The PPACA and the Uninsured, Sanders, and HRC
I have been listening to the Sanders healthcare Uninsured narrative and his own Undetailed healthcare plan. To me, much of this sounds like Republicans tossing around the usual nonsense about the PPACA. It would be better if Sanders just said we can do better than the PPACA and here is how we can get there (and then explain it). There is something to remember though and pre-PPACA involving the last all out effort to install healthcare in 1992 as led by HRC. It failed because Congress did not lead it and nothing else “major” has been brought to the table by Republicans except a lot of excuses. The Democrats do not escape critiquing either as they have been equally negligent in producing something, anything of plan to get people healthcare. The prelude to the passage of the PPACA was the Senator from Aetna, Joe Liberman, holding the PPACA captive until some fast maneuvering by Reid and Pelosi. Now Sanders may believe he can command a better healthcare plan into being; but, I doubt it will happen until people begin to demand it and change Congress. Not enough of people are doing so today.
“‘You’ve got to take out the Medicare buy-in,‘ Mr. Lieberman said. ‘You’ve got to forget about the public option. You probably have to take out the Class Act (Long Term Care), which was a whole new entitlement program that will, in future years, put us further into deficit.’”
A Blue Dog Senator, Ben Nelson wanted to know the impact of the Medicare buy-in. “I am concerned that it’s the forerunner of single payer, the ultimate single-payer plan, maybe even more directly than the public option.”
What happened then and why we have ended up with the PPACA in its present format was an agreement made by Congress Person Nancy Pelosi and Senator Harry Reid. With the winning of the Massachusetts Senate race by Scott Brown, the dynamics had changed once again in January of 2010.
The Christmas Eve passage of the PPACA bill by the Senate was on the table to be tweaked considerably to get what they wanted to pass into law with the 60-vote majority with Paul Kirk (replaced Edward Kennedy) and later with the election of Martha Coakley. The election of Republican Scott Brown as the new Senator from Massachusetts, stopped any thought of tweaking the Senate bill by the House especially with the conversations going on between Senators Lieberman and Nelson. Instead, Congress Person Nancy Pelosi and Senator Reed decided to take up the already passed bill from the Senate on the Floor of the House. It passed and the PPACA as we know it has been brought up some sixty-something times after the House Republicans passed it 219-212.
Since its passage, there has been a dispute over how many people are actually covered by the PPACA and why those who are not, are not. There have been mega-fabricated-stories on why it has failed people and there has been reasons or facts about why the PPACA does not cover people. Charles Gaba at ACASignups has tracked the signups to the PPACA since it was passed into law in 2010. He has one of the more accurate measurements of signups, why people lose coverage, and why they are not covered detailed on his site.
If you click on the Pice Chart, you will get a readable version of this pie chart. If you doubt its accuracy, Larry Levitt of Kaiser Family Foundation had this to say to Charles Gaba:
“Obviously some of the estimates are approximations, but I do not see any glaring problems. — Larry Levitt (@larry_levitt) March 29, 2016
Let’s get into this a bit and what I want to look into are the “Uninsured.”
• Adults Medicaid Eligible: 5.0 million; And not covered due to the state not expanding Medicaid
• Children Medicaid/CHIP Eligible: 3.0 million And not covered due to the state not expanding Medicaid
• Medicaid Gap: 2.8 million; States not implementing the Medicaid Expansion have penalized citizens from Medicaid (except as already
established under state law) and from the PPACA Market Exchange.
• Undocumented Immigrants: 4.7 million; Federal Law says no coverage available.
• Eligible for Subsidized Exchange policies: 6.5 million; And chose not to sign up.
• Ineligible for Subsidized Exchange policies: 7.0 million; And have the chance for ESI policies or has an income above the 400%.
Except for the 4.7 million undocumented immigrants, all people have a chance to have healthcare insurance of some type unless their state governments disenfranchise them. Now is this going to change with the election of a new president? Probably not until gerrymandering goes away and Congress changes which will not happen under HRC or Sanders. Stomp your foot all you want to, it will remain the same until people wise – up and figure out the Republicans and the big-money people are not on their side. Our biggest issue right now is to get a Justice on SCOTUS who will favor the people and not moneyed or religious interests like the Koch Brothers and Hobby Lobby. To bow out of an election if HRC wins or Sanders wins is self-defeating and not a good choice.
The links are there if you wish to read Kaiser or Charles Gaba. This is briefly what both had to say on the topic of the insured and uninsured. The election comments are my own and I hope you think carefully about the 2016 election.
“. . . and Congress changes which will not happen under HRC or Sanders. Stomp your foot all you want to, it will remain the same until people wise – up and figure out the Republicans and the big-money people are not on their side”
In other words, let’s all give up now trying to win back either house of Congress because run says it “will not happen.” Winning back 30 sets in the House is just impossible, even though there are more than that where the Republican won in the mid-term with just 55% or less.
I don’t know why in baseball, the losing team even bothers to play the 8th or 9th innings.
Urban
You know exactly what I mean as I have written on the PPACA and Healthcare extensively at AB. Winning back 30 seats is near impossible especially when many states such as Michigan have gerrymandered districts. 2020 will be the first time any state can change districts when a new census occurs or 4 years from now. Sanders and Hillary’s claiming they can change healthcare instantaneously is a pipe dream with the make up of the House today. And many of those Dems you count on may also be conservative in belief. Bitch all you want to here on AB; but, the likelihood of something happening soon is very small. Go yell at your Congressman.
That chart is a most excellent summary that I will bookmark. Thanks for bringing Charles Gaba’s work to my attention. It’s always helpful to have the detailed numbers at hand.
Thanks also for the historical summary. It is very lucky that we have the ACA at all considering the unfortunate series of circumstances. First, the Republicans kept Al Franken out of the Senate until July with recount delays. Then Ted Kennedy died. Then Scott Brown was elected. And finally Joe F***ing Lieberman put the ax into any hope of single payer. Even Obama (with Rahm Emanuel’s bad advice) gave up and the ACA passed only due to the clever work of Reid and Pelosi, who deserve the real credit.
Urban Legend, run said nothing of the kind. Basically, all he said was looking at reality suggests that dropping out over disappointment with your candidate not being the nominee is unwise.
Urban Legend is correct. I really don’t understand the pessimism and complacency.
No wonder Hillary has no energy in her campaign and I worry about voter turnout. If people feel there is no possibility for change they’ll drop out of politics and focus on work and family.
This post just seems like another excuse to punch hippies/millennials or rather, to troll them.
Most other advanced nations have single-payer and received better health care for less cost. Sanders points out the U.S. is a rich society, the wealthiest. Only a rigged economic and a rigged political system
is preventing us.
Sanders has said repeatedly, that we need a political revolution of ordinary young and working class people getting involved in order to change things. If you don’t understand that by now, I wonder at how much you’ve been paying attention to debate.
“Stomp your foot all you want.” What a patronizing thought.
I want to know how Hillary will improve it. I bet she will do very little and will use Republican obstructionism as an excuse. Then she’ll be primaried after serving one term.
Peter:
You get a pass for now as you do not know me. I am the resident healthcare and PPACA writer here. Just because you want it, does not mean it will happen. As I explained to Urban, there is more to this than just making a lot of noise. Something may happen over time and more than likely when Congressional districts are redrawn and not gerrymandered.
Obamacare’s November surprise
http://www.politico.com/story/2016/04/obamacare-rate-hikes-a-looming-political-headache-for-democrats-222663
Bernie Sanders’s Legacy? The Left May No Longer Need the Rich
http://www.nytimes.com/2016/05/06/upshot/bernie-sanderss-legacy-the-left-may-no-longer-need-the-rich.html
The healthcare Industry’s November surprise.
UL,
Why do you insist on the idea that facing reality is giving up?
That reality of not controlling Congress does not mean the Dems will not try to win every election they can. But there is no point in dreaming about the Dems winning 24 of the 34 Senate seats up in 2016.
We all know our health care system could be a lot better, but it isn’t going to get a lot better soon.
Clinton emphasizes what is possible, which in the short run is not very much. Still, there are incremental changes that could make a difference, and appointing more liberal judges could help as well.
Sanders emphasizes what we could have, but which we aren’t going to get in the short run. He too is going to make increment changes as politics allows and appoint more liberal judges.
This seems to be a glass half full or half empty situation. It depends on whether you are filling it or drinking from it. I’m backing Clinton, but I think she is too cautious. Granted, she’s had her fingers burned at least once on this very issue.
Kaleberg:
Turning Medicare loose to negotiate costs would go along way to fixing much of the cost issue. Where Medicare goes, Commercial Insurance follows.
Peter,
It is not true that “most other nations have single payer.” Only a few do, with the major ones being Australia, Canada, UK, and Taiwan, with UK having full blown socialized medicine in the sense that medical workers are state employees.
What is true is that every other member of the OECD has universal coverage, and even after adopting ACA, the US still does not, while having far higher costs and not all that great performance compared to these other nations.
Most common are hybrid systems, part public part private,like the US, but with lots of differences, including universal coverage, that have them performing far better than ours. This includes sucn nations as France, Germany, Sweden, Switzerland, and the Netherlands. The World Health Organization has rated France as having the world’s best system.
Barkley:
Not that I doubt your word as you are correct on the two tier systems existing in countries similar to the US and otherwise. Although I would normally bypass Wiki, Wiki does do a nice job on showing us which countries have a two tier system and the percentage paid by the public sector. https://en.wikipedia.org/wiki/Healthcare_in_Europe “
You do not win anything in a competitive contest by “facing up to reality.” That kind of talk is giving up. If you don’t recognize that it is, you’ve never been in a competitive contest. It’s nothing about stomping your feet, either although I should thank run for his (or her) attempt to impart lessons in maturity. Insulting the few readers you have, including even the ones who mostly agree with you, is a great way to build a following for a blog.
You get every frickin’ vote you can get, and if you don’t get them all now, you build on whatever effort you put into it. There are more than 30 House seats that are potentially winnable — relatively small margin of victory by the Republican in an extremely low turn-out mid-term — with (1) a determined and expensive effort by the Democratic Party to sell the Democratic brand to support candidates everywhere, and (2) a landslide, which seems like a possibility. And if I can’t win now, I’ll still take 212 seats over 188.
Urban:
It will take more than angry arm waving and stomping your foot while expressing your anger to win the nomination or this election. The Republicans did not arrive at this point in one election and it took several censuses to arrange the districting in a manner such that they could take over House. http://election.princeton.edu/2012/12/30/gerrymanders-part-1-busting-the-both-sides-do-it-myth/ In all, this would account for 26 seats in The House and you believe you can over power them? Indeed from 1990 onward for Michigan with three Repub legislatures in place to make the redistricting such that the state sent more Repubs (5 to 9) to The House than Dems even though the State vote Dem overall. At the worst it should have been even. http://election.princeton.edu/2015/12/08/the-net-effect-of-gerrymandering-in-nine-states-exceeds-that-of-population-clustering-in-all-50-states/
You need to understand it in order to win and make the progress they did. It was small margins mostly which won each district. 2020 offers a chance to fix the issues at hand with Redistricting and a new state by state strategy by the Dems is needed. I know which way the wind is blowin, I do not think you do..
Mr. Sanders goes to The White House is not quite the same as Mr. Sanders goes to the Senate. No one has said he is not a good candidate; but even with his backing by people, he was out maneuvered.
I don’t know what the hell you think I’m saying. I agree with everything you say here, and know perfectly well how important 2020 is. The question is whether, when the odds are against you, you say “It’s just too hard, I give up” or not. Or do you do the best you can do, and make it easier to make more progress later?
Angry arm waving? Stomping feet? Where exactly do you see that?
Best, of course, would be computer-generated districts, balancing equalization of population with minimizing total district perimeter (maximizing contiguity), without regard for race or party.