New Texas Abortion Law Could Be Worst Yet for Poor Women

Jul 3, 2013Andrea Flynn

The controversial SB 5 is the latest case of the Texas GOP pushing anti-abortion measures that marginalize low-income women.

The controversial SB 5 is the latest case of the Texas GOP pushing anti-abortion measures that marginalize low-income women.

Some 5,000 orange-clad men and women invaded the Texas capital in Austin on Monday in an emotional and enthusiastic show of support for reproductive rights. They faced off with Republican lawmakers still resolved to pass SB 5, the very bill limiting abortion access that was defeated last week after Senator Wendy Davis’s 11-hour filibuster. Yesterday, nearly 2,000 people showed up to testify against the bill as it was considered by the Texas House Affairs Committee, which approved it 8-3.

This latest effort to roll back women’s rights in Texas has met fierce opposition and resolve from Texans and other Americans who recognize the value of women’s health care. “When you silence one of us, you give voice to the millions who will continue to demand our lives, our choices, our independence,” Ilyse Hogue, president of NARAL Pro-Choice America, reminded us at Monday’s rally.

It has also highlighted the deep gulf between the lived experiences of women in Texas, particularly low-income women, and lawmakers who have inserted themselves into decisions that should only be made by women and their physicians.

Monday’s protest took place as Texas lawmakers convened for a second special session called by Governor Rick Perry. The bill they’re considering would make abortion after 20 weeks illegal, impose onerous requirements on abortion providers, and demand that all clinics meet costly and burdensome building requirements. If passed, 37 of the state’s 42 abortion providers will be forced to close their doors. This despite the fact that 79 percent of Texans believe abortion should be available to a woman under varying circumstances, while only 16 percent believe abortion should never be permitted.

This is just the latest in a seemingly never-ending assault on Texas women. In 2011, lawmakers decimated the Texas family planning program with a two-thirds budget cut that closed nearly 60 family planning clinics across the state and left almost 150,000 women without care.  Soon after, they also barred Planned Parenthood and other reproductive health clinics defined as “abortion affiliates” from the Women’s Health Program (WHP), a state Medicaid program on which thousands of poor women rely. Governor Perry insisted that former WHP patients could find new providers and claimed there were plenty to bridge the gap, but that simply is not the case. Clinics across Texas have reported a sharp drop in patients, and guess that former WHP clients are receiving no care at all.

To suggest so cavalierly that women simply find new providers is evidence that Republican lawmakers simply don’t understand – or don’t care about – the socioeconomic realities that shape women’s lives. Otherwise, they would recognize the absurdity of forcing women to navigate an increasingly complex health system to find new providers and then traverse hundreds of miles to receive basic care and services. This is a stark illustration of the privilege gap that exists between policymakers and the people they represent. 

After it became clear that the warnings of public health experts – who testified that such policies would impose a heavy economic toll on the state, result in negative health outcomes, and increase the demand for abortion – were becoming reality, lawmakers last month restored family planning funding to the 2014 budget. While this is certainly good news, returning to pre-2011 funding levels still leaves nearly 700,000 women without access to care and so far has enabled only three of the nearly 60 shuttered clinics to re-open. And even before the 2011 budget cuts, only one-third of the state’s 1 million women in need of family planning services received them through the state program. A provider shortage will persist for the foreseeable future; it is no easy task to reopen a clinic once it has shuttered its facility, released its staff, sold all its equipment, and sent its patients files elsewhere. 

If the current legislation were to pass, nearly all the state’s abortion providers would be forced to close. The majority of those are clinics that not only offer abortion services, but also provide contraception, STD testing, and cancer screenings for poor women. Many of those clinics are located in areas that are already bearing the brunt of family planning clinic closures (see map below). The few clinics that would remain open in Texas are located in urban areas, leaving women in rural Texas with even fewer health care options than they currently have. 

(Abortion data: New York Times and Planned Parenthood. Family Planning data: University of Texas Population Research Center)

What are women—especially poor women—to do? Women in Texas already face heavier burdens than women in many other states. Texas has one of the nation’s highest teen birth rates and percentages of women living in poverty. It has a lower percentage of pregnant women receiving prenatal care in their first trimester than any other state. It also has the highest percentage of uninsured children in the nation and provides the lowest monthly benefit for Women, Infant, and Children (WIC) recipients (an average of $26.86 compared to the national average of $41.52). And soon the majority of women may not have access to abortion care at any stage of their pregnancy.

Governor Perry’s policies have marginalized women who already bear the heavy weight of so many inequities. His latest efforts will only marginalize them further.

This anti-abortion legislation will not prevent women from getting abortions. It will simply push them across the border and into unsafe facilities like those operated by Kermit Gosnell. It’s passage will add to the fury that has escalated over the past three years as women have lost access to breast exams, birth control, and abortion services while being told it is for their own good. These lawmakers fail to understand that the full range of reproductive health services, including the ability to access an abortion, is absolutely central to women’s ability to lead happy, healthy, and productive lives – an ability that is itself essential to the strength of families, communities, states, and our nation.

On Monday, Planned Parenthood president Cecile Richards reminded the crowd in Austin of the old adage that you can measure a country by how well it treats its women. The same is true for Texas.  “We settled the prairie. We built this state. We raised our families,” said the ever-feisty daughter of former Texas governor and progressive icon Ann Richards. “We survived hurricanes and tornados, and we will survive the Texas legislature, too.”

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States and globally.

 

Rick Perry image via Shutterstock.com.

Share This

Will Delaying the Employer Mandate Deny Health Coverage to Workers?

Jul 3, 2013Richard Kirsch

The White House's decision shows sympathy for big employers, but it's not clear whether employees will have to shoulder the cost.

The surprise announcement from the Obama administration that it will delay for one year penalizing employers that do not offer health coverage to their workers is the latest capitulation by the White House to big businesses that want to shirk their responsibility to help pay for health insurance. But the decision leaves huge unanswered questions about whether health coverage for uninsured workers will also be denied.

The White House's decision shows sympathy for big employers, but it's not clear whether employees will have to shoulder the cost.

The surprise announcement from the Obama administration that it will delay for one year penalizing employers that do not offer health coverage to their workers is the latest capitulation by the White House to big businesses that want to shirk their responsibility to help pay for health insurance. But the decision leaves huge unanswered questions about whether health coverage for uninsured workers will also be denied.

Yesterday, the Treasury issued a notice delaying for one year, until 2015, the requirement that employers of more than 50 full-time employees (3 percent of all employers) report on whether they offer health coverage to their employees. The Affordable Care Act requires that these employers pay penalties when they they do not offer qualified coverage or when their workers access coverage through the new health care exchanges. The Treasury’s notice does not change the legal requirement that employers provide coverage, but it effectively negates enforcement of that requirement. The delay comes even though the Treasury has had more than three years to prepare to implement the law and an entire new industry has emerged advising employers on how to comply.

The notice, full of sympathy for employers who have to comply with the reporting requirements, totally ignores the implications for employees. What will happen to workers for companies that do not offer health insurance or that offer coverage that does not meet the law’s minimum requirements? These are huge questions, and it is remarkable that the Obama administration would publish the Treasury Department notice without addressing them.

Under the Affordable Care Act, workers who are offered acceptable coverage at work are not eligible to access health insurance through the new health insurance marketplaces (“exchanges”), which offer income-based subsidies to purchase health coverage. These workers must purchase the employer coverage or pay a fine.

So what happens under the Treasury Department rule if the marketplaces have no way to determine whether a worker has been offered qualified coverage? Would the uninsured worker be able to get subsidized coverage? It would be cruel to make employees, most of whom work for low wages, wait another year to get health insurance because the administration is giving big employers a break on reporting. If the administration is going to give employers a break, it should not do so at the expense of millions of uninsured or underinsured workers who have been looking forward to having health insurance available to them on January 1, 2014.

Another question is whether the penalty for not being insured, the individual mandate, would apply to an uninsured employee of a business that does not have to report on whether it is offering coverage and is avoiding the employer mandate penalty. What greater irony than to fine an employee because the Obama administration is eliminating fines for large employers?

The Obama administration’s decision continues a history, stemming from the business-friendly version of the Affordable Care Act that emerged from Max Baucus’s Senate Finance Committee, of bowing to the demands of big businesses to avoid responsibility for providing affordable coverage to their employees. The Affordable Care Act's only requirement for employers of 50 or more full-time workers is that they offer employers high-deductible plans, which require employees to pay a big chunk of their incomes for the coverage. If employers meet these skimpy provisions, they can avoid paying penalties and their workers are locked into the lousy coverage or required to pay a fine for the privilege of being uninsured. It is not clear how many employers will take this low-road route, but the history of the big low-wage employers – think WalMart and McDonalds – is not encouraging.

What matters now is that the White House treat employees with the same level of concern it has shown big business. To do that, the administration should make it clear that workers who state that they are not offered coverage by their employer, or that the coverage costs more than they can afford or has limited benefits, should be eligible to receive income-based subsidies in the new marketplaces. Simple justice, and the primary goal of the Affordable Care Act of guaranteeing affordable health coverage to all Americans, requires nothing less. 

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

Share This

Daily Digest - July 3: No One Really Needed That Insurance, Right?

Jul 3, 2013Rachel Goldfarb

Click here to receive the Daily Digest via email.

White House Delays Key Element of Health Care Law (AP)

Click here to receive the Daily Digest via email.

White House Delays Key Element of Health Care Law (AP)

Ricardo Alonoso-Zalvidar speaks to Roosevelt Institute Senior Fellow Richard Kirsch about the news that the administration is delaying implementation of the employer mandate. Kirsch is outraged about how this will affect employees who expected insurance on January 1, 2014.

Regulators to Beef Up Wall Street Rules…Thanks to Republicans?! (MoJo)

Erica Eichelberger asks Roosevelt Institute Fellow Mike Konczal why two Republicans on the FDIC want to tighten regulations on big banks' capital requirements. Konczal's explanation? They think it will reduce the blame on the FDIC if there is another bailout.

Murky Language Puts Homes Underwater (TAP)

David Dayen explains how banks are utilizing unclear language to make a loophole that allows them to dual-track homeowners, or continue pursuing foreclosure while the homeowner submits paperwork for mortgage modification. Until we fix this, people will continue to lose their homes.

How to Make Sure a Growing U.S. Economy Helps the Poor (Scholars Strategy Network)

Lane Kenworthy argues that the only way to ensure that economic growth helps the poor is to change the structure of the social safety net and tie benefits to growth. Otherwise, we leave swaths of people behind, which doesn't seem particularly American.

Making $7.75 an Hour, and Figuring There’s Little to Lose by Speaking Out (NYT)

Michael Powell talks to fast-food workers who are involved in the unionizing efforts in New York City. These workers have no fears about annoying their employers: what's the risk when you're making so little money to begin with?

Payroll Cards Are Under Scrutiny by New York’s Attorney General (NYT)

Jessica Silver-Greenberg reports that following Monday's story in the Times on payroll cards, the New York attorney general has opened an investigation. Employees must give explicit consent to be paid this way in New York, and why would anyone choose all those fees?

Hawaii Becomes Second State To Pass A Domestic Workers Bill Of Rights (ThinkProgress)

Bryce Covert discusses Hawaii's new law, which was signed on Tuesday and brings housekeepers, nannies and other domestic workers under the protection of labor laws such as the minimum wage, overtime, and anti-discrimination laws.

Oh, Right, the Jobs Crisis (The Nation)

John Nichols still sees the jobs crisis as the primary problem facing the U.S., and one that needs to be solved before many others. He's especially concerned with the groups that are struggling worst: people of color and young people.

Share This

Daily Digest - June 21: Changing Definitions, Unchanging Realities for Workers

Jun 21, 2013Rachel Goldfarb

Click here to receive the Daily Digest via email.

Is it Time to Tweak Obamacare? Sen. Joe Donnelly Thinks So. (WaPo)

Click here to receive the Daily Digest via email.

Is it Time to Tweak Obamacare? Sen. Joe Donnelly Thinks So. (WaPo)

Sarah Kliff speaks to the Senator, who wants to change the definition of full-time hours in the Affordable Care Act from 30 to 40. He wants to prevent part-time workers from getting their hours cut due to employers who don’t want to offer health insurance.

Who Killed Equality? (Bloomberg)

Ezra Klein says that the usual arguments on economic inequality ignore the power of government to set the rulebook, drawing on the work of Dean Baker. The current set of rules exacerbate income inequality, but they don't have to stay on the books.

The Economy Can’t Recover If the Workers Don’t (Campaign for America's Future)

Robert Borosage is concerned by the Fed's changing tone on the economic crisis and recovery, because as far as most Americans are concerned, we're still in the middle of the crisis. Stock market improvements are not average worker recovery.

Cutting Wages Won’t Create Jobs (The Hill)

Jack Temple argues that when we don't raise the minimum wage, we're effectively cutting it due to inflation, and that isn't helping unemployment. In fact, an increase in the minimum wage would serve as a major stimulus for the economy.

The Unpaid Internship Racket (MSNBC)

Timothy Noah considers the moral failings of unpaid internships, which go alongside their frequent illegality as shown by last week's ruling against Fox Searchlight. Beyond the inequality and abuse, there's the simple formulation that interns are workers, and workers get paid.

Profits Without Production (NYT)

Paul Krugman suggests that the biggest difference between today's economy and the past's is the growth of monopoly rents, or profits tied primarily to market dominance. This depresses perceived return on investments and wages, contributing to our weak recovery.

Bank of America Whistleblowers Allege Rot at the Core of the Mortgage Industrial Complex (HuffPo)

Ray Brescia reports on some of the most serious charges revealed in affidavits filed in litigation against Bank of America. If this is Bank of America's way of reforming its foreclosure practices, then it is clear that more oversight is necessary.

New on Next New Deal

One More Day for Women's Equality in New York

Roosevelt Institute Fellow Andrea Flynn writes on New York Governor Cuomo's Women's Equality Act, which contains one of the most progressive pieces of abortion legislation in the country. But the legislative session ends today, and the State Senate seems unwilling to take a vote on the issue.

Share This

What Will Obamacare Mean for the Low-Wage Work Crisis?

Jun 18, 2013Richard Kirsch

New health insurance marketplaces will make affordable care accessible to millions, but low-wage employees of big businesses may be left out.

One of the biggest issues that the Affordable Care Act (ACA) is meant to tackle is the lack of health coverage among low-wage workers. While there is good news for many low-wage workers in the new law, many others will still find themselves locked out of access to affordable coverage. Solving their concerns will be one more part of the huge challenge of confronting the power of mammoth low-wage employers in the new economy.

New health insurance marketplaces will make affordable care accessible to millions, but low-wage employees of big businesses may be left out.

One of the biggest issues that the Affordable Care Act (ACA) is meant to tackle is the lack of health coverage among low-wage workers. While there is good news for many low-wage workers in the new law, many others will still find themselves locked out of access to affordable coverage. Solving their concerns will be one more part of the huge challenge of confronting the power of mammoth low-wage employers in the new economy.

There has been a lot of coverage about the potential for fast food chains and other employers to cut the hours of some of their employees to under 30 a week in order to avoid having to offer them health coverage. To the extent that employers do cut back hours, it will accelerate a long-trend toward part-time low wage work; part-timers increased from 17 percent to 22 percent of the workforce just from 2007 to 2011.

The surge in part-time work is one aspect of the broader increase in low-wage work. Most of the jobs coming out of the recession are low-wage, which has hastened a trend going back 30 years of a growing number of low-wage jobs with no health benefits. The powerful eroding of good jobs is the greatest threat to broadly-shared economic prosperity. It destroys any promise of people living a middle-class life style, creates a two-tiered society, and undercuts the consumer buying power needed to move the economy forward.

The low-wage economy means more than just low wages. Post-World War II jobs, which came with employer-provided health coverage and a pension, are fast disappearing. Now more than four-in-ten workers do not get health coverage on the job. This includes many employees of small businesses, which do not offer any health coverage. It also includes millions of employees of large businesses, who either are not offered health coverage or can't afford the premiums.

Enter Obamacare. The good news in the ACA for low-wage workers who work for small employers (those with fewer than 50 full-time workers) is that many will have access to affordable health coverage for the first time through the new health insurance marketplaces. They will be able to sign up for subsidies that limit how much they pay in premiums to a percentage of their income and get plans with good benefits and moderate out-of-pocket costs. Those with incomes below 133 percent of the federal poverty level (about $15,000 for an individual) will be eligible for Medicaid in states that agree to expand coverage.

But for those who work for bigger employers – and some two-thirds of minimum wage jobs are at employers of 100 or more – it is not clear whether the ACA will deliver on its promise of affordable coverage. Ironically, part-time workers may come out ahead, with a much better chance of affordable coverage, while full-time low-wage workers may find coverage out of their financial reach.

Millions of people who don’t work more than 29 hours a week for any one employer will be eligible for affordable subsidized coverage through the new marketplaces. And even if employers trim back some workers' hours to get below the 30-hour mark, those workers may end up better financially and gain affordable coverage for the first time.

There will also be some employers who increase the hours of part-time workers to above 30 a week, as the Cumberland Farms stores, which employ 4,500 full-time workers and 2,700 part-timers, plan to do. Noting that  full-time workers stay with the business three to four times longer than part-timers, the Cumberland Farms CEO explains, ““Longer-tenured workers deliver a better experience for the customer.” According to the payroll-processing firm ADP, other businesses are also likely to encourage more workers to become eligible for employer coverage.

But it is not at all clear that full-time low wage workers for bigger employers will be able to get affordable coverage. That is because the big business lobby exercised its muscle in shaping the ACA in the Senate Finance Committee. All the law requires is that employers offer individual employee health coverage that does not cost more than 9.5 percent of an employee’s income in order for the business to escape paying a $2,000-to-$3,000 penalty. In addition, the ACA allows employers to offer plans with very high out-of-pocket costs.

Make no mistake about it; 9.5 percent of wages is a lot for anyone to pay for health insurance, and it is a huge amount for low-wage workers. By comparison, an employee who makes $12 an hour and works a 35-hour week would pay about 6 percent of his or her income on health insurance in the new marketplaces, for coverage which is almost certain to have better benefits and lower deductibles and co-payments.

And here’s the kicker: as long as a worker is offered the less-than-9.5-percent-of-income coverage at work, that worker is not eligible for the much better coverage in the marketplace. And if the worker decides that she can’t afford the premiums, she will be have to pay a penalty for not being insured.

The big outstanding question is, what will the bigger low-wage employers do? They could choose to offer affordable coverage to their employees. But the big fast food chains, retail giants, and box stores have a history of offering several levels of coverage to their employees, including bare-bones plans targeted at their lowest paid workers.  

Putting this all together, here is what health coverage for low-wage workers may look like after a couple of years of implementation of Obamacare: good coverage for those who work for smaller businesses and who don’t work more than 29 hours a week for any one employer, but either no coverage or coverage that is costly to buy and to use for many people who work more than 30 hours a week for the biggest low-wage employers in the country.

Seen in this light, Obamacare is one more step toward both improving and exacerbating the low-wage work crisis in the nation. The movement away from employer-provided health coverage is a huge step forward in creating a more just health care coverage system. But justice for low-wage workers at big businesses will mean confronting the power of companies like WalMart, McDonald's, and Bank of America (with its low-wage tellers). This is the same challenge we face in taking the other steps needed to modernize labor standards for the 21st Century: a higher minimum wage indexed to inflation, paid sick days and family leave, and overhauling labor laws so that workers’ rights to form unions is restored. It is fast becoming central to the fight for a new economy that works 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.

 

Health care reform advocates image via Shutterstock.com

Share This

The Next Big Obamacare Battle: The Low-Wage Workers Who Get Left Out

Apr 1, 2013Richard Kirsch

Reformers should start building a coalition to push for expanding the bill and making it more affordable.

Reformers should start building a coalition to push for expanding the bill and making it more affordable.

The whining from some fast food chains that they won’t be able to afford paying for their employee’s health coverage under Obamacare have gotten a lot of press. But what is more troubling is the recent news that some big chains are concluding that the costs won’t be nearly as high as they had projected. The reason: their employees won’t be able to afford the health insurance and will instead pay a fine and remain uninsured. This fight is just the first battle in the coming war over Obamacare that will center around those who get left out. Big flaws in the bill will mean that many low-wage workers will be forced to choose between paying huge chunks of their income on premiums or on a penalty that leaves them with no coverage at all. Reformers should take note and get ready for the coming struggle.

Last week, the Wall Street Journal reported that Wendy’s lowered its estimate of the cost of Obamacare for each of its restaurants by 80 percent, from $25,000 a store to $5,000. The hamburger chain figured that many of its full-time employees, who will be offered health insurance through the company, will turn down the coverage because, as the Journal reported, “they can get insurance through Medicaid or a family member, or because they prefer to pay the penalty for not having coverage.” That penalty starts at $95 a year, although it will go up to $695 by 2016.

Wendy’s isn’t alone. Several other fast food chains have come up with similar estimates. One example is Popeyes, which figures that since only 5 percent of its employees have signed up for the high deductible plan now offered at a price of only $2.50 a week, few workers will choose to pay an estimated $25 a week for the improved coverage it will offer under Obamacare. While the new coverage required under the law will be far superior to the plan Popeyes now offers, with a good list of benefits, it will still include a steep deductible, particularly for a low-wage worker.

The debate over fast food chains and their workers is revealing one of the biggest flaws in the Affordable Care Act. Many low-wage workers will be put in a very difficult position: pay a big chunk of their limited wages for health insurance that is costly to use, or pay a fine for the privilege of remaining uninsured. This is an example of how the debate around Obamacare is about to take a huge turn. Instead of partisan opponents fearmongering about the theoretical impact of the law, the new struggle will be around the actual experience of those Americans whom the law was written to protect: people who are uninsured because they can not afford coverage or are locked out of the system because they have a pre-existing health condition.

Come January 2014, millions of people will get affordable health coverage for the first time. These will mostly be working people who do not get insurance on the job now but will become newly eligible for Medicaid or income-based tax-credits to buy insurance in the new health insurance marketplaces (“exchanges”). This will also include those who will no longer be turned down because of a pre-existing condition. The expansion of Medicaid – in states that give that the green light – and the income-based subsidies will create a huge new constituency for Obamacare that will oppose any attempts to roll back the law.

But due to problems written into the Affordable Care Act, the news won’t all be good for many people who can’t get affordable coverage now. There are some for whom the coverage in the marketplaces will still be too costly because the subsidies are too stingy. For example, a single person who earns just $33,500 will be required to pay $258 a month in premiums, which is more than 9 percent of his or her gross income, for coverage. That’s a big chunk out of a moderate income and is more than twice as much as that person would pay under Massachusetts’s current, successful law. In fact, people who earn more than two times the federal poverty level would be required to pay premiums from 6.3 percent to 9.5 percent of their incomes. If those costs are out of their financial reach, the bleak alternative is to pay a fine for remaining uninsured. It’s true that the coverage will include good benefits, free preventive services, and a cap on out-of-pocket costs. But unless it is already paying high medical bills, that won’t help a working family pay a high premium. The millions who face this dilemma will not be happy to have to make the choice between premiums that will put a big squeeze on an already tight budget or paying a fine they can’t afford for no benefits at all.

Which brings us to the second big group of people who will face this dilemma: low-wage workers who work more than 30 hours a week for a business that has 50 or more full-time employees. These employers can require employees to pay up to 9.5 percent of their incomes as premiums. The premiums are likely to be less for individuals; Popeyes estimates $1,200 a year, which would be similar to what has been found workable in Massachusetts. However, unlike in Massachusetts, the minimum coverage will have very high out-of-pocket costs, so workers will face high premiums for coverage that they can’t afford to use (although preventive care will be free). Furthermore, employers could decide to put more of the costs on to their workers, forcing them to choose between the premium and fines.

The news is much worse for family coverage. The IRS ruled earlier this year that the 9.5 percent rule will apply to the cost of individual coverage, even if family coverage costs much more than this. Here is how the New York Times editorial board explained the impact, in an editorial titled, “A Cruel Blow to American Families”:

A Kaiser Family Foundation survey found that in 2012, employees’ annual share of insurance premiums averaged $951 for individual coverage and $4,316 for family coverage. Under the I.R.S. rule, such costs would be considered affordable for an employee with a household income of $35,000 a year — making the employee’s spouse and children ineligible for a public subsidy on a health exchange, even though that family would have to spend 12 percent of its income for the employer’s family plan.

The Times goes on to report that between 2 million and 3.9 million spouses and children could lose access to affordable coverage because of the ruling. Those are millions of people for whom the law will be an empty promise.

The major purpose of the Affordable Care Act was to make decent health coverage affordable to Americans, and the law’s success will depend on how well it does just that. Next year, many millions of now uninsured people will gain access, but there will be millions of others for whom the promise remains out of reach. In the toxic political atmosphere surrounding Obamacare, the people left out will take center stage.

Republicans will seize on this situation to argue that the law is not working and use these people’s frustrations to portray the law as an expensive failure. The task for the champions of the ACA will be to unite those who are benefiting under Obamacare with those who will only benefit if the law is made more affordable. And since making coverage more affordable will take the government and, ideally, employers paying for more of the premiums, enacting the fixes will require a big political lift, particularly in the current Congress. Meeting this challenge will require organizing the winners and the losers to push for strengthening the law together.

All of this will become an issue in the 2014 and 2016 elections. In this way, Obamacare will join Medicare, Social Security, and Medicaid as perennial issues of public debate, with competing visions of the role of government in assuring the security and well-being of our citizens. It’s a fight that never ends. 

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

Share This

Paul Ryan’s Budget Would Kill Health Insurance Programs – and Thousands of Americans

Mar 14, 2013Richard Kirsch

Ryan's budget priorities expose a disregard for the fundamental right to a healthy life.

I know you are not supposed to write in hyperbole, but sometimes the truth needs to be told. Paul Ryan’s budget, which kills Obamacare and cripples Medicare and Medicaid, would kill tens of thousands of people. Every year.

Ryan's budget priorities expose a disregard for the fundamental right to a healthy life.

I know you are not supposed to write in hyperbole, but sometimes the truth needs to be told. Paul Ryan’s budget, which kills Obamacare and cripples Medicare and Medicaid, would kill tens of thousands of people. Every year.

I have trouble with putting policy glosses on proposals that would deny health care coverage to millions of people and make care much more expensive to millions more. Because when more people lack health coverage, more people die. And when health costs prevent people from getting the care they need, they get more seriously ill.

How many people are we talking about? Estimates of the number of people who will die because they are uninsured vary, from about 500 to 1,000 for every one million who lack coverage. Repealing Obamacare would block promised coverage for 32 million people, so that would mean somewhere from 16,000 to 32,000 each year who will die prematurely. Of course, since some Republican governors and legislatures are not implementing the expansion of Medicaid coverage in their states, some of those deaths are already on their hands.

Which leads us to the Ryan plan for slashing Medicaid. He replaces a program that now entitles low-income people to health coverage with a block grant to states to spend however they want on health care for the poor. The federal government would save money by decreasing what it pays to state governments and states would get to do the dirty work of cutting people’s health care. That will mean fewer people on the program, higher out-of-pocket costs, or a reduction in coverage of medically necessary care. And more people dying who would have lived if they had kept their previous health coverage.

In cutting Medicaid, Ryan is fulfilling the biggest concern that Republican governors say they have when they consider expanding Medicaid under Obamacare. A typical remark came from Arizona Governor Jan Brewer: “As I weighed this decision, I was troubled by the possibility that a future President and Congress may take steps to reduce federal matching rates, leaving states with a greater and greater share of health costs over time.”

Everyone is familiar by now with Ryan’s proposal to replace Medicare with vouchers to buy private insurance. The Ryan voucher plan is not about controlling health care costs; instead, it is intended to shift costs from the federal government to the seniors and the disabled who are covered by Medicare. When people can’t afford the care they need – and the CBO reported that the first Ryan voucher plan would have doubled the already high cost of health care to seniors – they will get sicker.

The parts of Obamacare that Ryan doesn’t repeal underscore his cynicism. Ryan would keep the $716 billion in Medicare spending reductions over a decade, which he railed against when he was running for vice president. In his debate with Joe Biden, Ryan called the Medicare changes a “piggybank” for Obamacare, which would cause hospitals and nursing homes to close and lead to seniors losing benefits. None of this is true, as Biden pointed out. So now Ryan is using that $716 billion in savings to help him reach his goal of balancing the federal budget instead of what those savings were intended for: increasing Medicare benefits under Obamacare and expanding coverage to millions of Americans.

Remarkably, Ryan also keeps the other tax increases in Obamacare, some $1 trillion raised mostly from upper income taxpayers and various medical providers and insurers. Ryan is using money raised to provide life-saving health coverage to millions of people, taxes he and other Republicans railed against, to meet his fantasy target of balancing the budget in 10 years.

I’ve grown tired of providing a veneer of respectability to people in power – people with good health insurance, coverage that provides them with access to the best medical care, and pays most of their bills – who deny their constituents a basic human right. Governors and state legislatures who won’t expand Medicaid even though the federal government will pay virtually all of the cost. Members of Congress whose health coverage is largely paid for by their constituents who still make political hay by demagoging against Obamacare.

Fortunately for those whose lives are at risk, the Ryan budget is dead on arrival. But the debate about how to make the promise of Obamacare real is only just the beginning. States will continue to debate whether to expand Medicaid. And when Obamacare’s major provisions kick-in next January, there will be a new round of debates about whether families can afford the new coverage and whether employers and government should do more or less to assure that people get covered. What will not end is the real consequences in each of those decisions for people’s lives. 

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

Share This

States Saying No to Health Care Marketplaces is Good News

Feb 26, 2013Richard Kirsch

ObamaCare has a better chance at success if it's taken out of the hands of Republican governors who want to see it fail.

The headlines – “Many States Say 'No' to Health Insurance Exchanges,” to take one example – make it seem like bad news. But it’s not. It is good news that half the states are refusing to have anything to do with the new health insurance marketplaces being set up under the Affordable Care Act.

ObamaCare has a better chance at success if it's taken out of the hands of Republican governors who want to see it fail.

The headlines – “Many States Say 'No' to Health Insurance Exchanges,” to take one example – make it seem like bad news. But it’s not. It is good news that half the states are refusing to have anything to do with the new health insurance marketplaces being set up under the Affordable Care Act.

One of the biggest differences between the good version of ObamaCare passed by the House and the mediocre Senate version that became law was the question of whether the federal government or states would run the new health insurance marketplaces (called “exchanges” in the law). But resistance by Republican governors is leading to implementation of the law in a way that is much closer to the vision in the House bill.

The new health marketplaces are the centerpiece of ObamaCare, the mechanisms through which people who don’t get health coverage at work but make too much for Medicaid will be able to purchase subsidized health coverage, even if they have a pre-existing condition. The marketplaces, which are projected to cover 12 million people in 2012 and 29 million by 2021, will also offer more affordable insurance plans to small businesses.

The House legislation would have had the federal government run the marketplaces while allowing states the option of taking over if they could demonstrate the ability to do at least as good a job. Consumer advocates hoped that the result would be a good national marketplace, with some exemplary states demonstrating how to do an even better job at providing quality coverage and good access while controlling costs.

But the Senate legislation, which became law, gave the primary responsibility to each state to set up a marketplace, with the federal government as backup. Advocates were not pleased for two reasons. The first was a concern that states would do a very minimal job of protecting consumers. The second worry was that states would fumble the complicated task of getting the exchanges up and running by October 1, 2013, when they are open for enrollment.

In reality, the reluctance of so many Republican governors to cooperate with ObamaCare has led to the creation of a system that looks more like the House bill. The federal government will run the exchanges in 25 states and will have primary responsibility, in partnership with states, in seven more.

The last thing consumers needed was for governors who want the ACA to fail – like Florida’s Rick Scott and Texas’s Rick Perry – to be in charge of the law’s implementation. We can be sure that governors in these states would do the minimum amount under the law to sign people up or to protect consumers from high-priced, poor-quality health insurance plans.

On the other hand, some of the states that have decided to set up their own marketplaces are doing what the authors of the House law hoped: being models. Massachusetts, which has been running a marketplace since 2007, is the trailblazer. The state did an excellent job promoting health care coverage and making it easy to sign up, either online or in person. There are strict conflict-of-interest protections for the individuals who govern the marketplace. And they have only contracted with health insurance providers, including community providers, that offer quality coverage at a reasonable cost. As a result, premium inflation has been low.

Several states look like they will follow the Massachusetts example, including California, Connecticut, the District of Columbia, Oregon, Rhode Island, and Vermont (which is moving toward a single-payer plan in 2017). If these states prove successful in demonstrating that acting on behalf of individuals and small businesses results in better access at lower costs, the example is likely to be followed by other states and the federal government.

The open question is how good a job the Federal Department of Health and Human Services will do running the marketplaces in 32 states. This year, HHS is setting its sights on the essentials. The top priority – no small challenge – is getting up and running by October 1st, when people and small businesses can start enrolling. Setting up online systems that account for the different plans and the varying Medicaid and Child Health Insurance eligibility rules in each state is daunting. Enrollment will only be available online, and plans will be easy to compare. However, there will be contracts with state-based groups to assist with outreach and enrollment. The feds say they will pay at least some attention to assuring that community health centers are included as providers by some insurers.

For now, HHS is not implementing key measures to assure that quality health insurance is provided at the best possible cost. It has decided to wait four years until all health insurance plans must be fully accredited by quality assurance bodies. More significantly, it will not initially use its biggest tool, restricting access to the marketplaces to health insurance plans that meet quality standards at a reasonable cost. Most people in the health exchanges will have their costs capped at a percentage of their income, with the government picking up the difference. So limiting insurance plans to those that provide good value will be essential to keeping the system affordable to the government and resisting pressure to increase the cost to consumers.

This October, three and a half years after the ACA was passed, consumers will start enrolling in the new marketplaces. At that point, the debate about ObamaCare will shift from theory to practice. It is vitally important that people learn about the new marketplaces and can readily comparison shop and qualify for income-based subsidies for coverage. There will be huge headaches in the process. But there will be a lot fewer problems than if every state in the union was doing this on its own. It’s good to have one instance where opposition to ObamaCare from the right is all for the best. 

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.

 

Rick Perry image via Christopher Halloran / Shutterstock.com.

Share This

Emergency Contraception Use Spreads, but Many Women Are Still Left Out

Feb 26, 2013Ellen CheslerAndrea Flynn

New evidence shows more young women are using emergency contraception but we still have work to do to reduce all barriers.

New evidence shows more young women are using emergency contraception but we still have work to do to reduce all barriers.

A federal study released recently shows that use of emergency contraception (EC) in the United States, known colloquially as the “morning after” pill, has more than doubled in the past decade. This is good news. It demonstrates the critical and expanding role the method may now be playing in enabling women, particularly young women, to prevent unplanned pregnancies. But there are still serious hurdles women face in accessing this method of birth control. While access has expanded, there is still work to be done.

The study, conducted by the Centers for Disease Control and the National Center for Health Statistics, strengthens the case for promoting EC widely and making it more readily available. Based on interviews with more than 12,000 women from 2006-2010, the research finds that EC use among all sexually experienced women between the ages of 15-44 has increased to 11 percent (up from a baseline of 4.2 percent). That number is even higher among women 20-24, one of the highest risk groups for unplanned pregnancy. Nearly a quarter of this cohort now reports having used EC.

This is no coincidence. In 2006, nearly a decade after EC first entered the market under the trade name Plan B and after years of stalling and political maneuvering by the Food and Drug Administration (FDA), the agency finally ruled that the product can be provided without prescription to women over the age of 18. A year later, a federal judge ordered the FDA to make it available to women over the age of 17. An important provision of the Obama administration’s Affordable Care Act (ACA) also now promises to cover the cost of all methods of contraception, including this one.

The government study confirms what we already know: accidents happen. Half the participants report having used EC out of fear that their initial birth control method had failed; the other half used it because they had unprotected sex. This reminds us that even women who have a “plan A” need a “Plan B,” or, as the product is now also marketed, a “Next Choice.” Nearly one-third of all U.S. women using contraception rely on the pill, and approximately 16 percent use condoms – both effective methods when employed perfectly, but also ones prone to human error. Condoms break, and sometimes women forget to take a daily low-dose pill. And then there are still the many women who, because of lack of access, cost, forgetfulness, or spontaneity, still don’t consistently use birth control and need protection after the fact.

One of the most common arguments against EC is that it is really just an early abortion method masked as contraception. This simply has no basis in science, as most recently explained by the International Federation of Gynecology and Obstetrics. Unlike medication abortion, which terminates a pregnancy in its earliest stages, EC actually prevents a pregnancy from occurring.

The next most popular and equally erroneous claim is that increased access to EC – and, for that matter, any program or product that provides access to abortion, contraception, or sexuality education – will promote risky sexual behavior. Studies from diverse countries over many years tell us this is not the case. But new research coming out of New York City now confirms that access to EC right here at home does not encourage young people to become more sexually active. In fact, it does just the opposite. The NYC Department of Health recently reported a 12-point drop over 10 years, from 51 to 39 percent, in the proportion of public high school students who are sexually active. Over the past few years, the proportion of sexually active students using contraception, including Plan B, increased from 17 to nearly 27 percent. Both trends coincided with an expansion of school-based health centers that provide free contraception (including EC), counseling, and sexuality education.

So now we have homegrown data to show that when young people have access to sexual health information, no or low-cost products and services, they make better and safer decisions about their reproductive and sexual lives.

But while the federal data illustrates an overall increase in EC use, it also reveals an educational and economic divide among women who use it, suggesting the need for better information and access for low-income women. The CDC study finds that EC use is highest among college-educated women (12 percent), compared to women who have only completed high school or received a GED (7 percent). A 2011 study conducted by researchers at the Boston University School of Public Health also found that while a majority of pharmacies in low-income neighborhoods do have EC available, they often provide incorrect information about eligibility.

Add this to a number of other potential barriers, and it is clear why EC use isn’t higher.

The drug is not actually sold over the counter, where it would be most accessible, but rather behind the counter, where a pharmacist must retrieve it. (Still, this makes it more widely available in the 72-hour window after unprotected intercourse when it works most effectively.) Nine states around the country have a “conscience clause” on the books that permits pharmacists to deny filling a prescription on religious or moral grounds. Only 17 states and the District of Columbia explicitly require hospital emergency rooms to provide EC and related services to sexual assault victims.

The cost of EC is prohibitive for many potential clients. Plan B and Next Choice, the two most popular products on the market, range in price from $35 to $60 at a pharmacy and from $10 to $70 at Planned Parenthood and other public health clinics, which offer an income-based sliding fee scale and often include counseling and other services.

Even at these high prices, the limited market for the product may not provide private drug companies any incentive to advertise it beyond women’s magazines or other niche marketing sites. This means that young women just becoming sexually active, and all women who do not regularly visit a clinic or a private physician, may never learn about it. Age restrictions requiring a photo ID and concerns about confidentiality may also be intimidating and restrict use.

There are also a number of potential hurdles to EC provision under the Affordable Care Act. Will women be able to use their private insurance or Medicaid benefits to purchase it at a drug store? Or will they need to visit a Planned Parenthood or community clinic? What about the many states that are not planning to participate in the Medicaid expansion? How will low-income women in those states receive information about and access to EC and, for that matter, regular methods of contraception?

In recent years, Planned Parenthood has put forward an effective reproductive health information campaign using online and cell phone platforms. Millions of women, and especially young people, are now texting or visiting its website each month to learn about and gain access to EC, along with other important sexual health information.

The Obama health care plan needs to imitate and vastly expand this marketing approach if it is to be effective. At long last, the Affordable Care Act promises to provide a national policy that prioritizes women’s health and primary, preventive care. But we must seek greater clarity about its implementation. Our next challenge will be to buttress the ACA with an inventive, far-reaching public information campaign so a broad and diverse population can understand and access its many benefits. How about calling this campaign “Morning After in America"? For those Americans old enough to remember Ronald Reagan, this surely has a familiar ring!

Ellen Chesler is a Senior Fellow at the Roosevelt Institute and author of Woman of Valor: Margaret Sanger and the Birth Control Movement in America. Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. 

 

Contraception image via Shutterstock.com.

Share This

The Real State of the Union Requires a Stronger Government

Feb 15, 2013David B. Woolner

Instead of downplaying the role of government, we should recommit to a "spirit of charity."

We of the Republic sensed the truth that democratic government has innate capacity to protect its people against disasters once considered inevitable, to solve problems once considered unsolvable…

In this we Americans were discovering no wholly new truth; we were writing a new chapter in our book of self-government . –Franklin D. Roosevelt, 1937

Instead of downplaying the role of government, we should recommit to a "spirit of charity."

We of the Republic sensed the truth that democratic government has innate capacity to protect its people against disasters once considered inevitable, to solve problems once considered unsolvable…

In this we Americans were discovering no wholly new truth; we were writing a new chapter in our book of self-government . –Franklin D. Roosevelt, 1937

In his State of the Union address, President Obama challenged the Congress and the American people to join him in a common effort to make the United States a better nation; to recognize that while we “may do different jobs, and wear different uniforms” we are all “citizens” imbued with the rights and responsibility “to be the authors of the next great chapter in our American story.”

Certainly, the president’s call for “investments” in setting up universal preschool, increasing access to higher education, promoting research and development, fixing our broken infrastructure, and establishing a higher minimum wage so that in “the wealthiest nation on earth, no one who works full-time should have to live in poverty,” is a welcome development. So too is the president’s acknowledgment that there are still communities in this country where, thanks to inescapable pockets of rural and urban poverty, young adults find it virtually impossible to find their first job. “America,” he insisted, shouldnot [be] a place where chance of birth or circumstance should decide our destiny.”

And yet, if we examine the state of our union honestly, it not only becomes apparent that we are indeed a society where “chance of birth or circumstance” decides our destiny, but also a society that has fallen far behind the rest of the world in education, health care, infrastructure, and a host of other indicators that determine the overall quality of life.

In study after study, for example, Americans are found to be far less economically mobile than their counterparts in Canada and Europe. In education, the U.S. now ranks 17th in the developed world overall, while we are ranked 25th in math, 17th in science, and 14th in reading, well behind our Asian and European counterparts. For decades the U.S, was ranked number 1 in college graduation, but we now stand at number 12, and even more shocking, we are now ranked 79th in primary school enrollment. This is no way to sustain or build a competitive edge in a global economy.

Other statistics tell a similar tale. How many Americans, for example, are aware that out of the 35 most economically advanced countries in the world, the U.S. now holds the dubious distinction of ranking 34th in terms of child poverty, second only to Romania? In infant mortality, the U.S. ranks 48th. As for overall health and life expectancy, a recent report by the Institute of Medicine and the National Research Council found that among the 17 advanced nations it surveyed, the U.S.—which in the 1950s was ranked at the top for life expectancy and disease—has declined steadily since the 1980s. Today, “U.S. men rank last in life expectancy among the 17 countries in the study and US women rank second to last.” In infrastructure, the World Economic Forum recently ranked the U.S. 25th in the world, behind virtually all other advanced industrialized nations and even some in the developing world.

Still, there are some categories where the United States ranks number one: we have the highest incarceration rate in the world—far higher than countries like Russia, China, or Iran. We have the highest obesity rate in the world and we use more energy per capita than any other nation. And while the U.S. does not possess the highest homicide rate in the world—that distinction goes to Honduras—the rate of death from firearms in the U.S. is nearly 20 times higher than it is among our economic counterparts. And on a city-by-city basis, we would find that if New Orleans were a country, for example, its homicide rate would rank number 2 in the world.

Eighty years ago, when the United States found itself in an even more precarious state than it does today, Franklin Roosevelt used the occasion of his first inaugural address to say to the American people that “this is preeminently the time to speak the truth, the whole truth, frankly and boldly,” to avoid the temptation “to shrink from honestly facing conditions in our country today.” The president then went on to implore the American people to reject the fear and apprehension that had paralyzed the nation by reminding them that “in every dark hour of our national life, a leadership of frankness and of vigor has met with that understanding and support of the people” which is essential to overcoming the challenges we face.

Four years later, in the first State of the Union address of his second term, President Roosevelt observed that “the deeper purpose of democratic government is to assist as many of its citizens as possible, especially those who need it most, to improve their conditions of life…” But, he went on, even with the “present recovery,” the United States was “far from the goal of that deeper purpose, for there were still “far-reaching problems… for which democracy must find solutions if it is to consider itself successful.”

President Obama certainly echoed these sentiments when he spoke about the meaning of citizenship and “the enduring idea that this country only works when we accept certain obligations to one another and to future generations; that our rights are wrapped up in the rights of others.” But the president said little about the role of government in ensuring that these obligations are met, and he qualified his remarks by opening his speech with his oft-repeated maxim that the American people do not expect government “to solve every problem.”

FDR took a different tack. For him government was the instrument of the common people, and as such its primary responsibility was not to serve as an arbiter between the demands of the rich and the needs of the poor, but rather as the vehicle through which the hopes and aspirations of all Americans could be met. In this he argued that:

The defeats and victories of these years have given to us as a people a new understanding of our government and of ourselves…It has been brought home to us that the only effective guide for the safety of this most worldly of worlds, the greatest guide of all, is moral principle.

We do not see faith, hope, and charity as unattainable ideals, but we use them as stout supports of a nation fighting the fight for freedom in a modern civilization…

We seek not merely to make government a mechanical implement, but to give it the vibrant personal character that is the very embodiment of human charity.

We are poor indeed if this nation cannot afford to lift from every recess of American life the dread fear of the unemployed that they are not needed in the world. We cannot afford to accumulate a deficit in the books of human fortitude.

In the place of the palace of privilege we seek to build a temple out of faith and hope and charity.

To bring about a government guided by the “spirit of charity,” FDR initiated the most far-reaching social and economic reforms in our nation’s history; reforms designed to provide the average American with a measure of economic security; reforms that reduced the vast, unjust, and unsustainable economic inequality that had brought the country to ruin just a few short years before.

If we are going to “honestly” face “conditions in our country today,” then we need to recognize that the steady abandonment of the principles of governance put in place by Franklin Roosevelt in the past three decades have done enormous harm to the state of the union. In light of this, rather than repeat the conservative mantra that government cannot solve every problem, perhaps President Obama should follow the example of President Roosevelt by reminding the Congress and the American people that even though

Governments can err, [and] presidents do make mistakes… the immortal Dante tells us that Divine justice weighs the sins of the cold-blooded and the sins of the warm-hearted on different scales.

Better the occasional faults of a government that lives in a spirit of charity than the consistent omissions of a government frozen in the ice of its own indifference.

David Woolner is a Senior Fellow and Hyde Park Resident Historian for the Roosevelt Institute. He is currently writing a book entitled Cordell Hull, Anthony Eden and the Search for Anglo-American Cooperation, 1933-1938.

Share This

Pages