Tag Archives: health care

Sanders’ lost opportunity in appealing to California

As Hillary Clinton’s delegate count creeps towards a hard fought win, Bernie Sanders’ campaign has increasingly hung their hopes on one state alone – California. It might seem like a curious choice. Racially diverse and a part of the Democrats “blue wall,” California seems more comparable to Illinois, New York, or Pennsylvania – all states Hillary Clinton won. Sanders’ support has largely come from more predominantly White states, both within and outside of typical “blue states” with his wins admittedly coming from places as socially different as Oregon and West Virginia.

In spite of breaking the pattern so far, there’s a certain logic to it, particularly if Sanders returned to the rhetoric he used when first launching his campaign. California was initially touted by many as a success story for the implementation of Obamacare, but the longer term frustrations with putting it in place have created an untapped political market in the state that could be decisive if addressed well.

Like all states, California’s experience with Obama-era health care reform boils down to effectively three big picture changes:

  • Health care providers and health insurance companies face greater obligations to their patients and customers, but in exchange those customers are required to have coverage.
  • In order to help people who would have trouble paying for that coverage, medicaid and other assistance programs are given greater resources and more people are deemed to qualify for their assistance.
  • In order to make accessing and assessing insurance plans easier for everyone who can pay for that coverage, those plans will be helpfully listed on online-accessible exchanges.

That seems simple enough, right? At first, California avoided most of the pitfalls and hangups that other states experienced with putting together those initiatives – the state didn’t drag its feet to expand Medi-Cal or leave it to the federal government to build the online exchange’s website. The system worked. The public health care available was enough of a carrot and the threat of a tax penalty for lacking coverage was enough of a stick, and so in 2014’s open enrollment alone 1.9 million people applied for coverage through Medi-Cal and 1.3 million people purchased insurance through the exchanges.

Hopefully you noticed the discrepancy there. People too poor to afford insurance asked the state to provide it for them, and waited a decision. People with enough wealth to buy it bought and had it, end of story. This wasn’t an abstract demonstration of class inequality. This was about access to health insurance, at times to cover chronic or vital health problems. People died from lack of care while the wait list ballooned into the thousands.

Worse yet, the exchanges and Medi-Cal application system – although tied together into one system – would permit people to apply for Medi-Cal, and only that program, if they met the income standards to do so (see answer 9). Lower income people were literally obligated to wait, and denied access to expensive care in the name of protecting them from the cost. Meanwhile, the question of whether they would be liable under the tax penalties for lacking coverage while waiting for an answer from the state remained hanging in the air.

For all its horrifying flaws, with court rulings and administrative decisions this privatized public health insurance model has seen some improvement. Many Californians do, at the end of the day, want to retain the Covered California system, but there is a sizable chunk of the electorate that could stand to hear some talk about how to shake up the system for the better. Looking at the numbers of applicants and enrolled, as a raw number it’s probably a bigger one that is open to criticism of it, even while wanting the system to exist in some form. That’s a tricky place to articulate, where we need this public system but with different ideas underpinning it, but whoever describes it first could become surprisingly popular in California.

Bernie Sanders seemed prepared to be that candidate and speak in that way towards the beginning of the primary campaign. His messages on how he envisions health care policy still speak to many of the fundamental problems a “success story” like California has seen under Obamacare. Health care, under the PPACA, has not become an essential human right that the state must guarantee, but only a public good it will guarantee you if you demonstrate adequate need. The practical application of that – that by the thousands people have to wait for that assessment to occur – is a nightmarish reversal of any talk about inalienable rights, which the Sanders campaign continues to use. In short, the implication in some of Sanders’ statements, that he would reduce or even dismantle the application process for publically-provided health care, taps into the precise flaws and frustrations with the system as is in a place like California.

But, as of now, those have stayed just implications. To be frank, it’s unclear how much any president can or would be able to shape a redesigned ACA that would address that problem. Sanders might actually have a greater ability to champion that within the legislature, and to the extent that he has, could rely on replaying clips of that in a last minute ad blitz in California. He has less than a fortnight for that now. Can he pivot back to that discussion and articulate this nuanced point about a flaw within a means-tested public health care system? It might already be too little and too late.

The featured image for this article is of the California State Senate Chamber in Sacramento, California.

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Reproductive freedom is economic stability

Trigger warning: abortion, sexual assault / rape, sexism, cissexism

Against the backdrop of the Colorado Springs shooting at a Planned Parenthood, that and other abortion-providing organizations have seen not only intimidating violence but institutional attempts to shutter their doors of the past few years.

Concentrated in Republican-controlled states, one of the strictest provisions on abortion providers is set to advance to the Supreme Court for review with a decision expected in late Spring of next year. That ruling will affect the legality and further room available to legislatures in at least a score of states which if current trends continue would likely restrict abortion further if given the option.

Former Texan state Senator Wendy Davis appeared on national news recently to discuss the potential ramifications of that ruling. As part of a changing voice within the debates surrounding abortions and other reproductive healthcare, she explained that to her and others like her abortion access is not only a means of physical, bodily autonomy, but also a lifeline to basic control over personal financial planning. In her own words, “when women’s reproductive autonomy is controlled, their economic opportunity is controlled.”

Wendy Davis during her Texas Senate filibuster

Former state Senator Davis, while filibustering a new set of restrictions on abortion in 2013, from here.

With her limited time, Davis couldn’t expand on her point about the economics of reproductive healthcare to those seeking abortion or similar services. Others have made it clear how the people most in need of an option other than pregnancy, let alone parenthood, typically have the fewest resources to devote to simply accessing an abortion. With a dwindling number of providers in many of these states, someone finding themselves in that sort of situation would have to spend more money to travel further and most likely take off time from work to avoid the huge economic costs of pregnancy or parenthood.

This is typically where the moralizing starts. The unnecessarily incurred costs to access an abortion under these increasingly difficult restrictions are, supposedly, just the price paid for failing to abstain from sex or to use birth control. The people most likely to seek out abortions for economic reasons, however, are also the people with most inconsistent and mistaken sex education and the fewest resources to commit to a birth control regimen.

Running through that understanding of how they became pregnant, there’s a presumption that the pregnant person necessarily consented to have sex. In addition to sexual assault, there’s also the (not at all hoped for) failure of birth control plans, which is more likely the less consistent and less accurate the sex education on receives. There’s a number of factors at play here, but it’s clear that people with fewer resources to draw on are more likely to end up stuck in this type of situation.

Likewise, overwhelmingly the opponents of access to abortion want to similarly restrict sex education and access to contraceptives, offered by organizations like Planned Parenthood far more often than abortion services. The intent doesn’t appear to be preventing abortion, so much as making it a shameful and shame-able activity. The political goal isn’t to end abortion, but to hide it within a nightmarish corner of the world that the broader society doesn’t have to consider.

The moralizing isn’t just another conversation intruding into others’ personal reasons for preferring to have an abortion, for those with that perspective, it is the conversation. The desire to be a parent, filled with a kind of urgency that accepts the financial and other costs of that, is either treated as universal or is evangelized – without hearing that other people, directly living the effects of that decision, have different priorities.

Even as abortion in popular conversation is increasingly a part of an economic plank – argued for in combination with improved education, greater access to other healthcare, and better personal financial standing in general – there’s ways in which it is left out of a broader economic argument. It’s still often thought of as a separate issue, even if one increasingly harmonious with a broader view of how to structure the economy.

The Economic Policy Institute, for example, excluded it from their recently released twelve-point Women’s Economic Agenda. Aspects of their policy plank address the underlying economic issues by calling for a path to citizenship for undocumented immigrants, asking for policies to encourage labor organization, and specifically for an end to wage theft and wage discrimination. All of those are key financial factors that weigh heavily in the decisions of many to have an abortion.

Some policy prescriptions even more directly confront the economic situation that many pregnant people find themselves in. The agenda also called for greater access to childcare, as well as paid family and sick leave. Those are often specific economic realities that motivate people unsure if they can become parents to decide that they aren’t in a place where they can have children. In short, the policies here are designed to give people the resources to become parents, if they so choose.

What’s more, some of those policies useful to parents are also useful to those who for other reasons aren’t interested in having children at this time. The call for longer term scheduling, to ease planning, is vital for parents to be able to best interact with their children. It also is one of the key ways for someone who needs an abortion to plan ahead and not face the prospect of forgoing a potentially significant amount of pay to avoid the even larger costs of pregnancy and parenthood.

In short, this emerging set of policies, which has deep ties to a progressive vision of how to improve the current economy,  is rather compatible with the increasingly economic argument for retaining or even improving access to abortion. Still, abortion remains another issue for now, and has yet to be specifically invoked in the broader policy plank.

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