Dr. Strangelove and the Halbig Decision

Jul 22, 2014Mike Konczal

"Yes, but the whole point of a doomsday machine is lost if you keep it a secret! Why didn't you tell the world, eh?" - Dr. Strangelove

So the DC Circuit Court ruled in Halbig v. Burwell hat health care subsidies can only go to states that set up their own health care exchanges rather than use the federal ones. That means indivdiuals from the 34 states who get subsidized health care from the federal exchange would no longer be able to get subsidies. (Another court ruled against this logic today.) I don't normally do health care stuff, but I've read a lot about this case and something strikes me as very odd.

As I understand it, those on the right who are pushing the Halbig case argue that there's a doomsday machine built into Obamacare. (Adam Serwer at MSNBC also caught this doomsday machine analogy.) If states don't set up their health care exchanges then they don't receive subsidies for health care from the federal government. According to this theory, the liberals who designed health care reform did this knowing that if subsidies were pulled, the system would collapse for states that didn't set up their exchanges.

It's important to note that those on the right are not arguing that this is a typo in the bill, because that wouldn't necessarily be sufficient to overturn the subsidies. They are arguing that Congress intentionally put this language in there to compel, bribe, incentivize, and otherwise threaten states that didn't set up their own exchanges. In the rightwing argument, liberals were saying "we are making the citizens of your state purchase health care, and if you don't set up an exchange they won't get the subsidies necessary to make the system work, so you'd better set up an exchange."

The right's argument hinges on the idea that since there's no evidence that this isn't the intent, it must be the intent. As the two authors of the legal challenge put it, Obamacare "supporters’ approval of this text reveals that their intent was indeed to enact a bill that restricts tax credits to state-run Exchanges. At no point have defenders of the rule identified anything in the legislative history that contradicts" their reading.

Here's the thing, though: like Strangelove notes, a doomsday machine only works if you tell others about it. So, why weren't the people in the vast network associated with Obamacare telling everyone about this threatening doomsday device after the bill passed?

If this was actually the intent, you'd expect that during the period where states were debating whether to set up exchanges, this would have been a major threat raised by somebody. Anyone, from President Obama to congressional leaders to health care experts and lawyers to activist groups on the ground in red states fighting for implementation, would have been saying, "if your state doesn't set up a health care exchange, your citizens are screwed. At the very least, you'll be leaving money on the table." ("Leaving money on the table" is always a good point to bring up, and if this doomsday machine really were the intent of the law, it would be true.)

I know of no evidence of this being the case. Does anybody? Numerous people are arguing that the legislative intent is clearly on providing subsidies to the federal exchange users. No wonder the dissent argued that the Halbig ruling was "a fiction, a post hoc narrative concocted to provide a colorable explanation for the otherwise risible notion that Congress would have wanted insurance markets to collapse in States that elected not to create their own Exchanges."

That doesn't change what the DC Circuit did, of course, but it should make a random person stop and wonder how much of a cynical ploy this whole thing is.

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"Yes, but the whole point of a doomsday machine is lost if you keep it a secret! Why didn't you tell the world, eh?" - Dr. Strangelove

So the DC Circuit Court ruled in Halbig v. Burwell hat health care subsidies can only go to states that set up their own health care exchanges rather than use the federal ones. That means indivdiuals from the 34 states who get subsidized health care from the federal exchange would no longer be able to get subsidies. (Another court ruled against this logic today.) I don't normally do health care stuff, but I've read a lot about this case and something strikes me as very odd.

As I understand it, those on the right who are pushing the Halbig case argue that there's a doomsday machine built into Obamacare. (Adam Serwer at MSNBC also caught this doomsday machine analogy.) If states don't set up their health care exchanges then they don't receive subsidies for health care from the federal government. According to this theory, the liberals who designed health care reform did this knowing that if subsidies were pulled, the system would collapse for states that didn't set up their exchanges.

It's important to note that those on the right are not arguing that this is a typo in the bill, because that wouldn't necessarily be sufficient to overturn the subsidies. They are arguing that Congress intentionally put this language in there to compel, bribe, incentivize, and otherwise threaten states that didn't set up their own exchanges. In the rightwing argument, liberals were saying "we are making the citizens of your state purchase health care, and if you don't set up an exchange they won't get the subsidies necessary to make the system work, so you'd better set up an exchange."

The right's argument hinges on the idea that since there's no evidence that this isn't the intent, it must be the intent. As the two authors of the legal challenge put it, Obamacare "supporters’ approval of this text reveals that their intent was indeed to enact a bill that restricts tax credits to state-run Exchanges. At no point have defenders of the rule identified anything in the legislative history that contradicts" their reading.

Here's the thing, though: like Strangelove notes, a doomsday machine only works if you tell others about it. So, why weren't the people in the vast network associated with Obamacare telling everyone about this threatening doomsday device after the bill passed?

If this was actually the intent, you'd expect that during the period where states were debating whether to set up exchanges, this would have been a major threat raised by somebody. Anyone, from President Obama to congressional leaders to health care experts and lawyers to activist groups on the ground in red states fighting for implementation, would have been saying, "if your state doesn't set up a health care exchange, your citizens are screwed. At the very least, you'll be leaving money on the table." ("Leaving money on the table" is always a good point to bring up, and if this doomsday machine really were the intent of the law, it would be true.)

I know of no evidence of this being the case. Does anybody? Numerous people are arguing that the legislative intent is clearly on providing subsidies to the federal exchange users. No wonder the dissent argued that the Halbig ruling was "a fiction, a post hoc narrative concocted to provide a colorable explanation for the otherwise risible notion that Congress would have wanted insurance markets to collapse in States that elected not to create their own Exchanges."

That doesn't change what the DC Circuit did, of course, but it should make a random person stop and wonder how much of a cynical ploy this whole thing is.

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Daily Digest - July 17: Are We Building a Sustainable Future?

Jul 17, 2014Rachel Goldfarb

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Why This One UN Report on Sustainable Development is Different from the Rest (UN Dispatch)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Why This One UN Report on Sustainable Development is Different from the Rest (UN Dispatch)

Campus Network Senior Fellow for Defense and Diplomacy Nehemiah Rolle says the Global Sustainable Development Report incorporates a broad array of both science and policy data.

Will a Fox, Time Warner Deal Be Approved? (Bloomberg TV)

Roosevelt Institute Fellow Susan Crawford says the Federal Communications Commission has an interest in regulating these big mergers to protect the future of U.S. communications.

Imagining Economic Policy Focused on Women (Real News Network)

Roosevelt Institute Senior Fellow Rob Johnson points to minimum wage, work sharing, and paid family leave as key policies for improving women's opportunities and thus the economy as a whole.

Punish the Executives, Not Just the Banks (New Yorker)

The short-term incentives for individuals on Wall Street continue to encourage risky and destructive business practices, writes James Surowiecki, which is why bank settlements aren't effecting change.

America’s Unrequited Corporate Love Affair (MSNBC)

Timothy Noah says the trend toward reincorporating abroad to avoid U.S. taxes is only part of a larger negative shift in the relationship between American corporations and the state.

Hobby Lobby's Harvest: A Religious Exemption for LGBT Discrimination? (LA Times)

Michael Hiltzik looks to Dr. Martin Luther King, Jr. to explain why President Obama should not allow a religious exemption in his executive order barring discrimination against LBGT workers.

New on Next New Deal

Fighting Bad Science in the Senate

Roosevelt Institute Fellow Andrea Flynn says that even when they won't pass, strongly pro-choice bills like the Women's Health Protection Act are a means of fighting anti-choice falsehoods.

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Fighting Bad Science in the Senate

Jul 17, 2014Andrea Flynn

The Senate hearing for the Women's Health Protection Act shows just how important it is for women's health advocates to push for the facts.

The Senate hearing for the Women's Health Protection Act shows just how important it is for women's health advocates to push for the facts.

The propensity of anti-choice advocates to eulogize false science was on full display on Tuesday’s Senate hearing on the Women’s Health Protection Act (WHPA). That bill is a bold measure that would counter the relentless barrage of anti-choice legislation that has made abortion – a constitutionally protected medical procedure – all together inaccessible for many U.S. women.

The bill was introduced last year by Senators Richard Blumenthal and Tammy Baldwin and Representatives Judy Chu, Lois Frankel and Marcia Fudge. It prohibits states from applying regulations to reproductive health care centers and providers that do not also apply to other low-risk medical procedures. It would, essentially, remove politicians from decisions that – for every other medical issue – remain between individuals and their providers.

The WHPA is long overdue. For the past three years, conservative lawmakers have used the guise of protecting women’s health to pass more than 200 state laws that have closed clinics, eliminated abortion services, and left women across the country without access to critical reproductive health care. The WHPA would reverse many of those policies and prevent others from being passed.

Tuesday's hearing was representative of the broader debate over abortion rights. Those in favor of the bill argued that securing guaranteeing unfettered access to reproductive health care, including abortion, is critical to the health and lives of U.S. women and their families.

Those in opposition used familiar canards about abortion to argue the law would be calamitous for U.S. women. Representative Diane Black of Tennessee had the gall to make the abortion-leads-to-breast cancer claim, one that has been disproven many times over. Others repeatedly cited the horrific cases of Kermit Gosnell, insinuating that all abortion providers (abortionists, in their lingo) are predatory and that late term abortions are a common occurrence. In fact, if women had access to safe, comprehensive and intimidation-free care, Kermit Gosnell would have never been in business. Given the opposition’s testimony, you’d never know that late term abortion is actually a rarity. According to the Centers for Disease Control, more than 90 percent of all abortions occur before 13 weeks gestation, with just over 1 percent taking place past 21 weeks.

At one point Representative Black argued that abortion is actually not health care. The one in three U.S. women who have undergone the procedure would surely argue otherwise.

Perhaps the most ironic testimony against the WHPA – and in favor of abortion restrictions – came from Senator Ted Cruz, who hails from Texas, a state with so many abortion restrictions that women are now risking their health and lives by self-inducing abortions or crossing the border to get care in Mexico. Senator Cruz attempted to validate U.S. abortion restrictions by referencing a handful of European countries with gestational restrictions on abortions. This was a popular argument during the hearing for Texas’ HB2 – the bill responsible for shuttering the majority of clinics in that state.

Cruz wins the prize for cherry picking facts to best support his argument. When citing our European counterparts, he conveniently ignored that such abortion restrictions are entrenched in progressive public health systems that enable all individuals to access quality, affordable (often free) health care, including comprehensive reproductive healthcare. Senator Cruz and his colleagues have adamantly opposed similar policies in the U.S., particularly the Affordable Care Act’s provisions for contraceptive coverage and Medicaid expansion. On the one hand conservatives lean on European policies to argue for stricter abortion restrictions at home, and on the other they claim those policies are antithetical to the moral fabric of the United States.

Would Cruz support France’s policies that enable women to be fully reimbursed for the cost of their abortion and that guarantees girls ages 15 to 18 free birth control? Or Belgium’s policy that enables young people to be reimbursed for the cost of emergency contraception? Or the broad exceptions both countries make for cases of rape, incest, and fetal impairment, to preserve woman’s physical or mental health, and for social or economic reasons? He absolutely would not.

Given the House of Representatives seems to be more motivated by suing the President than by voting on – let alone passing – laws that will actually improve the health and lives of their constituents, it’s highly unlikely the WHPA will become law. But Tuesday's debate – and the bill itself – is significant and shows a willingness among pro-choice advocates to go on the offense after too many years of playing defense.

Bills such as the WHPA – even if they face a slim chance of being passed by a gridlocked Congress – provide an opportunity to call out conservatives' use of bad science in their attempts to convince women that lawmakers know best when it comes to their personal medical decisions. And they allow us to remind lawmakers and citizens that despite all of the rhetoric to the contrary, abortion is a common, safe and constitutionally protected medical procedure, and that regulating it into extinction will only force women into back-alley practices like those run by Gosnell, costing them their health and their lives.

Those in support of the WHPA showed anti-choice lawmakers that the days of make a sport of trampling women’s health and rights are numbered.

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

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The Supreme Court's One-Two Punch Against Women's Health: McCullen and Hobby Lobby

Jul 2, 2014Andrea Flynn

The Court's rulings place more barriers, both physical and financial, between U.S. women and basic health care.

The Court's rulings place more barriers, both physical and financial, between U.S. women and basic health care.

In the last week the Supreme Court announced two decisions that could dramatically change the landscape of women’s health access in the United States. It will be some time before we know the full impact of McCullen v. Coakley and Burwell v. Hobby Lobby, but in the short term two things are for sure. The decisions will make it more difficult and less safe for many women to get the care they need, and they will undoubtedly embolden a conservative movement that hardly needs fortification.

The last three years brought record setbacks to women’s health and rights. More abortion restrictions were enacted between 2011-2013 (205) than in the entire previous decade (189). Today nearly 90 percent of U.S. counties do not have an abortion provider and more than 56 percent of U.S. women live in a state hostile to abortion. In many states the procedure has essentially been regulated out of existence. But it’s not just abortion rights that are under attack. The days of conservatives being “anti-abortion” but pro-family planning are long behind us. Today’s conservatives view birth control as the gateway drug to abortion, and regulate it with the same zeal they once saved for abortion.

Restrictions to Title X funding are closing publicly funded clinics around the country. Those clinics serve to provide reproductive health services to low-income and young women, and the majority do not even provide abortions. There is reason to fear that other conservative states are following the lead of Texas, where thousands of women are dealing with the consequences of a complete lack of access to basic health care thanks to lawmakers who have closed a record number of clinics. 

Making matters worse, today 24 states are not participating in the Medicaid expansion originally mandated by the Affordable Care Act (ACA), leaving two-thirds of poor blacks and single mothers and more than half of low-wage workers uninsured.

It’s against this backdrop that we have McCullen and Hobby Lobby, two decisions that are effectively a one-two punch to U.S. women. They allow employers to erect financial barriers to contraceptive choice and embolden protesters to serve as physical and emotional barriers to women’s basic health care. 

In McCullen, the Court struck down as a violation of free speech a Massachusetts law that provided a 35-foot “buffer zone” around clinics that provide abortion. The law was created to protect patients entering clinics, and many states have similar regulations in place. It’s unclear what will happen to those other buffer zones. It’s also more than slightly ironic that the Supreme Court, the very body responsible for upholding freedom of speech, has a 100-foot buffer zone that is still intact.

Protesters will feel vindicated in their attempt to persuade, intimidate, threaten, and terrorize women from accessing care to which they are constitutionally guaranteed. Last weekend the Boston clinic at the heart of the McCullen case saw a threefold increase in protesters. That’s just in Massachusetts. Clinics in more conservative states regularly see hundreds of protesters on a given day.

Hobby Lobby was just one of more than 50 companies (supported by organizations like the Beckett Fund for Religious Liberty) that took issue with the ACA’s “contraceptive mandate,” the requirement that all employer-based health plans fully cover, without cost sharing, all FDA-approved methods of contraception. These companies filed claims against the mandate, arguing that intra-uterine devices (IUDs) and emergency contraception (EC) constitute abortion and therefore being required to provide coverage for those methods was a violation of their religious liberty. Never mind that by all accepted medical standards those methods prevent, not terminate, pregnancy. The Court ruled in favor of Hobby Lobby, allowing “closely held” companies – generally understood to be those having more than 50 percent of the value of their stock owned by five or fewer individuals – to refuse coverage of certain contraceptive methods.

So, what happens now? Well, most women who work for Hobby Lobby and other such companies will no longer have access to the contraceptive method of their choice. They will have to decide if they want to pay for those methods out of pocket or go to a clinic where they can receive subsidized care, if they are lucky enough to have access to one. This will place additional and unnecessary pressure on an already embattled public health infrastructure.

The majority claimed the Hobby Lobby ruling was narrow and would not have the sweeping consequences suggested in Justice Ginsburg’s scathing and on-point dissent. I’m not convinced. According to Harvard Business Review, 90 percent of U.S. companies are considered closely held, and those companies employ more than 51 percent of U.S. workers. There are already at least 80 other cases waiting to follow in Hobby Lobby’s footsteps. Given conservatives’ strategic organizing and employers’ willingness to carry the anti-reproductive rights, anti-Obama, anti-ACA banner, others will surely join the cause.

For the time being, the ACA – and the mandate – remain intact, even if somewhat fractured. We should continue to fight for the full implementation of the ACA, a historic – and by all measures successful – piece of legislation that is advancing the vision FDR articulated more than 70 years ago when he called for a Second Bill of Rights. That vision included medical care to allow all Americans to achieve and enjoy good health.

In falsely pitting freedom of speech and religion against women’s rights – as if women don’t also have rights to those same freedoms – the Supreme Court has given momentum to an already fast-moving train. Conservatives will only have more resolve to continue tearing down the building blocks of women’s health and rights. It’s going to take a lot to stop them. A lot of outrage, a lot of action, and a lot of engaged voters committed to standing up for women’s rights. Here’s hoping we can make that happen.

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

Image via Thinkstock

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Daily Digest - June 23: Weak Labor, Low Wages Feed Unstable Housing Market

Jun 23, 2014Rachel Goldfarb

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Housing Market Falters Amid Rising Prices, Lower-Paying Jobs (Bloomberg)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Housing Market Falters Amid Rising Prices, Lower-Paying Jobs (Bloomberg)

Kathleen M. Howley reports on new, weaker forecasts for the housing market, and blames slow labor growth, which is primarily in low-wage jobs, and stagnant wages.

Poll: Fewer Americans Blame Poverty on the Poor (NBC News)

A new poll shows a major shift in how Americans perceive the causes of poverty since 1995, writes Seth Freed Wessler. Nearly half of respondents today blame structural causes.

The Economic Argument for Raising Women's Pay (Political Research Associates)

Mariya Strauss assesses the economic benefits of pay equity, which include increased economic growth and tax revenues, as well as a reduced need for public assistance programs.

Republicans Finally Admit Why They Really Hate Obamacare (NY Mag)

As the predictions of Obamacare skeptics are steadily debunked, Jonathan Chait says conservatives are forced to admit they just don't like transfer programs to help the poor.

The Big Lobotomy (Washington Monthly)

Paul Glastris and Haley Sweetland Edwards look at how Republicans in Congress have cut the Congressional workforce, reducing expertise and capacity as well as limiting their own effectiveness.

Why Inequality Might Make Kids Drop Out of High School (WaPo)

A new study suggests that the "economic despair" caused by increased inequality is the reason for higher dropout rates, reports Matt O'Brien.

Finally! Big Investors Declare War on Big Banks (The Fiscal Times)

David Dayen reports on a new front in the post-financial crisis legal battle:  a group of investors sues the trustee banks that assembled mortgage bonds for abandoning quality standards.

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Daily Digest - June 12: Health Care Reform is Here to Stay, But Can It Be Improved?

Jun 12, 2014Rachel Goldfarb

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Time to Bring Back the Public Option — Medicare in All Exchanges (The Hill)

Click here to subscribe to Roosevelt First, our Monday through Friday morning email featuring the Daily Digest.

Time to Bring Back the Public Option — Medicare in All Exchanges (The Hill)

Roosevelt Institute Senior Fellow Richard Kirsch says that as the discussion of Obamacare shifts from repeal to reform, the first improvement should be expanding access to Medicare coverage.

Ken Burns: Go Ahead, Campaign on the Affordable Care Act (U.S. News & World Report)

Nikki Schwab reports on Ken Burns's remarks on current big policy issues at the "Inequality Begins at Birth" conference, where he screened his upcoming documentary about the Roosevelts.

Republicans Just Killed Elizabeth Warren's Plan to Ease Americans' Crushing Student Loan Debt (MoJo)

Senator Warren's bill would have allowed borrowers to refinance at lower interest rates, writes Patrick Caldwell. Republicans filibustered over the cost, but the bill would have reduced the deficit.

U.S. Economic Recovery Looks Distant as Growth Lingers (NYT)

Binyamin Appelbaum reports on the government's reduced expectations for annual growth, which are leading some economists to wonder whether the economy can ever fully rebound.

What the Foreclosure Crisis Looks Like in Urban Neighborhoods with Few Single-Family Homes (WaPo)

When foreclosure hits neighborhoods filled with small apartment buildings, it reduces cities' already limited supply of affordable rental stock, says Emily Badger.

New on Next New Deal

Do Taxpayers Care if Student Loans Are Paid Off Too Quickly? (On Fair Value Accounting)

Roosevelt Institute Fellow Mike Konczal argues that while private lenders might not like it when student loans are paid off ahead of schedule, the public shouldn't worry about it.

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Healing the Medical Field: How A Push Against Careers in Medicine Could Push Back on Burnout

Jun 10, 2014Anisha Hegde

When doctors speak out about burnout, it creates an opportunity to create a more sustainable way to practice medicine.

When doctors speak out about burnout, it creates an opportunity to create a more sustainable way to practice medicine.

This fall, I will join about 17,000 students matriculating into medical colleges across America. For all of us, gaining admission to a medical school was at least a four year long process of first discerning – through shadowing, taking rigorous science classes, and volunteering – that we want to be doctors, followed by studying for the MCAT and successfully completing the marathon-like admissions process. For most of us, gaining admission to a medical school is only the beginning of a decade of training in the practice of medicine.

A grueling work environment upon graduation from medical school apparently accompanies this daunting timeline. Domestically, there is a forecasted shortage of 130,600 doctors by 2025, which will likely be exacerbated by the millions of newly insured people under the Affordable Care Act and the increasing emphasis on preventive care. These changes are both tremendously positive for society, but create challenges in the field of medicine. With only 17,000 of the 40,000 yearly applicants matriculating into American medical schools, compared to 45,000 beginning law school and 100,000 beginning business school, reducing that shortage becomes hard to envision. The physician shortage is even more striking on a global scale, as reported by the New England Journal of Medicine.

We can also expect high burnout rates when we get to work. As I was completing secondary applications last fall, I noticed a plethora of headlines advising Millennials against careers in medicine, with multiple doctors leaving comments to express their agreement. I cannot recall reading even one article during that same time period encouraging students interested in service and science to pursue an MD. A survey by NerdWallet sums up the crux of the issues mentioned in the articles: doctors are deeply unsatisfied with their professional choices and would not choose careers in medicine if they could go back and do it all over again. 

Perhaps surprisingly, these articles never made me doubt my desire to become a doctor. Many of the doctors I have shadowed over the years have iterated the power of one positive patient encounter to carry them through the day, to recall as encouragement through the toughest moments. In these interactions between doctors and their patients, I have witnessed the privilege of serving someone in their time of need, the fulfilling skillset of helping someone stay healthy and the lifelong learning that is required in attempting to understand the human body.  These memories and observations have morphed into goals and have seen me through 2 am study sessions for organic chemistry tests and the aftermath of medical school rejection e-mails.

Though I haven't obeyed the command of the articles pushing back on medical school, they did lead to honest conversations with doctors about balancing work and family and about the weighty, taxing responsibility that accompanies a career in medicine. To address burnout, Diane Shannon highlights inexpensive yet seemingly effective measures, such as physician retreats and increased day-to-day clinical autonomy. She also points to larger overhauls and paradigm shifts, such as redirecting the reimbursement system to compensate for quality, as opposed to quantity, of care and employing third-parties to cultivate compassionate healthcare, which medical school curriculums also emphasize.

Maybe I am simply on a post-undergraduate-commencement high, but perhaps this deluge of articles from doctors who left their practices is an inception of a long-needed change in the world of medicine: elevating conversations about stress and concerns plaguing doctors onto a larger stage. This change promises to engage doctors before the final burnout and to fill doctor shortages in a sustainable way. At its core, this change is relevant to service sector fields from doctors to nurses to teachers. As a millennial entering medical school, I realize I know very little about what to expect when it comes to a career in medicine, but I am grateful to those who have spoken out. I hope that the attention they have brought to the dearth of humanity allotted to both the provider and the patient is the inception of a policy and culture-oriented journey to correct both.

Anisha Hegde is the Roosevelt Institute | Campus Network Senior Fellow for Health Care.

 

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Daily Digest - May 27: Taking Stock of Piketty's Capital

May 27, 2014Rachel Goldfarb

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Why Geithner Drives Liberals Nuts (Politico)

Ben White quotes Roosevelt Institute Fellow Mike Konczal, who says tensions over Tim Geithner's work during the financial crisis will come into play in the 2016 elections.

Click here to receive the Daily Digest via email.

Why Geithner Drives Liberals Nuts (Politico)

Ben White quotes Roosevelt Institute Fellow Mike Konczal, who says tensions over Tim Geithner's work during the financial crisis will come into play in the 2016 elections.

Thomas Piketty Accuses Financial Times of Dishonest Criticism (The Guardian)

Jennifer Rankin reports on Piketty's response, in which he maintains that his conclusions are solid even when looking at more recent data than he used in his book.

I.R.S. Bars Employers From Dumping Workers Into Health Exchanges (NYT)

Giving employees tax-free dollars to pay for insurance on the exchanges won't satisfy the Affordable Care Act's employer mandate, reports Robert Pear, and the fines are steep.

  • Roosevelt Take: Roosevelt Institute Senior Fellow Richard Kirsch suggests that employers that don't want to provide insurance should pay an additional payroll tax instead.

The Slow, Quiet Death of Extended Unemployment Benefits (MoJo)

Patrick Caldwell blames the lack of momentum on this issue on the House GOP, given that long-term unemployment is higher than it's ever been without federal emergency benefits.

New on Next New Deal

The FT Gets Piketty's Capital Argument Wrong

Roosevelt Institute Fellow Mike Konczal argues the Financial Times misses Thomas Piketty's central theme: the size and importance of capital will soon dwarf the rest of the economy.

The New Conservative Reformers Still Don't Have a Plan for Wall Street

Mike Konczal looks at a new report from conservative reformers and finds it lacking on financial reform. It doesn't address any of the current debates on issues like Too Big To Fail.

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In Georgia, Lawmakers Taking Pride in Policies That Hurt the Poor

May 16, 2014Andrea Flynn

This post is the final in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a close look at the state of Georgia, where the legislature is taking active steps against the Affordable Care Act.

This post is the final in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a close look at the state of Georgia, where the legislature is taking active steps against the Affordable Care Act.

Georgia has taken the lead in the mad dash to thwart the Affordable Care Act (ACA) and prevent poor people from accessing health care. Last week, Governor Nathan Deal signed into law two bills that ensure the state won’t be expanding Medicaid any time soon, and that make it decidedly more difficult for people to gain coverage under the ACA. These laws – a notch in the belt of conservatives preparing for the fall election – compound the social and economic injustices already experienced by many low-income Georgians.

House Bill 990 moves the authority to expand Medicaid out of the Governor’s office and over to lawmakers. In a state where conservative politics run deep, HB 990 is Governor Deal’s clever way of way of ensuring Medicaid expansion will never get passed, and abdicating all responsibility for the health and economic consequences that will surely result. The second bill, HB 943, restricts state and local agencies and their employees from advocating for Medicaid expansion, bans the creation of a state health insurance exchange, and prohibits the University of Georgia from continuing its navigator program once its original federal grant expires in August. The University’s navigators have been working throughout the state – especially in underserved rural areas – to help demystify the ACA, assist individuals in gaining coverage on the national exchange, and help those who already qualify for Medicaid to enroll.

“Someone else will now have to re-invent the wheel and figure out how to get resources to people in rural areas," said Beth Stephens of Georgia Watch, a non-partisan consumer advocacy organization.

Like many other states that refuse to participate in Medicaid expansion, Georgia isn’t faring so well by most socio-economic indicators. The poverty rate, which now hovers around 20 percent, is 50 percent higher than it was in 2000. Nearly two million Georgians do not have health coverage, ranking the state fifth nationally in numbers of uninsured. Close to half of those individuals between the ages 18 and 64 have incomes below 138 percent of the federal poverty level, many of whom would be covered under Medicaid expansion. Georgia has one of the nation’s highest unemployment rates (seven percent) and today the average family makes $6,000 less than it did 10 years ago, when inflation is factored in. Individuals living outside of major cities have few health care options. In recent years eight rural hospitals have closed, leaving residents with scarce health resources and hospital workers without jobs.

To make matters worse, lawmakers in Georgia have been systematically dismantling the state’s social safety net. Of the 300,000 Georgian families living below the poverty line, only 19,000 receive TANF and more than three quarters of those cases involve children only. That means that fewer than seven percent of low-income Georgians are able to get the welfare assistance they badly need. On the same day that Governor Deal signed the aforementioned bills, he also signed HB 772, requiring certain individuals to pass – and foot the bill for – a drug test before receiving welfare and food stamps. That bill is thought to be the nation’s most stringent when it comes to public assistance.

The environment is especially hostile for Georgia’s women, 21 percent of whom live in poverty (33 and 36 percent of Black and Hispanic Georgian women, respectively). More women in Georgia die of pregnancy-related causes than women in all but two other states. The U.S. maternal mortality rate (MMR) is 18.5; that is the number of women who die for every 100,000 births. Georgia’s MMR has more than doubled since 2004 and is now 35.5 (a shocking 63.8 for black women and 24.6 for white women). Expanding Medicaid would extend health coverage to more than 500,000 uninsured Georgians, 342,000 of them women. That coverage would surely save women’s lives.

Expanding Medicaid is the right thing to do, and it makes good economic sense. It would support the development of 70,343 jobs statewide in the next decade. In that time it would bring $33 billion of new federal funding into the state, generating $1.8 billion in new state revenue. Despite all this, and despite the fact that poverty is increasing, access to health care is decreasing, and more women are dying because of pregnancy than in any time in the past 20 years, conservatives in Georgia proudly reject Medicaid expansion.

Grassroots groups in the state are working hard to counter anti-ACA sentiments. SPARK Reproductive Justice Now, an Atlanta-based non-profit that is educating and mobilizing Georgians on issues related to the ACA, released a statement in support of Medicaid expansion immediately after the Supreme Court determined states could opt-out. In addition to hosting press conferences at the capital and participating in public education events, SPARK is empowering young people to collect and tell their own stories – and those of their families – to illustrate the need for improved health access in the state and clear up confusion about how the ACA would benefit various communities. The organization is also collaborating with health navigators, particularly those working in low-income, LGBT, and black communities, to get across the message that all Georgia citizens deserve health security. “We are telling them they shouldn’t have to worry about sacrificing gas, transportation, prescriptions, etc. We are putting it back on our state and our policymakers to make it right for everyone," said Malika Redmond, SPARK’s executive director.  

The majority of Georgians want lawmakers to make it right. Polls show that 59.6 percent disagree with the state’s refusal to participate in expansion. That sentiment is shared by 64.9 percent of women and by 82.9 percent of African-Americans.

Conservative lawmakers don’t seem to care. They are busy patting each other on the back for sticking it to Obama and undermining the ACA. But the ACA isn’t going away. It’s only getting stronger. And the only people conservatives are sticking it to are the poor families in their state that are already reeling from policies that are costing them their health, their happiness, and their lives. 

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

Banner photo via Flickr.

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Places for Hope in the Fight to Protect Women's Health and Rights

May 15, 2014Andrea Flynn

This post is the fourth in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today's post looks at states that are taking positive, proactive steps on women's access to health care.

This post is the fourth in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today's post looks at states that are taking positive, proactive steps on women's access to health care.

It’s National Women’s Health Week, but with conservative lawmakers around the country in a pissing match to see who can propose and pass more anti-women laws, it is sometimes difficult to find occasion to celebrate. However, there is reason for hope. A number of states are currently deliberating (or have passed) legislation that protects women’s access to health care, showing that states can be safe havens, not just hostile environments, for women and their families.

There has certainly been reason to despair. We are not even five months into the year and have already seen a barrage of anti women’s health legislation at the state level. 15 states have introduced abortion bans that would replace Roe v. Wade by instituting gestational bans as early as six weeks. 14 states have introduced regulations on abortion providers, similar to those that have shuttered 20 of the 44 clinics that provided abortions in Texas (in September when new restrictions are fully implemented, there will only be six left in the entire state). Seven states have proposed banning abortion coverage on insurance plans purchased through the Affordable Care Act’s health exchanges, eight have proposed banning such coverage in private health plans, and nine have proposed banning or regulating Medicaid coverage of abortion. 11 states have proposed legislation mandating abortion counseling and waiting periods, and four of those states use inaccurate information about the links between breast cancer and abortion. This compounds the crises created by the litany of anti-women’s health bills that states have passed in the last three years.

However, some states are moving in the opposite direction. California is modeling legislation that can protect women’s access to health care. Last fall, Governor Jerry Brown signed a bill that expands access to abortion by allowing nurse practitioners, midwives, and physician assistants to perform abortions during the first trimester. And a few weeks ago, State Senator Holly Mitchell (D-Los Angeles) introduced the Contraceptive Coverage Equity Act, which reinforces the ACA’s requirement that insurance companies cover all FDA approved contraceptive methods and counseling without cost-sharing. It also mandates insurance coverage of birth control for men without cost-sharing.

A number of states (including CA) had contraceptive equity laws in place before the ACA was implemented. However, there are vague provisions in the ACA, such as allowing insurers to limit benefits through “medical management techniques,” which are sometimes being used by physicians and insurers to deny women the contraceptive method of their choice (certainly was not the intent of the ACA). Older equity laws do not necessarily protect women who fall through confusion in the law. Updates like California's are necessary to ensure continuity of care.

California is far ahead of the pack, but it’s not alone. Legislators in New York are again attempting to pass the Women’s Equality Act (WEA), an omnibus bill that aims to protect reproductive health and abortion rights by codifying Roe v. Wade at the state level. It would also prevent income, housing, pregnancy, and family status discrimination; reduce human trafficking; protect victims of domestic violence; and stop workplace sexual harassment, among other provisions. The WEA was introduced by Governor Andrew Cuomo last year but failed in the final minutes of the legislative session because of disagreements over the bill’s abortion provision. The bill moves the issue of abortion access from the margins and puts it exactly where it should be: in the context of women’s economic and social security. After failing to pass the bill last year, legislators and advocates are working to advance the agenda again this year.

Lawmakers in Washington state are deliberating a measure that would require all health plans (including those in the state's exchange) that provide coverage for maternity care to also include coverage for abortion services. At a time when states are aggressively working to restrict insurance coverage of abortion, the Washington bill (which does include religious exemptions), stands out as a model of pro-choice legislation.

If passed, these bills would be great news for women in those respective states. Unfortunately, women who live outside these states won’t be so lucky, particularly those living in states that refuse to participate in Medicaid expansion. It’s hard to believe that in 2014 we need to resort to one-off pieces of legislation that protect only some women’s access to basic health care. But such are the times. The ACA was meant to be a path to health insurance for most Americans, and for many it has drastically improved access to quality, affordable healthcare. But challenges and changes to the law have left some of those in greatest need without coverage.

Conservatives have been so successful at passing anti-women’s health legislation because they have scores of ready-made bills at their fingertips when they come into office. Progressives need those same resources to protect the rights of women and families. The bills in California, New York, and Washington are important models for advocates and lawmakers in other states and municipalities who are working to counter the tide of anti-women’s health legislation that is sweeping the nation. Perhaps they will spark a quiet groundswell of pro-woman and pro-family laws. Now that would be something to celebrate. 

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

 

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