Republicans are slowly losing the health care battle

Public opinion is already against them

Welcome to a Sunday night edition of Progress Report.

My recovery from heart surgery has been moving forward at a slow-but-steady pace, pain morphing into soreness and exhaustion becoming less frequent fatigue. Yesterday, I took a walk outside for the first time since the surgery, and spent much of the time reminding myself that I can breathe again. A three block roundtrip to the bodega is still a few steps forward.

Every day brings something new. I’m supposed to keep my blood pressure steady during recovery, and were it not for a daily beta blocker pill, I probably would have failed miserably during today’s League Cup final.

In short: Liverpool Football Club, despite nearly the entire first team out with injury, outplayed, outlasted, and ultimately defeated Chelsea with a line-up that was dominated by junior players who in many cases barely ever played for the first team before. It was a bit like a team with a roster filled with minor leaguers beating the free-spending Yankees to win the pennant.

Being involved in the NYC chapter of the Official Liverpool Supporters Club which has taught me a lot about affinity and motivation. Fans from around the world connect despite so many differences, all united by a pursuit of joy that simply isn’t found in our politics. The dark clouds, blowing in from the far-right and swirling ominously overhead, make it difficult to muster a similar enthusiasm, but this work is only sustainable for people when it isn’t driven by fear and policed by cynics. We have to pursue dreams, not just dodge nightmares.

Please consider a subscribing and/or donating to keep Progress Report afloat and sustainable. Far-right extremists are financed by billionaires and corporations, who invest in conservative outlets, think tanks, and law firms to advance their interests. We rely on forward-thinking readers like you. Please help us fight the good fight.

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I came across a statistic the other day that truly shocked me: throughout the 1980s, more than 80% of all union strikes were prompted by employers attempting to cut back on health insurance benefits and shift the financial burden onto their workers. That it still today counts as a big victory if a union’s contract avoids any major changes to employee health plans is a searing indictment of a corrupt government’s disinterest in solving collective problems.

The nation’s privatized, employer-based health insurance system reached its zenith in the 1970s, then began an intractable decline. Industrial outsourcing, the growth of the non-union, low-wage service sector, and conservative antipathy all played a part, and in recent years, the number of Americans on employer health plans, once in the mid-60s, has bottomed out at 47%.

It underscores just how absurd it is that the problem still hasn’t been solved, though government intervention, through expanded Medicaid for lower-income Americans and subsidies on the ACA marketplace, has at least helped to fill in the gaps left by bad corporate actors and reduce the uninsured rate. Ideally, that government involvement would continue to grow, blunting the soaring cost of pharmaceuticals and preventing medical debt, but as is the case in virtually every other aspect of public policy in this country, politics and ideology are pulling states in polar opposite directions.

Unhealthy Abandonment

It’s been nearly a year since states were permitted to begin checking the eligibility of Medicaid recipients, triggering the “unwinding” that has thus far resulted in 18 million low-income Americans being kicked off of their health insurance.

I’ve been obsessively covering this purge since it began, in large part because a vast majority of Americans who have lost Medicaid were likely still eligible, and now the national media is starting to understand it as something more than just an unfortunate turn of events for some poor people.

As the New York Times reported this weekend, the unwinding has left millions of kids without health care and even more suffering from the downstream consequences of a huge cut in financial support for doctors’ offices and clinics.

Medicaid payments are “the lifeblood of our health centers and their ability to serve,” said Dr. Kyu Rhee, the president and chief executive of the National Association of Community Health Centers, which treat roughly one in 11 people in the United States and rely on Medicaid and federal grants to provide a financial cushion for the uncompensated care they give uninsured patients.

The loss of reimbursements for millions of patients has contributed to an already difficult financial picture for facilities that treat the poor: Unless Congress reaches a funding agreement, nearly $6 billion for federally financed health clinics, which serve over 30 million people, most of them low-income, could lapse in early March.

The situation is particularly dire in Texas, where more than two million people have been kicked off of the state’s very limited Medicaid program. As I reported in November, the sabotage has been very purposeful:

Some of the stories coming out of Texas are gutting:

The coverage losses are happening at an especially precarious time. Winter viruses are still circulating. Children are increasingly in need of behavioral health services, childhood vaccines and routine care for conditions such as diabetes and asthma, which commonly afflict low-income Americans.

Jessica Tucker, a single mother, broke into tears after receiving a $90 bill for her 3-year-old son Raylan’s primary care visit and tetanus vaccine at Bethesda, pleading with her mother by phone for help paying it. That morning, she had been informed that the toddler had been denied Medicaid coverage.

“I didn’t know what to do,” Ms. Tucker, who earns $10 per hour in a part-time job as a customer service associate, said, recounting the ordeal from her home in Gun Barrel City. She recently received a bill of almost $8,000 for an emergency room visit Raylan had after losing Medicaid, she said. His diagnosis: strep throat.

The clear moral catastrophe being inflicted on these families aside, this is just terrible public policy. The financial strain placed on public schools, hospitals, clinics, and other social services when children are unable to access care far exceeds the cost of preventative and early medical treatment. The medical debt that piles up on working people after $8000 emergency room visits saps the economy and leads to half a million bankruptcies per year.

“Culture of Life”

In what may be the least compelling underdog story ever written, Arkansas, with one-tenth the population of Texas, was still able to kick off more than 400,000 people from Medicaid, even with the expanded eligibility put in place by former Gov. Mike Beebe, a Democrat who was in office when the ACA was implemented.

The state rushed through the unwinding in six months, as proscribed by a law passed in 2022 under former GOP governor Asa Hutchinson. While there was brief talk that his successor, Gov. Sarah Huckabee Sanders, could move to repeal the law, she has instead sought to turn the screws even tighter on working people, and in ways that exceed even the cruelty that Texas Republicans have proven willing to pursue.

Last week, Huckabee Sanders announced that she opposed expanding Medicaid coverage to new mothers from 60 days postpartum to a full year, in spite of the fact that among its many dubious medical achievements, Arkansas has long led the nation in maternal mortality.

Instead of making it as easy and cheap as possible for new moms to continue to access care, she wants to simply inform the poorest, most overwhelmed people in the state of their ability to enroll in obscure programs or visit clinics that provide free care, which continue to struggle under the weight of a state with fewer and fewer delivery units and OBGYN care.

via Power to Decide

Arkansas is one of only four states to refuse to extend Medicaid coverage for new mothers. Idaho, Iowa, and Wisconsin have also held out, even as each state has pursued a ban on abortions. Idaho and Iowa have at least expanded Medicaid through the ACA, while the soon-to-be-extinct GOP supermajority in Wisconsin has refused to budge.

Refusing to extend health care to people is rarely in and of itself a popular political decision, and over the past few weeks, there has been a sudden surge in local news stories describing a growing pressure on GOP legislators in the ten states that have yet to expand Medicaid.

In South Carolina, some of the most ardent opponents of the program have suddenly become open to expansion — the huge influx of free federal dollars as state budgets shrink doesn’t hurt — while in Kansas, Democratic Gov. Laura Kelly’s long campaign to convince the Republican legislature to expand Medicaid has galvanized public support.

A recent survey conducted by a GOP polling firm found that 68% of Kansans supported Medicaid expansion, including 51% of Republican voters and a whopping 83% of small business owners. It’s worth noting that the poll asked voters about an expansion of KanCare, the name of the state’s Medicaid program, which likely made conservatives more amenable to the policy.

Unfortunately, the state’s GOP leaders continue to be committed to the immiseration of working people, so there’s little chance that it’ll be brought up for a vote any time soon.

There’s good news…

Whereas sociopaths still reign in Kansas, Texas, and Arkansas, there looks to be potential progress in some of the other holdout states.

The biggest intraparty battle right now is happening in Mississippi, where legislative leaders are ignoring Gov. Tate Reeves’ ongoing opposition to Medicaid expansion and forging forward with bills and hearings in service of the improving the state’s terrible health outcomes.

House Speaker Jason White, R-West, told Mississippi Today that the governor is entitled to his opinion on Medicaid policy, but he believes the GOP-controlled House will pass a bill this session that expands health insurance to more citizens.

“My position’s been pretty clear on the fact that we were going to explore and look at Medicaid as it affects hard-working, low-income Mississippians,” White said. “My ideas and thoughts about that haven’t changed. He’s the duly elected governor and he’s certainly entitled to his opinions on that matter. I don’t hold any of those against him. We just maybe here in the House have a different view of it.” 

In November, Reeves won re-election by fewer than four points in deep red Mississippi, in part because his Democratic opponent’s campaign focused heavily on Medicaid expansion. Reeves is relatively unpopular in the state, which would make a veto particularly risky.

In Oregon, meanwhile, the state House just passed a bill that would reduce corporate influence in health care by requiring that companies that offer medical services be run by medical professionals instead of Wall Street-focused executives.

There would be exemptions, including for hospitals and nursing homes, but advocates say it would be a huge step toward limiting the growing trend of private equity and big corporations like Amazon buying up health clinics, urgent care centers, managed care organizations, and other operators.

And in Virginia, the legislature moved one step closer to establishing the nation’s latest prescription drug price affordability board, which would have the power to set limits on egregiously expensive pharmaceuticals. It’s unclear whether Gov. Glenn Youngkin would sign the legislation. Democrats are expected to resume pursuit of passing a similar law in Michigan later this spring.

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