Daily Digest - December 3: Obamacare Doesn't Eliminate the Need for Title X

Dec 3, 2013Rachel Goldfarb

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What's the Deal: Why Is Title X Important to the Success of the ACA? (Roosevelt Institute)

Click here to receive the Daily Digest via email.

What's the Deal: Why Is Title X Important to the Success of the ACA? (Roosevelt Institute)

Roosevelt Institute Fellow Andrea Flynn breaks down the connection between Title X family planning clinics and the Affordable Care Act. She says that fully funding Title X would greatly increase the successes of health care reform.

Doing Macro First (NYT)

Paul Krugman agrees with Roosevelt Institute Fellow Mike Konczal's recent Wonkblog column where he suggested shifting the order of subjects in introductory economics courses. Putting macroeconomics first help students try to make sense of the current crisis.

The Exploited Laborers of the Liberal Media (Vice)

Charles Davis looks at the array of liberal publications that write about labor issues, including the internship economy, without paying their own interns. Some publications are finally changing that model, but only after public pressure.

The Solution to Unemployment Isn’t Better-Trained Workers: Or, Systemic Problems Have Systemic Solutions (An Und Für Sich)

Adam Kotsko points out that calls for better training won't do anything to solve the number of jobs available or the quality of those jobs. If worker education is expanded, as a Wal-Mart VP suggests in response to protests, Wal-Mart will just have a more educated staff.

Holiday Weekend Sales Dip on Discounts; E-commerce Jumps (Reuters)

Phil Wahba reports that while even more people went shopping over the holiday weekend, total sales were still down. Steep discounts may have drawn in shoppers, but they didn't help the stores' profit margins.

NY State Regulator Subpoenas 16 Websites for Ties to Payday Lenders (WSJ)

Shayndi Rice explains that the state's Department of Financial Services suspects these websites are selling personal information to direct payday lenders that charge illegally high rates. Some of these predatory lenders charge annual interest rates over 600 percent.

Fast-Food Workers In 100 Cities To Walk Off The Job (HuffPo)

Candice Choi and Sam Hananel report on the upcoming protest, which will happen on Thursday. Demonstrations are planned in another hundred cities in addition to the strikes, making this the largest protest yet in fast food workers' call for higher wages.

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Why Is Title X Important to the Success of the ACA?

Dec 2, 2013

As part of the Roosevelt Institute's "What's the Deal?" series, Fellow Andrea Flynn explains the importance of Title X in relation to the implementation of the Patient Protection and Affordable Care Act (PPACA).

As part of the Roosevelt Institute's "What's the Deal?" series, Fellow Andrea Flynn explains the importance of Title X in relation to the implementation of the Patient Protection and Affordable Care Act (PPACA).

Read Andrea's paper here.

Have an idea or topic suggestion for our "What's the Deal" series? Let us know by tweeting at #RIExplains and @RooseveltInst.

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Abortion Restrictions Are Harming Women's Health and Human Rights in Texas

Nov 25, 2013Andrea Flynn

Abortion restrictions in Texas are hurting low-income women in the Rio Grande Valley, which is proof positive that the U.S. needs to think about human rights locally, not just internationally.

Abortion restrictions in Texas are hurting low-income women in the Rio Grande Valley, which is proof positive that the U.S. needs to think about human rights locally, not just internationally.

Last week the Supreme Court decided to leave in place a Texas law that has essentially closed a third of the abortion providers in that state. On their own, the abortion restrictions are devastating. But in the context of three long years’ worth of family planning and women’s health cuts that violate the human rights of women in that state, they are catastrophic.

Over the summer Wendy Davis launched Texas into the national spotlight when she filibustered the same sweeping anti-abortion laws that were upheld by the Supreme Court. But long before that, women’s health advocates were sounding the alarm bells about the impact of massive family planning cuts that dismantled the state’s health infrastructure, on which millions of low-income women relied.

In order to understand the full implications of this week’s ruling, one must consider the current state of women’s health care – particularly that of low-income women – in Texas. The Center for Reproductive Rights (CRR) and the National Latina Institute for Reproductive Health (NLIRH) recently released a must-read report that illustrates the devastating human toll of family planning and reproductive health cuts on women living in Texas’s Rio Grande Valley.

The Valley is a marginalized region inside a state with some of the worst health disparities and the highest percentage of uninsured adults in the country. Many women in the Valley live in colonias, unincorporated communities along the U.S.-Mexico border, which often lack clean water, plumbing, electricity, and public transportation.

The report profiles women whose health and lives have changed along with the landscape of health infrastructures and systems in their communities. Women who detected lumps in their breasts four years ago but cannot afford the mammogram to determine if they are cancerous. Women who have received mammograms months ago but cannot get results because of exorbitant doctor’s fees. Women with ovarian cysts and cervical pain who risk their lives swimming across the river and traveling through towns rife with violence to access care in Mexico.

These women – and the thousands more they represent – must decide between paying rent, giving their children food and a roof over their heads, or having a mammogram, a Pap test, or contraceptives. “It’s one or the other, but not both,” they say. They live with a constant din of anxiety and fear, not knowing what disease is or might be growing in their bodies, where they will get care in emergency situations, or what will happen to their children if they become sick (or worse).

These women are living the consequences of calculated decisions made by conservative lawmakers to dismantle the state’s health safety net. Over the last two years, they cut the state’s family planning budget by two-thirds, from $111 million to $37.9 million. They established a tiered system and forfeited $30 million in federal funds so they could exclude Planned Parenthood and other organizations affiliated with abortion providers from receiving state or federal resources.

The 2011 policies shuttered 76 family planning clinics across the state (including 9 out of the Valley’s 32) and caused 55 more to reduce hours. Publicly funded clinics served 77 percent fewer patients in 2013 compared to 2011 (202,968 and 47,322, respectively). In the Valley public clinics went from serving 19,595 in 2011 to 5,470 in 2013. These trends are particularly troubling when you consider that even before the cuts, publicly funded family planning programs were providing care to less than 20 percent of the population in need.

As the CRR/NLIRH report describes, women in the Valley – particularly Latina women – experience the grave consequences of living at the intersections of race, class, gender, and immigration in the United States. They are 31 percent more likely to die of cervical cancer than women in non-border communities. In the rest of the country, rates of cervical cancer have been plummeting thanks to early detection and treatment, but among Latinas in the Valley the rate is increasing and cervical cancer deaths among Latinas is nearly twice that of non-Latina white women.

The report exposes the lesser-known consequences of the cuts and regulations on clinics that are still open. Remaining providers have reduced hours, laid off staff, increased fees, and stopped providing the most effective family planning methods all while managing a rapidly growing demand for their services. The average cost of a one-month supply of contraception and the fee for an annual exam has increased three- to four-fold since 2010. Ultrasounds and mammograms, once accessible thanks to subsidized rates, are no longer in reach of most women. Wait times often exceed several months.

For women living in areas where clinics have closed, reaching neighboring providers is often impossible due to transportation barriers. Buses are nonexistent, infrequent, or unreliable. Gas is too expensive. Childcare is hard to find. Taking time off work is not an option. For undocumented immigrants, traveling to other communities requires passing through internal checkpoints and risking deportation.

So what happens? Women purchase unregulated contraceptives off the black market, without consulting a doctor about which form of family planning is best for their bodies. They seek care in Mexico, taking the risk that they will not make it back across the border safely. Or, like many of the women described in the report, they forgo contraception and medical care because they simply cannot afford it.

This is the background upon which the most recent abortion restrictions have occurred. There is not a single abortion provider left in the Valley. At a minimum, women must travel three to five hours each way to access an abortion (and must make that trip multiple times thanks to ultrasound and counseling requirements). For most women, it might as well be outlawed.

Many of the women in the Valley do not reap the benefits of federal programs and policies meant to support low-income women. Undocumented immigrants are not eligible for public insurance programs. New immigrants must wait five years before becoming eligible for Medicaid. Texas is not expanding Medicaid under the Affordable Care Act, leaving those who aren’t poor enough for Medicaid but are too poor to qualify for subsidies out of luck.

Title X, the nation’s only program dedicated to family planning – which once provided effective and far reaching family planning care for the state’s low-income women – was seriously weakened by the above-mentioned regulations. (Luckily, the Obama administration recently took Title X out of the hands of the state government and endowed it to the Women’s Health and Family Planning Association of Texas, which has directed funding back to family planning clinics and even enabled a previously closed facility in the Valley to reopen.)

As the CRR/NLIRH report argues, the state of Texas has done more than just grievously neglect an underserved and marginalized community of women. It has violated the human rights of women in Texas, a duty it is legally obligated to respect, protect, and fulfill. American exceptionalism has relegated human rights to the international development sphere and deemed them unnecessary within our own borders. But for the health and lives of women in Texas and around the country, it is time we think about how we can use human rights to make America exceptional in ways we can be proud of. 

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.

Photo via Shutterstock.

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President's Insurance Announcement Keeps Eyes on the Prize

Nov 14, 2013Richard Kirsch

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

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

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

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

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

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

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

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

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

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

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

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

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

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What Do the Millennials Want From the Affordable Care Act?

Nov 12, 2013Anisha Hegde

Millennials are more interested in learning about how the Affordable Care Act works and obtaining health insurance than hyper-partisan rhetoric.

Millennials are more interested in learning about how the Affordable Care Act works and obtaining health insurance than hyper-partisan rhetoric.

In addition to serving as Senior Fellow for Health Care for the Roosevelt Institute | Campus Network, I am the Executive Director for my campus’ Roosevelt chapter. A few weeks ago at our general body meeting, I asked the crowd whether they had been talking with their friends about the Affordable Care Act, and what these conversations sounded like. Did they know the basics: that in January, most Americans will be expected to either carry at least minimal insurance or pay an opt-out penalty? Do they know that they will be able to stay on their parents’ insurance until they are 26, if they so choose? Have they compared the prices of different options available for young adults versus the penalty?

The question meant to take up the first ten minutes of our meeting turned into a full forty-minute discussion. As we scarfed down our pizza in true hungry college-student fashion, students shared their puzzlement about pro-ACA campaigns that encouraged individuals to just log on to healthcare.gov (you know, the website now infamous for its still-lingering usage problems) without further explanation as well as Generation Opportunity’s “don’t let government play doctor” campaign. In order to move the meeting along, we prematurely wrapped up the discussion, deciding that given the complexity of the ACA, Millennials want easy access to resources that educate us rather than simply feeding us instructions.

The kinds of resources we want are out there, but it seems their utility is suffocated by the louder (i.e. more well-funded) campaigns still focused on the politicization of health care reform. The campaigns focus on erroneous value-laden statements and criticism of public officials like Barack Obama and Kathleen Sebelius—ultimately leaving people aware of the latest stinging headlines but completely unaware that marketplaces opened October 1, or of the impact the marketplaces could have on them.

During our meeting, several students admitted that by getting sucked into media politicization of the ACA and calling into question the character of anyone who opposes it, they had lost sight of why we were retooling our health care system in the first place, and racing to fix the problems that came along with that process. The solid ten minutes of conversation that followed consisted of the health care wonks in the room answering the basic question of ‘why.’ Because we currently pay more for our health care than most other developed countries. Because our emergency rooms, required to treat all patients regardless of their insurance or ability to pay, drive up costs for the system as a whole. Because, in fixing these skyrocketing prices, we still believe that socioeconomic status should not determine an individual’s access to services essential for his or her life.

Even with the ‘why’ of health care reform answered, it is valid to make sure that the cure is not harder to stomach than the disease itself. For Millennials, one of the biggest pros of the Affordable Care Act is that individuals with lower salaries will be able to afford insurance and obtain health services thanks to government subsidies. This is critical, given that Millennials have the highest uninsured rates and that the Millennials with the highest uninsured rates are in the lowest income bracket. Possible cons must also be addressed, including the fact that Millennials who have a higher income might end up paying higher premiums for insurance purchased on the exchanges than they have paid on the individual market in the past. 

So, Millennials have choices to make, choices that were the cornerstone of the Supreme Court’s ruling to uphold the ACA. These choices will be colored by individual comparisons of marketplace premiums versus out-of-pocket costs, the future outlook and trajectory of these premiums, and which doctors and services would fall into certain networks, among other questions. Given that 53 percent of Millennials say they do not have a trusted source for information about the ACA, gauging an answer to these questions becomes a difficult, time-consuming task.

These sources need to be readily available and widely publicized soon, as the ACA relies on the comparatively healthier Millennials to keep premiums down for the rest of the population. Assuming discussion sparked in our Roosevelt chapter is a rough indication of Millennial sentiments as a whole, we are ready for the media to shift its focus from the embittered political debate to see that presenting one hyper-partisan side of the ACA leaves Millennials suspicious, unwilling to act either to keep premiums reasonable or to contribute to the defunding of the ACA. We do not want orders barked at us or abstractions and hyperboles hurled at us. Instead, we want the facts to empower us – to guide us in translating ACA jargon of marketplaces and mandates into the value of health care as a fundamental human right.

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

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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

Click here to receive the Daily Digest via email.

Aides Debated Obama Health-Care Coverage Promise (WSJ)

Click here to receive the Daily Digest via email.

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

Click here to receive the Daily Digest via email.

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

Click here to receive the Daily Digest via email.

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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