Richard Kirsch

Roosevelt Institute Senior Fellow

Recent Posts by Richard Kirsch

  • Farewell to Health Care for America Now

    Dec 19, 2013Richard Kirsch

    The campaign that won passage of health care reform is closing up shop, but its grassroots organizing efforts will stand as a model of success for progressives.

    The campaign that won passage of health care reform is closing up shop, but its grassroots organizing efforts will stand as a model of success for progressives.

    Health Care for America Now (HCAN), the grassroots campaign that powered passage of the Affordable Care Act, is about to close its doors, as planned when the campaign started. But the images it generated of Americans passionately fighting to make health care a right will remain with us for years to come. The new movie Inequality For All includes dramatic footage of an HCAN supporter standing up to a Tea Partier. Another documentary released last year, Escape Fire, has stirring footage of an HCAN rally. Pictures of people holding up HCAN signs or wearing HCAN buttons still appear regularly in news magazines. 

    Richard Kirsch at health care reform rallyIt makes great sense that HCAN’s actions have become iconic symbols of the fight for health justice in the United States. From its beginning, the heart of the HCAN campaign was outside the Beltway, its strategy grounded in the firm conviction that we could only win the fight for comprehensive reform if we based our campaign on grassroots organizing outside of Washington. We knew that inside the Beltway, the best we could do is provide a credible voice countering the army of thousands of lobbyists for the health care industry. But outside the Beltway, by organizing ordinary Americans, we could win.

    Creating a powerful grassroots force is not easy. It took building a campaign that pushed against the culture of D.C., with the support of a funder that was committed to building progressive capacity, not just winning on an issue. Most national issue campaigns are D.C.-centric, run by campaign operatives, constrained by a narrow band of legislative concerns, with an idea of field work that is narrowly focused on generating earned media and e-mails and phone calls to members of Congress. After a lot of debate, the union and community organizing leaders who built HCAN agreed to spend almost all of its non-paid media resources on field contracts with state-based community organizations and community labor coalitions. These local organizations partnered with the local chapters of national labor unions and netroots groups.

    The national strategy and tactics were relentlessly focused on empowering people at the local level to bring their personal passion, and often their personal stories, to their communities and members of Congress. Their work did generate lots of local media and calls to Congress, but it went much deeper than that, building the kind of relationships that are transformational. The campaign’s major funder, the Atlantic Philanthropies, was fully committed to the strategy, believing that even if the legislative effort fell short, their funds would leave in place a more sophisticated and robust capacity for progressive change at the local level. But because Atlantic had faith in the grassroots strategy, both of the foundation’s objectives – passing historic legislation and building capacity – were realized.

    While HCAN was always envisioned as a campaign that would end with the passage of legislation, HCAN’s leadership decided to launch HCAN 2.0 to defend the new law after its passage. With many fewer resources, HCAN continued the fight, working on consumer regulations to control insurance premiums, taking part in the public battle around the Supreme Court’s hearing on the ACA’s constitutionality, defending Medicare from privatization, pushing for Medicaid expansion, and always reminding us that the opponents of the ACA are eager to return Americans to the day when insurance companies were fully able to deny them care and jack up their premiums because, indeed, we do get sick.

    HCAN is now closing up shop. It may seem a funny time, with the current fracas over the implementation of the Affordable Care Act, but that is the point. The organization’s campaign mission was to win passage of a law, a mission extended to include “win and secure” the ACA. The debate over the shape of the ACA will continue for years to come – a struggle over how to fix, expand, roll back, or build upon the law. But as each of the millions of Americans who will enroll over the next few months sign up, another nail is hammered in the repeal coffin. Retiring HCAN, its mission accomplished, is another sign that the campaign is keeping its eyes on the prize.

    HCAN affirmed my belief that people organizing together can shape history. Paul Starr, the Pulitzer Prize-winning historian of health policy, told me that none of the failed attempts to pass comprehensive health reform had a major, grassroots field component. Earlier this year another noted historian of health reform, Theda Skocpol, published an analysis in which she credited the success of health care reform versus the failure of climate change legislation to HCAN’s deep grassroots strategy, compared with an elite, inside strategy of environmentalists.

    It is good to see those lessons being fully embraced by new leadership in the climate change movement, as seen most sharply in the Keystone pipeline fight. The campaign for immigration reform too is powered by a national, grassroots movement led by local leaders who are putting their lives on the line for change. The most energetic new labor organizing is built on helping low-wage workers take local actions, supported by their communities, as part of a growing national effort.

    Still, too many issue campaigns and too many funders fail to fully grasp the respectful partnerships and movement-building essential to defeat corporate power and right-wing politics. If we are to make the kind of transformational changes America and the world need, the politics HCAN pioneered, a sharply strategic national campaign built on empowering people through organizations around the country, points the way. 

    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.

     

    Photo: Fighting for Our Health

    Share This

  • Obama Updates His Story About America

    Dec 5, 2013Richard Kirsch

    When President Obama frames the story of the American dream as one that is harmed by economic inequality, progressives should cheer - and they should also prepare to sharpen that story and tie it to action.

    When President Obama frames the story of the American dream as one that is harmed by economic inequality, progressives should cheer - and they should also prepare to sharpen that story and tie it to action.

    Barak Obama captured the national imagination on the strength of his ability to tell his own story as part of our national story, starting with his keynote address at the Democratic National Convention in 2004. He was elected and remains personally popular in no small part because of the resonance of his story with the way Americans want to view themselves. In his speech yesterday on economic mobility, given at a Washington DC hub for community organizations that fight poverty, he continued to update that story, with a sharper focus on the dire crisis of the American dream, a stronger emphasis on the role of government, and a clearer attention to race.

    The President repeated the core of his story about America yesterday:

    Now, the premise that we’re all created equal is the opening line in the American story. And while we don’t promise equal outcomes, we have strived to deliver equal opportunity -- the idea that success doesn’t depend on being born into wealth or privilege, it depends on effort and merit. [Emphasis added].

    Obama has consistently framed our American story in terms of our values, and then linked those values to our economic success. The focus of his speech is that the story is no longer true:

    The combined trends of increased inequality and decreasing mobility pose a fundamental threat to the American Dream, our way of life, and what we stand for around the globe. And it is not simply a moral claim that I’m making here. There are practical consequences to rising inequality and reduced mobility. [Emphasis added]

    Opening his speech by saying that what he’s come to talk about is “a belief that we’re greater together than we are on our own,” he declares that the “defining challenge of our time” is “making sure our economy works for every working American.”

    Obama gives a history lesson, both about how we made the American Dream real and about how it has been lost. The President makes it clear that America’s success is grounded in an activist government, from Lincoln’s land grant colleges; to Teddy Roosevelt’s trust busting and eight-hour workday; to FDR’s Social Security, unemployment insurance, and minimum wage; to LBJ’s Medicare and Medicaid. “And as a result,” he summarizes, “America built the largest middle class the world has ever known. And for the three decades after World War II, it was the engine of our prosperity.”

    That last phrase – the middle class as the engine of prosperity – is at the core of the progressive economic narrative. This is a direct contradiction to the conservative story that business in a free market is the driver of wealth. That’s backwards, Obama explains, “When families have less to spend, that means businesses have fewer customers, and households rack up greater mortgage and credit card debt; meanwhile, concentrated wealth at the top is less likely to result in the kind of broadly based consumer spending that drives our economy, and together with lax regulation, may contribute to risky speculative bubbles.”

    When the President gets to his telling of how we got into this mess, he skirts lightly over who is to blame, which is the biggest consistent failing throughout his rhetoric. He begins by blaming technology and globalization, ignoring the fact that the other countries Obama recognizes as having much more economic mobility than the U.S., faced the same challenges.

    He then says that “As values of community broke down, and competitive pressure increased, businesses lobbied Washington to weaken unions and the value of the minimum wage. As a trickle-down ideology became more prominent, taxes were slashed for the wealthiest, while investments in things that make us all richer, like schools and infrastructure, were allowed to wither.”

    The President appears to be excusing business for their behavior. What he doesn’t say is that business was a leading force in breaking down those values, deciding that enriching shareholders and CEOs was more important than providing decent wages and support for communities. The reference to “trickle-down ideology” obscures the relentless attack by corporate America and the right upon Obama’s core values of “we’re greater together than on our own.”

    Any powerful story needs villains and it is here that Obama punts. Teddy Roosevelt laid it on “the unholy alliance between corrupt business and corrupt politics.” FDR clearly laid the blame on the “economic royalists.” For the right’s great communicator, Ronald Reagan, it was “welfare queens.” It is never clear from Obama who is to blame, which is a key reason that core parts of his story get lost. The President says that Americans have a “nagging sense that no matter how hard they work, the deck is stacked against them.” The truth is that Americans have a very strong sense that the deck is stacked against them by powerful corporations and the super-rich who use their lobbyists and campaign contributions to control our government.” If Obama is going to rally people to take on those forces, he has to name them and take them on.

    The President does take on President Reagan’s villain, a villain which is still at the center of right-wing opposition to Obama and government more generally. The speech yesterday was notable in that he directly challenged “the myth that this is a problem restricted to a small share of predominantly minority poor.” He says, “African Americans, Latinos, Native Americans are far more likely to suffer from a lack of opportunity.”

    After acknowledging continued racism, he bridges to class, “The decades-long shifts in the economy have hurt all groups: poor and middle class; inner city and rural folks; men and women; and Americans of all races.“ He says that we’re seeing the problems “one attributed to the urban poor” “pop up everywhere.”

    So if we’re going to take on growing inequality and try to improve upward mobility for all people, we’ve got to move beyond the false notion that this is an issue exclusively of minority concern. And we have to reject a politics that suggests any effort to address it in a meaningful way somehow pits the interests of a deserving middle class against those of an undeserving poor in search of handouts. [Emphasis added]

    The point of this speech – “you'll be pleased to know this is not a State of the Union Address” he jokes – is not to give specific solutions. Given the impossibility of passing anything in the House, that would be a fool’s errand. Obama instead aims to lay out a vision for how to move forward, based on his insistence that “government action time and again can make an enormous difference in increasing opportunity and bolstering ladders into the middle class.”

    His program for government action is grouped in five categories: tax policy and investment for growth; education and skills training; empowering workers; targeted programs for hard-hit communities; and programs that provide security, from Social Security to the Affordable Care Act.

    That third bucket – empowering workers – is a welcome focus, one that the President has too often skirted. “It’s time to ensure our collective bargaining laws function as they’re supposed to -- (applause) -- so unions have a level playing field to organize for a better deal for workers and better wages for the middle class.” Sensing one area with current political umph, he made a big push for raising the minimum wage.

    Stories need a happy ending, or at least some prospects of one. The last paragraph of Obama’s speech places that happy ending squarely on the shoulders of government, with echoes of FDR (“Let us never forget that government is ourselves and not an alien power over us”). Obama concludes with:

    But government can’t stand on the sidelines in our efforts. Because government is us. It can and should reflect our deepest values and commitments. And if we refocus our energies on building an economy that grows for everybody, and gives every child in this country a fair chance at success, then I remain confident that the future still looks brighter than the past, and that the best days for this country we love are still ahead.

    While progressives are often frustrated by the President they worked so hard to elect, we have a huge amount to learn from Obama’s deep understanding of how to powerfully express our core American values and link them to a story about the government’s role in creating broadly-based prosperity. Our job is to tell a sharper version of that story – with villains and anger to motivate action – as well as with hope, through our words and through our organizing. Today’s fast food actions around the nation are a great example. We agree with the President that an America that works for all of us “is the defining challenge of our time.” And it will remain our challenge long after Obama leaves the White House. 

    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.

    Photo of President Obama via Shutterstock.

    Share This

  • Courageous Boeing Workers Say No to Corporate Extortion

    Nov 18, 2013Richard Kirsch

    By rejecting a contract that amounted to corporate extortion, the Machinists Local 751 at Boeing have taken a stand for middle-class workers all over the country.

    In a remarkable act of courage and solidarity with the next generation, last week Boeing workers in Seattle soundly rejected corporate extortion, by voting down a contract which traded job guarantees for concessions that would severely erode the pay and benefits of younger workers. In doing so, the members of the Machinists are risking their jobs to save an America built on the middle class.

    By rejecting a contract that amounted to corporate extortion, the Machinists Local 751 at Boeing have taken a stand for middle-class workers all over the country.

    In a remarkable act of courage and solidarity with the next generation, last week Boeing workers in Seattle soundly rejected corporate extortion, by voting down a contract which traded job guarantees for concessions that would severely erode the pay and benefits of younger workers. In doing so, the members of the Machinists are risking their jobs to save an America built on the middle class.

    The dramatic fight of fast food workers for a minimal living wage, risking their jobs every time they take a day off to demonstrate, is one end of a corporate economy based on low wages, no benefits and no unions. That corporate strategy, aimed at maximizing profits, is destroying America’s middle class, wrecking the engine that powered the U.S. economy.

    On the other end of the middle class are workers like Boeing’s, who have fought together through their union for the good pay, pensions, health benefits and job security that characterized the increased prosperity and lowered income inequality of America in much of the second half of the 20th Century. But despite being a hugely profitable corporation, with dominance in the world aerospace market, Boeing is eager to follow the Wal-Mart/fast-food model of the 21st Century economy.

    Boeing is the aerospace and defense industry’s largest company, with its highest profits. In 2012 just the increase in Boeing revenues alone, $13 billion, would be equivalent to the 15th largest company in the industry. With a $319 billion backlog of orders  - about 3,700 planes – the company is set for years and is outpacing its only competition, Airbus. Last year, Boeing made $6.3 billion in profits and rewarded its CEO $27.5 million in compensation, a 20% hike from the previous year.

    Historically, Boeing’s Seattle workforce has shared in that wealth. With a 100-year history in the Puget Sound region, Boeing is still the area’s largest employer, its 70,000 employees dwarfing the 40,000 who work for Microsoft. Boeing workers are anchors of Seattle communities, both economically and civically.  And with good schools and colleges, transportation, and stable communities, the Seattle area has provided key public structures that have enabled Boeing to prosper. 

    But none of that matters – the high profits, the educated workers, the civic history – to a modern corporation that is driven only to maximize profits for its shareholders and pay for its top executives. Boeing moved its headquarters to Chicago in 2001 and decided to build its new 787 Dreamliner in South Carolina, with the first planes rolling out in 2012, assembled by 6,000 workers who earn $15 per hour, almost 50% less than what Washington assembly line workers earn.

    Early this month, Boeing tried to blackmail both its union members and Washington state. Declaring that it would consider moving assembly of a new line of 777X planes out of state, the corporation asked for mammoth tax incentives and huge concessions on wages and benefits. The Governor and State Legislature caved immediately, passing the largest development tax break for a company in American history, $8.7 billion over 16 years, in a special weekend session. The leadership of Machinists Local 751 also wavered, agreeing to put the contract up for a membership vote, over the objections of most of the union’s management council.

    But then a remarkable thing happened, in an age in which Americans, scared that they will lose what they have left, seem resigned to shrinking pay and disappearing benefits.  A grassroots swell of membership opposition to the contract rose up, leading to 67% of the member rejecting the contract. The members did so with their eyes wide open, understanding that Boeing might not be bluffing and despite the fact that Boeing combined bribery with their extortion; the contract would have provided a $10,000 signing bonus to each worker. So why did they show such resolve?

    In making their case, the members who organized against the contract focused on the fact that they would be giving up “hard fought contract negotiations and strikes by generations of Fighting Machinists that came before us. ” They warned, “Boeing is hoping you will deny the next generation many of the benefits we have today.”

    While the proposed contract came with skimpy pay increases and benefit cut-backs for all workers, younger Boeing workers and new hires would have been hit the hardest. Instead of a steady progression to higher wage rates as workers stayed with the company and acquired new skills – which is what Boeing contracts have guaranteed for years – under the proposed contract, recent hires and new hires would be locked into low pay, with glacial increases. The contract would have frozen current pensions and replaced future pensions with a 401K, the defined-contribution accounts that have no guaranteed pay-out and are subject to market risk. Boeing would have been allowed to transfer money from the over-funded workers’ pension fund to the under-funded executive retirement fund.

    Angered at the company’s “corporate threats and intimidation,” the members declared, “The one thing Boeing can’t take away is our solidarity.”

    Unlike Boeing, which has no allegiance to anything but the bottom line, the workers care about their community. As the 751voteno.com website stated, “We must be prepared for a decision they [Boeing] may make and understand that if they take the work elsewhere, they are responsible for that decision. We just could not destroy ourselves in order to keep the company from making a decision that destroys union and non-union workers alike, our communities and the investors.”

    That statement reminds me of a memorable insight I received in the first lecture of a finance class at the University of Chicago School of Business, delivered by Robert Hamada, a future dean of the School. Hamada pointed out that in the class we would be learning how a firm calculates return on investment (ROI), but that there was no reason that the calculations needed to be applied to ROI for shareholders. The same methods could be used to maximize ROI for workers, the community or society at large.

    As a society, we do not have to accept that the mammoth entities that control so much of our economy should operate just to benefit their shareholders. We can require that corporate decision making take into account its impact on its workers, our communities and the broader economy.

    That is what unions have done historically and still do at companies like Boeing, which pay high union wages, and in countries that support high rates of unionization.  To give workers a say in decision making, German corporations are required to have works councils, which have union members sharing in decisions – which the UAW is now trying to win in a Volkswagon plant in Tennessee –  and union representatives have the right to sit on corporate boards of directors. 

    Two years ago there was a huge uproar from conservatives when the National Labor Relations Board accused Boeing of moving to South Carolina in 2009 because of anti-union bias, which is prohibited under the National Labor Relations Act. The Board was roundly attacked for second guessing a corporate decision on where to locate jobs. But the Board’s action was based on a Boeing memo, which admitted “the only consistent advantage attributed to Charleston was the ability to ‘leverage’ the site placement decision toward ‘rebalancing an unbalanced and uncompetitive labor relationship.’” The Board dropped the case after the union and company agreed to a new labor contract, the very one that Boeing now wants to replace with the concessions that the union’s members just rejected.

    Part of the controversy around the Board’s decision was its novelty; cases are rare because it is difficult to prove that a company made relocation decisions based on anti-union bias. If we are going to reign in corporate destruction of wages and communities, we should instead imagine a labor law in which corporations are not able to expand into non-unionized facilities and make long-term investment decisions at the expense of jobs at already unionized facilities. These and other changes aimed at giving workers a powerful role in corporate governance are needed to balance the grip that corporate America now has on our economy and democracy.

    We will find out in the next year whether Boeing is bluffing or serious. Production problems at the South Carolina plant give the union some hope that Boeing might return to the bargaining table, although only after looking to see what they can extort in concessions for anti-union states.

    But regardless of where Boeing builds the 777X, the fight for an America in which hugely profitable corporations – whether it be Wal-Mart, McDonald’s or Boeing – share their wealth with their workers and their communities is just heating up. The bold vote by Boeing workers, like the wave of fast food strikes, are encouraging signs of a new movement of workers, supported by our communities, to build an America that again promises broadly based prosperity. 

    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.

     

    Boeing airplane landing image via Shutterstock.com

    Share This

  • President's Insurance Announcement Keeps Eyes on the Prize

    Nov 14, 2013Richard Kirsch

    By allowing people to keep their current plans for another year, even if those plans are not compliant with the Affordable Care Act, the President has retained a focus on the most important thing: insuring more Americans.

    By allowing people to keep their current plans for another year, even if those plans are not compliant with the Affordable Care Act, the President has retained a focus on the most important thing: insuring more Americans.

    President Obama’s move today to allow people to keep their current insurance plans for a year, as long as they are told that they may be able to get better coverage at a lower cost from the new exchanges, is smart politics with little likely policy damage. It keeps the eye on the prize: getting people enrolled. That is exactly why Republicans are likely to balk.

    For years the GOP has been throwing bombs at the Affordable Care Act (ACA) based on groundless talking points (a government takeover) or pure lies (death panels). I have always had confidence that as the law was actually implemented, and those charges demonstrated to be just hot air, that they would lose any punch beyond the hard-right base. My worries have always been about those who would see themselves as being hurt  (mostly by having to pay more than they can afford for coverage) when the law began to be implemented. Those are real people with real stories. The “if you like it you can keep it” firestorm is the first explosion of that fear.

    While the fact is that most people in the individual market will do better under the ACA’s new exchanges – once they are able to get into the enrollment system and apply for subsidies – there will be some people, mostly young, healthy, with good incomes, who would prefer to keep the coverage they have. And, as I wrote last week, since bad news is both more prevalent and more powerful than good news, their stories could threaten to define the law. By discrediting the ACA, it could also suppress enrollment, particularly given the botched rollout of Healthcare.gov.

    Democrats on the Hill are a panicky lot, driven to over-react to many issues that Americans outside of the Beltway ignore. But in this case, they were right to be concerned about not responding to what people most fear about health reform, that change will threaten what they now have. It was the power of that fear which led to the “if you like it you can keep it” promise in the first place.

    While the President’s credibility has sunk, he will not be on the ballot in 2014, but Democrats in Congress will. One of those Democrats, Senator Mary Landrieu of Louisiana, hit on a solution quickly. Landrieu has always been a consistent supporter of health reform and, despite representing a Red state, was never someone we were very concerned about losing in the legislative fight over the ACA. She deeply believes that people in her state should have health coverage. She stepped up last week with a bill that would allow people who are already covered to keep their insurance, but requires their insurance companies to tell them what ACA guaranteed benefits they won’t get with their current coverage and how to apply for coverage in the exchanges. Her proposal will make up for the misleading cancellation announcements sent out by insurance companies, which often have not told their policy holders that better, subsidized coverage might be available.

    Today Obama implemented Sen. Landrieu’s proposal with one major change: his rule would only extend the coverage until the end of 2014, consistent with other delays in implementation, such as the employer mandate. His goal is to get over this current hurdle and then continue to move as many people into the exchanges as possible.

    The President’s new rule is likely to be where the policy settles, but it is not likely to end the Congressional debate. The Republicans will seek to keep the issue alive by voting to approve a bill sponsored by House Energy and Commerce Chair Fred Upton, which would not just grandfather existing policies – the President’s promise – but open them up to more people. And that bill would leave out the information about the better, more affordable exchange policies in the Landrieu legislation and Obama rule.

    Democrats may decide they need to offer a legislative alternative to the Upton bill, which could be the Landrieu proposal. The policy concern with the Landrieu proposal is that premiums will rise and the exchanges will be harmed, if the healthiest people stay out, which is why Obama wants to limit the extension to one year. While that is certainly better policy, if Democrats go the Landrieu route it won’t be cataclysmic. Fairly quickly, the number of people left with their original policies will shrink as they get older and sicker and their insurance premiums rise. And as the exchanges grow and policies outside the exchanges dwindle, more insurers will drop coverage outside the exchanges all together.

    Will Republicans accept this compromise? Of course not. Everything they’ve done for the last five years demonstrates that they would rather try to keep the issue alive politically than address people’s problems.

    The President’s move allows him and Democrats to take the high ground. The most important task – to build a solid political foundation for the Affordable Care Act and realize its purpose – is getting people more people enrolled. The experience in Massachusetts demonstrated that low initial enrollment numbers are to be expected. There is every reason to expect a huge acceleration in enrollment as the web problems get fixed and we get closer to the deadlines. Including Medicaid, there are already more than half a million Americans who will be newly-covered next year. There will be millions more by early in 2014.  And as the opponents of Obamacare and government as a positive force in people’s lives know and fear, in the end, those are the people who will count.  

    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.

    Share This

  • Story Wars: Why Personal Stories Are Shaping the Health Care Battleground

    Nov 8, 2013Richard Kirsch

    It's natural for negative stories about the Affordable Care Act to have the biggest impact, but media bias is obscuring the facts.

    More than any other public policy issue, health care is very personal. So it is not surprising that personal stories are a central battleground for the public perception of the Affordable Care Act. And it is increasingly clear that this battle will be fought through the prisms of class and race.

    It's natural for negative stories about the Affordable Care Act to have the biggest impact, but media bias is obscuring the facts.

    More than any other public policy issue, health care is very personal. So it is not surprising that personal stories are a central battleground for the public perception of the Affordable Care Act. And it is increasingly clear that this battle will be fought through the prisms of class and race.

    The Affordable Care Act (ACA) would not have become law if it were not for the willingness of survivors of the nation’s health care mess – people who had lost loved ones, fought to get care after an insurance company denial, faced crippling medical costs – to tell their stories to members of Congress and the press. Many members of Congress voted for the bill, despite the political risk, because they were moved by personal encounters with constituents with compelling stories. Many of the most effective spokespeople during the legislative battle over the law were people whose lives and livelihoods had been threatened by our defective health coverage system.

    Now that the central part of the Affordable Care Act is finally being implemented, however painfully and slowly, personal stories are again becoming the focus of debate. The stories that the press has focused on recently have been mostly negative, largely because of three press biases. The first is that “if it bleeds, it leads.” Negative news gets people’s attention, raising people’s fears, a phenomenon with strong physiological and psychological roots that extends well beyond the news. Advocates for passage of the law used that to our advantage when we were chronicling insurance company abuses, but in the new terrain of the law’s implementation, it’s a handicap. Coverage of people successfully getting affordable coverage is not as compelling as that of someone who says she is being forced to pay higher premiums after being told she is losing her existing coverage.

    The second press bias is to take people at their word and not actually investigate them, particularly when they make good news. We have seen a lot of this in the coverage of people who have received letters from insurance companies telling them they are being forced into higher-priced plans.

    Take Deborah Cavallaro, a real-estate agent in suburban Los Angeles, who’s been on NBC Nightly News and Fox. Ms. Cavallaro is losing her current plan, which only covers two doctors visits a year and has a $5,000 deductible. She complained, “I’d be paying more for the exchange plans than I am currently paying,” after an insurance broker told her she would have to pay $478 a month compared to the $293 she now pays. But with a little research, Michael Hiltzik of the Los Angeles Times found that after her income-based subsidy, Cavallaro would pay only $33 a month more for a plan which covers all her doctors visits and has a $2,000 deductible.

    Cavallaro is typical of many of the people represented in the negative stories being run, in that she is white, suburban, and has a middle-class job. Reporters like Jonathan Cohn in The New Republic have explored the shoddy media coverage of other stories whose subjects are similar to Cavallaro.

    Which brings us to the third media bias, focusing on the white middle class. This is a general bias when it comes to the press, particularly when not reporting on government services or crime. In this case, it is a bias that will accentuate the problems with the Affordable Care Act and downplay its benefits to millions. As Cohn points out in another piece, there are some people who will pay more for comparable insurance plans under the new law. This is the small minority of people in the individual insurance market who, because they have been in good health and have enough income to buy insurance, have been able to find decent coverage at a price they can afford. Their good health has shielded them from big premium hikes or losing their coverage altogether, which will happen when they have a serious illness.

    One of the few good news stories I found that focused on someone who will benefit from losing her coverage was about Gail Roach, an African-American woman from Pittsburgh. Ms. Roach is a retired school district employee who will save $500 a month after receiving her subsidy. A diabetes sufferer, she’s been forced to pay a big premium because of her health condition.

    The ACA’s biggest beneficiaries are low- and moderate-income people, including poor people who have been denied Medicaid and people who work at low-wage jobs that don’t provide health coverage, who will now get big enough subsidies in the exchanges to afford coverage.  

    In fact, the biggest group benefiting from enrolling in coverage under the Affordable Care Act are people who are eligible for Medicaid. In Washington State, for example, where the exchanges are working well, there have been 42,605 Medicaid enrollees, compared to 6,390 who have signed up for the exchanges.  A New York Times article on how navigators are helping people to enroll in Kentucky tells the story of several people thrilled to be enrolled in Medicaid.

    The Times article also reveals the bias against people who are on public programs like Medicaid by recounting the story of one "well-dressed woman" in Kentucky:

    She had learned that she would be eligible for Medicaid under the new law, but she was unwilling to enroll because of what she saw as a stigma attached to the program. A substitute teacher, she wanted to know whether she could afford full-priced private exchange plans. “I don’t want to be a freeloader,” said the woman, who asked to be identified only by her middle name, Kay, because she said she was embarrassed about qualifying for Medicaid. “I believe in paying our way in life.”

    There may be a promising ending to Kay’s story. Kay did sign up for Medicaid, saying that she would pay for routine doctor visits herself but have Medicaid as a fall-back if she really got sick. Will the experience of finally getting health coverage change Kay’s views? Will she now be more secure, freed finally from the worries of huge medical debt if she gets seriously ill?

    This gets us back to the personal politics of health care and how they will impact the political debate. Kay’s U.S. senator, Mitch McConnell, who is up for re-election, has already dismissed the success of Kentucky’s launch of the ACA by saying, “Well, 85 percent of the people who’ve signed up in Kentucky have signed up for Medicaid. That’s free health care.” Will Kay want to vote for a guy who will take away her newly found health security?

    The next big political test for Obamacare will be whether it is a defining issue in the 2014 elections. That will depend both on the reality of people’s experiences and what people learn about the law from the media, which will largely be shaped by personal stories. Since the law will have no noticeable impact on the coverage of 85 percent of Americans, Obamacare should not be a big election issue. But we know that opponents will use every negative story to keep the issue alive.

    The most important task for supporters of the law will be to make sure that it does realize its promise of better coverage for millions of people. The more people who get enrolled and find, like Kay, Gail Roach, and even Deborah Cavallaro, that it is good for their health and their pocketbook, the better. Then supporters must forcefully fight to tell the personal stories of their success, even if it is boring, good news, often about struggling working families. 

    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.

    Share This

Pages