Medicaid Expansion in New Hampshire: Acknowledging an Important Victory – posted 3/30/2014 and published in the Concord Monitor 4/6/2014
This piece appeared in the Concord Monitor on April 6, 2014 under the title “Impressive Political Maturity from Medicaid Expansion Activists”. Jon
The passage of the bill which expands Medicaid coverage to low-income citizens in New Hampshire is a historic accomplishment. Governor Maggie Hassan signed the bill on March 27 and the program becomes available for most people on July 1.
The Medicaid expansion will cover 50,000 poor New Hampshire residents who previously had no insurance coverage. Up til now, Medicaid had gaps in coverage for adults because eligibility was restricted to specific categories. If you were a single parent with dependent children, an adult with disabilities or a poor elderly person, you possibly could qualify. Now all adults earning up to 138 percent of the federal poverty limit should be able to qualify. That translates into coverage for a single adult who is earning up to $15,856. The income limit rises based on family size.
There are many costs to being uninsured. Without insurance, people needing care often avoid it. Because people wait on getting medical care, chronic medical problems become acute, Medical bills become a disincentive to going to the doctor. In the worst cases, medical debt leads to bankruptcy, major depression and suicidal ideation. Medical providers have needed to raise rates on insured people to deal with the large numbers of uninsured so there is a big economic ripple effect. The Medicaid expansion will help to break this vicious cycle since those previously uninsured will now be paying through Medicaid.
Advocates deserve much credit for building a winning coalition around the Medicaid expansion. The political maturity of this effort was impressive. The coalition included, among others, business leaders, health care providers, seniors’ organizations and a wide array of advocates reflecting different interest groups.
Instead of posturing and making impossibly purist demands, advocates used creativity in adjusting a plan specific to New Hampshire. Under the bi-partisan bill, low-wage workers will be able to use federal Medicaid dollars to buy private health insurance. This is a bit unorthodox and requires a waiver from the federal government but it allowed moderate Republicans to jump on board.
Since the New Hampshire Senate is controlled by Republicans, getting the majority in the Senate to support the Medicaid expansion was no easy task. This is particularly true because many on the right have built their 2014 political platform on opposition to Obamacare. The Medicaid expansion is an essential element of Obamacare.
I do think there is much to learn from the success of advocates in this effort. As a long-time progressive and a reader particularly of the progressive and left-wing blogosphere, I am used to seeing the glass half empty perspective. Obamacare is not single payer national health insurance. So many gnash their teeth and bemoan that.
From my past experience, many of the bemoaners are removed from the legislative process. It is easy to rail from the sidelines when you are not in the game. In my earlier life when I previously worked as a legal aid lobbyist, I was always impressed by the persistence and determination of my typically more conservative opponents. Many of the business lobbyists practically seemed to live at the legislature 24/7. That was in stark contrast to progressives who were often MIA. I used to think my side could learn from the conservative forces who did not give up and go cry in their beer. You could always count on the conservatives to be there even when they were losing.
I think you can see the Medicaid expansion from the glass half full perspective. True, everyone is not covered but this is the biggest advance I have seen in many a moon. I think the reform sets the stage for further advances toward universal coverage.
I am hopeful that the New Hampshire example can influence other states to follow our lead. When the U.S. Supreme Court ruled in June 2012 and affirmed the constitutionality of the Affordable Care Act, the Court gave states an option of expanding Medicaid. With New Hampshire as the newest addition, 26 states have now signed on with the expansion.
However, that leaves 24 other states who have not opted for the Medicaid expansion. Six of the states, including Maine, are currently considering it. The New Hampshire example may offer a way forward for those states on the fence or currently balking.
An irony of the Medicaid expansion is that the states who are refusing expansion would benefit the most from it. The states include all the southern states as well as some heartland and Rocky Mountain states. We are talking five million poor uninsured adults who will lack coverage because their state did not opt for Medicaid expansion.
There is a gap in coverage between current Medicaid eligibility and the lower limit of those Obamacare recipients who would get subsidized insurance through the federal marketplace. Just to be more specific, of the five million people who live in states that have not opted to expand Medicaid, about 20% of that group reside in Texas, 16% in Florida, 8% in Georgia, and 7% in North Carolina.
A recent Gallup poll shows that the Southern states are where residents are struggling the most to afford health care. I guess the other side of Southern hospitality toward strangers is meanness toward your own citizens. You can be sure that the governors and legislators in the south who are blocking this advance have fine medical insurance coverage for themselves.
The Medicaid expansion will inject hundreds of millions of dollars in federal funds into New Hampshire’s economy. The federal Medicaid money will allow low wage workers to spend money on other critical needs like housing, food and utilities. This should be a direct benefit for local businesses.
As more states like New Hampshire enact the Medicaid expansion, I think it will put more pressure on the states who had initially opted out to reverse course. Their citizens will see the benefit and will want it for themselves. The course of change is usually not a straight shot . It is more circuitous and Medicaid expansion is no exception.
Tony Benn in 2008 (Regent’s University London/Flickr)
Ever since I learned that Tony Benn had passed away on March 14, I was looking for a good remembrance that would introduce the man and his life. The piece I am reprinting which was written by Norman Birnbaum was the best piece I found. It was on the website of the Nation Magazine. Benn who was described at the end of his life as a national treasure was one of England’s best known leftists.
My favorite Tony Benn story which is alluded to in the piece is about how Benn renounced his lordship. He had been a member of the House of Commons. When his father died in 1960, he became Viscount Stansgate. Benn then led a political struggle to change the British law so nobles could renounce their titles. He wanted to go back to serve in the House of Commons which he did. I liked his comment about the House of Lords: “The House of Lords is the British Outer Mongolia for retired politicians.”
Gary Younge, who also wrote a fine piece about Benn, said that the two things that stood out about him were his optimism and his persistence. He was a long-time activist. Benn was also famous for his quotes. I will share one additional one I like:
“What is the final corruption in politics? Earlier, it was to get into cabinet, before that, to be popular, but, later on, the final corruption is this kindly, harmless old gentleman. I’m very aware of that. I take the praise as sceptically as I took the abuse. I asked myself some time ago: what do you do when you’re old? You don’t whinge, you don’t talk all the time about the past, you don’t try and manage anything, you try and encourage people.”
The piece by Norman Birnbaum is below:
Tony Benn’s wealthy family performed public service for generations. His father was a minister in the postwar reform Labour government of Clement Attlee. The father, Lord Stansgate, was a typical radical member of the educated gentry, of the same moral stuff as Bertrand Russell. The father made a familiar British journey from liberalism, with its concerns for the dignity and rights of ordinary citizens, its distrust of elite pretensions to superior knowledge and privilege, to Labour in company with many others. That gave Labour its very complex moral culture—a juxtaposition of near revolutionary vision, a perpetually outraged sense of justice and a resolve to construct piece by piece what the Labour hymn terms “a new Jerusalem in England’s green and pleasant land.”
Tony Benn (Anthony Wedgwood Benn) died at age 88 last week—and was immediately and fulsomely praised by many well able to restrain their enthusiasm for him in his lifetime. He was a great parliamentary orator, an inspiring speaker at countless gatherings and meetings outside it, a tireless writer, and above all, a prophet who earned honor in his own country. Much in his background foretold a rather more conventional career, and he did indeed initially if ambivalently pursue one. He held senior cabinet posts in the Wilson and Callaghan governments of the sixties and seventies. He remained in Parliament, an increasingly acerbic and influential critic of both Thatcher and her successor John Major and of his own party’s supposed savior, Tony Blair, until 2001, when he retired “to devote more time to politics.”
British politics had changed immensely since Benn first entered Parliament in 1950. The class bound and locally rooted antagonists, Labour and Conservative, had to learn national media strategies in the television age. Imperial power was claimed, triumphantly, by the Americans, and the realistic British acknowledged, sorrowfully, that their nation was subordinate to its erstwhile cousins. The West Europeans (including old enemies Germany and Italy) had achieved more prosperity and successful welfare states administered by socialists and social Christians in alternation or alliance. Black and brown immigrants began to flow in from the Commonwealth. Harold Macmillan, a Tory Keynesian, won the 1959 general election with the slogan, “We are all workers now.” Labour argued endlessly about what a modern socialist project would entail.
Benn’s early career was chiefly conspicuous for his struggle to avoid having to move to the House of Lords after his father’s death in 1960. It took three years, but new legislation enabled him to renounce the Peerage. There were some signs of rebelliousness in a generally dutiful early political biography. He was one of the first parliamentarians to criticize South African apartheid, and—in opposition to the party leadership—voiced skepticism about Britain’s nuclear weaponry. Benn, unlike many of his Labour contemporaries, took seriously the more critical cultural and political currents in the larger society. These included, variously, the New Left, the Campaign for Nuclear Disarmament and a systematic disrespect for inherited patterns of deference and sobriety. When the New Left thought of profoundly altering Great Britain, we took the revolutionary step of opening The Partisan Café in Soho, central London. My memory is of Benn coming from time to time with his American wife, Caroline, a remarkably intelligent person utterly unsympathetic to the belief of many Britons (some in Labour) that nothing should ever be done for the first time.
It was not a belief congenial to Benn. His familial political inheritance was a doctrine of the necessity of continuous reform. Great social movements in modern Britain had solid textual inspiration—the prophetic books of the King James Bible. Speaking to The Spectator journalist Mary Whitfield not long before he died, Benn said:
My mother and father were both Congregationalists and Congregationalism is interesting because everyone has a hot line to the Almighty, you don’t need a Bishop to help you. So no hierarchies, just trust the people. We used to read the Bible every night and my mother told me that the Bible is the story of the conflict between the Kings who had power and the Prophets who preached righteousness. She taught me to support the Prophets against the Kings.
Benn’s path to the prophetic status he occupied for years took him through cabinet posts, profound political conflict, and internal exile in his own party. As minister and contender for party leadership posts he insisted on using the state to modernize Britain’s industry. Wilson and his rather more robust successor Callaghan were unwilling to undertake a total confrontation with the masters and ideologies of British financial capitalism, the City and Blair proudly declared that New Labour was the best ally of new (and old) money. Labour actually split in the early phases of the argument, a group led by Roy Jenkins and David Owen forming a new party. Thatcher in 1979 exploited these divisions to win an election and proceeded to total war on the trade unions and local and regional self government. Benn’s open intention of reconstructing Labour doctrine and practice in its entirety discountenanced and frightened many of his contemporaries in Labour, and he was relegated to the back benches.
Actually, his failure to remain in the party leadership (he sought the Deputy Leadership but was defeated in 1981) was liberating. Sufficient numbers of parliamentary colleagues agreed with him, or sympathized with him, to preclude his being completely excluded. He spoke for himself, or rather, for groups and ideas disregarded as Labour’s leaders flailed desperately in the effort to construct a coherent response to Thatcherism.
In December of 1980 he came to Washington as guest of the United Auto Workers and the Congressional Progressive Caucus (with the Democratic Socialists of America) to participate in a conference on Eurosocialism. The other guests included Willy Brandt, Felipe Gonzales, François Mitterrand and Olaf Palme. I spent some time with Tony on the occasion, and we talked of the imminence of Reaganism, our fears of the intensification of the Cold War, and the precarious position of the parties of reform. Tony had seen some of the Protestant fundamentalist television spectacles, with their calls for war on Communism and secularism, pluralism and the welfare state. To think, he said, that the origins of much of American democracy were the same as our own in Britain—the thoroughgoing democracy preached in Cromwell’s seventeenth-century revolution. I could offer very little consolation: the spiritual energy that had infused the New Deal and the Great Society, the civil rights movement, the Vietnam protests, had drained away. In both English-speaking nations, we were about to experience the woeful compromises, the retreats depicted as realistic advances, of the Third Way—to be incorporated later in the policies of Clinton and Blair.
I visited Tony occasionally, thereafter, on trips to London. I was struck by the quality of the younger people working in his parliamentary office. One of them was later to become a Nation intern, Ed Miliband. Upon Tony’s death, he issued a fine tribute to him, speaking as Labour’s leader, as an embodiment of conviction. Looking at Tony’s persistence in the past decades, the astonishing thing about it was indeed his unfailing moral generosity, his belief that the creative and communal potential of human nature could become actual, his sense that in total opposition he was custodian of treasures of national memory which ought not be allowed to dissipate.
No doubt, there was a good deal of his religious inheritance in it. There was also something enduringly solid in British culture, hard common sense. (Recall the Parliamentary debate after which the House of Commons rejected Cameron’s plans to intervene in Syria.) I recollect a talk by Tony in the London suburbs. A few hundred people came, plenty of seniors with a fair presence of younger persons. Tony looked around, began by estimating the average age of his auditors, and raised a question. “There are about twenty thousand years of life experience in this hall. Do you think our nation has taken full advantage of what you have to give?” Of course, Tony campaigned against the Iraq war, against the monetarization of British existence brought about by the sovereignty of the City, against the arrogance of elites. He will be remembered for something deeper, his respect for his fellow citizens as an expression of his belief in a national mission.
My Perspective on the 50th Anniversary of the War on Poverty – posted 3/15/2014 and published in the Concord Monitor on 3/20/2014
This article appeared in the Concord Monitor on March 20, 2014 under the title “Pointed in the Right Direction”.
2014 marks the 50th anniversary of the War on Poverty. Since January, there have been many commemorations and retrospective pieces written about this anniversary. 50 years offers a good time to step back and take stock of both progress and shortcomings.
When President Johnson launched the War on Poverty in 1964, it was a multi-pronged attack that featured a broad array of new government programs. These included such lasting accomplishments as Medicare, Medicaid, Head Start, Job Corps, Community Action Program, Community Health Centers and Legal Services. President Johnson also greatly strengthened Social Security, extending benefits for retirees, widows and the disabled.
Johnson tried to reduce poverty by creating new services. Many of the services sought to promote opportunity and success in the job market. This approach ran contrary to most influential analyzes of poverty which emphasized the role of unemployment and the solution of job creation. While the new programs did not end poverty, I think it is hard to deny their great value. Collectively, they did contribute to a lessening of the economic divide between rich and poor.
Over the last 50 years, poverty and poverty-related conditions have declined. This is in large part due to the safety net. While there are many ways to look at this, I would cite the rise in average income among the poorest fifth of Americans, the drop in infant mortality, and the disappearance of severe child malnutrition as significant gains. Whatever its other virtues, private enterprise was unable to accomplish these outcomes. The War on Poverty government programs did.
America in the sleepy Eisenhower fifties hid poverty off the beaten track. While it sometimes may not seem that way, we have come a long way from a time when poverty was invisible and not talked about.
However, I would admit that the War on Poverty has been only a partial success.
The War on Poverty did mean an acknowledgement of harsh realities and it prevented things from getting worse. It did not banish poverty. I would never deny the distance we have to go as a society to eliminate poverty but I think it is an error to fail to acknowledge the positives.
It is not surprising that the 50th anniversary would evoke a wide range of responses across the political spectrum. On the political Right, I saw these words used to characterize the War on Poverty: “ineffective”, “failure”, and “catastrophic”.
On March 3rd, the Majority Staff of the Congressional House Budget Committee, presenting the view of Budget Committee chair Paul Ryan, released a very long document entitled “The War on Poverty: 50 Years Later”. The document attempted to review a large number of federal programs.
Among other programs reviewed, the piece included a section on federally funded Legal Services. Because during my legal career, I had worked in Legal Services for 25 years, I looked forward to seeing the critical evaluation.
I would have to describe the Budget Committee piece as an ideological document. It appears to be agenda-driven with the goal to debunk the War on Poverty. Rather than any evaluation of the substantive work of Legal Services, the relevant section focused on two examples of fraud where administrators stole money from their Legal Services’ programs. It then went on to criticize the Legal Services Corporation for poor grant oversight.
Fair is not the first word that comes to mind to describe this evaluation. Over the 40 plus years of Legal Services, Legal Aid programs have represented hundreds of thousands if not millions of poor people on their individual problems whether it was eviction defense, a public benefit denial, a consumer scam or protection from domestic violence abuse. Legal Aid advocates have won innumerable victories that directly resulted in tangible client benefit. Where was any mention of that?
How can it be that a document purporting to evaluate 50 years of the War on Poverty included no mention of the actual work of Legal Services? Evaluations like the Budget Committee report reflect the distance of the report’s writers from poor people and their actual experience. It would be generous to characterize reports of this nature as “academic”.
Poverty is tough to talk about because just the word itself has become a political football. There are no generally shared definitions of what poverty is. There is cynicism and defeatism about ever eliminating poverty. To his credit, President Johnson sought to evoke an empathetic understanding of the poor.
While the War on Poverty has been represented as a Democratic Party endeavor, that is not entirely true. President Richard Nixon also invested heavily in the War on Poverty. Nixon played a leading role in establishing the Food Stamp program, the Women”s, Infant and Children (WIC) food program, and Supplemental Security Income (SSI). He also proposed a guaranteed national income that failed in the Senate after passing the House. I suppose this is forgotten history but it does show that the War on Poverty had more bi-partisan origins than people now would expect.
The War on Poverty pointed us as a society in the right direction. Without the goal of reducing and eliminating poverty , we will never get there. I submit it is unlikely we will make progress on eliminating poverty if that is not seen as an explicit societal goal.
The initial thrust of the War on Poverty did not last long because of the political reaction it engendered. Still, the programs I mentioned at the outset have become part of the accepted fabric of our society. Facile dismissals that ignore these programs lack balance. Since the Reagan era we have witnessed a sales job by the Hard Right on how government programs don’t work. While no program is beyond criticism, the sales job actually flies in the face of the programs I mentioned which are, in fact, very successful.
We currently lack politicians with the will, ability, drive and vision to move a new War on Poverty agenda forward. President Obama’s emphasis on economic inequality is timely but it appears he lacks the political strength to push this boulder uphill. We need poverty abolitionists who can make that happen.
It has been quite a few years since I have had a puppy. I recently made the plunge again.
48 hours later and I have to admit it is a struggle, albeit an enjoyable struggle, keeping up with puppy energy. My puppy Shady is a golden retriever, now 9 weeks old. He does not stop – he plays very hard and then crashes equally hard (you learn to appreciate the crash moments).
Damage control is a full-time mode. Puppy proofing is a necessity or it is bye-bye to any possessions in puppy proximity. For some reason Shady was attracted to two throw pillows on our living room sofa. He barked at the pillows, not sure why. They must be an attractive nuisance. How long the pillows will escape remains to be seen.
I think I had forgotten how oral puppies are. When I am at home, much of my time is consumed with making sure Shady is chewing on the right things. The dog likes to get into everything. Last night he tried to get inside my DVD player.
While I have not written about dogs before on this blog, I am a dog person. I grew up with dogs. Among others, I had a weimaraner named Duchess, a mutt named Honky, and a miniature schnauzer named Roman Gabriel. Also, when I first got together with my wife Debra, she had a beagle named Freckles.
Freckles was a real character. It would be easy to write a column about him alone. One day when we were at work, he ate the landlord’s couch. Debra told me a story about how he had been stolen once. (This happened before I knew her). She was living in Worcester Ma at the time and she put up missing signs all around her neighborhood. Two weeks went by with no sign of Freckles. Then Debra received a phone call. The guy on the other end (who had, in fact, stolen Freckles) said “You can come get your dog now”. When Debra went to pick up Freckles, it turned out that that very cute beagle had eaten the guy’s apartment.
Over the last 29 years or so, I have owned golden retrievers. There was the regal Rainbow (the first), placid and incredibly good-natured Tasha (an unbelievable swimmer), Toby ( golden mix we adopted), Rainbow (the second and not always the best behaved), Molly who lives to eat, and now Shady. Molly is 14. She is my longest lived golden and has totally outlived my expectations. The dog is in the heavyweight category. She keeps trucking although I would have to describe her response to the puppy as not unalloyed joy.
I had planned to write a more serious piece this weekend but Shady shot that plan to hell. Puppies require so much attention. On the other hand, I don’t think there is anything I would rather be doing. Shady is a great guy and a most entertaining and lovable companion. I am surprised how easy it has been for him to transition to our house.
My brother Rob said that puppies are harder than babies. Before Shady it has been a while since I have had either experience but I would have to agree. I did create a comfortable and secure fenced-in area to try and minimize destruction. Still, when Shady is up and about, you need NSA surveillance capability.
I am taking advantage of a lull in the action right now to write this. Not sure how long the lull will last. I do feel a bit ADHD-like in the puppy aftermath. My concentration is scattered tending to the puppy. I had told my wife that this is my dog so I did want to step up and be his primary caretaker.
For now, I will end with a quote I like from Milan Kundera:
“Dogs are our link to paradise. They don’t know evil or jealousy or discontent. To sit with a dog on a hillside on a glorious afternoon is to be back in Eden where doing nothing was not boring – it was peace”.
Sent from my iPad