“A Closer Look At Those Falling Into The Wingnut Hole”: Nearly 80% Of People In The Health Care Coverage Gap Reside In The South
Yesterday the Kaiser Family Foundation released some badly needed data on the characteristics of Americans who fall into what I’ve dubbed the “wingnut hole,” and that others just call the Coverage Gap. These are the people too poor to qualify for Obamacare subsidies for purchasing insurance in the exchanges, but too “rich” to qualify for the Medicaid benefits the drafters of the ACA assumed they would get but that their state governments blocked once the Supreme Court let them make the choice. Here’s the Kaiser Family Foundation’s take on the problem:
Medicaid eligibility for adults in states not expanding their programs is quite limited—the median income limit for parents in 2014 will be 47% of poverty, or an annual income of about $9,200 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits…. Nationwide, nearly five million poor uninsured adults are in this situation.
Who are they? Well, they’re mostly southerners:
The nearly five million poor uninsured adults who will fall into the “coverage gap” are spread across the states not expanding their Medicaid programs but are concentrated in states with the largest uninsured populations…. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania. There are no uninsured adults in the coverage gap in Wisconsin because the state will provide Medicaid eligibility to adults up to the poverty level in 2014.
The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state take-up of the ACA Medicaid expansion. As a whole, more people—and in particular more poor uninsured adults— reside in the South than in other regions. Further, the South has higher uninsured rates and more limited Medicaid eligibility than other regions. Southern states also have disproportionately opted not to expand their programs, and 11 of the 25 states not expanding Medicaid are in the South. These factors combined mean nearly 80% of people in the coverage gap reside in the South
They’re also hard to define by race or ethnicity:
The characteristics of the population that falls into the coverage gap largely mirror those of poor uninsured adults. For example, because racial/ethnic minorities are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes, they are disproportionately represented among poor uninsured adults and among people in the coverage gap. Nationally, about half (47%) of uninsured adults in the coverage gap are White non-Hispanics, 21% are Hispanic, and 27% are Black (Figure 3).
And they’re often the people left behind in wave after wave of incremental reforms based on expanding Medicaid and S-CHIP benefits to kids and their parents.
The characteristics of people in the coverage gap also reflect Medicaid program rules in states not expanding their programs. Because non-disabled adults without dependent children are ineligible for Medicaid coverage in most states not expanding Medicaid, regardless of their income, adults without dependent children account for a disproportionate share of people in the coverage gap (76%)…. Still, nearly a quarter (24%) of people in the coverage gap are poor parents whose income places them above Medicaid eligibility levels. The parent status of people in the coverage gap varies by state….due to variation in current state eligibility.
What doesn’t vary state by state is how outrageous it is to exclude the people who by the accident of a court decision fall into the “wingnut gap” of benefits available to people just above them on the income scale. They are for the most part the “working poor,” people with part-time or small-business jobs that don’t come with private health insurance.
They are ineligible for publicly-financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own.
You can argue that these people are those most in need of the Affordable Care Act, yet most likely to be excluded from its benefits.
These are also people with an unusually large personal stake in the outcome of the 2014 elections–the kind of people conservatives are thinking of when they conclude Obamacare has created a “tipping point” wherein actual or potential beneficiaries of government programs are essentially being bribed into voting Democratic. But if there’s been any growing groundswell of political mobilization of people in the “wingnut hole,” it has been very quiet. So they will likely become objects of anti-redistribution propaganda from the Right without becoming subjects of any major Democratic comeback.
The latest hope for people in the “wingnut hole” has been enthusiasm for securing Medicaid expansion by very broad waivers allowing states to work their will on the Medicaid program as a whole. To be very blunt about it, such “deals” have tended towards broadening the base of people eligible for Medicaid while degrading its benefits, with the federal government paying almost all the cost of implementation and sharing the political risk that it might fail. The situation is a reminder that about a hundred fifty years after the end of the Civil War, southern states are still fighting the “Reconstruction” potential of federal funds to interfere with the region’s grim perpetuation of inequality.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
“Standing For What People Will Fall For”: Rick Scott Backs Off Medicaid Expansion Days After Announcing Re-Election Bid
Just after making his 2014 re-election campaign official, Florida governor Rick Scott (R) appears to be backtracking on Medicaid expansion, avoiding questions concerning his past support on the expansion of the program in his state.
During an appearance on Wednesday, reporters asked the governor if Florida would pursue federal funds available through the Affordable Care Act to expand the state’s Medicaid program.
Scott ignored the question and instead focused on criticizing the health care reform law, which he says will cause “300,000 people in our state” to lose their insurance before the new year.
The comments echoed those made just a day before, when Scott dodged another question about expanding Medicaid, saying that “the biggest issue we’re dealing with right now” is the health care cancelations he says people in his state are “concerned about.”
“On top of the fact you see the plans that have been proposed, they have high deductibles, so I’m concerned about cost, quality, and access to health care, that’s our biggest problem right now,” Scott said.
The comments hint that Scott is now retracting his support for Medicaid expansion – a stance he surprisingly took earlier this year when he said that he would accept Obamacare funding to expand the program for low-income Americans in his state.
Even though $51 billion in federal funds are available for Florida, the state’s GOP-controlled legislature refused to pass a budget that included funding for Medicaid expansion.
At the time, Scott declared that “while the federal government is committed to paying 100 percent of the costs, I cannot, in good conscience, deny Floridians who need access to healthcare.”
Scott’s most recent change of heart is not too surprising now that his re-election bid is official, but it does offer his Democratic challenger — and former Florida Republican governor — Charlie Crist a point of attack.
Considering that Florida has the second-highest uninsured rates in the nation, Medicaid is especially important to constituents, specifically the approximately 850,000 Floridians who do not qualify for subsidized insurance under the federal law, but also do not qualify for Medicaid.
Without an extension of the program, those 850,000 low-income Floridians will continue to go uninsured.
The entire state also stands to lose should Scott decide to reject federal funds to expand Medicaid; a report released by the Commonwealth Fund finds that not extending the program — which “generates a net loss of federal funds” — will cost Florida taxpayers a whopping $9.2 billion by 2022.
By: Elissa Gomez, the National Memo, December 12, 2013
“Lifestyle Investments For The Rich And Famous”: When Charity Begins At Home, Particularly The Homes Of The Wealthy
It’s charity time, and not just because the holiday season reminds us to be charitable. As the tax year draws to a close, the charitable tax deduction beckons.
America’s wealthy are its largest beneficiaries. According to the Congressional Budget Office, $33 billion of last year’s $39 billion in total charitable deductions went to the richest 20 percent of Americans, of whom the richest 1 percent reaped the lion’s share.
The generosity of the super-rich is sometimes proffered as evidence they’re contributing as much to the nation’s well-being as they did decades ago when they paid a much larger share of their earnings in taxes. Think again.
Undoubtedly, super-rich family foundations, such as the Bill and Melinda Gates Foundation, are doing a lot of good. Wealthy philanthropic giving is on the rise, paralleling the rise in super-rich giving that characterized the late nineteenth century, when magnates (some called them “robber barons”) like Andrew Carnegie and John D. Rockefeller established philanthropic institutions that survive today.
But a large portion of the charitable deductions now claimed by America’s wealthy are for donations to culture palaces – operas, art museums, symphonies, and theaters – where they spend their leisure time hobnobbing with other wealthy benefactors.
Another portion is for contributions to the elite prep schools and universities they once attended or want their children to attend. (Such institutions typically give preference in admissions, a kind of affirmative action, to applicants and “legacies” whose parents have been notably generous.)
Harvard, Yale, Princeton, and the rest of the Ivy League are worthy institutions, to be sure, but they’re not known for educating large numbers of poor young people. (The University of California at Berkeley, where I teach, has more poor students eligible for Pell Grants than the entire Ivy League put together.) And they’re less likely to graduate aspiring social workers and legal defense attorneys than aspiring investment bankers and corporate lawyers.
I’m all in favor of supporting fancy museums and elite schools, but face it: These aren’t really charities as most people understand the term. They’re often investments in the life-styles the wealthy already enjoy and want their children to have as well. Increasingly, being rich in America means not having to come across anyone who’s not.
They’re also investments in prestige – especially if they result in the family name engraved on a new wing of an art museum, symphony hall, or ivied dorm.
It’s their business how they donate their money, of course. But not entirely. As with all tax deductions, the government has to match the charitable deduction with additional tax revenues or spending cuts; otherwise, the budget deficit widens.
In economic terms, a tax deduction is exactly the same as government spending. Which means the government will, in effect, hand out $40 billion this year for “charity” that’s going largely to wealthy people who use much of it to enhance their lifestyles.
To put this in perspective, $40 billion is more than the federal government will spend this year on Temporary Assistance for Needy Families (what’s left of welfare), school lunches for poor kids, and Head Start, put together.
Which raises the question of what the adjective “charitable” should mean. I can see why a taxpayer’s contribution to, say, the Salvation Army should be eligible for a charitable tax deduction. But why, exactly, should a contribution to the Guggenheim Museum or to Harvard Business School?
A while ago, New York’s Lincoln Center held a fund-raising gala supported by the charitable contributions of hedge fund industry leaders, some of whom take home $1 billion a year. I may be missing something but this doesn’t strike me as charity, either. Poor New Yorkers rarely attend concerts at Lincoln Center.
What portion of charitable giving actually goes to the poor? The Washington Post’s Dylan Matthews looked into this, and the best he could come up with was a 2005 analysis by Google and Indiana University’s Center for Philanthropy showing that even under the most generous assumptions only about a third of “charitable” donations were targeted to helping the poor.
At a time in our nation’s history when the number of poor Americans continues to rise, when government doesn’t have the money to do what’s needed, and when America’s very rich are richer than ever, this doesn’t seem right.
If Congress ever gets around to revising the tax code, it might consider limiting the charitable deduction to real charities.
By: Robert Reich, The Robert Reich Blog, December 12, 2013
“Making The Poor, And The U.S. Poorer Still”: It’s Both Unjust And Economically Unsound For Congress To Cut Benefits To The Poor
Congress may take up legislation this week to cut food stamps. The Senate passed a bill in June mandating $4 billion in cuts over 10 years; the House version, passed in September, imposes nearly $40 billion in reductions. A conference committee has been charged with resolving these differences. Somehow, this negotiation is occurring amid the worst poverty levels in two decades, a weak overall economy and rapidly falling budget deficits. Under these circumstances, it would be economically and morally unsound to carry out the cuts.
Nearly 20 percent of Americans are officially poor or near poor. The Census Bureau reports that 15 percent of the population — nearly 47 million people — lives in poverty, including 22 percent of children. For an individual, this means annual income of $12,000 or less. For a family of four, the poverty threshold is $24,000 or less. Consider what living on those amounts would mean.
Roughly 18 million other people are near poor, living within 130 percent of the poverty line, according to census data. For individuals, this means earning $15,000 or less. These people often weave in and out of official poverty, depending on the month.
Most Americans living in poverty experience hunger or the pervasive fear of it. The U.S. Department of Agriculture reported that 49 million Americans, including 16 million children, lived in food-insecure households last year. That means that at some point in 2012, these households did not have enough food or were uncertain of having enough. That is as if all of California, Oregon and Washington were experiencing hunger or were afraid of it. There are serious social, economic and health consequences; for instance, diabetes, obesity and other chronic conditions afflict Americans who don’t have access to adequate nutrition.
Total federal spending on the Supplemental Nutrition Assistance Program (SNAP), this country’s main hunger prevention program, was $82.5 billion in fiscal 2013. To some that sounds like a lot, but it’s a small fraction of a $3.5 trillion budget and $16 trillion economy. This is evident when per-capita benefits are studied: The 2009 American Recovery and Reinvestment Act temporarily raised the weekly SNAP benefit by $25 to $33 for a family of four. But that temporary increase was allowed to expire this fall, so the SNAP benefit is back to the lower figure, or less than $1.40 per person per meal. These are small amounts relative to grocery costs, and even then only those with incomes below 130 percent of the poverty line are eligible for the aid.
It is hard to reconcile traditional American values of hard work and generosity with the levels of poverty and fear of hunger in our country, especially because large shares of those suffering this plight work. Nearly 11 million working Americans had annual income below the poverty line last year.
The working poor or near poor are also disadvantaged by our tax system. When a low-wage worker gets a raise or his or her spouse joins the workforce, food stamps are cut back. The family’s Medicaid eligibility is in jeopardy, and earned-income tax credit refunds are reduced or eliminated. A November 2012 Congressional Budget Office analysis concluded that the marginal tax rate imposed on increased income for such workers can be as much as 95 cents on every additional dollar earned. This is counterproductive.
Food stamps aren’t just a question of social justice; they are also a matter of economic policy. SNAP spending was increased in 2009 as part of the stimulus legislation to help rescue the economy. Like other elements of that legislation, the idea was to put money into the pockets of financially distressed Americans who would immediately spend it. The CBO reported that this legislation was largely effective in protecting the economy. More broadly, investments such as SNAP equip the poor and near poor to succeed economically. Good nutrition — as well as health care, education and secure housing — is a requisite for productivity, helping unemployed or marginally employed workers move into better jobs. This also allows them to build a better life for their children.
We believe that it would be both unjust and economically unsound for Congress to cut benefits to the poor and near poor. It has been a generation since our country last had a robust conversation about combating poverty. Now is the time to reinvigorate that conversation, not cut needed benefits.
“Today’s GOP”: Clueless, Heartless, And Gutless
The most charitable thing you can say about the Republican Party is that it has an image problem. Even if you support its policies, no clear-eyed observer can deny that on any given day the GOP looks clueless, heartless, and gutless.
Just take today. For all of President Obama’s problems and their correlation to the future of the Democratic Party (see: lack of credibility and competence), it takes just four stories to see how much worse things are for the GOP.
“Invisible Child: Dasani’s Homeless Life“ is a wrenching New York Times portrait of a girl stuck in poverty in the shadow of Manhattan’s opulence. More than that, it’s the story of our times.
In the short span of Dasani’s life, her city has been reborn. The skyline soars with luxury towers, beacons of a new gilded age. More than 200 miles of fresh bike lanes connect commuters to high-tech jobs, passing through upgraded parks and avant-garde projects like the High Line and Jane’s Carousel. Posh retail has spread from its Manhattan roots to the city’s other boroughs. These are the crown jewels of Mayor Michael R. Bloomberg’s long reign, which began just seven months after Dasani was born.
In the shadows of this renewal, it is Dasani’s population who have been left behind. The ranks of the poor have risen, with almost half of New Yorkers living near or below the poverty line. Their traditional anchors—affordable housing and jobs that pay a living wage—have weakened as the city reorders itself around the whims of the wealthy.
Long before Mayor-elect Bill de Blasio rose to power by denouncing the city’s inequality, children like Dasani were being pushed further into the margins, and not just in New York. Cities across the nation have become flash points of polarization, as one population has bounced back from the recession while another continues to struggle. One in five American children is now living in poverty, giving the United States the highest child poverty rate of any developed nation except for Romania.
Written by Andrea Elliott and illustrated by photographer Ruth Fremson, Dasani’s story is an indictment of a political system that is aiding and abetting America’s division by class, where the rich get richer, the poor get poorer, and the middle class gets squeezed into oblivion. Both major parties are complicit, but Republicans, more than Democrats, seem especially eager to widen and exploit American inequality. Take the next story, for example.
“Rand Paul: Unemployment Benefits Extension Would Be a ‘Disservice’ to Workers.” Unless Congress extends the Emergency Unemployment Compensation program, 1.3 million long-term jobless Americans will lose their benefits during the holidays. That’s good news, says the senator from Kentucky who hopes to be the 2016 GOP presidential nominee.
“When you allow people to be on unemployment insurance for 99 weeks, you’re causing them to become part of this perpetual unemployed group in our economy,” Paul argued on Fox News Sunday, citing an unnamed study. “I do support unemployment benefits for the 26 weeks that they’re paid for. If you extend it beyond that, you do a disservice to these workers,”
He’s wrong, and he’s making the GOP look clueless. Studies typically cited by the GOP are old and irrelevant to the current economy, which is in the midst of a once-a-century economic shift that makes it extraordinarily difficult for some workers to adjust.
Obama and fellow Democrats support the extension but seem unwilling to make it a precondition for a short-term budget deal. That means Republicans will probably get their way, and the have-nots will have less. Making matters worse …
“Making the Poor Poorer” is an op-ed in The Washington Post by Clinton-era Treasury Secretary Robert Rubin, Deputy Treasury Secretary Roger Altman, and economist Melissa Kearney. They argue that GOP-led plans to reduce food stamps would be “economically and morally unsound.” Despite shrinking social mobility and durable unemployment, Congress is poised to reduce a benefit that currently amounts to just $1.40 per person per meal. It looks heartless.
“It is hard to reconcile traditional American values of hard work and generosity with the levels of poverty and fear of hunger in our country, especially because large shares of those suffering this plight work,” they wrote. “Nearly 11 million working Americans had annual income below the poverty line last year.”
Republicans argue that the food-stamp program is growing, which they blame on Democrats rather than a global economic revolution and the lingering effects of a recession rooted in Clinton- and Bush-era policies. It most cases, poverty isn’t the fault of the poor. Trust us, the GOP says. And yet …
“The Bogus Claim That Obama Is ‘Closing’ the Vatican Embassy” is a Washington Post story that has nothing to do with the economy but everything to do with trust. Former Florida Gov. Jeb Bush and the Republican senatorial campaign committee falsely accused the White House of closing the embassy. The committee went so far as to call the White House anti-religion, a hateful slur. This is what political parties do: Find and create issues that divide Americans, exploit our ignorance and fear, and repeat.
The Republican Party, in particular, doesn’t have the courage to defy extreme elements of its coalition, such as those who pushed the Vatican-closing story. Bush knew or should have known that the story was wrong. The same goes for the National Republican Senatorial Campaign Committee. Indeed, sources tell me that there was some internal debate about whether to launch the attack. Level heads didn’t prevail. Gutless won.
By: Ron Fournier, The National Journal, December 9, 2013
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