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.

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Daily Digest - November 4: You Can Keep It, Unless Your Insurance is No Good

Nov 4, 2013Rachel Goldfarb

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Aides Debated Obama Health-Care Coverage Promise (WSJ)

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Aides Debated Obama Health-Care Coverage Promise (WSJ)

Colleen McCain Nelson, Peter Nicholas, and Carol E. Lee speak to Roosevelt Institute Senior Fellow Richard Kirsch about the President's assurance that people who liked their insurance would get to keep it. He says adding an asterisk for good insurance wasn't practical.

The Tea Party’s Assault on Workers (WaPo)

Roosevelt Institute Fellow Mike Konczal writes that states controlled by the GOP aren't just taking action against public sector workers. Coordinated legislation across these states is harming private sector workers and limiting local labor protections, too.

Absolute 'credibility issue' for Obama (The Kudlow Report)

Roosevelt Institute Fellow Dorian Warren appears on CNBC to discuss how the Healthcare.Gov rollout has harmed the Affordable Care Act and the President. He points out that 97% of Americans are unaffected by the website, which limits the potential damage.

Walmart Is Trying to Block Workers' Disability Benefits (MoJo)

Erika Eichelberger reports on a case before the Supreme Court which could make more difficult for all workers to obtain disability benefits. Walmart is trying to argue that appeals must occur within three years of filing a disability claim - regardless of how long that decision takes.

Burns Explores Roosevelt Legacy in New Documentary; Screening at Ga. Home of FDR (WaPo)

The Associated Press reports on an early screening of part of his new documentary on the Roosevelt family. Burns attempts to get beyond "treacly and superficial" stories to the real history and legacies of Theodore, Franklin, and Eleanor Roosevelt.

New on Next New Deal

The Origins of "If You Like Your Health Insurance, You Can Keep It"

Roosevelt Institute Senior Fellow Richard Kirsch explains why the President's leading message on health care was necessary. A more nuanced explanation would have allowed Republican fear-mongering to kill reform.

Federal Court Decision Doesn't Just Limit Abortion: It Creates a Crisis for Women's Health Care in Texas

Roosevelt Institute Fellow Andrea Flynn writes on the Fifth Circuit decision that has shut down numerous women's health clinics across Texas. The state's new abortion laws aren't just limiting access to a legal medical procedure - they're limiting access to all health care.

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Federal Court Decision Doesn't Just Limit Abortion: It Creates a Crisis for Women's Health Care in Texas

Nov 1, 2013Andrea Flynn

Yesterday's decision, which will close about one third of the clinics that provide abortion care in Texas, will change the landscape of women's health care infrastructure in the state, maybe permanently.

Yesterday's decision, which will close about one third of the clinics that provide abortion care in Texas, will change the landscape of women's health care infrastructure in the state, maybe permanently.

We used to think change couldn’t happen overnight. That’s certainly not the case in Texas, where in the last 24 hours the landscape of abortion access has changed drastically.  Many women who went to bed anticipating an abortion appointment today woke up to find their clinic closed thanks to yesterday’s U.S. Court of Appeals decision that the state’s draconian abortion regulations do not constitute an undue burden on women.  

That decision immediately shuttered clinics whose abortion providers do not have hospital admitting privileges within 30 miles the clinic. We don’t know yet know the exact number of closures, but information from the Texas Equal Access (TEA) Fund and the Lilith Fund – important organizations that enable low-income women seeking abortion care to access it by helping to pay for the procedures – put that number at between 13 and 15 out of a total of 36 clinics across the state. Some parts of the state, such as the Lower Rio Grande Valley – home to two of the nation’s poorest counties – are left with no provider at all.

Of the clinics that remain open, many have some physicians on staff who have not obtained admitting privileges and as of today cannot perform abortions. Those clinics will be forced to serve fewer patients at the very time more and more women from across the state will rely on them for care.

The most recent decision is the latest in the never-ending onslaught on women’s rights in the state of Texas. It comes only three days after a federal judge blocked the law because he believed it would be deemed unconstitutional and found it to be “without a rational basis and place[ing] a substantial obstacle in the path of a woman seeking an abortion.” But, as The New York Times reported, the appeals panel came to the opposite conclusion, saying the admitting privileges rule is in fact constitutional because it serves a “legitimate state interest” by regulating doctors and does not impose an undue burden on the right to abortion.

Women seeking abortions just before the 16-week mark are especially in trouble today. There are currently only two facilities in Texas that perform abortions between 16 and 20 weeks. But the closure of so many clinics today and in the coming weeks will force women seeking abortions to traverse the state to access care, which will likely increase the number of procedures that have to happen in this window. This travel requires time and resources that many women simply do not have.

As part of the sweeping anti-abortion legislation passed this summer, Texas lawmakers today also implemented a ban on abortion after 20 weeks and a law that providers must adhere to out-of-date regulations for medication abortion.

For women needing an abortion at or after 20 weeks in Texas there are few options. Abortion at this stage of pregnancy is outlawed in neighboring Louisiana, Oklahoma, and Arkansas. Women could travel to Albuquerque, NM, but the city will soon hold a special election for a ban on abortion past twenty weeks, so that could be off the table too.

Abortions occurring after this gestational limit represent a small fraction of the total. Conservatives demonize women seeking later term abortions as being lazy, careless or irresponsible. This couldn’t be further from the truth. The reality is that the majority of women who seek an abortion this late in pregnancy do so because they learn of a fetal abnormality or are unable to afford one sooner; for those whose economic circumstances preclude them from accessing care when they first need it, traveling across or out of the state is just not possible.

The requirement that physicians use an outdated protocol on medication abortion is a blatant attempt to throw one more obstacle at women seeking the procedure. The original FDA guidelines require a higher dosage of medication than is necessary, carry higher risks of complications, require four visits to a clinic, and restrict the procedure to seven weeks. The more current protocol followed by nearly all providers in the U.S. and around the world calls for a lower dose and enables women to access it up to nine weeks of pregnancy. So on the one hand, anti-choice lawmakers chastise women for not seeking abortions early in pregnancy, and on the other they make it nearly impossible and less safe for women to access the procedure as soon as possible.

In Texas, conservative politicians and anti-choice activists have been maniacally focused on decimating the health infrastructure that serves as a point of primary care for hundreds of thousands of low-income women.  Since 2011, 76 family planning clinics have closed. Now at least a third of the state’s abortion providers – the majority of which also provide a full range of women’s health services – are closed. This is nothing short of a crisis situation.  

Lindsay Rodriguez of the Lilith Fund said, “All of these regulations disproportionately fall on low-income, rural women, and women of color. When lawmakers say a lot of women still have access, it’s not the people who need it most.”

Conservative lawmakers insist that all of the restrictions and regulations are in fact in the best interest of women. Nothing is more disingenuous. As my colleague Susan Holmberg and I wrote in August, restrictions on family planning and abortion do nothing but create more unintended pregnancies, more abortions, more sexually transmitted diseases, and push abortions into later stages of pregnancy.

Women’s health advocates are sure to appeal yesterday’s ruling. But in the meantime clinics are closed. Lights are shut off, staffs are let go, buildings are sold and women are just stuck. Conservatives have left their mark on the health of Texas women for the foreseeable future. You can tear down an infrastructure overnight, but building it back up will take far longer. Even if yesterday’s decision is overturned, women in Texas will be left without the care they need for years to come.  

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. You can follow her on Twitter @dreaflynn.

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The Origins of "If You Like Your Health Insurance, You Can Keep It"

Nov 1, 2013Richard Kirsch

President Obama used a slight exaggeration to counteract Republican fear-mongering and provide more and better health coverage to all Americans.

There are good reasons why President Obama’s leading message on health care during the 2008 campaign, often repeated since, was “if you like your health insurance, you can keep it.” That message was created to overcome the fear-mongering that had blocked legislative efforts to make health care a government-guaranteed right in the United States for a century.

President Obama used a slight exaggeration to counteract Republican fear-mongering and provide more and better health coverage to all Americans.

There are good reasons why President Obama’s leading message on health care during the 2008 campaign, often repeated since, was “if you like your health insurance, you can keep it.” That message was created to overcome the fear-mongering that had blocked legislative efforts to make health care a government-guaranteed right in the United States for a century.

Our health is of central importance to our lives, deeply personal to our well-being and those of our loved ones. That concern has translated politically; for decades, people have told pollsters that health care is a top concern. It is why every 15 to 20 years – from 1912 to 2008 – the nation has returned to a discussion about whether and how the government should guarantee health coverage, the debate rising phoenix-like from one spectacular defeat after another. A big reason for those defeats has been that opponents have exploited those deep feelings to scare the public about proposed reforms.

As one of the people who engaged early on in building the effort that led to the passage of the Affordable Care Act, I am keenly aware of this history. I wrote in 2003 that debates over health care turn dramatically when they move from the problem to the solution. Almost everyone agrees there’s a problem, but when a solution is proposed, people’s first question will be, “how will it impact me?”

The extensive public opinion research we conducted from 2006 to 2008 emphasized that same point: people would look closely at how any proposed reforms impacted their lives. Yes, Americans are worried about high health care costs and alarmed at the prospect of losing coverage. Yes, they may be unhappy with the quality and security of the coverage they have. But at the same time, they are desperate to hold on to it, because at least it’s something.   

We also knew that those who wanted to block health care reform would play on people’s fears, a lesson learned most recently in the 1993-1994 fight over the Clinton health plan, in which opponents made wild claims about government bureaucrats coming between you and your doctor and denying you coverage.

In that context, it was essential to assure the 85 percent of Americans with health coverage that reform would not be a threat. Hence, “If you like your health care, you can keep it.” That message reassured people and let them be open to the rest of the message: proposed reforms would guarantee quality, affordable coverage to everyone and fix the real problems people were facing. After all, the first part of that sentence, "if you like it," implies that lots of people would love to improve their coverage by making it more affordable and secure and by ending insurance company abuses.

Hillary Clinton’s campaign understood this early on, and she used the message consistently when she talked about health care reform during the Democratic primaries. Soon after she dropped out, Obama made it a key part of his health care message. But the promise that you could keep your health care was more than just a message; for almost everyone, it was an accurate description of the almost identical reform policies proposed by Clinton and Obama, which became the foundation for the Affordable Care Act.

The ACA preserves (with small but important improvements) the current system of health care financing for the vast majority of Americans: employer-based coverage, Medicare, and Medicaid. Those are the 94 percent of people with coverage for whom the “if you like it, you can keep it” promise is true.

For the 6 percent of insured who buy coverage on their own, the more accurate message would have been, “If you have good insurance and you like it, you can keep it.” The ACA reforms a corrupt individual insurance market. No longer can insurers turn people down due to a pre-existing condition or raise rates and drop people because they get sick. The ACA bans the sale of plans with such skimpy benefits and high-out-of-pockets costs that they are worthless if someone gets seriously ill.

As we predicted, the opponents of reform used fear-mongering – death panels, government takeover of health care, and on and on – to try to kill the Affordable Care Act. They are still at it, including cynically jumping on the website’s enrollment problems and now insurance companies sending letters to customers which hide the fact that companies are being forced for the first time to sell a good, reliable product.

The opponents of reform have used reckless, baseless charges to try to kill reform. I’m glad that President Obama used a slight exaggeration to finally provide secure health coverage for all Americans.

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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Daily Digest - November 1: Going Further Than Dodd-Frank

Nov 1, 2013Rachel Goldfarb

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Four Intriguing Ideas for How to Fix the Banks (Bloomberg Businessweek)

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Four Intriguing Ideas for How to Fix the Banks (Bloomberg Businessweek)

Peter Coy speaks to Roosevelt Institute Fellow Mike Konczal about the upcoming report from the Roosevelt Institute and Americans for Financial Reform, "An Unfinished Mission: Making Wall Street Work for Us." He previews four of the papers from the report, including Mike's.

  • Roosevelt Institute Event: This report with be presented at a conference in Washington, DC on November 12, featuring a keynote from Senator Elizabeth Warren. For more information, click here.

Southwest Takes the Legal Battlefront on Abortion (Women's eNews)

Reshmi Kaur Oberoi looks at the current fights over abortion access in the southwestern United States. She references Roosevelt Institute Fellow Andrea Flynn's recent white paper on Title X in discussing access to reproductive care for Hispanic women in Texas.

  • Roosevelt Take: Andrea's white paper, "The Title X Factor: Why the Health of America's Women Depends on More Funding for Family Planning," argues that increasing funding for Title X will strengthen the Affordable Care Act, especially in the earlier phases of implementation.

How States Taken Over by the GOP in 2010 Have Been Quietly Screwing Over the American Worker (The Nation)

Zoë Carpenter looks at an Economic Policy Institute report on state-level attacks on labor. This coordinated campaign of cookie-cutter style legislation is hurting workers of all sorts - unionized and nonunionized, public and private.

Newt’s Revenge: Child Labor Makes a Comeback (Salon)

Josh Eidelson points out that the attack on labor has included rollbacks of child labor laws in four states. The American Legislative Exchange Council (ALEC), which coordinates much of this legislation, apparently thinks attacking adult workers' rights isn't enough.

A War on the Poor (NYT)

Paul Krugman asks why the Republican party has shifted so far away from supporting programs that help the needy. He blames a combination of market ideology, an awareness of the changing racial dynamics of this country, and libertarian fantasy.

  • Roosevelt Take: Roosevelt Institute Senior Fellow and Director of the Bernard L. Schwartz Rediscovering Government Initiative Jeff Madrick appeared on Countdown with Keith Olbermann to discuss this topic back in 2011.

War Brews on Spending Cuts (MSNBC)

Suzy Khimm reports on the coalition working to protect "non-defense" discretionary spending. The budget negotiations are primarily over this category of spending, which includes everything from mental health care to Census data collection to Head Start.

New on Next New Deal

Show Your Invisible Hand: Why the SEC Should Make Corporations Disclose Political Contributions

Roosevelt Institute Director of Research Susan Holmberg argues that requiring corporations to disclose their political contributions is good for investors and for the companies, which risk executives using political contributions for their own good.

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Daily Digest - October 30: Getting Government Websites Right

Oct 30, 2013Rachel Goldfarb

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One Federal Website That Works (Bloomberg View)

Click here to receive the Daily Digest via email.

One Federal Website That Works (Bloomberg View)

Roosevelt Institute Fellow Susan Crawford looks at a new site by the Consumer Financial Protection Bureau, which makes regulations transparent and accessible. The CFPB also followed development practices that other agencies should copy, like open source software.

Alone in the Dark: Susan Crawford and the Telecom Industry (WNYC)

Manoush Zomorodi interviews Susan about how telecommunications companies deal with disasters like Hurricane Sandy. Deregulation has created a situation where the industry isn't required to have backup power to keep customers connected in emergencies.

JPMorgan Settlement is Justice, not a Shakedown (WaPo)

Katrina vanden Heuvel argues that the $13 billion settlement is hardly enough, because the money means nothing to JPMorgan Chase. She thinks that "perp walks" are necessary so that individuals are held accountable.

America’s New Hunger Crisis (MSNBC)

Ned Resnikoff looks at the demands on food pantries since 2009, and speaks to staff who are concerned about increased need when an automatic food stamp cut goes into effect this week. Pantries are already strained, and federal funding was hit by sequestration.

Time to Investigate Those Insurance Company Letters (TAP)

Paul Waldman says that when insurers send letters that say a plan has been canceled and push customers onto more expensive plans, they're obscuring the facts. Plans are being required to cover more, and that's usually called an improvement, not a cancelation.

How a Frustrated Blogger Made Expanding Social Security a Respectable Idea (Pacific Standard)

David Dayen profiles Duncan Black, known as Atrios online, who has spent the past year pushing for increases in Social Security benefits. He pushed a dramatic expansion hoping for smaller changes, but people are taking his idea seriously.

No Grand Bargain: Why Dems Think They Won't Have to Budge on Sequester Demands (MoJo)

Patrick Caldwell suggests that the Democrats will be unwilling to take any budget deal that doesn't eliminate sequestration. If they have to insist on a series of short-term continuing resolutions instead, it's the Republicans who are likely to land in hot water.

New on Next New Deal

The Solution Economy: Problem Solving Everyone Can Agree On

Roosevelt Institute | Campus Network Senior Fellow for Economic Development Azi Hussain argues that the solution economy, which solves societal problems with public-private partnerships, could be one of the only things the right and left can agree on right now.

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Daily Digest - October 29: Remember When the GOP Supported Family Planning?

Oct 29, 2013Rachel Goldfarb

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Richard Nixon Knew Family Planning Saves Taxpayer Dollars, But Today’s GOP Doesn’t Care (Next New Deal)

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Richard Nixon Knew Family Planning Saves Taxpayer Dollars, But Today’s GOP Doesn’t Care (Next New Deal)

Roosevelt Institute Fellow Andrea Flynn argues that Title X funding needs to be increased, because demand for family planning services will go up as more people get health insurance. Unfortunately, the GOP has forgotten that this program is fiscally effective.

  • Roosevelt Take: Read Andrea's new white paper, "The Title X Factor: Why the Health of America's Women Depends on More Funding for Family Planning," here.

Here’s how GOP Obamacare Hypocrisy Backfires (Salon)

Michael Lind draws on a recent piece by Roosevelt Institute Fellow Mike Konczal to discuss the right's plans for the social safety net. If means testing and privatization become part of Social Security and Medicare too, he thinks we're in for some ineffective changes.

  • Roosevelt Take: Mike's piece argues that the struggles of Healthcare.Gov are proof that old-school New Deal-style liberal programs eliminate many potential administrative problems.

Ohio Governor Defies G.O.P. With Defense of Social Safety Net (NYT)

Trip Gabriel reports on Gov. John R. Kaisch's critique of his own party's "war on the poor." The governor worked around the GOP-led legislature to accept the Medicaid expansion, because he knows it will help his neediest citizens.

Food Stamps Will Get Cut by $5 billion This Week — and More Cuts Could Follow (WaPo)

Brad Plumer reports that an automatic cut is going to hit SNAP funding on November 1 with the end of a 2009 stimulus bill boost. Between that cut and current negotiations over SNAP, some Americans will be struggling with how to buy groceries and feed their families.

How Sequestration Gets Even Worse Next Year (ThinkProgress)

Bryce Covert reminds us that the automatic cuts of sequestration get even larger in 2014. With a lot of the accounting tricks that were used to soften the blow this year gone, sequestration part two will hit hard, and it won't be good for the economy.

Why Do Women Do Market Work? (TAP)

Matt Bruenig responds to a recent rant from Gavin McInnes of Vice against working women, bringing up the data that proves why women work. It turns out that in husband-wife families where both work, 54 percent would be in or near poverty without her income.

Yes, There’s a Budget Deal in the Works. Here’s What It Will Look Like (NY Mag)

Jonathan Chait says that a small budget deal is in the works, which will replace sequestration cuts with something more livable for everyone. He thinks there will still be some revenue increases, but they won't be tax rate increases.

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Richard Nixon Knew Family Planning Saves Taxpayer Dollars, But Today’s GOP Doesn’t Care

Oct 28, 2013Andrea Flynn

As the Affordable Care Act helps more Americans get health insurance, it's time to increase funding for Title X, because the need for family planning services is only going up.

As the Affordable Care Act helps more Americans get health insurance, it's time to increase funding for Title X, because the need for family planning services is only going up.

For more than 40 years, Title X has provided family planning and reproductive health services to millions of American women. More recently, conservative lawmakers have targeted Title X as part of their obsession with shrinking the social safety net and restricting access to women’s health care. Those same opponents are now likely to argue that the Affordable Care Act’s (ACA) focus on women’s health renders Title X unnecessary.  But as I argue in my new paper published by the Roosevelt Institute, that is simply not the case. In reality, the success of the ACA and the health of women across the country are dependent on even greater support for existing family planning programs.

Title X is the nation’s only program solely dedicated to family planning. It was passed into law in 1970 with overwhelming bipartisan support and can in fact be credited to two Republican presidents: Richard Nixon, who signed the bill into law, and then-Congressman George H.W. Bush, who led the legislative effort. It provides critical medical care to low-income, immigrant, and young women and enables clinics to pay for and maintain facilities, train and hire staff, and purchase equipment and supplies.

Despite being perennially underfunded, the program delivers incredible health results. Last year it served 4.76 million women, preventing an estimated 996,000 unintended pregnancies, 200,000 of which were among teens. Research has shown that services provided at Title X clinics save federal and state governments more than $3 billion every year.

As millions of Americans gain health coverage for the first time thanks to the ACA, clinics funded by Title X will become an even more critical building block of our nation's health system. Even when individuals obtain coverage, many will continue to choose publicly funded clinics as their main source of care. In the four years following the implementation of Massachusetts’ health care reform, which served as the model for the ACA, publicly funded health centers experienced a 31 percent increase in patients, even though the number of uninsured visiting those facilities fell by more than 15 percent.

Even women who are already fully insured will continue to rely on Title X clinics for family planning because they can do so in complete confidence. Issues like intimate partner violence and religious beliefs of employers, family, and partners, cause many women to circumvent their insurance plans when accessing family planning services and instead rely on public providers.

The fact is, despite the GOP’s relentless strategic misinformation campaigns and the technology problems that bedeviled the rollout this month, the ACA is good for women. It mandates that insurance plans fully cover all methods of contraception, prohibits gender discrimination and denial of care based on pre-existing conditions, and enables young people to stay on their parent’s plans until they are 26. It requires plans to cover pap tests, STD screening, preconception and prenatal care visits, postpartum counseling and breastfeeding support, and one well visit a year. Make no mistake: this is groundbreaking.

Despite these historic advancements, many women will remain uninsured in the years to come. There are lots of reasons for this, not the least of which is the refusal of many states to accept federal funding for the expansion of Medicaid.  

The ACA was intended to be a path to health care for all Americans, and a major pillar of the law was the expansion of Medicaid to all individuals who fall below 138 percent of the federal poverty level ($15,415 for an individual or $26,344 for a family of three), with subsidies for individuals above that level to buy insurance in the marketplaces. But last year the Supreme Court ruled that the federal government could not constitutionally require states to expand Medicaid, and conservative lawmakers pounced on the opportunity to block a major component of the ACA.

Today, 22 states refuse to expand Medicaid even though the federal government will foot 100 percent of the bill for the first three years and cover at least 90 percent of the cost after that. These states are denying care to more than 3.5 million low-income women who badly need it. The New York Times reported that as a result, two-thirds of poor black and single mothers and more than half of uninsured, low-wage workers will remain without coverage.

Basically, women who fall into the coverage gap are not considered poor enough for Medicaid by their states, but because the ACA originally intended for them to be covered by the expansion, they also don't qualify for subsidies. And even if they did, the cost of subsidized insurance would likely still be prohibitive given their income level. These individuals will have no choice but to rely on the social safety net – in this case, Title X-funded clinics – for care.

The very critics who have staked their political careers on sinking the ACA and preventing scores of women from accessing family planning services – and who shut down the government in an attempt to do so – would love nothing more than to do away with Title X. They have tried unsuccessfully in recent years, and the program will certainly be in their crosshairs as they continue to chip away at the host of social programs on which low-income women rely.

The ACA, while an enormous advancement for women’s health, does not eliminate the need for the Title X program. Rather, Title X will maximize the impact and reach of the ACA and ensure quality care for those who will remain uninsured.

In the forthcoming budget battles, women’s health advocates will have to fight tooth and nail to maintain Title X’s current funding level, which has already been diminished by sequestration. The program is as critical today as it was when it was created. Today’s very different breed of GOP lawmakers could use a reminder that it was their own party four decades ago that realized investing in family planning was a critical way to improve the health of women, communities, and the entire nation. Who ever thought we’d be longing for Nixon? 

Read Andrea's paper, "The Title X Factor: Why the Health of America's Women Depends on More Funding for Family Planning," here.

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. You can follow her on Twitter @dreaflynn.

 

Woman with pregnancy test banner image via Shutterstock.com

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The Title X Factor: Why the Health of America's Women Depends on More Funding for Family Planning

Oct 28, 2013

Download the paper (PDF) by Andrea Flynn

The Patient Protection and Affordable Care Act (ACA) represents an unprecedented expansion of the nation’s health care system and an historic investment in the health of American women and girls. The ACA has already improved the lives of millions and will make health care accessible for millions more as rollout continues this year and next.

Download the paper (PDF) by Andrea Flynn

The Patient Protection and Affordable Care Act (ACA) represents an unprecedented expansion of the nation’s health care system and an historic investment in the health of American women and girls. The ACA has already improved the lives of millions and will make health care accessible for millions more as rollout continues this year and next.

Fulfilling the promise of the ACA depends on the continued support and success of existing programs – like Title X, the federal family planning program – that serve as pillars of the nation’s still fragile primary health care infrastructure. Title X provides critical medical care and “wrap around” services for family planning clinics nationwide, enabling them to pay for and maintain facilities, train and hire staff, purchase equipment and supplies, and offer a host of services for specific populations.

Family planning is central to women’s health and social and economic security. Given the tenuous state of the U.S. economy, the vulnerability of women’s health programs in the face of unrelenting political attacks, and the fragility of the social safety net more broadly, public funding for family planning is more critical than ever. Critics may argue that because the ACA meets the needs of many women, Title X is no longer necessary. In fact, the opposite is true. Continued – indeed, increased – funding of Title X will maximize the impact and reach of the ACA and ensure continued care for those who will remain uninsured despite this landmark legislation.

Key Findings:

  • The ACA demands an unprecedented scaling up in the nation’s health infrastructure, and fulfilling the promise of the law will depend on the continued support and success of Title X.
  • The demand for Title X-funded clinics will only increase in coming years as more individuals seek care and those who already rely on safety net providers continue to do so.
  • Despite their coverage status,women will continue to rely on Title X-funded clinics because of the clinics’ experience in and commitment to providing care in a safe, confidential setting.
  • For many women, particularly young women and low- income women, Title X-funded clinics are a critical entry point into the health system. These clinics will be in even greater demand in the coming months as more women obtain coverage and seek a variety of health services.
  • Despite the extraordinary promise of the ACA, many will remain uninsured and for those individuals Title X providers will remain one of the only sources of quality, affordable family planning care.

Read "The Title X Factor: Why the Health of America's Women Depends on More Funding for Family Planning," by Roosevelt Institute Fellow Andrea Flynn.

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Daily Digest - October 28: Watching the Surveillance State - and its Money

Oct 28, 2013Rachel Goldfarb

Click here to receive the Daily Digest via email.

Data Shows Democrats Fully Embraced by Surveillance Industry (The Real News Network)

Click here to receive the Daily Digest via email.

Data Shows Democrats Fully Embraced by Surveillance Industry (The Real News Network)

Roosevelt Institute Senior Fellow Tom Ferguson speaks to Jaisal Noor about his new working paper, which drew a connection between the surveillance state and campaign donations. When PRISM became public, it was hard to miss the connection in the data.

  • Roosevelt Take: "Party Competition and Industrial Structure in the 2012 Elections," by Tom Ferguson, Paul Jorgensen, and Jie Chen, is available here.

Post-Partisan: Fixing our ideological divide (Reuters)

Roosevelt Institute Senior Fellow Jonathan Soros argues that geographic segregation among ideological lines is causing more partisanship then gerrymandering. Changing district lines won't fix that, but some alternative election models might.

Politics and Reality Radio (Public Reality Radio)

Roosevelt Institute Fellow Mike Konczal speaks with Joshua Holland about how the rollout of Healthcare.Gov vindicates an old-school New Deal style of liberalism. Neoliberal approaches to social insurance are causing the problems here, not progressive ideas.

  • Roosevelt Take: Mike wrote about this topic for Next New Deal last week.

Making government simpler is complicated (WaPo)

Roosevelt Institute Fellow Mike Konczal considers what a "simple" regulation really means. If "simple" policies aren't easy to implement with clear and simple results, are they are simple, or just inefficient nudges?

The Republicans' War on the Poor (Rolling Stone)

Elizabeth Drew writes on the GOP's assault on food stamps, which ignores the program's decades of success. This is a prime example of the current government dysfunction, in which the Tea Party disrupts long-standing policies for its anti-Obama crusade.

Bipartisan Budget Love Suddenly in the Air (NY Mag)

Jonathan Chait suggests that there may finally be space for compromise in budget negotiations. For one thing, some Republicans are finally admitting that compromise doesn't mean that the Democrats give in to all their demands.

For Some, Joblessness Is Not a Temporary Problem (NYT)

Floyd Norris looks at the international problem of long-term unemployment, which is even worse in other developed countries than in the U.S., where for the first time since World War II, more people have been unemployed for over a year then for less then four weeks.

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