“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
“The Psyche Of An Uninformed Conservative”: Rand Paul Needs To Stop Writing A Revisionist History Of Civil Rights
I understand that a revisionist history of the civil rights movement is of great psychological importance to some conservatives. We’ll probably hear a lot more of it on Monday in conjunction with a MLK Holiday many of their forebears opposed.
But Rand Paul’s forays into this area are just plain ill-advised. Last April he gave a speech at Howard University that pursued the ridiculous theory that the New Deal was essentially a complement to Jim Crow in its “enslavement” of African-Americans to the terrible indignity of material living assistance. And now we have this, via WaPo’s Aaron Blake:
Sen. Rand Paul (R-Ky.), in an interview Thursday, likened President Obama’s governing philosophy to the kind of “majority rule” that led to Jim Crow laws and Japanese internment camps.
Speaking on Fox News, Paul reacted to Obama’s repeated assertions that Republicans should win elections if they want to control the agenda in Washington. Obama has also suggested in recent days that he might pursue more executive actions — changes made without Congress.
“The danger to majority rule — to him sort of thinking, well, the majority voted for me, now I’m the majority, I can do whatever I want, and that there are no rules that restrain me — that’s what gave us Jim Crow,” Paul said. “That’s what gave us the internment of the Japanese — that the majority said you don’t have individual rights, and individual rights don’t come from your creator, and they’re not guaranteed by the Constitution. It’s just whatever the majority wants.”
Paul added: “There’s a real danger to that viewpoint, but it’s consistent with the progressive viewpoint. … Progressives believe in majority rule, not constitutional rule.”
Don’t be confused with the conflation of the Japanese interment outrage—a temporary product of wartime hysteria which no one at the time regarded as “progressive”—with Jim Crow. The original Constitution which Paul and his followers worship certainly didn’t concern itself with the rights of racial minorities. It took the most egregious exercise of “majority rule” in U.S. history—the Civil War—to abolish slavery. Only a majority given extraordinary power by the self-exclusion of southerners was in a position to pass the 13th, 14th and 15th amendments to the Constitution, the most important efforts taken until 1964 to vindicate the rights of racial minorities. It was a failure of will by the majority that led to the abandonment of Reconstruction and the establishment of the Jim Crow regime. And it was the power of the minority in the Senate (and by the 1930s or so, the minority in the Democratic Party) to thwart majority rule via the filibuster that kept Jim Crow in place for so very long.
And BTW, it’s conservatives, far more than progressives, who perpetually chafe at judicial enforcement of individual rights, unless it happens to coincide with their own policy goals. But in any event, Paul and others like him really need to stop trying to invoke the legacy of the Civil Rights movement to attack “majority rule” on behalf of a “constitutional conservatism” aimed at creating a oligarchical or even theocratic dictatorship of absolute private property rights and puny government. The “minorities” they want to protect are snowy white and very privileged.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, January 17, 2014
“Wage Boost Could Pay Democrats Dividends”: Republicans Blocking An Increase In The Federal Minimum Wage Do So At Their Own Peril
American liberalism and the Democratic Party — two partially overlapping but by no means identical institutions — have set themselves an unusually clear agenda for 2014: reducing economic inequality and boosting workers’ incomes. These are causes they can fight for on multiple fronts.
Raising the minimum wage should offer the course of least resistance. Although congressional Republicans may persist in blocking an increase in the federal minimum wage, they do so at their own peril. Raising the wage is one of the few issues in U.S. politics that commands across-the-board public support. A CBS News poll in November found that even 57 percent of Republicans support such an increase.
Democrats have concluded that they can turn Republican legislators’ opposition to raising the wage into an electoral issue by using state ballot measures. As states are free to set their own minimum-wage standards — though the rates take effect only when they exceed the federal minimum — Democrats are working to put wage-increase initiatives before voters in states that will have contested House and Senate races in 2014, including Arkansas, Alaska, South Dakota and New Mexico. Such ballot measures have proved an effective way to increase turnout of low-income and minority voters, which can translate into more ballots cast for Democratic candidates.
(Although economic libertarians object to the minimum wage on theoretical grounds, a look at the states that have refused to enact minimum-pay statutes suggests that the real opposition to the minimum wage is rooted in something else. Those states are Alabama, Louisiana, Mississippi, South Carolina and Tennessee — places where persistent racism and the heritage of slavery seem to me a far more likely cause of opposition to the minimum wage than any ideological infatuation with the works of Ayn Rand.)
Most efforts to raise the minimum wage this year are likely to come in blue states and cities. The recent leftward movement of U.S. cities, symbolized by the landslide election of Bill de Blasio as New York’s mayor, is an underappreciated factor in U.S. politics. Twenty years ago, six of the country’s dozen largest cities had Republican mayors. Today, none do, even when those cities — including Houston, Dallas and Phoenix — are nestled in red states. The transformation of major U.S. cities is rooted in demographics, as immigrants and young professionals — both preponderantly liberal constituencies — have clustered in urban areas.
In some states, cities have the power to raise the minimum wage above the state level. That’s how San Francisco was able to set its wage level above California’s and why Seattle is likely this year to raise its minimum wage well above that in the rest of Washington. New York City lacks that power, though it’s probable that de Blasio will try to persuade legislators in Albany that his city — one of the least affordable on the planet — should be given that freedom.
Whether they can raise their minimum wage or not, the nation’s ever-bluer cities have a range of other options to increase incomes. They could require developers that receive municipal tax breaks or other assistance to pay their employees a living wage above the minimum wage. They could enact paid sick leave or paid family leave requirements. They could reduce the local cost of living by requiring developers of luxury housing to build affordable housing as well.
At the federal level, too, Democrats can do more than battle for a higher minimum wage. They could call for an increase to the earned-income tax credit, an idea much loved by some conservatives (Ronald Reagan especially) that provides a federal supplement to the income of workers who fall below the poverty threshold. They could refuse to vote for the Trans-Pacific Partnership — a trade pact being negotiated with Pacific Rim nations, including such notably low-wage countries as Vietnam — or for the “fast-track” authority that would likely guarantee TPP passage unless the Congressional Budget Office can demonstrate that the measure won’t lower the wages of U.S. workers.
The ongoing efforts of fast-food workers and Wal-Mart employees to win higher pay will continue to remind both the public and legislators that millions of adults earn poverty-level wages in today’s United States. With the near-elimination of collective bargaining from the private sector, it will largely be up to Democrats in Congress, state legislatures and city halls to provide the wage boosts that unions once secured. That would help millions of Americans in their pocketbooks — and some Democratic candidates at the polls.
By: Harold Meyerson, Opinion Writer, The Washington Post, January 2, 2014
“Targeted Demobilization Of Minority Voters”: The Most Disgraceful Practice In American Politics Today
It’s called “targeted demobilization of minority voters.” The phrase comes from Perspectives on Politics, a leading journal published by the American Political Science Association. December’s issue includes a sobering article by Keith G. Bentele and Erin E. O’Brien titled, “Jim Crow 2.0? Why States Consider and Adopt Restrictive Voter Access Policies.” The abstract tells the basic story:
Recent years have seen a dramatic increase in state legislation likely to reduce access for some voters, including photo identification and proof of citizenship requirements, registration restrictions, absentee ballot voting restrictions, and reductions in early voting. Political operatives often ascribe malicious motives when their opponents either endorse or oppose such legislation. In an effort to bring empirical clarity and epistemological standards to what has been a deeply-charged, partisan, and frequently anecdotal debate, we use multiple specialized regression approaches to examine factors associated with both the proposal and adoption of restrictive voter access legislation from 2006-2011. Our results indicate that proposal and passage are highly partisan, strategic, and racialized affairs. These findings are consistent with a scenario in which the targeted demobilization of minority voters and African Americans is a central driver of recent legislative developments…. [emphasis added]
Bentele and O’Brien’s statistical analysis of 2006-2011 data makes plain what was already pretty obvious. Republican governors and legislatures have sought to hinder minority turnout for partisan purposes. States were especially likely to pass restrictive voting laws if Republicans were politically dominant, but where the state observed rising minority turnout or where the state was becoming more competitive in the national presidential race. Variables that capture the strategic value to Republicans of minority voter suppression are more powerful predictors of restrictive voting legislation than is actual incidence of voter fraud.
This is the most disgraceful and toxic practice in American political life. It’s out there. It’s blatant. I keep waiting for decent conservatives to speak out against this stuff. Now that would be a Sister Souldjah moment worth watching. So far, no takers.
Memories of these efforts will darken the Republican Party’s reputation for many years. It certainly should.
By: Harold Pollack, Ten Miles Square, The Washington Monthly, December 30, 2013
“The GOP’s Insane Race Strategy”: A Monstrous Injustice, Shoulder-To-Shoulder With The Worst Villains In American History
Over at TMS today, Harold Pollack highlights a stark paper from Perspectives on Politics. The Republican shameful record on minority voting during the 2012 election was a common story on the left. But after closer study, the results are in, and they aren’t pretty:
Our results indicate that proposal and passage are highly partisan, strategic, and racialized affairs. These findings are consistent with a scenario in which the targeted demobilization of minority voters and African Americans is a central driver of recent legislative developments.
Harold unpacks the study:
Bentele and O’Brien’s statistical analysis of 2006-2011 data makes plain what was already pretty obvious. Republican governors and legislatures have sought to hinder minority turnout for partisan purposes. States were especially likely to pass restrictive voting laws if Republicans were politically dominant, but where the state observed rising minority turnout or where the state was becoming more competitive in the national presidential race. Variables that capture the strategic value to Republicans of minority voter suppression are more powerful predictors of restrictive voting legislation than is actual incidence of voter fraud.
And sure, as Harold says, this is utterly disgraceful. But perhaps the most baffling aspect about this kind of behavior is that it doesn’t even work anymore. The GOP lost in 2012. Trying to systematically disenfranchise people along racial lines is a monstrous injustice that puts you shoulder-to-shoulder with some of the worst villains in American history. But if it doesn’t even work—and in fact inspires a larger overreaction, as seems to be the case, what is the point?
I think, as Josh Marshall suggested awhile ago putting this phenomenon in historical context, that these are longstanding political habits the downsides of which have only recently come into focus, as the country becomes steadily less white:
Does this mean the GOP is ‘racist’? No. At least not in its entirety. But it benefited mightily from it. What it means is that our politics is significantly framed around the politics of race and, on balance, it’s been a winning issue for the GOP for the 40 or 50 odd years since white Southerners moved into the Republican party and created a powerful electoral anchor for the party. They raised their sails to the winds of racial animosity and it worked in spades. For decades, you got more white votes pushing this brand of politics than you lost in minority votes. It was a good political bargain. But as the racial composition of the electorate changed, we reached a tipping, one that became visible in sharp relief in 2012.
It’s hard to know from the outside just what combination of wishful thinking, epistemic closure, belief in fake voter fraud, etc., motivates this kind of behavior. But it has to be true that the actual party operatives designing and pushing through these measures which are so obviously aimed at minority citizens know exactly what they’re doing. Here’s hoping that in the future, they’re cynical enough to know that strategy has run its course.
By: Ryan Cooper, Washington Monthly Political Animal, December 30, 2013
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