“The Fight Is History, Done, Finito”: The Affordable Care Act Is Here To Stay
Now that the fight over Obamacare is history, perhaps everyone can finally focus on making the program work the way it was designed. Or, preferably, better.
The fight is history, you realize. Done. Finito. Yesterday’s news.
Any existential threat to the Affordable Care Act (ACA) ended with the popping of champagne corks as the new year arrived. That was when an estimated 6 million uninsured Americans received coverage through expanded Medicaid eligibility or the federal and state health insurance exchanges. Obamacare is now a fait accompli; nobody is going to take this coverage away.
There may be more huffing, puffing and symbolic attempts at repeal by Republicans in Congress. There may be continued resistance and sabotage by Republican governors and GOP-controlled state legislatures. But the whole context has changed.
Now, officials in states that refused to participate in Medicaid expansion will have to explain why so many of their constituents — about 5 million nationwide — remain uninsured when they could have qualified for coverage. More than 1 million of these needlessly uninsured Americans live in Texas, which is targeted by Democrats as ripe for inroads because of its rapidly changing demographics. Will Gov. Rick Perry (R) be forced to reconsider his Obamacare rejectionism? Or will he ultimately be remembered for speeding the state’s transition from red to blue?
Performance of the federal insurance exchange Web site, HealthCare.gov, will continue to improve, if only because the initial flood of applicants is bound to subside. Meanwhile, insurance costs and benefits in states that refused to set up their own exchanges will be compared with those in states that did. There will be questions about how the new law is performing — but no one will be able to pretend it does not exist.
And we will surely hear more stories about individuals taking advantage of the law’s consumer benefits, especially the fact that preexisting conditions can no longer be used to deny coverage. This is life-changing for insurance seekers who suffer from chronic illnesses such as diabetes or who have survived cancer.
Opponents of the law can hardly advocate going back to a system in which those who really need insurance can’t get it. What they can do, and surely will, is make lots of noise by pretending that any problem with anyone’s health insurance is due to the Affordable Care Act. Before Obamacare, millions of Americans had their policies canceled by the insurance companies every year. Millions more had their premiums raised, their coverage reduced or both. Now when these things happen, critics will try to blame the new law.
Increasingly, though, the GOP will sound foolish and irrelevant if it continues to put all of its eggs in the “repeal and replace” basket. The problem is that the Affordable Care Act is a set of free-market reforms based on ideas developed in conservative think tanks. Republicans who want to repeal Obamacare would have to replace it with something suspiciously similar.
If Republicans in Congress would work with the administration to make technical corrections to the Affordable Care Act, they could claim a victory of sorts: Obama gave you this mess and we cleaned it up. But after demonizing the program — and the president — for so long, the party has painted itself into a corner.
Note to the GOP: “We refuse, under any circumstances, to make the law work better for the citizens we represent” is perhaps not the ideal campaign slogan for the midterm election.
The real problem with the ACA, and let’s be honest, is that it doesn’t go far enough. The decision to work within the existing framework of private, for-profit insurance companies meant building a tremendously complicated new system that still doesn’t quite get the job done: Even if all the states were fully participating, only about 30 million of the 48 million uninsured would be covered.
But Obamacare does establish the principle that health care is a right, not a privilege — and that this is true not just for children, the elderly and the poor but for all Americans.
Throughout the nation’s history, it has taken long, hard work to win universal recognition of what we consider our basic rights. Perhaps future legislation will expand and streamline the ACA reforms until everyone is covered. Or perhaps we’ll move toward a single-payer system, possibly by expanding Medicare and Medicaid until they meet in the middle.
I don’t know how we’ll get there, but we’re now on the road to universal health care. There’s no turning back.
By: Eugene Robinson, Opinion Writer, The Washington Post, January 3, 2014
“The South’s New Lost Cause”: A Mason-Dixon Line Of Health Care Dispair
Before he was immortalized for saving the union, freeing the slaves and giving the best political speech in American history, Abraham Lincoln was just an unpopular new president handed a colossal crisis. Elected with 39.7 percent of the vote, Lincoln told a big lie in his inaugural address of 1861.
“I have no purpose, directly or indirectly, to interfere with the institution of slavery in the states where it exists,” he said, reaching out to the breakaway South. “I believe I have no lawful right to do so, and I have no inclination to do so.”
He was saying to a Confederacy that would enshrine owning another human being in its new constitution: If you like the slaves you’ve got now, you can keep them. It was a lie in the sense that Lincoln made a promise, changed by circumstances, that he broke less than two years later — and probably never meant to keep.
The comparisons of President Obama to Lincoln fade with every day of the shrinking modern presidency. As for the broken-promise scale: Lincoln said an entire section of the country could continue to enslave more than one in three of its people. Obama wrongly assured about five million people that they could keep their bare-bones health plans if they liked them (later amended when it turned out not to be true).
As inapt as those comparisons are, what is distressingly similar today is how the South is once again committed to taking a backward path. By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States.
And they are doing it out of spite. Elsewhere, the expansion of Medicaid, the health care program for the poor, has been one of the few success stories of Obamacare. It may be too complicated for the one-dimensional Beltway press. Either that, or it doesn’t fit the narrative of failure.
But in the states that have embraced a program that reaches out to low-wage workers, almost 500,000 people have signed up for health care in less than two months time. This is good for business, good for state taxpayers (because the federal government is subsidizing the expansion) and can do much to lessen the collateral damages of poverty, from crime to poor diets. In Kentucky, which has bravely tried to buck the retrograde tide, Medicaid expansion is projected to create 17,000 jobs. In Washington, the state predicts 10,000 new jobs and savings of $300 million in the first 18 months of expansion.
Beyond Medicaid, the states that have diligently tried to make the private health care exchanges work are putting their regions on a path that will make them far more livable, easing the burden of crippling, uninsured medical bills — the leading cause of personal bankruptcy.
And those states aren’t going to turn back the clock and revert to the bad old days, no matter how Republicans try to kill health care reform in the wake of the federal rollout. Many are refusing to accept Obama’s “fix” of allowing people to keep sketchy health care policies. If they follow the pattern of Massachusetts — where a mere 123 people enrolled in the first month of Romneycare, after which it gradually took off — the progressive states could end up with more than 95 percent of their residents insured.
What we could see, 10 years from now, is a Mason-Dixon line of health care. One side (with exceptions for conservative Midwest and mountain states) would be the insured North, a place where health care coverage was affordable and available to most people. On the other side would be the uninsured South, where health care for the poor would amount to treating charity cases in hospital emergency rooms.
Texas, where one in four people have no health care and Gov. Rick Perry proudly resists extending the Medicaid helping hand to the working poor, would be the leading backwater in this Dixie of Despair. In the 11 states of the old Confederacy, only Arkansas and Tennessee are now open to Medicaid expansion.
The South, already the poorest region in the country, with all the attendant problems, would acquire another distinction — a place where, if you were sick and earned just enough money that you didn’t qualify for traditional Medicare, you might face the current system’s version of a death panel.
The only good news is that a handful of political leaders down South have grasped the utter stupidity of refusing to help their own people, or even giving the state exchanges a chance. In this month’s recent special election for a congressional seat in a solidly Republican Louisiana district, a pragmatic businessman, Vance McAllister, beat a Tea Party candidate with the full Obama derangement syndrome. The winner said Obamacare was the law of the land and might as well be applied in Louisiana, the nation’s third poorest state. (It didn’t hurt that he had the backing of a “Duck Dynasty” star.)
But most of the South is defiant — their own Lost Cause for the 21st century.
By: Timothy Egan, Op-Ed Contributor, The New York Times, November 21, 2013
“The GOP Blocking Of Medicaid Expansion”: The Huge Obamacare Story You Aren’t Reading About That Could Help Even More People
Today it’s a few hundred thousand people. By next year, it will be at least a few million. Their health insurance status is changing dramatically: What they have in 2014 and beyond will look nothing like what they had in 2013 and before. For many of these people, the difference will be hundreds or even thousands of dollars a year. In a few cases, it may be the difference between life and death.
You probably think I’m talking about the people getting cancellation notices about their private insurance policies. I’m not. I’m talking about the people getting Medicaid. Both stories are consequences of the Affordable Care Act. But one is getting way, way more attention than the other.
It’s no mystery why. Stories of people losing something are more compelling than stories of people gaining something. The policy cancellation story is also newsier, because fewer people expected it to happen. Obamacare’s expansion of Medicaid was something the advocates of reform advertised. Reform’s effect on people with skimpy or medically underwritten insurance policies they liked was something that few advocates, including the president, even acknowledged. Had Obama pointed out, all along, that some people might lose existing plans or pay more for coverage in 2014, it would seem a lot less shocking.
But there is also a class element to the way this debate has evolved. By and large, the people receiving those cancellation notices and facing large premium increases are at least reasonably affluent. They’re not necessarily rich, particularly if they live in higher cost areas of the country. Many of them sweat monthly bills just like most of the country does. But, by definition, they don’t qualify for huge subsidies that would offset premium increases mostly or completely. By contrast, the people getting Medicaid are poor. They have to be, because it’s the only way to sign up for the program. And as political scientists have shown, the poor don’t command the same kind of attention from politicians that the middle class—and particularly the upper middle class—does.
And this fact, I suspect, is also magnifying the impact of those cancellation letters. The best estimates suggest that 12 to 15 million people currently buy coverage on their own—i.e, in what’s known as the non-group market. It appears that only a fraction of them will get to keep their current policies. The rest will end up having to get new coverage, or updated versions of their old coverage, that offers greater benefits and/or is available to everybody, regardless of pre-existing condition. That will drive up the price of insurance.
But when you take into account the subsidies, which for many people will knock the price of insurance right back down, and the number of people who would gladly pay more for insurance that offers real protection from financial shock, the number of people who truly end up feeling worse off ends up a lot smaller than 12 or 15 million. And even those people will end up with good health insurance, though they’ll be paying more for it and may not want it.
Meanwhile, the best available projections suggest that 13 million people will eventually sign up for Medicaid. That’s a much larger number of people, most of whom had no insurance—none—before. That doesn’t even include more than ten million presently uninsured people expected to get insurance through employers and the new marketplaces, assuming all of the websites start working better, or the millions of seniors getting extra help with their prescrpition drugs.
Of course, the story of the Medicaid expansion is also one of suffering. But that’s because Republicans governors and lawmakers are blocking expansion of Medicaid in their states. About 5 million people who would be eligible for Medicaid under Obamacare’s new guidelines won’t be getting it. Here’s a mental exercise. How many stories have cable news and the networks run about people with private insurance getting cancellation notices? And how many have they run about people who would be getting Medicaid if only their state lawmakers would stop blocking expansion?
You can find examples. My colleague Alec MacGillis has waged a lonely crusade to remind people about this situation. The New York Times had a terrific front-page story on this in early October. In the Washington Post, Ruth Marcus on Friday wrote about Paul Tumulty, in Texas, who can’t get insurance because Governor Rick Perry has blocked that state’s Medicaid expansion. Tumulty, who is the brother of Post staff writer Karen, has kidney disease. Wiithout Medicaid he can’t get comprehensive coverage, because, as Karen put it, “he is, paradoxically, too poor for subsidies.”
But these articles are the exception more than the rule. Obama tried to draw attention to the issue last week, when he visited Texas. But the trip didn’t generate much in the way of new coverage of Medicaid.
Should the president have been more candid about the impact his plan would have on people buying their own coverage? Yes. Should we pay attention to those people, particularly when they must now pay more for equivalent coverage? Definitely. Should this put extra pressure on the administration and some states to fix their websites? You bet. But that’s not the only Obamacare news right now. The law is making life better for a great many people—and would help even more if only Republican lawmakers would relent. Those stories need attention, too.
By: Jonathan Cohn, the New Republic, November 10, 2013
“The Republican Self-Preservation Act”: Texas Voter ID Law Discriminates Against Women, Students And Minorities
Texas’s new voter ID law got off to a rocky start this week as early voting began for state constitutional amendments. The law was previously blocked as discriminatory by the federal courts under the Voting Rights Act in 2012, until the Supreme Court invalidated Section 4 of the VRA in June. (The Department of Justice has filed suit against the law under Section 2 of the VRA.) Now we are seeing the disastrous ramifications of the Supreme Court’s decision.
Based on Texas’ own data, 600,000 to 800,000 registered voters don’t have the government-issued ID needed to cast a ballot, with Hispanics 46 to 120 percent more likely than whites to lack an ID. But a much larger segment of the electorate, particularly women, will be impacted by the requirement that a voter’s ID be “substantially similar” to their name on the voter registration rolls. According to a 2006 study by the Brennan Center for Justice, a third of all women have citizenship documents that do not match their current legal name.
Just yesterday, this happened (via Rick Hasen), from KiiiTV in South Texas:
“What I have used for voter registration and for identification for the last 52 years was not sufficient yesterday when I went to vote,” 117th District Court Judge Sandra Watts said.
Watts has voted in every election for the last forty-nine years. The name on her driver’s license has remained the same for fifty-two years, and the address on her voter registration card or driver’s license hasn’t changed in more than two decades. So imagine her surprise when she was told by voting officials that she would have to sign a “voters affidavit” affirming she was who she said she was.
“Someone looked at that and said, ‘Well, they’re not the same,’” Watts said.
The difference? On the driver’s license, Judge Watts’s maiden name is her middle name. On her voter registration, it’s her actual middle name. That was enough under the new, more strict voter fraud law, to send up a red flag.
“This is the first time I have ever had a problem voting,” Watts said.
The disproportionate impact of the law on women voters could be a major factor in upcoming Texas elections, especially now that Wendy Davis is running for governor in 2014.
Moreover, the state is doing very little to make sure that voters who don’t have an ID can get one. As I mentioned, 600–800,000 registered voters don’t have an acceptable voter ID, but according to the Dallas Morning News “only 41 of the new cards were issued by DPS [Department of Public Safety] as of last week.”
Getting a valid photo ID in Texas can be far more difficult than one assumes. To obtain one of the government-issued IDs now needed to vote, voters must first pay for underlying documents to confirm their identity, the cheapest option being a birth certificate for $22 (otherwise known as a “poll tax”); there are no DMV offices in eighty-one of 254 counties in the state, with some voters needing to travel up to 250 miles to the closest location. Counties with a significant Hispanic population are less likely to have a DMV office, while Hispanic residents in such counties are twice as likely as whites to not have the new voter ID (Hispanics in Texas are also twice as likely as whites to not have a car). “A law that forces poorer citizens to choose between their wages and their franchise unquestionably denies or abridges their right to vote,” a federal court wrote last year when it blocked the law.
Texas has set up mobile voter ID units in twenty counties to help people obtain an ID, but has issued new IDs to only twenty voters at the sites so far.
Supporters of the voter ID law, such as Governor Rick Perry, argue that it’s necessary to stop the rampant menace of voter fraud. But there’s no evidence that voter impersonation fraud is a problem in Texas. According to the comprehensive News21 database, there has been only one successful conviction for voter impersonation—I repeat, only one—since 2000.
Texas has the distinction of being one of the few states that allows you to vote with a concealed weapons permit, but not a student ID. Provisions like these suggest that the law was aimed less at stopping voter fraud and more at stopping the changing demographics of the state. Based on what we’re seeing thus far, the law might better be described as the Republican Self-Preservation Act.
By: Ari Berman, The Nation, October 23, 2013
“We Only Discriminate For Partisan Reasons”: Texas Struggles To Defend Discriminatory Voting Policies
It’s been about three weeks since the Justice Department, relying on what’s left of the Voting Rights Act, went after voter-discrimination policies in Texas. The U.S. Supreme Court may have severely damaged the VRA, but the Justice Department nevertheless argued that when “intentional voting discrimination” is found, changes to voting rights cannot be permitted to continue.
This week, as Adam Serwer reported, Texas submitted a brief presenting their defense.
Texas didn’t discriminate against minority voters. It was only because they were Democrats. And even if it did, the racial discrimination Texas engaged in is nowhere near as bad as the stuff that happened in the 1960s.
These are some of the arguments the state of Texas is making in an attempt to stave off federal supervision of its election laws. In late July, citing the state’s recent history of discrimination, the Justice Department asked a federal court to place the entire state back under “preclearance.” That means the state would have to submit its election law changes in advance to the Justice Department, which would ensure Texas wasn’t disenfranchising voters on the basis of race.
The arguments from Gov. Rick Perry’s (R) administration are pretty amazing, especially considering federal courts already found Texas’ election policies discriminatory as recently as two years ago, before the Supreme Court intervened.
As Kevin Drum explained, Texas’ first argument, as pushed by state Attorney General Greg Abbott, “is that, sure, Texas has tried to discriminate as recently as 2011, but their efforts were overturned by a court. So that means there are no current violations, and thus no reason to grant any kind of ‘equitable relief.'”
The second argument is the half-glass-full tack. As Serwer put it, “[T]he state claims, even if Texas did discriminate, and the state stresses that it did not, it was nothing as bad as ‘the ‘pervasive,’ ‘flagrant,’ ‘widespread,’ and ‘rampant’ discrimination that originally justified preclearance in 1965.’ So as long as Texas skies aren’t alight with flames from burning crosses, what’s the big whoop?”
But it’s the third argument that’s truly amazing.
From the brief filed by the state:
DOJ’s accusations of racial discrimination are baseless. In 2011, both houses of the Texas Legislature were controlled by large Republican majorities, and their redistricting decisions were designed to increase the Republican Party’s electoral prospects at the expense of the Democrats….The redistricting decisions of which DOJ complains were motivated by partisan rather than racial considerations, and the plaintiffs and DOJ have zero evidence to prove the contrary.
Got that? Texas wasn’t trying to discriminate against racial and ethnic minorities; Texas was simply trying to discriminate against racial and ethnic minorities who vote for Democrats.
In other words, Texas’ defense is that state policymakers were trying to crush the Democratic vote, and this led to inadvertent discrimination against African Americans and Latinos. As such, the argument goes, Texas was motivated by crass partisanship, and not racism, so the discrimination doesn’t really count.
Any chance this might be persuasive in court? Brenda Wright, a voting law expert with the liberal think tank Demos, told Serwer, “I don’t think it’s going to work, frankly. The mere desire to achieve partisan advantage does not give Texas a free hand to engage in racial discrimination. If the only way you can protect white incumbents is by diluting the voting strength of Hispanic citizens, you are engaging in intentional racial discrimination, and the courts will see that.”
By: Steve Benen, The Maddow Blog, August 13, 2013
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