven of its justices rendered the Affordable Care Act’s Medicaid expansion entirely voluntary.
We have no choice but to call this what it is: death by Obama Derangement Syndrome.
By: Bob Cesca, Managing Editor for The Daily Banter; Published in The Huffington Post, April 28, 2014
“Obamascare Tactics In Red State Races”: Passing Laws That Prevent Any Future Governor From Accepting Medicaid Money
If I asked you to name two states where the incumbent Republican governors might lose reelection this fall, you would likely, I expect, say Florida and Pennsylvania. I doubt very much you’d offer up Georgia and Kansas.
But lo and behold—the contests in both of those states are right now a little closer than you’d expect. In Kansas, Sam Brownback is the governor. You remember Brownback—he was a senator for a spell, best remembered (by me anyway) for his prominent role in that hideous Republican appropriation of poor Terry Schiavo in their zealotry to “promote life.” In Georgia, the bossman is Nathan Deal, also a former Congressman, whose term is best remembered for the way he announced a departure date for his gubernatorial run. (He realized that the House would be voting on Obamacare shortly thereafter, and delayed his departure so he could vote against it.)
It ought to be easy-peasy-lemon-squeezy for right-wing Republicans to get reelected in those states, but recent polls have shown them dangling along the margin-of-error cliff. Deal leads Jason Carter (yep, Jimmy’s grandson) by just 3.4 percent in the realclearpolitics average, and Brownback actually trailed Democrat Paul Davis 42-40 in one February poll. Brownback’s approval rating is also deeply underwater. So it’s conceivable—that’s as far as we should prudently go—that both could lose.
Now, here’s the rub. Both, naturally, oppose the expansion of Obamacare into their states. They say no force on earth or in heaven will make them take that Medicaid money. It’s estimated that 600,000 Georgians and 78,000 Kansans would benefit. But they’re having none of it. And that’s their right. But what they’re doing now, in cahoots with friendly legislators, is a step beyond: In both states, they’re passing laws that would prevent any future governor from accepting the Medicaid money.
It works like this. Under the Affordable Care Act, the process by which states decide to accept the money is entirely up to them. Some states determined that legislative action should be required. You may have read about the Republicans in the Florida legislature rebuffing GOP Governor Rick Scott for the five minutes he was toying with taking the money. New Virginia Governor Terry McAuliffe wants the money badly, and his Democratic State Senate is with him, but they’re hamstrung by the GOP-controlled House of Delegates, which is against.
Initially, Georgia and Kansas were states where it was just the governor’s call. Which was fine as long as the Republicans looked like sure things. But the polls tightened up, and people started getting a little antsy. Hey, what if a Democratic governor got elected and said, ‘Okay, Barack, write me that check?’
And so Brownback signed his state’s law last Friday. His office just announced it this week. Why the delay? Shouldn’t one such as Sam Brownback be proud of signing this socialism-blocking law? Well, it turns out that it was originally a law about something else, requiring the state to provide quick payment to certain in-state Medicaid care providers. This provision was tacked on late. A Wichita Democrat, Jim Ward, said: “That bill is what I think is endemic with this legislative process under this governor and this speaker and Senate president. There was no hearing. There were no opportunities for people who have a stake in Medicaid expansion to come in and talk about it.”
In Georgia, it’s easier. The legislation was passed about a month ago. If Deal doesn’t veto it, it becomes law. And since he supports it—indeed, since his staff helped write this law that willingly hands gubernatorial power over to the legislature—it will. And into the bargain, the Georgia legislature also passed—on the next-to-last day of the session—a bill that blocks state employees from helping Georgians sign up for care under the ACA.
So stop and think about this. Kansas and Georgia have just taken what was a gubernatorial decision out of the hands of not only current but future governors. You can argue plausibly that the people’s representatives should have a say in such a decision, on principle. But principle wasn’t at work here. Political expediency was. Legislators in the two states know that Republicans are likely to have control as far as the eye can see. And they’ll never say yes. And they’re doing all this in the name of what? In the name of denying 678,000 people a chance at health-insurance coverage.
It gets worse. The ACA makes cuts to certain current Medicaid programs on the assumption that states would take this new Medicaid money. It cut funding for hospitals that serve the poor, cuts intended to be mitigated by the fact that a large number of poor would now be insured once the states they live in accepted the new money. But in states that did not, those people are suffering even more. Several rural hospitals in Georgia have closed. They could be saved if the state took the Medicaid money.
Carter vows he’s going to make this skeezy law, and the Medicaid question generally, an issue. The Georgia law has sparked large protests and arrests and might end up being the most important issue in the campaign. In Kansas, Davis supports Medicaid expansion—and according to a recent poll so do 55 percent of Kansans, against just 39 percent who oppose taking the money. So maybe there’s not as much the matter with Kansas as we thought. With the people, anyway. The governor and the legislators are another matter.
By: Michael Tomasky, The Daily Beast, April 23, 2014
“Making The GOP Pay For Medicaid Obstruction”: National Democrats, Especially, Need To Stop Equivocating About The Benefits Of The Law
Jonathan Martin wrote a primer this weekend on why many nervous Democrats won’t take President Obama’s advice – or mine — and run on the Affordable Care Act in the 2014 midterms. To me, it seems like a chicken and egg problem: Vulnerable Democrats won’t run on the ACA because key groups of voters don’t like it. But why should voters like it if even Democrats won’t defend it?
But there is one ACA issue where Republicans seem to be on the defensive, and that’s on the question of Medicaid expansion. Even Georgia Democratic Senate candidate Michelle Nunn and gubernatorial candidate Jason Carter, who have been wishy-washy on the law, support Medicaid expansion – and that’s partly because polls show 59 percent of Georgians support it too. Gov. Nathan Deal has tried to pass the decision off to the state Legislature, which is widely seen as an effort to pass the buck. Kansas Sen. Sam Brownback just managed to do the same thing, on Friday signing a bill that gave the Republican-dominated Legislature the power to decide on Medicaid expansion – but they won’t meet again until 2015.
In Florida, newly minted Democrat Charlie Crist is hitting Gov. Rick Scott hard for his refusal to accept Medicaid funding. Much like in Georgia, 58 percent of Florida voters want to see their state take the federal funds. Crist leads Scott in the latest polling.
And Republican Senate candidates Scott Brown of New Hampshire (it seems wrong not to write Massachusetts, Scott), Tom Cotton of Arkansas and Terri Lynn Land of Michigan have all refused to take a stand on Medicaid expansion, which might make them the biggest cowards of all.
In Louisiana, Democrats are trying to bypass Gov. Bobby Jindal and let state voters decide whether to accept $16 billion in expanded federal Medicaid funding, to cover 242,000 newly eligible Louisianans. The federal funding would create 15,600 new healthcare jobs, according to Families USA. Vulnerable Democratic Sen. Mary Landrieu has been hitting Jindal hard on the issue, and the New Orleans Times-Picayune just called on the state Legislature to back the referendum notion, blaming Jindal’s presidential ambitions for his decision to turn down the funds. Even conservatives, the paper suggested (perhaps with a little sarcasm), ought to back an effort to give voters a say on the matter. What are they afraid of? Well, the Koch-funded Americans for Prosperity, for one thing, which has promised to campaign against Republicans who support Medicaid expansion.
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