How Low-Income Americans Live (and Whether They Live) Depends on Where They Live

November 3, 2014

TalkPoverty.org recently hosted an online panel discussion on policy solutions to the economic insecurity — and downright poverty — that the latest Census figures confirm.

Toward the end of the discussion, the moderator asked panelists for their views on the “political environment” for their solutions. None saw more than the remotest chance of positive action by Congress. All noted good things happening at state and local levels — and expressed hopes for more.

There’s a flip side to these good things. They aren’t happening everywhere. And they almost surely won’t. We have a sort of inequality that’s not much talked about — the markedly unequal opportunities and safety-net supports for low-income people, depending on where they live.

Nothing new about this, of course. I’m moved to remark on it by an analysis the Urban Institute published the same day as the panel discussion.

The Institute looks at what will happen to poor and near-poor uninsured adults in the 23 states that haven’t expanded their Medicaid programs, as the Affordable Care Act required, until the Supreme Court said it couldn’t.

As you may recall, the ACA had required states to provide Medicaid coverage to non-elderly adults with incomes no greater than 133% of the federal poverty line — effectively 138% because of the way income is calculated.

The law also allows anyone in the same age bracket to purchase health insurance on an exchange if they can’t get affordable health insurance through their employer, but only if their income was at least 100% of the FPL.

What this means is that an estimated 6.3 million people have fallen into a coverage gap, being ineligible for both unexpanded Medicaid and for affordable health insurance offered on an exchange.

Needless to say (I hope) very few adults so poor can get health insurance sponsored by their employers. And there’s no way they can afford to buy it at market rates.

Their median annual income is just $9,500 — 65% of the FPL, the Institute reports. But it’s considerably lower in a number of states — 61% of the FPL in three (all Southern) and 49% in Alaska, where the median annual income for left-out residents is $7,422.

And, of course, half of the adults in the coverage gap have incomes lower, which means trying to get by on no more than $800 a month in most of the non-expansion states.

Some of these states have also done their best to limit purchases on the exchange that the federal government set up because they wouldn’t create their own.

As I’m sure you’re well aware, the exchange website isn’t altogether user-friendly. Even if it were, assessing the different plans offered and deciding which to choose wouldn’t be easy, especially if you’ve never had health insurance before.

The ACA, however, provided funds for “navigators” to inform consumers and help them through the enrollment process. And the U.S. Department of Health and Human Services established requirements to make sure they could do the job, e.g., training on a range of topics, a certification exam.

At least 13 states piled additional requirements on, according to a Health Care America Now review. Texas, for example, doubled the training hour requirements and added background checks. Can’t have ex-felons advising people on health insurance, you know.

It also requires community groups to secure liability protection, e.g., an insurance policy, for the navigators they retain and to comply with a bunch of additional rules. More costs clearly intended to hamstring the groups’ activities.

Indiana and several other states did something similar through licensing requirements that reportedly cost as much as $175 per navigator. Florida barred navigators from its public health offices.

We can see the results in the latest American Community Survey figures. In Texas 22.1% of the population had no health insurance last year. In the District of Columbia and Hawaii, just 6.7% of residents didn’t. Only Massachusetts, whose own healthcare reform gave it a jumpstart, had a lower rate.

We see similar divides in other state-level policies that affect the lives of low-income people, e.g., minimum wage rates, welfare benefits. I single the ACA pushback out because it’s so egregiously political, perverse and consequential.

Political because the state governors and/or legislative majorities want the ACA to fail — and more importantly, to ensure they don’t get beaten in the next primaries by candidates even further to the right.

Perverse in part because expanding Medicaid wouldn’t cost the states one thin dime until 2016 and only 10% of the costs of health care for the newly-eligible from 2020 forward.

Some of these costs would be offset by savings on care for people without insurance, however. So the extra states would have to spend would be a miniscule percent of what they have to spend anyway — 0.3%, on average, another Urban Institute analysis found.

And some states, the Institute concluded, would probably come out ahead. Another of its studies estimated states’ total savings at $12 billion to $19 billion a year, beginning in 2020.

We don’t need number-crunching to know that states gain nothing by deterring their residents from purchasing health insurance on an exchange. If anything, they’re stiffing their hospitals, virtually all of which must provide emergency care, whether patients can pay for it or not.

But people without health insurance generally don’t get much else by way of medical care. No routine checkups to detect so-called silent health problems like diabetes and hypertension. No screenings that can detect certain types of cancers.

Nor do people without health insurance generally have the wherewithal to follow recommendations they may get, e.g., to take prescribed medications at prescribed intervals, to get followup tests.

There’s been a lot of back-and-forth among experts over how many people will die because their states haven’t expanded Medicaid. The truth is we don’t know (yet).

But it seems as clear as day that low-income people — and some not-so-low — can look forward to longer, healthier lives in some states and will die unnecessarily in others. And if that’s not inequality, then I don’t know what is.

 


Congress Fiddles While Children’s Health at Risk

October 23, 2014

Nearly two million children may soon have no affordable health insurance — perhaps no health insurance at all. They’re at risk because federal funding for the Children’s Health Insurance Program will expire next year, unless Congress extends it — or fixes the so-called family glitch in the Affordable Care Act.

The number rises to 2.7 million if one also counts children who are eligible for CHIP, but not enrolled and others in Medicaid because some states and the District of Columbia used CHIP funding to expand eligibility, rather than create an altogether separate program.

More than 400 organizations that advocate and provide services for children have urged Congress to keep CHIP fully funded until at least 2019 — even if, as seems unlikely, Republicans agree to fix the glitch.

But say they did. First Focus, which has been pushing hard for renewed CHIP funding, argues that the program would still be needed. First some background, then the reasons why and finally the reasons the issue is more urgent than it may seem.

What is CHIP?

Congress created CHIP in 1997 to close a gap not unlike the one that could soon open. While very poor children qualified for Medicaid, families with somewhat higher incomes couldn’t afford health insurance, especially because relatively few could get it through their employers.

At the time, 23% of children in families below twice the federal poverty line were uninsured. Last year, all but 7.3% of children had health insurance — well over half through CHIP or Medicaid, according to Families USA.

Insurance coverage is far from the whole story. CHIP is designed specifically for children’s healthcare needs. States that operate CHIP through their Medicaid plans must provide a prescribed battery of early and periodic screening, diagnostic and treatment services.

States that have standalone CHIP programs must also provide a wide range of preventive services, as well as outpatient treatment and in-hospital care.

How is CHIP funded?

CHIP is sort of like Medicaid in that the federal government pays a share of the costs states incur in providing health care for those enrolled in their programs. The so-called match varies according to a formula, just as it does with Medicaid. It’s generally higher — on average, 71%.

But unlike Medicaid, CHIP is a block grant. In other words, the federal government gives states just so much, rather than a percent of their annual costs.

If that’s not enough, states can put children on a waiting list. Or they can require families to share more of the costs, though the law puts strict limits on premiums, copays and the like — the strictest for the lowest-income families. Or they can cut reimbursement rates — a cost-saver that tends to limit access to care.

How did the ACA deal with CHIP?

The ACA requires states to shift children whose incomes are at or below 133% of the federal poverty line into Medicaid. For technical reasons, the threshold is effectively 138% of the FPL — currently $27,310 for a parent with two children. The Supreme Court’s ruling that states can’t be compelled to expand their Medicaid programs has no affect on this child coverage mandate.

At the same time, the ACA prohibited states from lowering their CHIP eligibility standards — or changing their applications procedures to reduce enrollment — until the end of Fiscal Year 2019.

It provided for a higher match, beginning in Fiscal Year 2015. But it authorized funding only till then. Seemingly another glitch resulting from the haste to get the ACA passed.

More than half the states and the District cover children in families with incomes at or above 250% of the FPL — and 19 states and the District, with incomes of at least 300% of the FPL.

So it might seem that most states and the District would have to pick up the full cost of health care for a great many children enrolled in their programs unless Congress renews CHIP funding. We thus see the Washington Post editorial board warning of a “potential unfunded mandate.”

Not so, the Vice President for Health Policy at First Focus advised me. States will have no obligation to maintain their CHIP enrollment standards and procedures if Congress doesn’t come through with federal funding.

Why do we still need CHIP?

As I’ve already noted, there’s the family glitch in the ACA. The term refers to an ambiguous provision that the Internal Revenue Service has decided bars families from getting subsidies for health insurance purchased on an exchange if a working member’s employer offers health insurance that’s affordable for him/her alone.

Family coverage, as I’m sure many of you know, is considerably more expensive than coverage for only a worker. So some children — other dependents too — will probably be priced out of the market.

It’s not just premiums we need to be concerned about. A healthcare consulting firm crunched the cost-sharing numbers in 35 states, i.e., the premiums, deductibles and copays, that families are responsible for.

The experts found that families at 160% of the FPL would face out-of-pocket costs averaging seven times what they currently pay if their children were insured through a health plan purchased on an exchange rather than CHIP.

Bigger shocks to the pocketbook for families whose children have special healthcare needs like asthma and diabetes — as much as $5,200 a year per child.

At the same time, the experts found that certain services most CHIP programs provide at no cost to the family would either not be covered at all or require cost-sharing. Only 37% of the health plans reviewed covered hearing exams, while all the CHIP plans did.

And in most cases, families would have to pay an additional premium, plus some further costs for their children’s dental care — a benefit required in CHIP.

What’s so urgent?

The federal fiscal year began only weeks ago. So it might seem that Congress has a lot of time before it has to come to grips with further funding for CHIP.

Most states, however, begin their fiscal years on July 1. Only two and the District begin theirs as late as the fed. So budget drafting is already underway. A big problem when there’s a big question mark about funding for CHIP.

Googling around, one finds many warnings of potential disruption. States unwilling, for obvious reasons, to renew their contracts with health plans. The plans, therefore, not renewing their contracts with pediatricians and other providers. Providers reluctant to accept CHIP-insured patients because they don’t know whether they’ll get paid.

And as Say Ahh! blogger Elisabeth Wright Burak adds, parents in acute anxiety because they don’t know whether their children will have affordable health insurance come fall.

Healthcare lobbyist Billy Wynne foresees troubles ahead in our fractitious Congress — worse as the months go by. We just might help create a proper sense of urgency if enough of us weigh in. A MoveOn.org petition makes this quick and easy to do.

UPDATE: Shortly after I published this, First Focus posted a new letter to Congressional leaders, signed by some 1,200 organizations. It urges them to include a four-year extension of CHIP funding in the next “legislative vehicle” that moves during the lame duck session that will begin soon after the November elections. It says that an estimate 10.2 million children could otherwise have” their health coverage disrupted.”


Lower Healthcare Spending, Better Health for Low-Income Americans

March 20, 2014

Now, here’s an interesting idea. We’re spending so much on health care because we’re under-spending on programs and services that make for a healthy population.

This is the thesis of a new book entitled The American Health Care Paradox. It’s not for the casual reader, and I confess I haven’t read it.

But public health professor and Health Stew blogger John McDonough provides a summary of the main argument, with eye-popping graphs. And we get another, broader overview of the research in slides the coauthors prepared for a conference last September.

The paradox the title refers to has been often discussed. The U.S. spends much more per capita on health care than any other highly-developed country — 50% more than the next two biggest spenders, according to recent figures from the OECD (Organisation for Economic Co-operation and Development).

But the outcomes don’t show it. Life expectancy is below the average for the OECD countries — lower, in fact, than all but eight of them, none nearly so wealthy as the U.S.

The U.S. also ranks very low on some other common health indicators — both maternal and infant mortality rates, for example, and the rate of infants born weighing dangerously little.

It’s common to attribute these, as the OECD does, to the fact that the U.S. is one of the very few developed countries without a universal healthcare system and to our extraordinarily high obesity rate – a function, the OECD suggests, of the many “disadvantaged” among us.

The American Health Care Paradox coauthors don’t dismiss these factors. But they’ve got a different explanation. Basically, we spend a lot on curing illnesses — or keeping people alive when we can’t, even when they’re almost sure to die very soon.

But we scrimp on what they call social services, e.g., education and job training, housing assistance, cash benefits for jobless workers and people with disabilities, support services for seniors and “family supports,” by which I suppose they mean things like high-quality affordable child care.

We spend less on these than any other OECD country. And our ratio of social services to healthcare spending is the lowest too. This, said ex-Wonkblogger Ezra Klein, helps explain why 5% of the population accounted for about half our healthcare spending in 2008.

Well, we’re moving bumpily (and imperfectly) toward an expanded, publicly-subsidized healthcare system. And we already have some evidence that the Affordable Care Act is slowing the growth of healthcare spending.

But at the same time, we’re in a cost-cutting mode on social services. The recent budget deal doesn’t alter this, since real-dollar spending for non-defense programs that depend on annual appropriations will be 15% lower this year — and 17% lower next year — than in 2010.

Spending isn’t the only issue. Our healthcare services move on one track and our social services on another — actually, on many tracks.

A child may show up in an emergency room on a regular basis, gasping for breath, despite the medications for her asthma. The treating physicians may suspect that mold in the home and/or fumes from the highway outside are triggers.

They’ll tell the parents, one supposes, if they’ve taken the time to talk about the home environment — and know how to listen. But linking them to a nonprofit legal service that will go after the landlord or to a public agency that could provide the assistance they’d need to move is generally not how a hospital operates.

There are some exceptions. As I’ve written before, a nonprofit called Health Leads fills “prescriptions” for food, heating and other assistance as a partner with physicians in the clinics where it’s located.

It aims, its website says, to “align the forces necessary” to change our healthcare system to one that “addresses all patients’ basic resource needs.” Forces do seem to be aligning in various ways.

Hospitals, for example, have begun tackling hunger as a health issue, as U.S. News reports.

A dozen in an Ohio-based system have been feeding local residents. The system itself has opened a grocery store with fresh produce, whole grains and the like in a food desert where one of its hospitals is located.

And some of its hospitals now screen patients for food insecurity and sign those at risk up for SNAP (the food stamp program) or give them a supply of groceries when they’re discharged.

Massachusetts General Hospital also screens for food insecurity and helps with SNAP applications, as do two of its primary care clinics. The clinics also enroll pregnant women and mothers of young children in WIC, operate food pantries and offer healthy meals cooking classes.

The Affordable Care Act provides incentives for hospitals to address public health issues like food insecurity, says the former executive director of one in Connecticut that serves low-cost meals to seniors.

Links to unaffiliated social services still seem limited, however, even though the American Health Care Paradox coauthors found that both healthcare and social service providers want the more holistic approach that linkages could provide.

They’ve got barriers to overcome, including insufficient resources. But investing in systems that would support collaboration — and in the social services themselves — would pay off in lower healthcare costs.

More genuine well-being for low-income patients too.


Year End Checkup for Shared Prosperity in DC

January 2, 2014

End of year seems a good time to look at how the District of Columbia is progressing — or not — toward becoming One City. So I turned to the indicators that the Half in Ten campaign published a couple of weeks ago.

We do see progress, especially if we look back to the first set, which, for the most part, shows where we were in 2010. But it’s a fragmentary picture — even more so if we focus only on the indicators Half in Ten could update, as I will here.

About the Indicators

Half in Ten chose the indicators in 2011, when it reset the clock for its original goal — cutting poverty in half in 10 years.

As I wrote at the time, they reflect a broader vision — not only less poverty, but more broadly-shared prosperity. For the latter, Half in Ten defined three priorities — creating good jobs, promoting family economic security and strengthening families and communities.

It picked 10 indicators for states and the District, presumably based in part on data it could directly access or secure from other organizations.

Even so, some of the data in latest set aren’t as current as one would wish. And the good job indicators are largely indicators of people who’d qualify for good jobs, rather than the extent to which such jobs are available.

The online report is still, so far as I know, the only single source of so many figures that allow us to measure progress toward social and economic justice.

The report also provides two bases for assessing each state-level figure — a best-to-worst numerical ranking and a better-or-worse figure, based on what Half in Ten calls the “U.S. average.” This is apparently another term for the nationwide rate.

I’m a bit queasy about comparing the District’s rates to the averages. (See note below.) But I’ll use the averages because they may provide a useful perspective. The rankings, as I’ve said before, are an apples-to-oranges comparison, so far as the District is concerned.

Poverty Reduction

As you may already know, the poverty rate in the District was 18.2% last year. This was about 3.1% higher than the U.S. average, according to Half in Ten.* But it was 2% lower than in 2010.

The child poverty rate shows more progress. It was 26.5% in 2012, as compared to 30.4% in 2010. But it was 5.5% higher than the U.S. average. And that, obviously, was alarmingly high too.

Access to Good Jobs

The unemployment rate in the District 8.9% last year — 0.8% higher than the U.S. average. The rate in 2010 was 9.9%.

How much of the dip indicates more residents working is an open question, since the rate doesn’t include jobless workers who’ve given up looking or potential workers who decided not to start. We know that they’ve been a major reason the national unemployment rate has dropped.

The disconnected youth rate, i.e., the percent of teens and young adults who were neither in school nor working, dropped from 17% in 2010 to 14% last year. This is 2% lower than the U.S. average, but the same as in 2011.

Economic Security

Health insurance coverage is one of the District’s strongest points. Only 9.14% of residents under 65 and below 138% of the federal poverty line (the cut-off for Medicaid eligibility under the Affordable Care Act) had no health insurance during 2012.

This is 8.6% lower than the U.S. average and 3.92% lower than the District’s own rate in 2011, the earliest year Half in Ten could report.

The District also does fairly well on food insecurity — at least in light of the poverty rate and the high costs of housing here. During 2010-12, 12% of D.C. households didn’t always have the resources to provide enough food for all members.

This is about 1.9% lower than the U.S. average and 1% lower than the District’s initial two-year rate.

On the other hand, only 17% of District residents who were jobless and looking for work in 2012 received unemployment benefits. This is nearly 11.7% lower than the U.S. average, though about 1.5% higher than in 2010.

It’s hard to know what accounts for such a low rate. One factor probably is that many laid-off workers in our thriving restaurant, hotel and home services sectors couldn’t meet the minimum earnings requirements for unemployment benefits.

Stronger Families and Communities

Just two updated indicators in this category — and neither altogether current. One is the teen birth rate, i.e., the number of births to women between the ages of 15 and 19 for every 1,000 in this age group. In 2011, it was 41.8 — about 10.4% more than the U.S. average. But it was 45.5 in 2010.

The other indicator is the number of children per 1,000 who were in foster care. In 2011, there were 16 — about 10.3% more than the U.S. average. But the rate was 20 per 1,000 only the year before.

These are not only indicators of family and community strength. The teen birth rate is linked to child and maternal health, to high school completion and thus to employment — and to poverty, though perhaps less as cause than effect.

Similarly, growing up in foster care has been linked to a host of later problems, including some flagged by the indicators here, e.g., poverty, disconnection from both school and work.

What’s true for these indicators is true for others as well. Each gives us a measure of individual and community well-being, but the measures are inter-connected in a variety of ways.

Which, I suppose, merely reaffirms the need for a holistic approach to both poverty reduction and a more equitable sharing of the prosperity in this very wealthy country.

* The source for the District’s poverty rate is the American Community Survey’s one-year estimate. However, the one-year estimate for the nation as a whole produces a smaller “worse than” difference than the Half in Ten figure I’ve replicated. By my calculations, the figure should be about 2.3%.


Budget Bill Fails on Unemployment Benefits, But Will Renew Health Insurance Help for Low-Income People

December 16, 2013

As I’m sure you know, the budget deal we’ve been reading so much about didn’t fold in an extension of the Emergency Unemployment Compensation program. And it’s highly doubtful Senate Democrats will upset the apple cart by adding it as an amendment to the bill the House passed.

The omission will, at the very least, make for a tough January for 1.3 million jobless workers and their families, who’ve got rent and other bills to pay. More harms to millions more if Congress actually lets the program die — not a foregone conclusion.

On a cheerier note, the budget legislation the House passed did fold in, via an amendment, extensions of two programs that benefit low-income individuals and families. Both, in different ways, help ensure that they can continue to get affordable health care.

They weren’t familiar to me. Perhaps aren’t to some of you either. So here are brief summaries, plus a bit of policy perspective.

The Transitional Medicaid Assistance program, as its name implies, allows some low-income families to get up to a year of Medicaid benefits when they’d otherwise lose them because their incomes boost them over their state’s eligibility threshold — typically just 61% of the federal poverty line, but far lower in about a dozen states.

TMA temporarily averts an unintended penalty to parents in the Temporary Assistance for Needy Families program who move from welfare to low-wage work — one of those so-called “cliffs” that works against a primary TANF goal.

Those whose income rises because they get a raise or an increase in hours can qualify, as can those who come to the end of a partial income disregard that some states and the District of Columbia provide so that earnings from work increase family income, rather than merely replace cash assistance.

The Affordable Care Act initially would have enabled the lowest earners to remain in Medicaid until they made enough to lift their families above 133% of the FPL — effectively 138%, for technical reasons.

Now that 25 states haven’t expanded their Medicaid programs — a choice the Supreme Court’s ACA ruling allows — TMA remains an important, though time-limited protection.

The program also affords some months of protection for very low-income parents when their child support payments rise — or for that matter, when the absent parent merely starts paying them. Here again, it’s diminishing a conflict between two government priorities.

The Qualifying Individuals program provides federal funding to states so that they can pay Medicare Part B premiums for seniors with incomes between 120% and 135% of the FPL. Younger people who receive SSDI (Social Security Disability Insurance) benefits also qualify.

The QI program is that last tier of premium assistance for low-income Medicare enrollees — unless, in some cases, they are disabled and working.

Part B, as you probably know, covers most of the costs of outpatient care, lab tests, “medically necessary” equipment like a walker or a blood sugar monitor and certain in-home, health-related services.

For most people, the Part B premium will cost slightly less than $1,260 in the upcoming year — a real bargain, but a strain on the budget of someone who’s total income may be about $13,790.*

No one in the Senate — except maybe a few of those “wacko birds” — will oppose the amendment that extends these programs, since it also includes the annual “doc fix,” i.e. a measure to forestall what, by this time, would be a 24.4% cut in Medicare reimbursements to physicians.

Senate Minority Leader Mitch McConnell reportedly objects to the whole budget deal, as do several other Republican Senators who are looking nervously — or hopefully — at their Tea Party constituents. But they can’t stop it from passing, even if they vote against it.

So two worthy programs will live for another year — both small, but important to those who benefit and to bipartisan interests in promoting work and controlling health care costs.

Not enough to make us stand up and cheer for a bill that could, in many ways, have been better — and not only because it leaves jobless workers in the lurch.

But if you look at Congressman Ryan’s latest budget plan, you can see that we could easily have been heading toward another government shutdown — and even greater pressures on programs that serve low-income people’s needs.

* This is 120% of the 2013 federal poverty line for a single person, rounded up.


Why Right-Wing Opposition to Obamacare Matters

October 9, 2013

I left off by remarking that hard-core opposition to Obamacare has damaged the program, though not blocked the rollout. Here are some examples, well-known and less so.

In the States

At this point, 22 Republican governors and legislatures have refused to expand their Medicaid programs, as the law required until the Supreme Court said it couldn’t.

Their unremitting hostility to Obamacare has left a total of 4.9 million of their poorest constituents no chance for affordable health insurance. An additional 1.5 million are in the same boat due to foot-dragging and other factors, e.g., recently-proposed alternatives to something less than a straightforward expansion.

At the same time, a goodly number of states are doing all they can to keep those who could get affordable insurance through one of the exchanges from knowing it’s available and choosing a plan that makes sense for them and their families.

The victims here will be largely low-wage workers, especially those who work for small businesses and/or part-time. Also some people who are genuinely self-employed and others whom employers misclassify as independent contractors.

In Congress

Meanwhile, it’s highly doubtful that Republicans in Congress will help fix glitches in the law so it works as intended.

One of the more problematic will leave some as-yet unknown number of families with neither affordable employer-sponsored health insurance nor a subsidy to purchase on an exchange.

This is because, as the law is written, a worker whose employer provides health insurance can buy on an exchange instead only if the plan is unaffordable, defined as more than 9.5% of household income.

But the percent applies to the cost of insurance for the worker only — typically just over a third of what a plan for a whole family costs, according to the Kaiser Family Foundation’s latest survey.

The General Accounting Office reports that the affordable standard will affect approximately 460,000 children — perhaps considerably more in 2015, when federal funding for the Children’s Health Insurance Program is due to expire.

Hard to believe Congress intended this. But the Obama administration says it’s “the most defensible” reading of the law as written.

In other words, it’s up to Congress to tinker with the language if it doesn’t want dependent family members uninsured — or workers begging employers to drop their health insurance plans and pay the modest penalty for not having one, if they’re large enough for the penalty to apply.

This isn’t the only glitch that’s come to light. The United Methodist Church and several other large church organizations warn that their health plans could fold because they can’t be offered on the exchanges, where their clergy and other employees could have the costs subsidized.

Washington Monthly bloggers Anne Kim and Ed Kilgore say that, according to most “observers,” the exclusion of the church plans was simply an oversight.

Two Senate Democrats have introduced a fix. But a spokesperson for one of them doesn’t expect a vote because the push to repeal — or more recently, to cripple — Obamacare “has disincentivized Republicans from working with us on this.”

And then, as you may have read, there’s an ambiguity in the law relating to Members of Congress and some of their staff.

They’re required to purchase health insurance on an exchange, although they were covered by their employer (the federal government). Now some Republicans are saying that said employer can’t continue paying a share of the insurance, as the Office of Personnel Management decided it would.

But Senator Charles Grassley (R-IA), the original sponsor of the provision, says that the law “makes no changes to the employer contribution.” He calls the law’s silence on this “a drafting error.”

Under ordinary circumstances, Congress would have simply put a little patch in the law to clearly authorize what the best evidence indicates the majority intended.

Instead, a majority in the House and some in the Senate want to force their staffers to pay many thousands of dollars more than the average private-sector worker pays — merely to stir up resentment over a so-called “exemption” that’s nothing of the sort.

We’ve got a somewhat similar problem with subsidies for people who purchase health insurance on an exchange the federal government is operating because their state wouldn’t.

The Cato Institute’s Michael Cannon, who abhors anything that smacks of universal coverage, and Jonathan Adler, a libertarian law professor, claim the subsidies are illegal because the law restricts them to state-run exchanges.

And one can read the law that way, though other legal experts have argued — persuasively, I think — that it’s demonstrably contrary to what Congress intended.

Here again, in ordinary circumstances, Congress would fix what even Cannon and Adler refer to as a “glitch.”

Instead, we’re going to have, at the very least, taxpayer money wasted defending a rule that protects many more Americans from having to go without health insurance because they can’t pay the market rate.

The basic issue here is that any major law, especially one that strikes out into new territory won’t be perfect as initially enacted. Witness the initial limits in Social Security, for example.

But so long as a majority of Congressional Republicans want Obamacare to fail — and there are enough of them in Congress to control what passes — we’re stuck with what we’ve got.


What’s Behind the Fixation on Obamacare?

October 7, 2013

I’m having withdrawal symptoms. Not symptoms that my body is craving formerly-abused substances. Rather, symptoms that I want to withdraw from following what’s going on — and not — on Capitol Hill.

I’m tired, as I’m sure you are, of the day-by-day, blow-by-blow reports and commentary on who said what, what’s really on their minds, who will do what next, what they should do instead, etc.

And I’m anxious because I can’t persuade myself that this is all a lot of kabuki theater staged to ensure that Republicans up for re-election don’t lose their primaries to candidates more radically right-wing than they.

This may be simply because I’m prone to worrying — one of the things I do best, in fact.

Wonkblogger-in-chief Ezra Klein thinks the government shutdown is really a fine thing because it makes default on the debt less likely. And bad as the shutdown is, everyone knows default would be a whole lot worse.

Noam Schrieber at The New Republic arrived at a similar conclusion, based on the political calculations he supposes House Speaker John Boehner will make.

On the other hand, Howard Gleckman at the Tax Policy Center says that for many House Republicans, Obamacare is the white whale, a.k.a. Moby Dick, that so obsessed Captain Ahab.

The end result, as you may recall, was that he and all but one of his crew members died in a futile effort to kill the creature, who wouldn’t have harmed them if left alone.

There is, to me, something apt in this analogy. Obamacare clearly isn’t just a program Republicans don’t like — different somehow from the many, many other items the House leadership planned to include in its debt ceiling bill.

It’s a symbol for diverse antipathies — not the least of which is Obama. At any rate, I don’t know how else to explain what’s appearing more and more like an obsession.

Bill Moyers & Company’s Joshua Holland, among others, argues that right-wingers feel they’ve got to stop Obamacare now because otherwise Americans will soon find out that it delivers meaningful benefits.

It will thus “provide solid evidence that government can improve people’s lives.” So, Holland says, it’s “an existential threat” to the Tea Party types, who rail against “big government.”

Also, not coincidentally, against the taxes we pay for such public goods as education, clean air and water and what we’ve got by way of a safety net.

Eduardo Porter at The New York Times also refers to “an existential threat.” For him, it’s the distinct possibility that a “large slice of the middle class” will shift its allegiance to Democrats because of the benefits of Obamacare.

In short, a shrewd political calculation, rather than “only some folks gettin’ their crazy on,” in Jared Bernstein’s priceless words.

But there is some deep hostility to social programs here.

Thus, we have Washington Post columnist George Will comparing the insurance subsidies to a heroin drip that will make Americans “instant addicts” — just as we’ve become addicted to other entitlements like Social Security.

See also Senator Ted Cruz, who alleges that the President plans to get as many of us as possible “hooked on the subsidies, addicted to the sugar.”

Ah, well. Taking the most optimistic view of things, the economy will be rescued from the devastating consequences of default. And Obamacare will continue to roll out, as the law provides.

But that doesn’t mean the hard-core opposition hasn’t done damage. Some examples in my next post.


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