• Once Again, the ACA Survived SCOTUS -- But the Fight Isn't Over Yet

    Jun 25, 2015Andrea Flynn

    Today the Supreme Court decided in favor of the government and the more than 6 million individuals who now have health coverage thanks to the Affordable Care Act’s subsidies. The 6–3 King v. Burwell decision—which determined that individuals in all states, not just those that established their own health exchanges, could be eligible for federal subsidies—is a win for President Obama, for the law more broadly, and for the health and economic security of millions of women and their families.

    Today the Supreme Court decided in favor of the government and the more than 6 million individuals who now have health coverage thanks to the Affordable Care Act’s subsidies. The 6–3 King v. Burwell decision—which determined that individuals in all states, not just those that established their own health exchanges, could be eligible for federal subsidies—is a win for President Obama, for the law more broadly, and for the health and economic security of millions of women and their families. As I described in my recent policy note, the ACA has expanded women’s access to care, improved the quality of their coverage, and in the process increased women’s economic security. Today’s decision ensures that—for the time being—the law will continue to do all of those things and more.

    The ACA expanded coverage to 16.5 million people and elevated the floor of coverage for women. Since 2010, 8.7 million women have gained maternity coverage; 48.5 million women with private insurance can access preventive services with no cost-sharing; and as many as 65 million women are no longer charged higher premiums based on pre-existing conditions. In 2013, the number of women who filled their birth control prescriptions without co-pays grew from 1.3 million to 5.1 million, and the share of women who had access to birth control with no out-of-pocket costs grew from 14 percent to 56 percent. This has been a significant improvement over the pre-ACA system in which women had to pay out of pocket for preventive services like pap smears and breast exams, were routinely charged more than men, and many couldn’t afford maternity coverage during pregnancy.

    Over the past five years the ACA has begun to ease the financial burdens of health coverage and care for women, who are more likely than men to live in poverty. Today more than two-thirds of low-wage workers are women—half of them women of color—and many work long hours with no health benefits. Wage inequality causes Black and Latina women to lose approximately $19,000 and $23,279 a year, respectively. A loss of subsidies would have been especially harmful to women of color, who represent nearly half of all uninsured women eligible for tax credits in states using the federal exchange. Those subsidies are the only path to insurance for 1.1 million Black women, approximately 2 million Latinas, nearly a quarter-million Asian women, and more than 100,000 Native American women. Many of those women live in one of three states: Florida, Georgia, or Texas.

    When women have good coverage and access to care, they are better able to make decisions about the timing and size of their families. They are able to prevent illnesses that cause them to miss work force them to lose a paycheck, and threaten their employment. They have healthier babies and children. Fewer out-of-pocket medical costs free up more money for food, childcare, education, housing, transportation, and savings. Health coverage won’t singlehandedly solve the serious challenges facing low-income women and families. Indeed, our country’s soaring inequality and persistent injustices demand sweeping social and economic reforms. But without the very basic ability to care for their bodies, visit a doctor, plan the timing and size of their families, and make independent reproductive health decisions, women will never be able to take full advantage of other economic opportunities.

    Today’s decision is especially important for women considering conservative lawmakers’ relentless attempts to roll back access to reproductive health care. Consider that just yesterday House Republicans voted to completely eliminate Title X (the federal family planning program), to expand religious exemptions allowing employers and insurers to opt out of covering anything they find morally or religiously objectionable, to implement new abortion restrictions with no exception for the life or health of pregnant women, and to renew the Hyde Amendment, which prohibits Medicaid coverage of abortion.

    So the ACA is safe for now, and the Supreme Court’s ruling will allow the law to become even more ingrained in our social and political fabric. However, we can be sure the vitriolic political opposition is not over. The GOP presidential hopefuls didn’t waste any time letting their constituents know today’s decision wouldn’t stop their attempts to undermine the law. And conservative lawmakers on the Hill will continue to push budget proposals that would unravel the law’s most important components and reduce funding for social programs critical to the wellbeing of low-income families. We should celebrate the King v. Burwell decision, but we must not stop making the case that for women and families, comprehensive, affordable health coverage—and by extension, care—is as much a matter of health as it is economic security.

    Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter at @dreaflynn.

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  • NYC Taxi Owners Are Denying Benefits to Drivers. The City Council Can Stop Them.

    Jun 25, 2015Richard Kirsch

    Earlier this month, the New York City Council enacted basic protections for workers at car washes, one group of exploited, largely immigrant workers. Next up on the City Council’s to-do list should be reversing a court decision that robbed taxi drivers, another group of mostly immigrant workers, of health and disability benefits.

    Earlier this month, the New York City Council enacted basic protections for workers at car washes, one group of exploited, largely immigrant workers. Next up on the City Council’s to-do list should be reversing a court decision that robbed taxi drivers, another group of mostly immigrant workers, of health and disability benefits.

    New York City’s taxi drivers are one more group of workers who decades ago were legally considered employees but now are classified as independent contractors, with low and unpredictable wages, long work hours, and no benefits. Over the last two decades, taxi driving has become a career for many new immigrants.

    Starting in 1996, drivers began organizing together, through the New York Taxi Workers Alliance, to win an increased share of cab fares and other protections. Two years ago, the Taxi Workers Alliance organized successfully to get the Taxi and Limousine Commission, which regulates the industry, to designate six cents from every cab ride to a fund to pay for disability and health benefits for drivers.

    The Taxi Workers Alliance, through an RFP process, won a contract to set up a fund that would provide a modest disability payment of $350 for 26 weeks, plus other benefits, such as vision, dental, and hearing. Drivers would still be responsible for their own health insurance, with many relying on the Affordable Care Act.

    Even though the fund does not cost the taxi owners a dime, they still sued to stop it, arguing that the commission overstepped its authority, and earlier this month a New York State appeals court agreed. As Bhairavi Desai, the Executive Director of the Taxi Worker Alliance, told me, the owners saw the health and disability fund “as a basis for the union…They were hell-bent on stopping the union and having the drivers have any benefits.”

    An irony of the court’s ruling is that one reason that taxi drivers are considered to be independent contractors by the National Labor Relations Board (NLRB) is that they work in a highly regulated industry, in which many of their pay and working conditions are regulated by the Taxi and Limousine Commission. But when the commission acted to fund a much-needed benefit, the court, at the behest of the owners, blocked the way. The court said that it was up to a legislative body to decide on a new policy like using fares to finance a health and disability fund.

    The other reason that the NLRB considers the drivers to be independent contractors is that they cruise for riders instead of being dispatched by the taxi companies. This in contrast with drivers of “black cars” in New York, who are dispatched by the limousine companies and therefore legally under their control. Some of the limousine drivers have joined the machinists union (IAMAW).

    Looking into the future, competition from services like Uber may push New York’s cab companies to adopt an app for riders to call cabs. Earlier this month, the California Labor Commissioner’s office ruled that an Uber driver there was an employee, in part because of Uber’s reliance on apps.

    For now, the court’s decision puts the issue squarely in front of the New York City Council. Since their election in 2013, both New York City Mayor Bill de Blasio and the new progressive majority on the council have made bolstering the ability of low-wage workers to care for and support their families a hallmark of their policies. One of their first actions was to strengthen a new law requiring that workers receive paid sick time. The new regulations establishing worker and environmental protections at car washes are the latest such action.

    Laws that improve wages and benefits for New York’s working families are not only fair, they are a fundamental strategy to move New York’s economy forward. The more New Yorkers have the ability to care and support their families, the more New York will build a middle class that is the basis for strong communities and an economy not wholly dependent on Wall Street.

    With some $2 million already collected and a contract with the Taxi Worker Alliance signed, passing an ordinance to approve using the six cents per fare for the health and disability fund should be an easy fix. But the taxi industry in New York is profitable and powerful and finances election campaigns. Still, that’s why New York City has public financing of campaigns and a pro-worker and pro-community mayor and City Council. Hopefully, they’ll quickly step up to the plate so that New York City’s taxi drivers can have their own organization provide essential benefits for their and their families’ health. 

    Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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  • Millennials Are Not Post-Racial: An Ivy League Education

    Jun 24, 2015Riley Jones

    “I don’t see race” is the oft-heard refrain of many Millennial men and women. Surveys have shown that people of this generation believe themselves to be more tolerant of racial differences than older Americans. These are young people who see the progress America has made in addressing racial disparities as irreversible.

    “I don’t see race” is the oft-heard refrain of many Millennial men and women. Surveys have shown that people of this generation believe themselves to be more tolerant of racial differences than older Americans. These are young people who see the progress America has made in addressing racial disparities as irreversible. This sense of finality stems from a belief—proliferated in the 1980s and 1990s—that federal, state, and local governments have made a concerted effort , through measures including the Civil Rights Act, the Voting Rights Act, and affirmative action, to eliminate racial injustice in our society. To some, the election of a Black president in 2008 further symbolized a national transcendence of past prejudices. Because of these assumptions, many Millennials have failed to critically analyze the condition of African-Americans, who continue to face discrimination and inequality. This failure, in turn, has led to a dearth of substantive policy solutions to change the structural foundations of a system that has underserved too many for much too long.

    As a low-income Black student at Columbia University from the South Side of Chicago, I am well assured that the breadth and depth of my experiences are not immediately relevant when compared to the experiences of my peers from more affluent places. Discussing Greece based off a literary interpretation is daunting when a majority of the class has seen the islands firsthand. However, I am certain that I belong here just as much as the next person. The influx in recent years of low-income students, most of whom happen to be racial minorities, in elite and selective college environments has provided for a mixture of class and race that has never been experienced on so massive a scale. From 2000 to 2011, the National Center for Education Statistics has measured a 12 and 14 percent increase in college enrollment for Black and Hispanic students, respectively. The wealth of difference between these groups has catalyzed the belief, in Millennial circles, that this is a post-racial generation.

    There is a tendency, in the logic of post-racial America, to equate interpersonal racism (i.e. “I don’t like you because you’re Black”) with the racial barriers that structures and institutions have created (i.e. white students graduate from elite and selective colleges at significantly higher rates than Black students). Thus the students of the Millennial generation, and the schools that facilitate their interactions, are treading in uncharted waters when it comes to dealing with subtler racial disparities, and the results have been mediocre at best. The racism of our forefathers took the form of bricks and billy clubs, while today’s prejudices move more like an “invisible hand,” guiding young people—mostly Black and Latino—from urban ghettos to prisons and from impoverished schools to massive student loan debt.

    Only by interrogating the structural foundations of American political and economic institutions does one begin to understand the fault in post-racial logic. For example, Columbia explicitly accepts qualified students on the basis of their economic indigence through certain programs. The retention rate, much less the graduation rate, does not even begin to rival that of wealthier students, who also tend to be whiter What is lost is that these students need different kinds of support than the university is used to giving. To say that race plays a role is to draw the ire of administrators who earnestly believe that the system is absolved of doubt because they are not personally racist. This is the work of structural racism: a demonstrated inequality cannot be labeled racial unless there is tangible proof of intent to discriminate based on race.

    White Millennials, unlike their forebears, are not typically characterized by active interpersonal racial animosity; they are characterized by their silence in the face of the oppressive structural conditions that society engenders. It is not that people say that they accept me despite the color of my skin; it is that they openly express fear about walking in Harlem in the middle of the day even though the people they fear look like me. It is their acquiescence to and wholesale endorsement of a school that has made gentrification a commodity ready to be sold. The only way to truly root out this inequity is to call racism what it is.

    Once the underpinnings of an actively unjust structure are called into question, progress can be made. Perhaps more accurately, policy can be made. The Civil Rights Movement used policy to effectively ban segregation in the United States. Ferguson and Baltimore have shown that the tradition of advocating for justice at the grassroots level has not waned; the challenge moving forward will be creating solutions that ensure unjustified police homicides will be prevented and not go unpunished. The outdated policy measures of the past will not suffice to rid the United States of its racial ills; we must show Millennials—the leaders of today and tomorrow—that racism still exists so they can press on ever more firmly toward its extinction.

    Riley Jones is a Roosevelt Institute Campus Network member and a rising junior at Columbia University.

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  • King v. Burwell Could Turn Back the Clock for Women's Health

    Jun 23, 2015Andrea Flynn

    In the coming days the Supreme Court will decide King v. Burwell, a case on which the health coverage of more than 6 million individuals—and in some ways the future of the Affordable Care Act (ACA)—hinges. As we anticipate that ruling, and as conservative lawmakers propose potential solutions to the crisis that will ensue should they “win,” we should pause and remember that the ACA has profoundly improved the quality of women’s health coverage, expanded women’s access to care, and increased women’s economic security.

    In the coming days the Supreme Court will decide King v. Burwell, a case on which the health coverage of more than 6 million individuals—and in some ways the future of the Affordable Care Act (ACA)—hinges. As we anticipate that ruling, and as conservative lawmakers propose potential solutions to the crisis that will ensue should they “win,” we should pause and remember that the ACA has profoundly improved the quality of women’s health coverage, expanded women’s access to care, and increased women’s economic security. As I describe in a policy note released today by the Roosevelt Institute, if policymakers are serious about the health and financial wellbeing of women and families, they should expand and strengthen the ACA, not reverse or repeal it.

    The ACA expanded coverage to 16.5 million people and elevated the floor of coverage for women. In the pre-ACA system, women were routinely charged more than men, had to pay out of pocket for preventive services like pap smears and breast exams, and many couldn’t afford maternity coverage while they were pregnant. But since President Obama signed the ACA into law, 8.7 million women have gained maternity coverage; 48.5 million women with private insurance can access preventive services with no cost-sharing; and as many as 65 million women are no longer charged higher premiums based on pre-existing conditions. In 2013, the number of women who filled their birth control prescriptions without co-pays grew from 1.3 million to 5.1 million, and the share of women who had access to birth control with no out-of-pocket costs grew from 14 percent to 56 percent .

    For millions of women, the ACA has begun to ease the financial burdens of health coverage and care. Before the ACA, women were far more likely than men to have to forgo care because of cost concerns, and for all women—but especially those without coverage—cost was a major barrier to care. Many women had difficulties paying their medical bills (52 percent of uninsured women and 44 percent of low-income women, compared to 28 percent of women overall). This should be no surprise, given that it’s more likely for women—particularly women of color—to live in poverty. Today more than two-thirds of low-wage workers are women—half of them women of color—and many work long hours with no health benefits. Wage inequality causes Black and Latina women to lose approximately $19,000 and $23,279 a year, respectively.

    A loss of subsidies would be especially harmful to women of color. In states that are using the federal exchange, women of color represent nearly half of uninsured women eligible for tax credits. Those subsidies are the only path to insurance for 1.1 million Black women, approximately 2 million Latinas, nearly a quarter-million Asian women, and more than 100,000 Native American women. Many of those women live in one of three states: Florida, Georgia, or Texas.

    Comprehensive, affordable coverage—and by extension, care—is as much a matter of health as it is economic security. When women have good coverage and access to care, they are able to prevent illnesses that take them out of work, threaten their employment, and force them to lose a paycheck. They are better able to make decisions about the timing and size of their families. They have healthier babies and children, fewer out-of-pocket medical costs, and more money for food, childcare, education, housing, transportation, and savings. Health coverage won’t singlehandedly solve the myriad challenges facing low-income women and families; indeed, the United States’ soaring inequality demands sweeping social and economic reforms. But without the very basic ability to care for their bodies, visit a doctor, plan the timing and size of their families, and make independent reproductive health decisions, women will never be able to take full advantage of other economic opportunities.

    The political vitriol of the past five years has blurred our collective memory of just how badly we needed health reform before we got it. Opponents of the ACA argue that we cannot afford for the law to prevail. But the truth is we can’t afford for it not to. In most other countries families are not driven into poverty because they seek needed care, and they don’t avoid seeking care out of fear that doing so will drive them into bankruptcy. The United States is unfortunately exceptional in this regard. For too long the right to health has been unfulfilled in the United States, and the ACA has begun to change that for millions. Neither the Supreme Court nor conservative lawmakers should turn back the clock now.

    Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter at @dreaflynn.

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