START A PETITION 27,000,000 members: the world's largest community for good
START A PETITION
x

States of Health


Health & Wellness  (tags: americans, babies, cancer, children, death, disease, drugs, family, government, healthcare, illness, medicine, prevention, protection, research, risks, safety, science, society, treatment, women )

Kit
- 600 days ago - newyorker.com
The law's actual manifestation, however, is rather anodyne: as of October 1st, healthcare.gov is scheduled to open for business. A Web site where people who don't have health coverage through an employer or the government can find a range of health->



Select names from your address book   |   Help
   

We hate spam. We do not sell or share the email addresses you provide.

Comments

Kit B. (276)
Monday September 30, 2013, 9:15 am
Cartoon/ illustration Credit: ILLUSTRATION: Tom Bachtell and The New Yorker Cartoon Bank



Ours can be an unforgiving country. Paul Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn’t have health insurance. “I should have known better,” he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.

This week, the centerpiece of the Affordable Care Act, which provides health-insurance coverage to millions of people like Sullivan, is slated to go into effect. Republican leaders have described the event in apocalyptic terms, as Republican leaders have described proposals to expand health coverage for three-quarters of a century. In 1946, Senator Robert Taft denounced President Harry Truman’s plan for national health insurance as “the most socialistic measure this Congress has ever had before it.” Fifteen years later, Ronald Reagan argued that, if Medicare were to be enacted, “one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” And now comes Senate Minority Leader Mitch McConnell describing the Affordable Care Act as a “monstrosity,” “a disaster,” and the “single worst piece of legislation passed in the last fifty years.” Lacking the votes to repeal the law, Republican hard-liners want to shut down the federal government unless Democrats agree to halt its implementation.

The law’s actual manifestation, however, is rather anodyne: as of October 1st, healthcare.gov is scheduled to open for business. A Web site where people who don’t have health coverage through an employer or the government can find a range of health plans available to them, it resembles nothing more sinister than an eBay for insurance. Because it’s a marketplace, prices keep falling lower than the Congressional Budget Office predicted, by more than sixteen per cent on average. Federal subsidies trim costs even further, and more people living near the poverty level will qualify for free Medicaid coverage.

How this will unfold, though, depends on where you live. Governors and legislatures in about half the states—from California to New York, Minnesota to Maryland—are working faithfully to implement the law with as few glitches as possible. In the other half—Indiana to Texas, Utah to South Carolina—they are working equally faithfully to obstruct its implementation. Still fundamentally in dispute is whether we as a society have a duty to protect people like Paul Sullivan. Not only do conservatives not think so; they seem to see providing that protection as a threat to America itself.

Obstructionism has taken three forms. The first is a refusal by some states to accept federal funds to expand their Medicaid programs. Under the law, the funds cover a hundred per cent of state costs for three years and no less than ninety per cent thereafter. Every calculation shows substantial savings for state budgets and millions more people covered. Nonetheless, twenty-five states are turning down the assistance. The second is a refusal to operate a state health exchange that would provide individuals with insurance options. In effect, conservatives are choosing to make Washington set up the insurance market, and then complaining about a government takeover. The third form of obstructionism is outright sabotage. Conservative groups are campaigning to persuade young people, in particular, that going without insurance is “better for you”—advice that no responsible parent would ever give to a child. Congress has also tied up funding for the Web site, making delays and snags that much more inevitable.



Some states are going further, passing measures to make it difficult for people to enroll. The health-care-reform act enables local health centers and other organizations to provide “navigators” to help those who have difficulties enrolling, because they are ill, or disabled, or simply overwhelmed by the choices. Medicare has a virtually identical program to help senior citizens sort through their coverage options. No one has had a problem with Medicare navigators. But more than a dozen states have passed measures subjecting health-exchange navigators to strict requirements: licensing exams, heavy licensing fees, insurance bonds. Florida has attempted to ban them from county health departments, where large numbers of uninsured people go for care. Tennessee recently adopted an emergency rule declaring that anyone who could be described as an “enrollment assister” must undergo a criminal background check, fingerprinting, and twelve hours of course work. The hurdles would hamper hospital financial counsellors in the state—and, by some interpretations, ordinary good Samaritans—from simply helping someone get insurance.

This kind of obstructionism has been seen before. After the Supreme Court’s ruling in Brown v. Board of Education, in 1954, Virginia shut down schools in Charlottesville, Norfolk, and Warren County rather than accept black children in white schools. When the courts forced the schools to open, the governor followed a number of other Southern states in instituting hurdles such as “pupil placement” reviews, “freedom of choice” plans that provided nothing of the sort, and incessant legal delays. While in some states meaningful progress occurred rapidly, in others it took many years. We face a similar situation with health-care reform. In some states, Paul Sullivan’s fate will become rare. In others, it will remain a reality for an unconscionable number of people. Of some three thousand counties in the nation, a hundred and fourteen account for half of the uninsured. Sixty-two of those counties are in states that have accepted the key elements of Obamacare, including funding to expand Medicaid. Fifty-two are not.

So far, the health-care-reform law has allowed more than three million people under the age of twenty-six to stay on their parents’ insurance policy. The seventeen million children with preëxisting medical conditions cannot be excluded from insurance eligibility or forced to pay inflated rates. And more than twenty million uninsured will gain protection they didn’t have. It won’t be the thirty-two million hoped for, and it’s becoming clear that the meaning of the plan’s legacy will be fought over not for a few months but for years. Still, state by state, a new norm is coming into being: if you’re a freelancer, or between jobs, or want to start your own business but have a family member with a serious health issue, or if you become injured or ill, you are entitled to basic protection.

Conservatives keep hoping that they can drive the system to collapse. That won’t happen. Enough people, states, and health-care interests are committed to making it work, just as the Massachusetts version has for the past seven years. And people now have a straightforward way to resist the forces of obstruction: sign up for coverage, if they don’t have it, and help others do so as well. ♦
*****

by Atul Gawande | The New Yorker Magazine |

ILLUSTRATION: Tom Bachtell
 

Arielle S. (316)
Monday September 30, 2013, 10:28 am
Great post, Kit! I have heard so many people repeating the lies that will not die....and I am so weary of those who have lots begrudging those who have little something as necessary as health care. At the same time, I know at least one staunch Republican who is delighted to be able to cover her family now.....perhaps the Repugs are not at all concerned about failure but worried about success?
 

Malgorzata Zmuda (185)
Monday September 30, 2013, 1:03 pm
dzięki
 

Bryna Pizzo (139)
Monday September 30, 2013, 1:36 pm
This is an excellent article. Thank you for sharing it, Kit.
 

GGmaSheila D. (174)
Monday September 30, 2013, 3:33 pm
Won't even talk to my mother about any of the healthcare changes. She believes the GOPTP lies, without question - even going so far as to say she feels sorry for me when I find out "the truth". Not worth my stress level rise to bring it up, or continue when she tries to bring it up.
 

Kit B. (276)
Monday September 30, 2013, 3:37 pm

Please keep in mind that the web-site is easy to use, answers questions and will help people find the insurance program and price that will fit their needs.

https://www.healthcare.gov/

-----OR-----

By phone

We’re available 24/7

1-800-318-2596

TTY: 1-855-889-4325
 

Birgit W. (156)
Monday September 30, 2013, 3:41 pm
Thanks.
 

june t. (66)
Monday September 30, 2013, 4:40 pm
thanks
 

Robert K. (31)
Monday September 30, 2013, 5:11 pm
Denial isn't just a river in Egypt any more, it's the Republican reaction to facts.
 

JL A. (285)
Monday September 30, 2013, 6:17 pm
Thanks for continuing to post the factual information about and how people can get coverage Kit--I suspect at least several more people have learned enough to get coverage with one or more of them avoiding death or financial disaster by doing so--quite a difference to make in people's lives/
 

mario aloxinh (0)
Monday September 30, 2013, 8:17 pm
Good post. I like it
Friv 2
Friv
 

Gary A L. (137)
Tuesday October 1, 2013, 9:45 am
thanks kit great factual post keep up the good work amazing no trolls here yet
 
Or, log in with your
Facebook account:
Please add your comment: (plain text only please. Allowable HTML: <a>)


Track Comments: Notify me with a personal message when other people comment on this story


Loading Noted By...Please Wait

 

 
Content and comments expressed here are the opinions of Care2 users and not necessarily that of Care2.com or its affiliates.