Today’s Supreme Court rulings came and went without a word on the Affordable Care Act. Supposedly another set of rulings come Thursday, but the consensus seems to be that next Monday will be the day. Until then, I recommend a micro-piece in The New Republic, by Alec MacGillis, following the uninsured in Tennessee as they attend a free health clinic (my emphasis added):
As Robin Layman, a mother of two who has major health troubles but no insurance, arrived at a free clinic here, she had a big personal stake in the Supreme Court’s imminent decision on the new national health care law.
Not that she realized that. “What new law?” she said. “I’ve not heard anything about that.”
[…] Layman was hardly the only patient unaware that the law aims to help people like her, by expanding health insurance beginning in 2014. And this gets to the heart of the political dilemma for Democrats: Despite spending tremendous political capital to pass the law, the party is unlikely to win many votes from the law’s future beneficiaries, most of whom live in Republican-dominated states in the South and West. In fact, many at the clinic said they don’t vote at all.
Well, that part about not voting rings familiar. Sometimes I think that if I was a bloodless advisor to politico’s I’d be telling them to ignore the low-income vote. Instead, aim for the sweet spot in the middle. For many on the left it isn’t a matter of addressing low-income concerns, but middle-class concerns about the poor. In the process you’ll pick up those few on the bottom that do vote and aspire to hit the middle of the ladder some day. For many on the right it isn’t a matter of helping them do so, but addressing middle-income concerns about economic stability and safety without punishing the high-end tax brackets in the process. A tad bit cynical and sad to boot, I know.
Anyway, it’s important to remember that whatever ruling comes down on Monday it will have real consequences for real people, especially those who have the most to lose, are unaware of that fact, and democratically disengaged from the policies that affect them.
He acknowledged that some of his colleagues were less than thrilled about the law’s coverage expansion because Medicaid reimbursement rates are low (though the law brings them up slightly for primary care). But he said that doctors in rural Tennessee would have no choice but to see Medicaid patients, since so many patients would have that coverage. “I’m not going to starve to death,” he said. “I don’t know any doctors who’ve starved to death.”
Read what Aaron Carroll has to say about doctor’s “barely making ends meet.”