Justifying Cruelty

As yesterday’s post pointed out, Perry and the Texas GOP Left Me Out, there are many hard working Texans who are being denied Medicaid because of ideology. GOP state Sen. Charles Schwertner’s recent Op-Ed is an attempt to try and justify the cruel decision of the GOP to deny expanding Medicaid in Texas.

Schwertner focuses mainly on one aspect of the study relating to emergency room visits.

Earlier this month, Science magazine published the results of a randomized, peer-reviewed study detailing Oregon’s experience in expanding Medicaid to the same population of independent, able-bodied adults that Texas is now asked to consider. Despite showing no improvement in measurable health outcomes over the study’s two-year timeframe, those enrolled in Medicaid were actually shown to use their local emergency room 40 percent more frequently than a control group of the uninsured. The factors driving this result are twofold — convenience and a lack of access to alternative primary care.

An uncomfortable truth of American health care is that, while most people only use the emergency room for legitimate medical emergencies, many also use it for the same reason they use fast food drive-thrus and video-on-demand — it’s convenient. Despite their considerable expense, emergency rooms will treat anyone who walks through the door, require no appointments, and are open 24 hours a day, something of great importance to those who are either unwilling or unable to seek primary care during normal business hours. Since Medicaid enrollees share no cost burden for their medical care, they also have no incentive to seek that care in a less costly setting.

While that’s true, it’s not a surprise, More emergency room use isn’t necessarily bad.

I’ve written about the OHIE so many times, I’m not wasting time praising it. Let me say that I have no problem believing these results. Unlike many others, I’ve never really believed that increasing insurance coverage leads to less ED use.  There are tons of reasons people use the ED over primary care. (See a 2010 post here http://theincidentaleconomist.com/wordpress/when-the-emergency-room-is-your-only-option/).

Improved access will lead to, well, increased access. Emergency room care was never free, no matter what people heard in the media. Telling people that they can NOW go to the emergency room with coverage should lead to MORE people going to the emergency room. Increased access does not always mean decreased spending and more primary care.

Moreover, until someone proves to me that the increased ED use was unnecessary, I don’t know why anyone would assume it’s a bad thing. If our goal is to increase people’s access to the health care system, getting more people insurance (like Medicaid) is a good tool for that. If our goal is to help people make more effective use of the healthcare system, increasing coverage isn’t necessarily going to be as good a tool.

The goal of Obamacare is to help people, and that’s what’s always scared the right wing ideologues.  If people again see that the government can actually help people they’re ideology is doomed.

There was also good news in the study which Paul Krugman pointed out, Medicaid Nonsense.

Busy day, no additional blogging until much later. But you should be reading The Incidental Economist on the Oregon Medicaid study that’s creating a lot of fuss today. Basically, budget woes forced Oregon to allocate Medicaid access by lottery, giving a rare randomized experiment. Those who got Medicaid suffered much less financial distress and less depression; they received more preventive care; but on some (not all dimensions) their health wasn’t significantly better than those who lost out in the lottery.

Somehow, conservatives think this is a big win for their opposition to universal health insurance. Why? What it suggests is that the health benefits of ANY kind of health insurance are somewhat hard to identify over a two year period; so, are you about to give up your own insurance, or is your best bet that having that insurance is still a very good idea? And the financial benefits are a big part of that! Since you are going to treat your illnesses, better not to bankrupt yourself in the process, right?

Oh, and until now the claim of right-wingers has been that Medicaid actually makes you sicker; serious researchers have always said that this was a case of selection bias, because sicker people got Medicaid — and now we have confirmation: those who got Medicaid were at least somewhat healthier than those who didn’t.

Above all, you should bear in mind that if health insurance is a good idea — and you are nuts if you let this study persuade you otherwise — Medicaid is cheaper than private insurance. So where is the downside?

And Ezra Klein had this to say about the study, Here’s what the Oregon Medicaid study really said.

Here’s what we can say with certainty: Medicaid works as health insurance.

That might seem obvious. It’s actually not. A big criticism of Medicaid is that it pays doctors so little that it’s essentially worthless because no doctor will see you. But the Oregon residents who won the Medicaid lottery got much more health care — including preventive health care — than the residents who lost it. They also saw catastrophic health costs basically vanish.

[…]

The problem with the Oregon study is that it doesn’t help us figure out how to make health care or health insurance better. We don’t know if the results speak to the health care you get through all health insurance or just Medicaid or if they’re just an artifact of the study’s timeframe and sample size. We don’t know if different ways of designing insurance programs would lead to radically different care outcomes (we actually tried a randomized study on that question in the 70s, and the answer, at least then, was “not really”). And so we don’t know whether we’re seeing a problem in Medicaid, an inconvenient truth about medical care, or something else. Worse, we don’t know what to do next.

But we could find out. Studies like this one don’t need to be so rare. The government could put a very small amount of money — say, one percent of the federal budget — toward designing and conducting them across all areas of public policy and the results would help us spend the rest of our dollars much more wisely. There’s no reason the Oregon experiment has to be a unicorn.

I think that’s a great point, we need more studies to see how things are actually working.  No one thinks Obamacare is perfect, and as most government programs, will be changed going forward.  All the ideologues have been calling it a failure since it passed. That Schwertner and the like would discount the good news in the study – of how people are actually being helped – and overly focus on the negative is not surprising. That’s what they do when they’re trying to justify cruelty.

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What’s Been Happening- Lt. Gov Debate, Davis Fights Back, SOTU

On Monday night the four GOP candidates for Lt. Gov of Texas got together for a debate.  The topics were – end of life issues, border security, Dan Patrick’s bankruptcy, Dewhurst’s phone call, double-dipping, abortion, marijuana, creationism, and term limits.  I guess that’s what the GOP base cares about?

PDiddie sums it up here, Four boobs on the tube.

All four want to force a woman to give birth to a child that is the product of rape or incest.  All four said that the judge who compelled the hospital to end life support for a brain-dead pregnant woman carrying a deformed fetus was wrong, and would support a bill in the next session to prevent another judge from doing so.

All four support the teaching of creationism in public schools.  All four are opposed to the decriminalization of marijuana.  (Only Patterson among them favors the use of medical pot.)  All except Patterson want a fifty-foot-high wall at the Rio Grande border armed with machine gun turrets and high voltage current running through the concertina wire at the top.  (That’s barely an exaggeration.)

Dan Patrick wouldn’t pay back the debts he went bankrupt on, even now that he has the money.  Jerry Patterson can say “tetrahydrocannabinol”, several times, without mangling it.  Todd Staples’ head is still too large for his body.  And Dewhurst is so confident of victory that he didn’t bother to work in any time for debate practice.

No questions about infrastructure, or water, or the environment, or the Texas economy, or education, or Medicaid expansion, or predatory payday lenders, or anything of substance to anyone outside the Tea Party base of the Texas Republican Party.

That’s why Texas Democrats declared Democratic candidate for Lt. Gov. Leticia Van de Putte the winner of the debate.

“Tonight the four candidates performed like they serve: Lt Governor Dewhurst deflected the blame to others, Sen. Patrick lacked reasonable solutions, Commissioner Staples blamed President Obama, and Commissioner Patterson talked down to voters.  Tea party extremists showed us once again that Republicans simply do not represent mainstream Texan values. Texas voters deserve better from their elected officials. Tonight’s clear winner was State Senator Leticia Van de Putte. She is the only candidate in the Lt. Governor race with the record, vision, and everyday Texan values to lead our state.”

Wendy Davis’ daughters cleared the air about the lies that have been told about their mother and their family.

Davis and Democratic candidate for Lt. Gov. Van De Putte each gave a speech in Austin last night. Watch them here.

President Obama gave his SOTU speech last night. It was good, but likely won’t change much, if anything. The President’s main issue is the one it’s been from the beginning of his presidency. He still won’t do what needs to be done, Rules of Liberal Political Success.  He’s never told the American people who is responsible for the economic mess, and held those who caused it responsible.  It’s just not something he’s capable of doing, for whatever reason, and it doesn’t make me mad anymore.

What’s Good For The Middle Class Is Good For America

This article, Here Comes the Anti-Government Left, gets to the heart of what makes Elizabeth Warren so popular, and feared – by the elites in both parties – at the same time.  Warren is taking aim at the soft underbelly that supports both parties – corporations, Wall Street, and the banks.  While also being the sole advocate for a group neither party wants to overtly offend – the middle class.

Warren spends much less time fulminating against the rich per se. Though she has an interest in inequality, she talks far more about the middle-class than the poor. Her signal preoccupation is the way financial institutions have amassed enormous economic and political advantages at the expense of everyone else. She has co-sponsored a bill that would break up the megabanks. She has labored to expose why it is that federal regulators never take big banks to court. She decries the way reform battles in Congress pit a few dozen activists against thousands of industry lobbyists, an asymmetry that virtually guarantees victory for the status quo.

[…]

But the substance of Warren’s agenda is far more radical. She wants to upend a fundamentally corrupt system, one in which big banks and other interests have co-opted the apparatus of government.

Co-opted government, means that we’ve morphed into an oligarchy and our democracy is no longer.

Warren questions the very legitimacy of their wealth and power. “I’ve been in the Senate for nearly a year and believe as strongly as ever that the system is rigged,” she said in a recent speech.

We don’t have a free market, we have a rigged market. Rigged in favor of the wealthy and powerful. And in order for the middle class to get back to prominence and power, and for our government to again resemble something similar to democracy, those in power now must lose some of their power. And that’s why Warren is more favored and feared.

Warren-style populism, on the other hand, goes right to the source of the cynicism. In the same way that Middle America believed government was mostly benefiting the undeserving poor in the 1980s and early 90s, today they believe it mostly benefits undeserving rich and powerful. And, just as Democrats had to dispel the former belief before they could advance the rest of their agenda, today they must dispel the latter. Warren’s approach does that.

Warren is all about putting those responsible for our rigged system on the spot.

Here’s what she had to say about the GOP killing unemployment insurance, This is just wrong.

Millions of families are hanging on by their fingernails to their place in the middle class – and the United States Senate just voted to let them fall.

I’m ashamed that the Senate didn’t extend unemployment benefits yesterday. I’m sickened that my colleagues went home last night knowing that they just cut off a little help for millions of people who have worked hard and who can’t find a job.

And I’m appalled that so many Senators cannot admit the simple reality: we are still in the middle of a jobs crisis. People have been looking for work for months or even years. Many are starting to give up entirely. Young people are beginning to think that there isn’t a future out there for them. Long-term unemployment isn’t just about money; it’s also about losing hope.

These people – our friends, our families, our neighbors – they weren’t the ones who broke our economy. So many people worked hard, played by the rules, and did everything we told them to – and now struggle to find work. They need our help.

We help because we care about people, but we also help because it is good for the economy. The numbers show money put into unemployment goes right back into the economy to help stimulate more demand and more business activity. According to a new Congressional report, in just one week after unemployment benefits expired, our state economies lost $400 million. Extending unemployment makes good business sense.

There’s so much we should be doing to strengthen our economy and rebuild our middle class, and yesterday we took a step backwards. Washington needs to get back to work solving problems – not making them worse – so families can get back to work.

I really don’t get why the Republicans would stand in the way on this issue. I don’t get it, but I’m taking stock – and like many of my colleagues who voted to help people yesterday, I’m not giving up

Congress didn’t haggle over “pay-fors” when the big banks needed a bail out. American working families deserve, at the least, the same respect the banks got.  What’s good for the middle class is good for America, is the new slogan.

Further Reading:
Meet the people who are so rich they`ve already paid their 2014 Social Security tax (more here).

John Carter & The GOP’s Misplaced Priorities

Congressman John Carter (R-Round Rock) has his priorities misplaced. In an interview with Roll Call Carter tells what the GOP’s strategy will be in 2014, GOP Negotiator: No Immigration Overhaul This Year.

Boehner told the conference and the press last week that leaders and committee chairmen will produce a blueprint outlining agreed-upon principles for overhauling the nation’s immigration system, leading many to speculate that votes on the issue could be held later this year.

“I’m opposed to voting on a bill this year,” said Carter, who was a member of GOP leadership last Congress. “I was in conference when John announced that. It was a surprise to me as much as it was a surprise to anybody else.”

[…]

Carter added that the votes could leave Republicans vulnerable to primary attacks from the right, especially if, as is expected, the changes take on the question of the legal status of some 11 million undocumented immigrants living in the United States.

“I personally think this is the wrong time from our standpoint to go forward on immigration,” he said. “It’s an election year. I mean Texas is in the middle of primaries right now.”

That said, Carter would contribute to policy change efforts if he is asked, he said. His views on timing do not necessarily mean he will oppose bills if they come to the floor.

At the end of the conversation, (from the audio), Carter was pressed on why he thought it was a mistake.

Top of the bill being that it’s not good politically for the country?
Carter: Top of the bill being that it changes the subject.
From Obamacare?
Carter: There you go.

It’s an election year now and Carter the GOP, and the tea party want no part of immigration reform. They don’t want the base of the party to stay home in November, and they believe passing immigration reform would do that.  They also believe that what worked n 2010, will work again in 2014. 2010 Redux. Why Not?

They need to turn out white senior citizens who hate Obama. They figure if it ain’t broke, they’re not going to fix it. We’ll see if they’re right.

Carter last year said this about immigration reform in the local Chamber of Commerce news.

“Economically for the state of Texas, there is probably no bigger issue right now in Washington D.C.,” Carter said, explaining that Texas has the largest influx of immigrants of any state.

The only thing that’s different from when Carter made that statement is the calendar.  It’s now an election year and immigration cannot be allowed to, “capture the media cycle”.  Economics aside, the immigration issue, is about people, families and most important human dignity. Keeping immigrants in the shadows, because it’s not good politics for the GOP in an election year, shows exactly what the GOP’s priorities are.

Just as keeping their cruel, and failed plan of trying to take away health insurance from the millions that are now insured, front and center in 2014 does. Obamacare enrollment has been growing faster in Texas since December.  Also over 200,000 more Texans would have health insurance had Perry and the GOP allowed Medicaid to be expanded. We can only imagine how many tens of thousands more Texans would have health insurance had the Texas GOP not been fighting against Obamacare from the beginning.

But what Carter and the GOP’s cynical political ploy shows is that they’re not concerned about working to solve problems.  They’re only concerned about keeping things the same as they are now.  We cannot move past these two issues, and many more, if we keep electing the same people to office.  If again, too many of us who don’t vote and don’t get to the polls in November then nothing will change.  The sad truth is that the only way they can repeat their success of 2010, is if we allow them to do it again in 2014.

Here are several ways to combat that, 9 Ways to Channel Your Inner Activist in 2014.

And be sure and check our Carter’s opponent in 2014, Democrat Louie Minor.

It’s Been 50 Years Since LBJ Declared War On Poverty

Here’s an excerpt from LBJ’s SOTU speech on January 8, 1964.

Unfortunately, many Americans live on the outskirts of hope–some because of their poverty, and some because of their color, and all too many because of both. Our task is to help replace their despair with opportunity.

This administration today, here and now, declares unconditional war on poverty in America. I urge this Congress and all Americans to join with me in that effort.

It will not be a short or easy struggle, no single weapon or strategy will suffice, but we shall not rest until that war is won. The richest Nation on earth can afford to win it. We cannot afford to lose it. One thousand dollars invested in salvaging an unemployable youth today can return $40,000 or more in his lifetime.

Poverty is a national problem, requiring improved national organization and support. But this attack, to be effective, must also be organized at the State and the local level and must be supported and directed by State and local efforts.

For the war against poverty will not be won here in Washington. It must be won in the field, in every private home, in every public office, from the courthouse to the White House.

The program I shall propose will emphasize this cooperative approach to help that one-fifth of all American families with incomes too small to even meet their basic needs. [Emphasis added]

What LBJ was saying is that the war on poverty will be ongoing and take an coordinated effort from the entire country. Instead, as Digby points out – after early success – this war was obstructed, or sabotaged, Revisiting the War on Poverty.

Today is the 50th anniversary of that speech and there are a lot of commemorations and discussions about how and why we find ourselves still confronting growing poverty 50 years later. I thought it might be interesting to just briefly discuss why it became so discredited over the years and how the right wing won the argument for so long.

She’s goes on to point out the insidious ways this has been done.

There are many reasons for it, but one major way they did it was to sabotage the programs.  Rick Perlstein explains:

… [O]ne way conservatism has responded in its years in governmental power has been to install its own brand of bright-eyed madmen–bureaucrats who self-consciously understood their job as weakening the bureaucracies under their care. Richard Nixon, reading his 1972 landslide as a mandate for a hard-right turn in policy-making, pioneered this move by appointing conservative movement activist Howard Phillips as his head of the Office of Economic Opportunity, in charge of administering the War on Poverty. The Reagan Administration built up the obscure Office of Information and Regulatory Affairs into what historian Thomas Frank has described as “a mighty fortress dominating the strategic chokepoints of big government,” giving business lobbyists a chance to pass judgment on all new lines of federal regulation. And the Administration of George W. Bush (as Alan Wolfe notes in another essay in this symposium) similarly tapped anti-government administrators to run the government.

Also, I’m sorry to say, this. But then the President made it clear before he ran that he was sympathetic to Reagan and his supporters’ determination to clear out the dead wood of the Great Society.)Of course, the robotic mantra of “pragmatic, private/public, devolution,outsourcing” to fix the intractable problems of poverty and middle class torpor have been the watchwords of both parties for nearly a quarter of a century so there’s no surprise.

They didn’t invent this sort of thing in the 60s, of course. They’ve been playing this way for a very long time, as Perlstein illustrates in the rest of that article, which is well worth looking at, especially if you are of the mistaken impression that the Koch brothers are the first plutocrats in American history to create front groups to sell their aristocratic agenda.

When reading things like this, and thinking about how the wing-nuts and plutocrats have obstructed Obamacare, it’s impossible not to wonder how things would be different if we’d have worked together to combat poverty or improve health care. Instead of working against these goals for ideological reasons.

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From this graph we can see that the poverty rated has improved significantly since the war on poverty was declared. But like so much in our country, things has stagnated over the last 40 years. As the CBPP says, War on Poverty: Large Positive Impact, But More Work Remains.

If The Government Helps the People They Lose

Kuff tells it like it is on Perry and the GOP when it comes to health care in Texas, Rick Perry doesn’t want people to get health insurance.

It takes a certain level of sociopathy to say something like that when you are the Governor of the state with by far the highest number of uninsured people, and you’ve been Governor for thirteen years without doing a single thing about it. Except for all the things you’ve done to deny health insurance to people, such as the CHIP cuts and our famously stingy Medicaid eligibility requirements and onerous enrollment processes. Hey, remember when we spent a couple hundred million dollars outsourcing our Health and Human Services Commission and gave the money to a private firm that didn’t know its ass from a pencil eraser? Those were the days, my friend.

The antipathy towards health insurance comes through in everything Rick Perry – and David Dewhurst and Greg Abbott and the rest of the sorry lot – does, from imposing needless burdens on navigators to refusing to expand Medicaid to refusing to implement an exchange, and on and on. If there were some honest ongoing effort over the past decade-plus to do something about the millions of uninsured in Texas, that would be one thing. But the record, and the inactivity, speak for themselves. There’s really no other way to characterize it. Millions ofpeople have become insured around the country, but all we get here is rage and denial.

Oh, and bad journalism, no doubt influenced by the lying and obfuscation. Do make sure you click those two links and read the stories, which have now coaxed an apology for the half-assed job they did from the Star-Telegram. Senators Sylvia Garcia and Rodney Ellis have more.

I would add that it’s not just that Perry doesn’t want people to have health insurance, but that he doesn’t want them to have government insurance or insurance that is subsidized by the government. They want to make sure that the American people don’t get the idea in their head that the government can actually do things to help them.  As long as someone is paying for it themselves and it’s coming from an insurance corporation he would have absolutely no problem with it.  It’s just that people getting health care from their government is abhorrent to him, and always has been to the wing-nuts.

This is the same fight we’ve been having since the inception of the New Deal under FDR.  Author Lane Kenworthy has an excerpt of his new book, Social Democratic America, here America’s Social Democratic Future.  He does a great job of explaining what’s got conservatives in an tizzy.

Obamacare, as the law is commonly known, is the most significant reform of the U.S. health-care system in half a century. It aims to increase the share of Americans who have health insurance, improve the quality of health insurance plans, and slow the growth of health-care spending. But the fight over the law is about more than just health-care policy, and the bitterness of the conflict is driven by more than just partisan polarization. Obamacare has become the central battleground in an ongoing war between liberals and conservatives over the size and scope of the U.S. government, a fight whose origins stretch back to the Great Depression and the New Deal.

The passage of Obamacare has caused such controversy in part because it seems to signal a new stage of government activism, leading some conservatives to oppose it as a decisive and possibly inexorable turn to the left. “Precisely because the Affordable Care Act is the realization of a half-century long liberal dream,” the conservative commentator Peter Wehner wrote recently in The Weekly Standard, “if it fails, it will be a crushing blow not just to Barack Obama but to American liberalism itself. Why? Because Obamacare is in many ways the avatar, the archetype, of modern liberalism. That’s true in terms of its coercive elements, its soaring confidence in technocratic solutions, its ambition to centralize decisionmaking, and its belief that government knows best.”

Such apocalyptic arguments vastly overstate Obamacare’s practical significance. But they also obscure the more interesting reality, which is that the ACA represents another step on a long, slow, but steady journey away from the classical liberal capitalist state and toward a peculiarly American version of social democracy. Unlike in, say, northern Europe, where social democracy has been enacted deliberately and comprehensively over the years by ideologically self-aware political movements, in the United States, a more modest and patchy social safety net has been pieced together by pragmatic politicians and technocrats tackling individual problems. Powerful forces will continue to fight those efforts, and the resulting social insurance policies will emerge more gradually and be less universal, less efficient, and less effective than they would otherwise have been. But the opponents are fighting a losing battle and can only slow down and distort the final outcome rather than stop it. Thanks to a combination of popular demand, technocratic supply, and gradually increasing national wealth, social democracy is the future of the United States.

Health care should be a right in our country.  To them Obamacare, which is not government run health care,  is a total repudiation of what they stand for, no matter how many people it helps. What they are for is privatization, which always costs more.

Privatization takes inherently governmental functions — everything from national defense to mass transit and roads — and turns them over to the control of private actors, whose goal is to extract maximum revenue while costing as little as possible.

Republicans have long advocated this in the name of free markets — saying that privatizing government services reduces the size of government. Democrats express more mixed support, but they sometimes go along for the privatizing ride.

Yet it isn’t true, as a general rule, that privatization shrinks the public sector. When investor demand for high returns is combined with the natural monopolies of public assets, what often results instead is citizens finding themselves saddled with high fees and poor service.

Even more perniciously, selling infrastructure such as toll roads puts the coercive power of the state in the hands of private actors. We have great public assets built by prior generations. We should and could be building a better country for our children, rather than liquidating what we have.

Some might call that looting, not liquidating.  It’s about ideology for them, and not about finding solutions.  There’s no tax cut that can be passed to give people health care, so there out of ideas.  They have no policy proposal to insure the uninsured.  All they have is bad things to say about those without insurance, and to keep trying to destroy Obamacare.

This is why in Texas we must have new leadership.  It’s the only way the uninsured will get insurance in Texas.

The way forward on health care

The most valid place to start when criticizing the Affordable Care Act is from the left. Kevin Zeese and Margaret Flowers do a great job of that, Obamacare: The Biggest Insurance Scam in History.

The fundamental flaw of the ACA is that it entrenches a market-based system that treats health care as a commodity and profit center for Wall Street. The big drivers of the rising cost of health care – insurance, pharmaceuticals and for-profit hospitals – continue. The wealth divide that is a major byproduct of neoliberal economics is institutionalized by law under the ACA. Some, like Senator Ted Cruz, will receive the best health care from their employer, in Cruz’s case his wife’s employer, Goldman Sachs. Others, forced into the individual insurance marketplace, will be divided in four classes based on wealth, and millions will be in Medicaid, the inadequate health plan for the poor. Thus, after a high-stakes partisan battle, we’ve made no progress in confronting the fundamental problems in US health care. Indeed we have made some of them worse.

There was an easier route and a more politically popular route. All that President Obama had to do was to push for what he used to believe in, Medicare for all. By just dropping two words, “over 65,” the United States would not have needed the 2,200-page ACA. Then the country could have worked to gradually improve Medicare so that the United States moved toward the best health care in the world, rather than being mired at the bottom.

To replace Obamacare with the single-payer system, we need to be clear about the shortcomings of the law, especially its fundamental flaw of making a human right, one of many human rights Americans do not realize they have, into a commodity like a cellphone. We need to recognize that ending the corporate domination of health care is part of breaking the domination of big business over the US government and the economy. Health care is at the center of the conflict of our times, the battle between the people and corporate interests, the battle to put people and planet before profits.

The problem is that neither party is working toward a real solution like that, which the people favor. While it’s clear that the right wing wants to stop the ACA, they have no solution other than some free-market scheme like we had before.

One part of the fight between the right wing and President Obama that’s so disturbing, especially in Texas, is our elected GOP leaders cruel decision not to expand Medicaid.  It’s going to cause unneeded suffering. It’s created the coverage gap and will effect over 1 million Texans.

Nationally, nearly five million poor uninsured adults will fall into the “coverage gap” that results from state decisions not to expand Medicaid, meaning their income is above current Medicaid eligibility but below the lower limit for Marketplace premium tax credits. These individuals would have been newly-eligible for Medicaid had their state chosen to expand coverage. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania.

The interesting thing is that the Medicaid expansion part may be the most beneficial to the Democrats in the future. Toward the end of this this recent Evan Smith interview with Jonathan Alter, Alter talks about how Texas suffer, because of this decision in the near future. In essence saying that people may see Texas as a risky place to live, as opposed to a state where they can get health care.

Not to mention the cruelty of the decision, Romneycare/Obamacare Architect Jonathan Gruber Blasts ‘Disgusting’ Refusal To Expand Medicaid.

Sattler: Is the refusal of 25 states to expand Medicaid distorting the market?

Gruber: I think in those states, by my own estimates, it’s going to raise premiums by about 15 percent in the exchange because sicker people will be in the exchange. I think it’s really disgusting that these states aren’t providing their poorest residents free insurance [financed] by the federal government. It’s pretty amazing that they can get away with that.

Sattler: What do you think about the right-wing argument that having no insurance at all is better than Medicaid?

Gruber:  It’s just incorrect. There’s no credible evidence to support that. There have been dozens of studies over the years that show that giving Medicaid to patients improves their health. Most recently a study I was involved with in Oregon just sort of randomly assigned Medicaid to people and found significant improvements in mental health.

Sattler: Do you expect more states to expand their Medicaid programs?

Gruber: Right now we’re at about half the states expanding. That’s going to grow over time. But we’re going to have a hardcore group of states that don’t want to expand, and I hope there’s pressure to do so.

The ACA is what we have to work with right now. If it’s repealed we’re likely in a worse place then when we started. The criticism from the left is valid and damning of the ACA. Unfortunately the political will does not exist, and our political system is too corrupted, at this time to get something like Medicare for all passed. The best was forward is to elect politicians that are committed to fixing what’s wrong with the ACA, by moving us closer to a single-payer/Medicare for all health care system. And in Texas that must start with electing those who are committed to expanding Medicaid.

Further Reading:
MAP: The 5 Million People The GOP Cut Out Of Obamacare.
Quote: The ACA as redistribution.