The unfortunate victim is 32 year-old Charlene Dill, an uninsured mother living in Florida, who passed away from complications around a treatable heart condition. It mostly went untreated because Dill was poor and uninsured in a state that so-far refuses to expand Medicaid.
Brian Beutler, now writing for The New Republic:
She also fell into what policy experts call the Medicaid coverage gap — a hole the Supreme Court punctured in the health safety net when seven of its justices rendered the Affordable Care Act’s Medicaid expansion entirely voluntary.
Over 20 Republican state governments have ripped that hole wide open by refusing billions of federal dollars, offered on the sole condition that they be used to insure residents who earn less than 138 percent of the federal poverty level. In their states, residents who weren’t previously eligible for Medicaid, but currently earn too little to qualify for subsidies to purchase private insurance, are out of luck. Experts estimate that five million people nationwide have fallen into the gap. Nearly a million of those people reside in Florida alone — collateral damage in the GOP’s war against Obamacare. Dill was one of those people. She was selling a vacuum cleaner to earn the money she needed to buy her heart medication when she collapsed.
He further raises some important distinctions on the moral imperative of highlighting these stories in the effort to eliminate the coverage gap in non-expanding states. But the real tyranny is giving poor folks a fighting chance when the freedom to die selling vacuum cleaners for heart meds is so much sweeter.
When I was thirteen I was nervous around girls and the people who bullied me for being too quiet. At seventeen I was thinking about going to college for art, and saying goodbye to the father of my late dad. I was not worried about exercising agency in a social structure that demands different behavior based on the color of my skin, or else.
Earlier this month a Florida judge declared a mistrial over the killing of 17 year-old Jordan Davis. The person who shot him, Michael Dunn, white, had fired several rounds into a vehicle with Davis, black, and his friends after a disagreement over loud music.
There’s a lot more to this story, but none more achingly tragic than the fact that a son was murdered for talking while black in front of the wrong person. There is no better chronicler of this than Ta-Nehisi Coates, who took his 13 year-old son to speak with Davis’ mother.
Last Thursday, I took my son to meet Lucia McBath, because he is 13, about the age when a black boy begins to directly understand what his country thinks of him. His parents cannot save him. His parents cannot save both his person and his humanity. At 13, I learned that whole streets were prohibited to me, that ways of speaking, walking, and laughing made me a target. That is because within the relative peace of America, great violence—institutional, interpersonal, existential—marks the black experience. The progeny of the plundered were all around me in West Baltimore—were, in fact, me. No one was amused. If I were to carve out some peace myself, I could not be amused either. I think I lost some of myself out there, some of the softness that was rightfully mine, to a set of behavioral codes for addressing the block. I think these talks that we have with our sons—how to address the police, how not to be intimidating to white people, how to live among the singularly plundered—kill certain parts of them which are as wonderful as anything. I think the very tools which allow us to walk through the world, crush our wings and dash the dream of flight.
Jordan Davis was also given a series of talks, which McBath believes ultimately got him killed.
That’s the beginning. Read the rest.
Since the beginning of last year there’s been a successive wave of states moving forward on expanding Medicaid under the Affordable Care Act. Indiana, led by the fairly conservative Republican Governor Mike Pence who opposes the ACA, has thus far refused to expand the joint federal-state insurance program that provides comprehensive coverage for low-income Americans.
Yet it hasn’t been an entirely silent refusal. In 2013 Indiana requested, and ultimately received, an extension of a pilot program (HIP) that provides health insurance coverage through high-deductible plans paired with health savings accounts to almost 40,000 low-income Hoosiers. As a part of that request the state also inquired about expanding HIP using Medicaid expansion funding provided by the 2010 health care law.
To my knowledge there’s been no official response on that question, but last November Governor Pence quietly requested a meeting with Health and Human Services Secretary Kathleen Sebelius to further discuss the possibility. On Friday that meeting happened. Read the rest of this entry
I’m a little late to this but feel free to file this news under “Things that won’t happen this year;” the state of Indiana won’t put a measure on this year’s midterm election ballot that would constitutionally ban the state from recognizing same-sex marriages.
The Indianapolis Star reported last Friday:
A decision Thursday by the Indiana Senate not to restore the original language of the proposed constitutional amendment means that even if it passes, as expected, during a final vote Monday, it would have to pass a future legislature and couldn’t go before voters until at least 2016.
As ThinkProgress’ Zach Ford explains, “Because amendments must be approved in identical form in two consecutive legislative sessions, this new version will need to be approved again.” This still leaves open the possibility for putting a constitutional ban on the ballot two years from now. Of course by 2016 the whole initiative might be moot. Since the Supreme Court struck down part of the federal Defence of Marriage Act opponents of same-sex marriage are 0-5 in federal courts – most recently in Virginia.
Yet if you’re still a fan of awful discriminatory policy, look no further than to the effort — which is going nowhere in the state Senate — in Kansas to implement it’s own anti-gay throwback to the Jim Crow era.
I’m way late to commenting on this but the winter issue of Jacobin, the “quarterly magazine of culture and polemic,” sparked some interesting discussions over Miya Tokumitsu’s essay on the nature of “do what you love” (DWYL) and the culture of work. She described the phrase as “the unofficial work mantra for our time,” prompting a thoughtful agreement from Leah Libresco in The American Conservative, and argues that it’s an ascription that ultimately delegitimizes the real work of those for whom the mantra it is intended for as well as the labor of those it necessarily ignores.
Tokumitsu explains why:
“Superficially, DWYL is an uplifting piece of advice, urging us to ponder what it is we most enjoy doing and then turn that activity into a wage-generating enterprise. But why should our pleasure be for profit? Who is the audience for this dictum? Who is not?
By keeping us focused on ourselves and our individual happiness, DWYL distracts us from the working conditions of others while validating our own choices and relieving us from obligations to all who labor, whether or not they love it. It is the secret handshake of the privileged and a worldview that disguises its elitism as noble self-betterment. According to this way of thinking, labor is not something one does for compensation, but an act of self-love. If profit doesn’t happen to follow, it is because the worker’s passion and determination were insufficient. Its real achievement is making workers believe their labor serves the self and not the marketplace.”
The whole piece is well-worth reading. She asks all the right sociological questions for something like DWYL; who is meant for and who does it ignore? Does it recognize the social structure that produces it? These are all basic but, as Tokumitsu emphasizes, the very nature of the mantra hides those answers in the pursuit of introspection.
I don’t know if DWYL really is “the unofficial work mantra for our time,” in such a way as to elevate it to its own ideology — as opposed to just another cultural mechanism for some to justify life decisions when they have the good fortune to take risks. Likewise, the companion phrase “love what you do,” as the cultural equivalent of a leftover, offers only the most token of gestures towards providing a false sense of empowerment. Yet even if it doesn’t deserve that level of scrutiny, the act of criticizing DWYL didn’t deserve befuddlement, nor the Twitter equivalent of ‘damn hippies.’
Note: Partially reposted from the McLean Parlor.
On Tuesday the nonpartisan Congressional Budget Office (CBO) released a whole heap of reports on various budget and policy projections. While the CBO expects the federal budget deficit to be larger than previously thought over the next decade (primarily due to a weaker economy), if you were anywhere within spitting distance of the internet the top storyline was about the agency’s report on the projected employment effects of the Affordable Care Act.
Namely, that the CBO expects the ACA to
kill 2.3 million jobs over the next decade. Actually the agency said nothing like that, but you’d be excused from thinking otherwise when reading any number of headlines in the media. As the Washington Post’s Glenn Kessler wrote, “this is not about jobs. It’s about workers — and the choices they make.” In a rare instance of Republicans choosing to be suddenly ignorant of supply-side economics, the employment effects that the CBO is projecting is all about the supply of labor — in short, the effect of workers choosing to work less or leave the workforce all together. This is pointedly not a projection of employers laying off workers because of the health care law. The distinction is important because the policy discussion that follows a proper understanding is entirely different than one where firms are demanding less labor.
Republicans are getting a small taste of what it means to be proactive on health care reform.
As Dylan Scott at Talking Points Memo chronicled Friday morning, less than a week after three Senate GOP members released the Patient CARE Act (PCARE) one significant part has been quietly revised:
The original eight-page proposal released by the Senate Republicans — Richard Burr of North Carolina, Tom Coburn of Oklahoma, and Orrin Hatch of Utah — said that the new cap would be “65 percent of an average plan’s costs.” Health policy experts told TPM that this would likely result in a big tax increase on most Americans and some would probably lose their insurance.
Some time after the original proposal was released Monday, a new one-page explainer on the tax provisions appeared on Coburn’s website, below the link to the original proposal. And it included a huge change. The cap would now be “65 percent of the average market price for an expensive high-option plan” instead of just “an average plan’s costs,” as the original proposal said. The language in the original eight-page proposal had not been changed as of Thursday evening.
Since PCARE was announced on Monday there’s been considerable discussion from health care wonks, some of which was shared yesterday, and especially on Twitter. One other notable critique came from health care expert Ezekiel Emanuel in the New York Times on Tuesday, who accurately described that the Republican plan (as described on paper) would bring about a substantial tax increase for people who have employer-sponsored insurance (ESI). A private score from the new Center for Health and Economy then came out on Thursday. While clarifying some aspects (including that the cap on ESI was the biggest pay-for) there were enough caveats to the score that, even given the extremely preliminary nature of the results, we’re left with more questions than answers.
Note: Originally posted at The McLean Parlor
Congress is finally ready to pass a Farm Bill this week that would spend some $950 billion over the next ten years. Relative to the current baseline for funding on agricultural subsidies and food assistance to low-income Americans, the legislation would cut around $23 billion dollars. Just over a third of those savings would come from the largest portion of the bill — SNAP (food stamps) — for a total of over $8 billion. Those cuts are seen as a compromise between previous Senate and House versions, where the former intended $4 billion in spending reductions on the SNAP program versus the $40 billion Republicans were seeking.
On the agricultural side, most notably, legislators have agreed to scrap the direct payment program for farmers while using most of the savings to expand crop insurance and other forms of farm aid. For more information on that side of things I’d recommend Brad Plummer’s post and accompanying chart to put all that spending in context.
The compromise for SNAP funding is certainly not splitting the difference between previous respective versions. Because it excludes much of the severe cuts in the Republican-led House offering, this week’s bill elicited an ‘all things being equal’ thumbs-up from the left-leaning Center for Budget and Policy Priorities (CBPP). Yet that doesn’t mean the legislative outcome won’t leave a not-insignificant number of people less well-off, and, unsurprisingly, the largest segment of those folks are low-income Americans. Read the rest of this entry
On Monday three Republican Senators,Tom Coburn, Orrin Hatch, and Richard Burr, released a legislative proposal to repeal and replace the Affordable Care Act titled “The Patient Choice, Affordability, Responsibility, and Empowerment Act” (PCARE). The outline is generally considered the most comprehensive effort by conservatives to fulfill the years-long promise of a serious replacement plan to follow repeal of the president’s health care law. While those on the left may find little or nothing to their liking (not that it was written for them), there are a few surprising features.
For one, it doesn’t really repeal Obamacare. This might be confusing considering that the first and only section of the first title is, in fact, to “Repeal Obamacare.” But as Duke University public professor Don Taylor notes in his quick response the rest of the Act actually “locks in a good deal of the structure of the ACA, and addresses changes from that new status quo.” If you’ve been paying attention to numerous attempts to repeal Obamacare in the past couple of years this is a comparative sea change in conservative orientation towards the law. It’s also one that, even if the contents leave much to be desired, is an encouraging step towards taking health care reform seriously. Read the rest of this entry
Last week the Orlando Sentinel reported on a conference hosted by business leaders, local government, and advocacy groups to raise awareness about homelessness in Osceola County — of which Disney World partially resides within. The group ‘summit’ included the results of a joint public-private funded report* on “The State of Homelessness in Osceola County.” According to the study the “number of homeless school-age children and parents rose by 54 percent to more than 5,000 in the past year alone.”
Businesses and government leaders have been particularly worried about the prolificacy of homelessness there because, like many urban areas in the past thirty years or so, one of the solutions (for families especially) in the absence of adequate services is to save up just enough money to stay in motels that rent by the week. Nationally the portion of homeless staying in motels is comparatively small, but according to the new report in Osceola that number 25 percent — five times the national average. Yet staying in those places are seen as somewhat of a dead-end solution, though, in that while the cost is just enough to afford it’s likewise too much to save for more permanent housing. This is especially true in Osceola (emphasis mine):
That leads directly to the next point of emphasis: what these families earn against the cost of Osceola County housing. One adult working full time at $9.07 per hour earns $1,556 monthly before taxes. According to the “affordability principle” – no more than 30 percent of a household’s income should go toward housing — the household should be paying $467 monthly to maintain stability.
But, the fair market rate for a one ($825) or two-bedroom ($983) rental leaves them “precariously housed” — paying more than half of their income for housing, which is not sustainable long-term.
So what makes this a particular problem in Osceola?
As Andrae Bailey, executive director of the Central Florida Commission on Homelessness, told the Sentinel on Thursday:
[...] the “shockingly high” number of homeless families in Osceola stem from a unique intersection of low-wage jobs, high mobility, cheap and plentiful motel rooms, a lack of homeless shelters and, some say, a lack of code enforcement that allows families to stay in motels for months — sometimes years — at a time.
When families miss those weekly payments motel owners are upset because they cannot be evicted without a court order — a costly endeavor when these establishments are home to some 800 homeless school-aged children. With all of this happening in an area that heavily relies on tourism (including the tax revenues from such), and “in the shadow of” the carefully-curated magical image of Disney, it’s easy to see a broad coalition of community groups coming together to solve such a pressing issue. Read the rest of this entry
This, according to the Salt Lake Tribune, is undoubtedly good news for thousands of uninsured Utahans. On Wednesday Utah Gov. Gary Herbert told reporters he wants to move forward on the Medicaid portion of the Affordable Care Act during his monthly news conference, stating that “[d]oing nothing … I’ve taken off the table. Doing nothing is not an option.” The public commitment from the governor, praised by state Democrats, sets the stage for expanding the joint state-federal insurance program for low-income Americans. No other details were given, but as the National Journal reported the “governor is considering two expansion plans offered by the state legislature, both of which involve using the Medicaid dollars toward private plans.”
A “private option” proposal was accepted by Health and Human Services (HHS) in Arkansas. Iowa, Pennsylvania, and Michigan are also pursuing similar avenues towards insuring those with annual incomes below 138 percent of the federal poverty line (just under $27,000 for a family of three). Using Medicaid dollars to enroll those in the coverage gap — residents who earn too much under existing state eligibility standards and too little to qualify for subsidies on the insurance exchanges — is certainly a possibility in other states who have so far declined to expand the program. For instance, the recent confluence of red states moving forward might influence those discussions that were planned between HHS and Indiana Gov. Mike Pence.
Utah’s decision now means, as Dan Diamond wrote in Forbes, that a majority of states have or are planning to expand Medicaid in one form or another. It’s also worth considering, at this point, that this portion of the health care law may slowly (and quietly) be disengaged from broader Republican opposition. Read the rest of this entry
Around 6.3 million individuals have been determined eligible for Medicaid or the Children Health Insurance Program from October 1st through December 31 of last year, according to a new report from the Center for Medicare and Medicaid Services (CMS). The new data highlights applications and determinations for both programs since the launch of Healthcare.gov and the state-run insurance exchanges, though the total number also includes information reported through existing state agencies.
CMS cautions that the numbers are preliminary, and the report is strewn with several caveats that make analysis below the top-line number ill-advised. Because states are still transitioning to a more simplified reporting process the number reported Wednesday includes those individuals newly enrolled and, from some states, those people that have had their existing coverage renewed. Moreover, some states, like Florida, have separate state agencies for their CHIP program whose numbers were not included in this report.
That being said, most of the states reporting data also provided a baseline for comparison, and in regard to those states that have expanded Medicaid and those that have declined, one particular section stands out: Read the rest of this entry
In a new Gallup poll released on the economy just over two-thirds of Americans are unhappy with the distribution of wealth and income in the United States. Inequality has become a salient topic recently: from Pope Francis’ remarks, to the recent anniversary of the War on Poverty, and speeches by both President Obama and Senator Marco Rubio. That focus seems to reflect in Monday’s results from Gallup, where dissatisfaction about economic inequality is elevated even along partisan lines.
Conducted earlier this month, the poll found that 67 percent of national adults are either “somewhat” or “very dissatisfied” this aspect of economic life in America. As Gallup notes, “[a]ttitudes about the distribution of income and wealth are highly related to partisanship,” but even broken down along partisan lines there is a surprising level of concern over inequality. Here is the full table: Read the rest of this entry
Over at The McLean Parlor I’ve got several links for folks to read on Martin Luther King Jr. Day. Feel free to head on over there and check them out. One, by MSNBC’s Ned Resnikoff, highlights “Four ways Martin Luther King Jr. wanted to battle inequality” (Aviva Shen has a good piece as well). As Resnikoff writes, “in the last year of his life, King poured most of his energy into launching the Poor People’s Campaign, an organization dedicated to advocating for economic justice.” To my perception there seems to be a greater awareness for Dr. King’s opposition to the Vietnam War than for the Poor People’s Campaign – the latter effort resulted in the Poor People’s March and the establishment of “Resurrection City” in 1968.
Here is an excerpt from the Henry Louis Gates Jr. documentary The Two Nations of Black America on Dr. King’s focus on justice for the poor:
Fifty percent. That’s the estimated percentage of Medicare beneficiaries that earn less than $25,500 according to a new issue brief from the Kaiser Family Foundation (KFF). The report examines the effects of current law on Medicare premiums as well as proposed policy changes that would further increase the cost-sharing contribution of higher-income earners.
After the passage of The Medicare Modernization Act (MMA) of 2003, starting in 2007 the income thresholds for premiums in Medicare Part B (supplementary medical insurance that helps pay for some services not covered by Part A) have been indexed to the rate of inflation “so that about 5 percent of all Medicare beneficiaries would pay the higher, income-related premium each year.” In 2013 that income threshold was about $85,000 for individuals and $170,000 for couples. The Affordable Care Act froze those thresholds through 2019, which is increasing the number of those subject to higher cost-sharing, and by which time KFF estimates will include over five million beneficiaries (before falling again as the rate is re-indexed).
The brief also explores the consequences of premium increases included in the Affordable Care Act for high-income earners (along the same thresholds) enrolled in Medicare Part D. That portion of the law has been in effect since 2011 and, according to KFF, in 2013 about 1.3 million (four percent) of Part D beneficiaries paid the higher premiums. Projecting through 2019, they estimate that “approximately 9 percent of all Part D enrollees (4.0 million beneficiaries) are projected to be subject to the income-related Part D premium.”
In outlining these effects they produced this graphic on the distribution of beneficiary income; a picture that should make people reconsider ideas that shift significant costs to most folks on Medicare: Read the rest of this entry
Last week Republican lawmakers in Indiana signaled a renewed effort to legislate drug testing requirements for welfare recipients. As the Indianapolis Business Journal reported Thursday, the policy would require people who receive help through the Temporary Assistance for Needy Families (TANF) program to complete a written test to determine the risk for drug addiction, and “[t]hose identified would be pooled together and half of those subjected to a random drug test.”
The new push for scrutinizing the 12,837 Hoosier families receiving assistance follows a similar attempt last year. That legislation was pulled after a House Democrat successfully amended the bill to include drug testing of the lawmakers themselves. According to the Herald Bulletin, the new screening proposal represents a broader reform effort “intended to reduce fraud, [and] will also limit what can be bought with food stamps and require food stamp beneficiaries to show a photo ID when making a purchase.”
Several of these ideas, though, face well-known legal and institutional challenges. Read the rest of this entry