Jonathan Cohn at the New Republic, as a leftward commentator, has consistently struck the best tone and balance on health care reform. One of his recurring frames through which to discuss the Affordable Care Act applies to both supporters and opponents; namely, to admit that the law consists of a series of trade-offs. For the former that means acknowledging that some part of a portion will indeed be getting a less-favorable deal on their health insurance, while the latter should concede that people will indeed benefit by gaining coverage they were previously denied. As with anything, of course, context is important here.
This is especially true as it relates to the press reporting on these trade-offs. Yesterday he pushed back on the deluge of media coverage on some number of upper-middle class Americans facing complications over their individual insurance plan renewals. Those are due in no small part to the ACA’s regulations on health insurance in the market which mandates that, among other things, new plans cover a list of essential benefits and cost-sharing caps. These are real effects that deserve to be documented.
Yet in their pursuit to spend a disproportionate amount of time on this aspect, they’re failing to tell the bifurcated story of a larger number of Americans being affected by the ACA’s Medicaid expansion.
“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 prescription 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?”
The sheer number of people gaining coverage thanks to the Medicaid expansion is huge. To the extent that this failure represents a media bias for bad news, this should be expected. The insurance cancellation story represents a confluence of incentives the media cannot ignore. It’s an ideal segment when you can pair profiles of individuals under these circumstances with vacuous political speculation on what it means for the administration.
Yet as Cohn also notes there is a class aspect as well. Folks getting letters are, comparatively speaking, well-to-do. The larger number of Americans who are deliberately being denied insurance are not. This comports with other ways in which income dictates the amount of deference you get from important social institutions. These relationships — political, financial, media — have a rational, if morally dubious, explanation for a lack of reciprocity.
The impact of this policy decision, to reject the Medicaid expansion, is important. People in states that already have strict eligibility standards for Medicaid are being deliberately denied insurance. For many of these places the income cutoff for adults are exceptionally low. So 409,350 people in Georgia being denied coverage live in a state where single, working, mothers of one have to make less than $4,400 to qualify for Medicaid. There are 763,890 Americans living in Florida who will also fall into this gap, wherein an unemployed adult with a child earning $3,000 annually is disqualified from assistance. In Texas, 1,046,430 will still face an eligibility framework that denies working poor parents insurance if they make more than 25 percent of the Federal Poverty Line — which is $4882.50 a year for family of three. In all three states earning one dollar a year means you don’t get help if you are not a parent. These bad news stories deserve to be told.