Let Uncle Sam Do Health Care Exchanges

When Congress approved the Affordable Care Act, it allowed states to set up insurance exchanges to help their uninsured residents shop for health insurance. Ironically, 18 states, largely run by Republicans, have opted to leave the exchanges up to the federal government. The punting governors probably are doing their insurance consumers a favor.

An estimated 25 million people who don’t get insurance through their job are expected to get insurance coverage through the exchanges, once the system is set up in October 2013 to start signing up people for new insurance plans that will take effect in January 2014. The exchanges also will help people find out if they qualify for insurance tax credits, which are available to uninsured people who earn up to $44,680, or four times the federal poverty level, which is $11,170 this year.

As of Dec. 9, 17 states and D.C. have decided to establish their own state-based exchanges; five states will partner with the federal government to set up their exchanges; and 18 states have indicated they will leave the exchange up to the federal government, Melissa Harris-Perry noted on her MSNBC show.

Jay Engoff, a former official with the federal Health and Human Services Department, told Harris-Perry that a federal exchange is more likely than state exchanges to provide individuals with the sort of bargaining power against insurance companies that they would have if they worked for a large business. The exchanges will offer “apples to apples” comparisons that will make it easier to find the best deal, Engoff said. Insurance companies and hospitals actually would prefer that states run the exchanges because they “will not standardize benefits packages, will not really enable people to make apples to apples comparisons,” whereas federally created exchanges will do so, Engoff said, according to RawStory.com (Dec. 9).

“So the insurance companies, ironically, they want the governors and the states to elect to do the state exchange, whereas the other part of the Republican’s constituency, the Tea Party people, they just want the state to do nothing, and to allow the federal government to do it,” he said.
Rep. Donna Edwards (D-Md.) said that some in Congress originally wanted more “universality” in the system and the option for state control was a compromise. But now, she said, a large state like Texas, where Gov. Rick Perry has publicly dismissed the exchanges, “becomes a major major marketplace for experimentation.”

Texas has a miserable record on health insurance regulation, which consists largely of clerks filing rate increase announcements from the insurance companies. Anybody who shops for individual insurance coverage in the past few years, as this editor has, has wondered over a bewildering array of choices with little recourse. We ended up with a policy with a large deductible, a few exceptions for pre-existing conditions and a bunch of riders that leave us wondering what, if any, coverage we actually would get if we got sick. We have more confidence in Obama’s administration than we do with Perry’s administration to drive hard bargains with the insurance companies and to hold those companies accountable.

The Affordable Care Act also offers states the option to expand Medicaid to cover the working poor who earn up to 133% of the poverty level. That is $14,484 for a single person and $29,726 for a family of four and the expansion would cover many of those unfortunates who work, usually part-time, for skinflint organizations such as Papa John’s, the Olive Garden, the Red Lobster and Walmart, which have suggested that they would reduce the hours of part-timers to avoid being required to provide insurance for them. If all states implemented the expansion, Medicaid would cover an additional 21.3 million people by 2022, including one million uninsured low-income adult Texans who don’t qualify under the current program. The expansion costs the states nothing for the first three years. After that, the states would pay 5% of the Medicaid cost in 2017, and up to 10% in 2021. But that’s too much for nine Republican governors, including Perry of Texas, which has the highest rate of uninsured at 24%; Florida’s Rick Scott, Georgia’s Nathan Deal Louisiana’s Bobby Jindal and South Carolina’s Nikki Haley, whose states are tied for fourth on the list of uninsured with 20% each; Alabama’s Robert Bentley (14% uninsured); Maine’s Paul LePage (10%); Mississippi’s Phil Bryant (19%); South Dakota’s Dennis Daugaard (13%); and Oklahoma’s Mary Fallin (17%). They are rejecting the Medicaid expansion because it would increase their states’ costs in future years. In fact, they just don’t care about the working poor. The cost of caring for the uninsured will fall on hospitals who must treat those who show up at their emergency rooms.

According to the Advisory Board Co., which keeps a daily tally at advisory.com of how each state stands on ACA’s Medicaid expansion, six states are leaning against participating in the Medicaid expansion: Iowa, Nebraska, Nevada, New Jersey, Virginia and Wyoming. States that will participate in the Medicaid expansion include Arkansas, California, Connecticut, Delaware, D.C., Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Missouri, Rhode Island, Vermont and Washington. Four states leaning toward participating are Kentucky, New Hampshire, New York and Oregon; and 18 others are undecided.

Ironically, the states that reject the Medicaid expansion might end up spending more for health care and pass more uncompensated costs on to hospitals and local governments. The Kaiser Family Foundation notes that the individual mandate likely will encourage half a million Texans who qualify for Medicaid but haven’t enrolled to finally sign up, but at a cost of around $7,000 a head, or $3.9 billion over 10 years under the restrictive old plan, where the state pays about 39% of the cost. Or the state could take the extra federal money, expand its eligibility rules and cover 2.4 million low-income residents for $3,300 a head over the decade.

“In short, the state can pay the retail price for its new Medicaid enrollees, or it can pay the bulk rate,” Jordan Weissmann wrote at TheAtlantic.com (Nov. 26).

Weissman also noted that under the expanded program Medicaid would pay an additional $24 billion to Texas hospitals over the decade. “That, in turn, could bring down the overall cost of care, since patients with health coverage won’t need to subsidize those without,” he wrote. “All that, and it would get to reap the benefits of a healthier, presumably more productive workforce, paid for overwhelmingly with tax dollars they’ll be sending to Washington no matter what.

“Maybe governors like Perry don’t believe in higher spending or a bigger social safety net. But surely they believe on getting a good deal on insuring a large number of their residents, rather than a bad deal on insuring just a few of them. Failing that, they have to believe in retrieving as much of their citizens’ tax dollars as they can. Really, that’s just fiscal conservatism.”

But just as Republicans who oppose the implementation of the Affordable Care Act cannot be trusted to run health insurance exchanges and they are resisting expansion of Medicaid which could show that the government insurance program can efficiently provide health coverage to the working poor, President Obama should not agree to Republican demands that the fiscal austerity negotiations in Washington, D.C., result in cuts to Social Security, Medicare or Medicaid. Republicans have floated the idea of raising the Medicare eligibility age from 65 to 67 as one way to reduce senior health care spending, and some Democrats appear to be open to the idea of making some cuts, but raising the eligibility age is a terrible idea. If anything, the Medicare age should be lowered.

The proposal to raise the Medicare eligibility age might just be a trial balloon raised by the White House to draw out the Republicans, but progressives should shoot down this trial balloon. Contact your senators and your Congress member, and/or any senators or members of Congress to whom you may have supported, and tell them that regardless of what President Obama might agree to, if they vote for a “Grand Bargain” that cuts benefits to Social Security, Medicare or Medicaid they will get a primary opponent and you will donate to that challenger. This is no time to give up hard-fought ground to those who would repeal Medicare, privatize Social Security and deny Medicaid to the working poor. — JMC

From The Progressive Populist, January 1-15, 2013

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Copyright © 2012 The Progressive Populist
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Selections from the January 1-15, 2012 issue

COVER/Joan Walsh
The case against Hillary

EDITORIAL
Let Uncle Sam do health exchanges

LETTERS TO THE EDITOR 

FR. DONNELL KIRCHNER
How church’s mission was helped by elections

RURAL ROUTES/Margot McMillen
EZ for corporate developers, hard on taxpayers

DISPATCHES
‘Right to work’ blitz starts war in Mich.;
GOP ready to hold debt ceiling hostage again;
Dem leaders back off from raising Medicare age;
Progressive Reform calls for executive orders on health, safety and climate regs;
Hostess took workers' pension money to fund company;
Senate report on CIA interrogations may be withheld;
Poll finds Gov. Haley vulnerable in S.C.;
Poll: Keep feds' hands off state pot laws;
Texas gives $19B in biz tax subsidies;
Family planning cuts increase families;
Repubs still blame ACORN;
Demand labor rights in trade pact;
Virginia senator proposes scheme to rig presidential election ...
MARK ANDERSON
Teen fights school tracking measures

JOEL D. JOSEPH
How to raise revenue without raising taxes

BOB BURNETT
Global climate change: preparing for WWIII

HEALTH CARE/Joan Retsinas
Ideological resolve: the courage to be cruel

SAM URETSKY
Winning the debates

WAYNE O’LEARY
Life among the cliff dwellers

JOHN BUELL
Beware of the bipartisan menace

THE AMERICAS/Roberto Rodriguez
Anti-thesis to segregation: Raza studies now!

DON ROLLINS
Funding for pregnant teens under fire

GENE NICHOL
Racialized criminal justice
BOOK REVIEW/Seth Sandronsky
Is doomsday ok?

MICHAEL SILVERSTEIN
A prayer for higher taxes

ROB PATTERSON
Dems’ win little help for liberal talkers

POPULIST PICKS

and more ...

George Will plays the intellectual but tells the “big lie”

By Marc Jampole

George Will told “The Big Lie” in his column this week, which I read in the Pittsburgh Tribune-Review as “Off the cliff of credibility.”

Long-time followers of the pseudo intellectual Will know he is capable of telling a whopper.  His Wikipedia biography details a fib he told in a 2009 article about global warming, which he was trying to prove isn’t happening by citing a learned source for a false statistic.  When the learned source called Will on it, Will persisted—much like Romney persisted in his falsehood that Jeep was moving jobs from Ohio to China. Will kept repeating his fib and kept citing the source who had publicly repudiated him.

Will, who conceals his bankrupt rightwing economic hokum behind the demeanor of a coldly objective and slightly pedantic university scholar, was at his old lying tricks again this week. Either that or he really is pretty stupid.

Here’s the lie: When Sen. Richard Durbin (D-Ill.) said, “Social Security has not added one penny to the deficit” Charles P. Blahous III, a member of the Social Security board of trustees, wrote to the Post to say that in 2012 this program will add $165 billion to the deficit because benefit expenditures exceed Social Security tax revenue by that amount and “this gap is filled entirely by revenue that the federal government borrows’.” The fact that the second-ranking Senate Democrat is off by 16,500,000,000,000 pennies reveals the sort of precise thinking that got the country into its current condition and that supposedly will produce a cure. It is enough to make you want to hop in your Fisker and drive off a fiscal cliff.

Durbin is right and Will is a liar, because he knows Durbin is right. Will knows that the payroll taxes that the federal government collects go to a special trust fund for Social Security. That trust fund has a massive surplus. It is true that in 2012, the trust fund spent $165 billion more than it took in, which is maybe the third time that has ever happened. That’s why we collect surpluses for Social Security in many years—so the money is there in the lean years.

What’s also true is that the federal government has borrowed money from the Social Security Trust Fund, and if it didn’t have to pay it back, it would be $165 billion less in the hole this year, but that’s funny math: sooner or later the federal government has to pay back what it borrowed from the Social Security trust fund to finance Bush II’s meaningless and bloody wars and to meet all of the government’s commitments during the time it was starved of funds because of the Bush II tax cuts. But that’s not Social Security creating a deficit. That’s the federal government having to pony up to pay off its debts, including what it owes to Social Security recipients.

 

Our big Social Security problem is that the baby boom is going through retirement and the generations behind it chronologically are significantly smaller, leaving a smaller number of people to pay into the system for those currently receiving benefits. But that problem will work itself out over time, especially when the smaller workforce increases the value of labor. All the system needs is a quick fix, and the easiest one would be to remove the cap on income that is taxed for Social Security purposes.

 

George Will knows all this basic information, that is, assuming that he is the student of history and of civics that he purports to be.  But he would rather see the government get out of the retirement pension business, unless it is to collect the tax and give it directly to the private sector to invest on a non-guaranteed basis.

 

While there have always been a lot of lies and myths floating around the political blathersphere, the big lie is that the Social Security system is bankrupt or on its last legs.

 

For the casual follower of Will, it may seem like a shock that he tells a big fat whopper about the major source of income for most retired Americans. But to those who have followed him carefully for the last few decades, it’s par for the course. Will cloaks his inaccuracies in a fairly erudite vocabulary, but it’s the same set of lies you can hear delivered much more explicitly by Rush Limbaugh and Sean Hannity.

The right wing persists in using failed slogans and attitudes

By Marc Jampole

It’s amazing that the right-wing ideologues in the news media continue to use failed slogans and continue to take repudiated positions. It’s as if there has been a message retrenchment to the basics of Romneyism among media stalwarts.

I didn’t realize that the right-wing media was channeling Romney’s worst until earlier this week when channel surfing while driving home from the office: I heard Rush Limbaugh take off on the 47% of the country who are takers; the 47% first promulgated as the “other” whom Mitt Romney would never help as president. Just what the wealthy racist donors wanted to hear. But not what the voters wanted to hear.

I can never bring up the 47% canard without pointing out that these moochers include senior citizens who paid payroll taxes and are now receiving Social Security and Medicare, veterans who fought for our country and children who find themselves in poor families for no fault of their own. There’s most of Romney and Rush’s 47%.

So why did Rush persist in conveying the thought that half the country are moochers and do it in the same ill-fated words? Doesn’t he realize that a good part of his audience are part of that 47% and know it?

I thought Rush was losing it to attack the 47% after the election results, but he’s not the only media maven (or is that craven) to channel the Mittman this week. The wicked witch of the North, East, West and South, Ann Coulter, penned a column today in which she lashed out at Hispanics and immigrants and told a lot of whoppers. As the analysis in the Huffington News pointed out, Coulter accuses Hispanics of looking for handouts when statistics show that Latinos use less than their share of government benefits compared to the rest of the population. Coulter says that immigrants from Latin America have too many babies out of wedlock. Again, Huffington cites facts that prove her wrong.

When Romney’s strong anti-immigration stand turned off Hispanic voters, it guaranteed that he would lose some key swing states and the election. Many Republicans were beginning to express the view that there was no reason not to take a more favorable view of reforming immigration laws in a way that pleased Hispanic voters.  You would think that as a Republican shill, Coulter would fall in line. Instead she has thrown more red meat to the ultra-right nativists who favor mass deportations and building a 30-foot high wall along our borders. 

I know that both Rush and Coulter always have to ratchet up the audacity to keep the attention of the masses and pump up their ratings. But in both cases, they used tired, old, failed, lie-ridden rhetoric that the political party they support had repudiated.

Why resurrect these false and failed ideas? I’m guessing that keeping these lies out there will make sure that some part of the population will continue to believe them and therefore continue to vote Republican even if the GOP economic stands work against their best interests. It’s a short term strategy, since this Republican core is losing population.

Universities should increase merit scholarships, but end athletic ones, plus stop giving breaks to legacies

One of the minor threads in the vast patchwork quilt called anti-intellectualism in the mass media is the assault on merit scholarships for college students.  For example, the New York Times used today’s report on the effort of the University of Oklahoma to attract National Merit Scholarship winners to treat the practice of giving these high academic achievers as controversial. To quote the article, penned by Richard Peréz-Peña, “Oklahoma’s program touches on a long-running argument within higher education, about the role of ‘merit aid’ — scholarships that schools give on the basis of credentials like grades, test scores or musical skills — versus the aid that nearly all schools give on the basis of a student’s financial need.”

Interestingly enough, the writer cites school officials at Michigan State and Texas A&M as opponents to academic scholarships. These two schools are well known for funding the minor league training of a number of professional football and basketball players. But then again, Oklahoma also gives a lot of money to star athletes.

Inputting “against merit scholarships” into the Google machine will yield hundreds of other articles arguing against giving scholarships to students who are high achievers but don’t need the money.

I can speak with some personal experience on this issue, as seven years ago Northeastern University awarded my son Ezra a full merit scholarship covering room, board and tuition for four years.  Although his mother and I both make incomes that disqualified us from receiving any need-based assistance, I never felt bad about my son taking Northeastern’s money. Ezra maintained a high grade point average in the most advanced academic courses that his urban high school offered, scored highly in his SATs and was involved in a slew of extra-curricular activities. (FYI, he won a number of university and national scholarships for his academic performance at Northeastern and is now getting his PhD in structural engineering at Stanford, funded by a National Science Foundation fellowship.)

By the way, just at his high school alone I knew of at least 10 other students with credentials similar to Ezra’s—different skills and different activities, but all showing a clear demonstration of talent, drive and creativity.  Whatever one wants to say about the overall decline of secondary school education in the U.S., no one can dispute the fact that the best students today are far more educated and skilled than the top dogs of any previous generation.  And that there are more of them now.

To attract top-flight students, Northeastern offers merit scholarships, just as a large number of universities offer room, board and tuition to attract athletes who will help their teams ascend the football and basketball rankings. If you take the scholarship from my son, then take away the athletic scholarship from the suburban kid who went to sleep-away football camp every summer.  At least the academic scholarship has something to do with the mission of higher education. 

The scandal is not that a well-off kid got a scholarship. 

The scandal is that there are too few merit scholarships for the number of deserving students.   Instead of ending merit aid, as many colleges are threatening to do, merit and need scholarships should be expanded and athletic scholarships should be completely eliminated.   

Another scandal is that too many talented high school students in poor school districts do not get the same opportunities to learn and excel that the kids in richer school districts and independent private schools get.  Universities would do more for fairness if they used their enormous resources to make access to educational opportunity available to all children.

And yet another scandal is the fact that too many high school students end up going to college when instead they should be in vocational or career training.  While 70% of all high school graduates go to college, a far lower percentage of all jobs require a four-year college education.  That great disconnect leads to college graduation rates of about 50% and a whole lot of young people with a lot of debt and nothing to show for it.

And how about the large number of places reserved for legacies and athletes? A study a few years ago showed that both these groups get bigger breaks on their SAT scores than minorities do. There’s something scandalous when my son’s truly brilliant chess buddy complains that legacies hold back the class and impede his education at one of America’s very most prestigious universities.

Yes, there’s a lot to fix in higher education, and not just in the process by which high school seniors are selected.  I don’t think that ending merit scholarships to deserving kids belongs on higher education’s agenda for change, and it befuddles me why media outlets like the Times want to keep it there. 

In youth chess, my son learned that there is nothing wrong about giving a trophy to the winner, but that it is unfair if a deserving kid doesn’t have a chance to compete. That’s the real problem for higher education, and one that not just colleges, but school districts and all levels of government should seek to solve.

Why is all the talk about cutting payments to the poor and elderly? How about cutting defense?

By Marc Jampole

 

So far, the mainstream news media and the Conservative propaganda machine both agree that the payments to the poor and elderly should be the focus of public discussions of a deal to cut government spending to go along with the almost certain increase in taxes on the ultra-wealthy and wealthy.

 

That may be changing now that 22 House members from both sides of the aisle announced that military spending should be part of the deal to avoid the fiscal cliff.

 

The dirty little not-so-secret story of the deficit we face is that military spending and historic tax cuts for the wealthy are what fueled its tremendous increase during the Bush and early Obama years.

 

Here are some facts I picked up from the Friends Committee on National Legislation, the national lobbying group for the Quakers:

•  Military spending has doubled in the last 10 years, primarily to pay for the wars in Iraq and Afghanistan.
• U.S. per capita spending on its military budget has increased by 72 percent since 1998.
• Military spending accounts for half of all the funds that Congress appropriates every year.
• The U.S. military budget accounted for nearly 48 percent of global military spending, as of 2010. U.S. presence in the world includes hundreds of military bases in Europe.

After all other wars since World War II, the nation has cut back on military spending and tended to other needs at home. The cut in military spending after the Cold War ended was called the Peace Dividend.  It is most associated with the Clinton years of economic growth and federal deficit reduction. The other thing that Clinton (and before him, Bush I) did was to raise taxes, especially on the more well-off. 

 

That increasing government revenues and spending on people instead of guns grows the economy makes sense for all except the navel-gazers brainwashed by the myth that the market is always right. The tax part is simple: rich folk save their money, whereas the government spends its money and that creates jobs. 

 

Military spending doesn’t re-circulate into the economy creating echoes of additional wealth as much as spending on people does. There is a value in investing in military technology and a lot of technological advances began in the military, but if we put the same research dollars to use on peaceful uses immediately it would make our research much more efficient. Let’s put it this way: Would you rather have our scientists and research engineers working on new bombing systems or a barrier system that keeps the shores protected from the next Sandy or Katrina without harming the environment? That’s an easy call except to the hoard of elected officials and lobbyists who feed at the trough of military contractors.

 

One thing to keep in mind is that neither party is all that serious about the deficit. It’s just a side show to make sure that we don’t go too far into downward income redistribution. The so-called fiscal cliff leads to a great reduction of the deficit, as government spending is cut and taxes are raised. Even Republicans, however, admit that if we suck too much money out of the economy to pay to the rich folk and foreign banks and governments that own our debt we’ll sink into another depression. So everyone’s a Keynesian, but no one wants to admit it.

 

The deficit was caused by low taxes on the wealthy and military spending. Those are the places to look for the money to pump into the economy while stabilizing the debt level.