“Health Care Nightmares”: There’s An Extraordinary Ugliness Of Spirit Abroad In Today’s GOP America
When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.
Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare”; on the same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.” Some nightmare. And the overall gain, including children and those who signed up during the late-March enrollment surge, must be considerably larger.
But while Obamacare is looking like anything but a nightmare, there are indeed some nightmarish things happening on the health care front. For it turns out that there’s a startling ugliness of spirit abroad in modern America — and health reform has brought that ugliness out into the open.
Let’s start with the good news about reform, which keeps coming in. First, there was the amazing come-from-behind surge in enrollments. Then there were a series of surveys — from Gallup, the Urban Institute, and RAND — all suggesting large gains in coverage. Taken individually, any one of these indicators might be dismissed as an outlier, but taken together they paint an unmistakable picture of major progress.
But wait: What about all the people who lost their policies thanks to Obamacare? The answer is that this looks more than ever like a relatively small issue hyped by right-wing propaganda. RAND finds that fewer than a million people who previously had individual insurance became uninsured — and many of those transitions, one guesses, had nothing to do with Obamacare. It’s worth noting that, so far, not one of the supposed horror stories touted in Koch-backed anti-reform advertisements has stood up to scrutiny, suggesting that real horror stories are rare.
It will be months before we have a full picture, but it’s clear that the number of uninsured Americans has already dropped significantly — not least in Mr. McConnell’s home state. It appears that around 40 percent of Kentucky’s uninsured population has already gained coverage, and we can expect a lot more people to sign up next year.
Republicans clearly have no idea how to respond to these developments. They can’t offer any real alternative to Obamacare, because you can’t achieve the good stuff in the Affordable Care Act, like coverage for people with pre-existing medical conditions, without also including the stuff they hate, the requirement that everyone buy insurance and the subsidies that make that requirement possible. Their political strategy has been to talk vaguely about replacing reform while waiting for its inevitable collapse. And what if reform doesn’t collapse? They have no idea what to do.
At the state level, however, Republican governors and legislators are still in a position to block the act’s expansion of Medicaid, denying health care to millions of vulnerable Americans. And they have seized that opportunity with gusto: Most Republican-controlled states, totaling half the nation, have rejected Medicaid expansion. And it shows. The number of uninsured Americans is dropping much faster in states accepting Medicaid expansion than in states rejecting it.
What’s amazing about this wave of rejection is that it appears to be motivated by pure spite. The federal government is prepared to pay for Medicaid expansion, so it would cost the states nothing, and would, in fact, provide an inflow of dollars. The health economist Jonathan Gruber, one of the principal architects of health reform — and normally a very mild-mannered guy — recently summed it up: The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.
And while supposed Obamacare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.
But nobody expects to see a lot of prominent Republicans declaring that rejecting Medicaid expansion is wrong, that caring for Americans in need is more important than scoring political points against the Obama administration. As I said, there’s an extraordinary ugliness of spirit abroad in today’s America, which health reform has brought out into the open.
And that revelation, not reform itself — which is going pretty well — is the real Obamacare nightmare.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April, 11, 2014
“Texas, Where Crazy Gets Elected”: There’s Crazy, And Then There’s Texas Crazy
So what happens in Texas when the Republican gubernatorial candidate invites Ted Nugent to the state to campaign for him not long after the Motor City Motormouth has called the President of the United States a “subhuman mongrel,” not to mention a “Communist” and a “gangster”? Would you believe, as Maxwell Smart used to say, that the candidate increases his lead? Well that’s what has happened. There’s crazy, and then there’s Texas crazy.
In a poll that came out Monday, conducted as the Nugent controversy was brewing, Republican Greg Abbott leads Democrat Wendy Davis by 11 points, which Politico notes is up from six points in a poll last year. Now there are surely other reasons for this little surgette, but it certainly shows that Abbott’s decision to keep company with Nugent did him no harm at all in the state.
You think that’s bad, get a load of this, from the same poll. The candidate leading the Democratic field for the right to seek John Cornyn’s Senate seat is a woman named Kesha Rogers. Two of her top ideas? Impeach Barack Obama and repeal the Affordable Care Act. Yes, you read it right. She’s the leading Democrat. She’s also a La Rouchie, a fact that far from hiding she seems intent to rub in the other candidates’ faces: I can ramble on about crazy worldwide banking conspiracies all I want, she seems to be saying, but as long as I want to impeach Obama and repeal Obamacare, you can’t touch me! There’s crazy, and there’s Texas crazy.
This would all be merely amusing, but there’s another side to Texas crazy. Let’s get serious now for a few paragraphs.
If you read me often enough, you know that one of my themes is that the Democrats, with enough money, creativity, and guts, ought to be able to turn Obamacare into a positive. Millions of people across the country, especially in the states that opted in and accepted the Medicaid money, have insurance now and the peace of mind about themselves and their children that comes with it. Besides which, have you noticed that all the Republican hoo-ha about these alleged horror stories never holds up on examination? Paul Krugman wrote a terrific column on this topic Monday. Literally every high-profile Obamacare-nightmare story retailed by one of these yoyos turns out, once reporters start poking around, not to be at all as advertised. So we have a party that loathes the ACA and its effects and many millions of dollars to go find its victims, and so far it hasn’t really turned up one.
Now—back to Texas. Two recent briefing papers from academics affiliated with the excellent Scholars’ Strategy Network shed considerable light on what Obamacare could be doing for Texas, if only its politicians would permit it.
Texas—hold on to your ten-gallon hat, because this is a shocker—leads the country in the percentage of its people who are uninsured; a gaudy 24.6 percent. Nearly 37 percent of Hispanics are without coverage, as are 22 percent of African Americans, and 23 percent of women. That’s a small army of people who would benefit from the state having accepted the federal Medicaid money and set up an exchange. But Texas’s leaders from Rick Perry on down are having none of it.
In one paper, Jessica Sharac, Peter Shin, and Sara Rosenbaum of George Washington University cite a recent study noting that “if Texas had agreed to expand Medicaid, more than two million uninsured people would likely have gained health insurance.” In another, Ling Zhu and Markie McBrayer of the University of Houston compare how poor people are faring so far in Texas and California, the latter of course being among the states that have accepted the Medicaid expansion. They write: “More than 2.2 million Californians were added to that state’s expanded Medicaid program by the end of January, compared to just over 80,000 Texans who signed up after realizing they were already eligible for the existing state Medicaid program.”
Together, the papers (they’re very short, you should go read them) paint the picture you’d expect. Our two largest states, one working to insure its people and the other doing everything in its power to prevent that. And remember—Texas could be doing this at very minimal cost. Washington is paying full freight on the expansion until 2016, and then a slightly declining share, but still, 90 percent every year after 2019. It’s almost free. And Texas ain’t playin’. Indeed Perry turned down (cue Dr. Evil) nine billion dollars.
So now let’s circle back to the governor’s race. Of course, Abbott opened his campaign last fall pounding Davis on Obamacare, thundering that she’d open the door to this iniquity. Davis has been talking a lot about Ted Nugent, but she’s had rather little to say on the subject of Perry refusing, and Abbott vowing to continue to refuse, $9 billion.
Would all those uninsured Latinos and blacks and women be energized to come out and vote for the candidate who dared to make a big issue of this? I admit it’s hard to say. But Davis is a long shot anyway. Nothing against her—Jesus himself could come back and run as a Democrat in that state, and rather than pull that Democratic lever for Him, most Texans would just wonder when the Redeemer went socialist on them (answer: he always was!).
Of course it would be risky. Of course she’d drop in the polls for a while. But she’d still have nearly eight months to explain to people that $9 billion is real money, that all this is happening anyway whether Texas Republicans like it or not, and since it is happening well by cracky she’s not going to leave millions of Texans not getting what their counterparts in other states are getting. As it is, those people have no one really fighting for them. That’s Texas crazy, too.
By: Michael Tomasky, The Daily Beast, February 26, 2014
“Pete Sessions And The GOP’s ‘Immoral’ Conservatism”: Allowing People To Die To Advance A Political Philosophy Isn’t Just Bad Policy
“It is immoral.”
That was the judgment of Rep. Pete Sessions, a Texas Republican and committee chairman, on the House floor this week. But the subject of his sermon wasn’t the Assad regime in Syria or human trafficking. What Sessions found immoral was the repugnant notion that the government would help Americans who lost their jobs and are looking for work.
Sessions was preaching in response to Democrats’ pleas that the Republican majority hold a vote on restoring unemployment-insurance benefits to the 1.7 million who have lost them since the benefits expired six weeks ago and the 70,000 or so who are losing them each week. Sessions, on the floor to usher through the House “sportsmen’s heritage and recreational enhancement” legislation, explained why he wouldn’t bring up jobless benefits: “I believe it is immoral for this country to have as a policy extending long-term unemployment to people rather than us working on creation of jobs.”
In fact, the economy has added about 8.5 million private-sector jobs in the last 47 months, and overall unemployment, at 6.6 percent in January, would be substantially lower if Sessions and his colleagues hadn’t been so successful in their “work” of cutting government spending when the recovery was fragile.
One result of the Great Recession, though, has been historically high long-term unemployment — 3.6 million people out of work 27 weeks or more, according to Friday’s Labor Department report. This is falling — by 1.1 million over the last year — but those still searching, from all parts of the country and all walks of life, need help.
Republican opponents of the benefits extension said they would consider extending that help if it were “paid for” by saving money elsewhere. So Senate Democrats drafted a three-month extension that was paid for using an accounting method Republicans have supported in the past. Republicans responded with another filibuster — and on Thursday they again succeeded in blocking an extension of benefits.
Those opposing unemployment insurance were conspicuously absent during the debate. Sen. Jim Inhofe (R-Okla.) was brave enough to issue a statement: “We can get Americans back to work and our economy booming again, but this is not achieved by Washington turning a temporary federal benefit into another welfare program.”
That echoes the Sessions complaint that extending benefits is “immoral.” And, as is often the case, these complaints, in turn, echo Rush Limbaugh. After President Obama on Jan. 31 signed a memorandum directing the federal government not to discriminate against the long-term unemployed, the radio host responded: “So he says, ‘I’m directing every federal agency to make sure we are evaluating candidates on the level, without regard to their employment history.’ What if they’re fired because they’re drunk? What if they’re fired because they were having affairs with the boss’s secretary? Doesn’t matter. Can’t look at that.”
Of course, the memorandum says no such thing. Limbaugh and his congressional apostles are justifying indifference to the unemployed much the way one denies a panhandler under the rationale that he would use the money only to buy more booze. But these are not panhandlers; these are, by definition, people who had been working and are trying to work again.
The Sessions/Inhofe/Limbaugh definition of morality is based in the ideal world of universal productivity they’d like to see, but it offers little help for human misery in the real world. This morality can be seen, too, in the attempt, led by Sen. Marco Rubio (R-Fla.) and embraced by many conservative lawmakers, to repeal the “risk corridors” that protect health insurers from unanticipated losses under Obamacare. That would likely bring down the entire health-care law, as its foes desire. But a collapse would also cause 30 million to 40 million additional people to lose their health insurance suddenly, with no obvious solution or easy way back to the old system. “It would precipitate a crisis,” says Larry Levitt of the Kaiser Family Foundation.
This morality is also at work in the decisions by 25 states under Republican control to reject the expansion of Medicaid offered under Obamacare. The states generally object because they are philosophically opposed to entitlement programs. But a new study from researchers at Harvard Medical School and City University of New York calculates that 7,115 to 17,104 more people will die annually than would have if their states had accepted the Medicaid expansion. The researchers, who favor a single-payer health system, examined demographic data and past insurance expansions.
Conservatives dispute the study’s findings, and I hope the critics are right. Allowing people to die to advance your political philosophy isn’t just bad policy. It’s immoral.
By: Dana Milbank, Opinion Writer, The Washington Post, February 7, 2014
“A Moral Issue”: Blacks, Latinos To Pay Disproportionate Price Over Blocked Medicaid Expansion
Minorities are disproportionately affected by 25 states’ decision to opt out of Medicaid expansion, a report finds.
Blacks make up 13 percent of the nation’s population but will represent 27 percent of those who will lose out on Medicaid coverage because of these states’ refusal to expand the program’s eligibility to the national standard under Obamacare, according to the 11th Annual Martin Luther King Jr. State of the Dream Report.
Latinos make up 15 percent of the population and 21 percent of the coverage gap. Whites, meanwhile, will be underrepresented—they are 65 percent of the population but have only 47 percent in the gap.
Had the Affordable Care Act been fully implemented, half of the 50 million people who were uninsured before the 2010 law was passed would gain access to coverage through the state and federal health insurance exchanges or the Medicaid expansion. Because of the 2012 Supreme Court decision that ruled states’ expansion of the program optional, 25 states have chosen not to expand Medicaid to include wage earners up to 138 percent of the federal poverty line.
The Medicaid coverage gap will leave out 5 million of the 10 million who would have gained coverage, exacerbating existing racial health disparities in the United States, a focus of Thursday’s report from the equal-rights group United for a Fair Economy.
Poor blacks are 7.3 times—and poor Latinos 5.7 times—as likely as poor whites to live in high-poverty neighborhoods that aggravate health problems. That gap is because of minorities’ limited access to health services and good food, as well as the great stresses from crime and racism, according to the report.
The data also find that 29 percent of Latinos, 19 percent of blacks, 15 percent of Asians, and 11 percent of whites were uninsured in 2012.
Republican governors are leading many of the states that have declined to expand the entitlement program. The federal government has committed to paying 100 percent of the expansion for the first few years, but the governors say they fear the feds will go back on their word, leaving states with unsustainable budget costs.
Other GOP governors have declined to expand the program out of ideological objections to an expansion of the nation’s social safety net.
The report’s authors are frustrated by the blocked expansion.
“With no expanded Medicaid, and little or no assistance to purchase insurance in the health exchanges, the actions of these elected leaders in these states are creating a vast hole in the new health care law—a 25-state coverage gap—through which nearly 5 million low income Americans will now fall,” UFE writes.
“Access to health care is, first and foremost, a moral issue,” the report continues. “It’s a question of right and wrong. Tolerating vast inequalities in health and health care along the lines of race or class sends the disturbing message that we as a society value the lives of people in various groups differently.”
Despite the blocked Medicaid expansion, the Affordable Care Act diminishes the racial health gap by expanding programs to promote diversity in health professions; supports cultural competency training to help doctors communicate with patients of color; and establishes research initiatives to explore the cause of health inequality. It also allows people with preexisting conditions—more common in impoverished neighborhoods due to the quality of life—to gain access to coverage.
But some people who do not have health insurance will continue to live without it. Others will be ineligible because of their immigration status. Still others won’t qualify because of their employment situation. Blacks and Latinos are more likely to work in lower-wage or part-time jobs where they are less likely to receive employer-sponsored coverage.
In addition to the lack of insurance and access to affordable health services, residential segregation and the stress of living in poverty are primary factors contributing to poor health in the black and Latino communities. Those types of communities are commonly found in “food deserts,” or areas of the country where people have little access to a grocery store with fresh produce and instead are surrounded by fast food joints. The report says that half of black neighborhoods lack a full-service grocery.
Among UFE’s recommendations to permanently close the racial health gap are the continued pursuit of a single-payer, universal health insurance system, where employment and work situations would no longer play a role in access, quality, and cost of care. They also, of course, hope to see all 50 states expand Medicaid and take the lead on fully implementing and supporting the Affordable Care Act.
They also propose increasing funding to permanently fund Medicaid at the federal level, heighten funding for outreach and education efforts, and allow undocumented immigrants to take part in the system. More systemic policies—more diverse housing, improved access to services in areas of extreme poverty, raising the minimum wage—would also help address the disparity between the races in overall population health.
By: Clara Ritger, The National Journal, January 16, 2014
“Obamacare And Emergency Rooms, A Bit Of Perspective Needed”: Oregon Study Doesn’t Undermine Affordable Care Act Claims
Headlines based on a study of emergency room visits by a few thousand Oregon Medicaid beneficiaries undoubtedly gave the Obama administration heartburn last week. Although the study predated the Medicaid expansion authorized by the Affordable Care Act — which began in some states on January 1 — many who wrote about the Oregon study jumped to the conclusion that the millions of newly enrolled Medicaid beneficiaries would make greater — not less — use of the ER for routine care.
I may be going out on a limb, but I for one don’t buy the idea that the Oregon study means emergency rooms are going to get even more crowded. And that’s because more Americans will finally have insurance.
Reform advocates have long suggested that getting folks out of the ranks of the uninsured should cut down on visits to the ER for noncritical medical care. Many people who lack coverage don’t have a primary care physician and all too often make trips to the ER when their illness or injury could have been treated more appropriately and inexpensively in a clinic or doctor’s office.
The Oregon study, which was published in the journal Science, would seem to disprove that theory.
In 2008, two years before the ACA was enacted, Oregon increased the number of Medicare beneficiaries in a novel way: by lottery. Many Oregonians who had been on a waiting list for the state’s Medicaid program got lucky when their names were drawn and they were added to the rolls.
The researchers who wrote the Science article studied the emergency room use of about 25,000 of the successful and unsuccessful lottery participants and found that those who won coverage actually made more trips to the ER over 18 months than those whose names were not drawn.
Headline writers were quick to draw their conclusions: Obamacare would not reduce unnecessary ER visits.
“Emergency Visits Seen Increasing with Health Law,” read the headline above the New York Times story last Thursday.
“Obamacare Medicaid Expansion to Worsen Hospital ER Burden,” said Bloomberg.
And Forbes gave us this: “New Oregon Data: Expanding Medicaid Increases Usage of Emergency Rooms, Undermining Central Rational for Obamacare.”
“For years,” wrote Forbes columnist Avik Roy, “it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. ‘Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,’ said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion.”
There is more than a bit of twisted logic in that paragraph. It is true that those of us with insurance pay considerably more for it because those who don’t have it often can’t pay for their ER care. That’s because the hospital shifts the cost of that “uncompensated care” to its insured customers. Researchers have estimated that people with insurance pay $1,000 more a year for it than they would if this cost shifting didn’t have to occur.
Bringing uninsured people into coverage eliminates much of that cost shifting. And that’s a good thing, considering that the vast majority of Americans with health coverage — even after the Medicaid expansion — get it through private insurance companies, either at work or on their own.
The actual increase in the number of visits per person among the newly insured in Oregon via the Medicaid lottery was 0.41. In other words, each new enrollee made 0.41 visits more on average during the 18 months than the 1.02 ER visits made by those who remained uninsured.
When you look at it from the perspective of those numbers, and the actual amount Oregon spent per person, as University of Chicago health policy expert Harold Pollack did in a healthinsurance.org post, this is far from a “sky is falling” disaster in the making. And it is actually reducing the cost shifting.
Also, as Pollack pointed out, “the emergency departments will be reliably paid for care they provide … (With coverage expansion) providers don’t have to fear the burdens or uncompensated care, and…they don’t need to cruelly pursue low-income patients over bad debts.
It’s also important to keep in mind that private insurers now manage most of the states’ Medicaid populations, and they will be vigilant in their efforts to steer their new Medicaid enrollees away from the ERs and to more appropriate and cost-effective settings. WellPoint subsidiary Amerigroup described in a recent policy brief, for example, how its efforts to reduce primary care-treatable ER visits among Medicaid beneficiaries resulted in a savings of more than 50 percent.
Rather than rushing to conclusions, let’s see how the Medicaid expansion under Obamacare actually plays out in the years ahead.
By: Wendell Potter, The Center for Public Integrity, January 6, 2014
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