Health Care

How Barack Obama Trapped the GOP On Health Care

It was all downhill from here.
Barack Obama has done many dastardly things to Republicans. He regularly ridicules their arguments. He insists on being treated as though he were legitimately the president of the United States. And most cruelly of all, he beat their standard-bearers in two national elections. Is it any wonder they loathe him so? But one thing Obama has done to the GOP has gone unnoticed: he made it impossible for them to be serious about health care policy. By now you're well familiar with how the core of the Affordable Care Act—a ban on insurance companies denying coverage for pre-existing conditions (also known as "guaranteed issue"), accompanied by an individual mandate and subsidies for people of moderate incomes to purchase private insurance—was originally a conservative proposal. The idea was that unlike in most other western countries where a large government program like Medicare covers all citizens, you could achieve something close to universal coverage and health security through the use...

Laying It All Out On Medicare

Flickr/Donkey Hotey
The release of a new Paul Ryan budget plan is always the occasion for a lot of ridicule from liberals, for a whole bunch of reasons, and this year's will be no different. Ryan's budgets always manage to combine a remarkable cruelty toward poor people with a sunny optimism that draconian cuts to social services will result in a veritable explosion of economic growth, allowing us to balance the budget without taking anything away from the truly important priorities (like military spending) or, heaven forbid, forcing wealthy people to pay more in taxes. I'm sure there are other people preparing detailed critiques of the Ryan budget, but I want to focus on one thing this brings up: the question of how we talk about Medicare. As he has before in his budgets, Ryan proposes to repeal the benefits of the Affordable Care Act, like subsidies for middle-class people to buy insurance and the expansion of Medicaid, but he'd keep the tax increases and Medicare cuts that the bill included in order...

Sunday Show Becomes 10 Percent Less Awful

Look! People who know what they're talking about!
A week and a half ago, I wrote a post over at the Plum Line with a couple of suggestions for how the Sunday shows could become less terrible. Some commenters pointed out that the real audience for these programs isn't actual people, but those within the Washington bubble for whom status and influence are everything. So my suggestion that the shows should never again interview a White House communication director or a "party strategist" of any kind—in other words, people who are there solely for the purpose of spinning—was unlikely to get much of a hearing. And my suggestion to drastically scale back on interviews with elected officials, who are also exceedingly unlikely to say anything interesting, would likewise fall on deaf ears. Which is perfectly true, and it hasn't stopped me from complaining about this topic before. But lo and behold, on yesterday's Meet the Press, something remarkable happened: They booked Jonathan Cohn of The New Republic and Avik Roy of Forbes to talk about...

Is the "Mend It" Period of the Affordable Care Act's Evolution Beginning?

All of a sudden, people in Washington seem to want to fix the Affordable Care Act. And regardless of their motivations, that should be—well, maybe "celebrated" is too strong a word, but we can see it as a necessary and positive development. Is it possible that the arguments about whether the ACA was a good idea or should have been passed in the first place are actually going to fade away, and we can get down to the businesses of strengthening the parts of it that are working and fixing the parts that aren't? It might be so. Sure, cretinous congressional candidates will continue to display their seriousness by pumping paper copies of the law with bullets , probably for years to come. But with this year's open enrollment period coming to an end in a few days, a particular reality is starting to set in, namely that, however you feel about the law, millions of Americans have now gotten health insurance because of it. Repealing it would mean taking that insurance away. So let's look at...

Hobby Lobby and the Return of the "Negro Travelers' Green Book"

Jalopnik
V ictor Green loved to travel. Being a mail carrier in the mid-20th century was a good, solid job, and the heyday of the American automobile was just beginning. Americans felt more mobile than ever before, especially once Eisenhower's interstate highway system expanded like a web through the country. The freedom of the open road beckoned. But Victor did not feel particularly free. As an African American, much of the nation was closed off to him and his family. Hotels rented rooms only to whites; restaurants wouldn't take his money; shops and markets kept their doors shut. Jim Crow was everywhere. So he wrote the first travel guide for African Americans, listing restaurants, hotels, gas stations, and even private homes that would aid the “Negro Traveler.” Known as The Green Book, it was an essential part of African American life for more than 20 years. By 1952, it had expanded its listings to include barbershops, bars, and nightclubs. Such a guide was essential, since each particular...

The Strange Bedfellows of the Anti-Contraception Alliance

AP Images/Patrick Semansky
AP Images/Patrick Semansky O n March 25, lawyers representing the owners of a large purveyor of craft supplies and a much smaller cabinetry business will appear before the Supreme Court in what has become the cornerstone case for opponents of the Affordable Care Act’s “contraception mandate.” Under the mandate, all employers—with the exception of religious organizations like churches—must include free birth control under their insurance plans. Catholic schools, hospitals, and social service agencies immediately raised a ruckus. Dozens of Catholic nonprofits filed lawsuits against the government, arguing that because their tradition forbids them from using birth control, paying for it—even indirectly through insurance—would violate their religious liberty. The cases that will appear before the highest court deal with a different question: whether the owners of corporations can claim religious liberty exemptions. But there’s a stranger and less remarked-upon twist. The owners of both...

News Flash: An Abortion Provider Wins in Kansas

AP Photo/John Hanna
AP Photo/John Hanna Dr. Ann Kristin Neuhaus observes a State Board of Healing Arts meeting flanked by her attorneys, Kelly Kauffman, left, and Bob Eye in Topeka, Kansas. S ince the death of George Tiller, the third-trimester abortion provider who was killed in Wichita in 2009, former abortion doctor Ann Kristin Neuhaus has been fighting Operation Rescue—one of the country’s most radical anti-choice groups—alone. As part of their effort to oust “Tiller the Killer,” Operation Rescue lodged frequent accusations of medical misconduct with the Board of Healing Arts, the state medical licensing board, against Tiller and his colleagues. After his murder, Operation Rescue turned the full force of its ire on Neuhaus, who had worked on and off as a consultant for Tiller in the early 2000s. Appeals to the Board of Healing Arts hadn’t worked in the past, but the 2010 elections swept in Sam Brownback, a virulent opponent of abortion, as governor. Brownback had the power to select new members for...

This Is Your Camry On Drugs

The change in the social perception of drunk driving is one of the great public health success stories of the last half-century. It went from being perceived as an amusing bit of recklessness to something truly despicable, and today drunk driving deaths are half of what they were a few decades ago. And now that recreational marijuana is legal in Washington and Colorado, almost surely to be followed by other states, there's a renewed need to discourage driving while high. The key to the success of the drunk driving campaign was creating a new social norm, one in which people would discourage each other from driving drunk. It also gave people a means to avoid it, by popularizing the idea of the designated driver. Washington state is starting a campaign to discourage driving while high with three PSAs soon to be airing in the state. No frying eggs here: OK, so that's kind of funny. But I'm a little skeptical about whether it will have a dramatic impact. The ad does include the idea of...

The Last Rural Abortion Clinics in Texas Just Shut Down

AP Images/Pat Sullivan
S ince November, the last abortion clinics in East Texas and the Rio Grande Valley, some of the poorest and most remote parts of the state, have been hanging on by their fingernails. The two clinics, both outposts of a network of abortion providers called Whole Woman’s Health, stayed open with slimmed-down staffs while their owner, Amy Hagstrom Miller, struggled to comply with the first chunk of HB2—the voluminous anti-choice law passed by the Texas legislature last summer—which requires abortion doctors to obtain admitting privileges at a local hospital. Today, after weeks of failed negotiations with nearby hospitals, Hagstrom Miller announced that both clinics are closing their doors. The clinics in Beaumont, about an hour east of Houston, and McAllen, just north of the Mexico border in the Rio Grande Valley, were the last rural abortion providers left in Texas. Between July, when HB2 passed, and November, when the admitting privileges requirement went into effect, nearly half of...

Hey Bert, Is This Thing Loaded?

Click inside for more charts!
Since the Newtown shootings, liberal commentators have been paying greater attention to all kinds of firearm-related issues, including accidental shootings. Josh Marshall in particular often tweets the accidental shooting of the day—" Georgia Man Accidentally Shot Cousin to Death When Gun Fell From Lap " was today's, following on " Ohio Boy Fatally Shoots Brother With Handgun He Thought Was a BB Gun ." Which got me wondering, how many of these incidents are there? What interests me for the moment aren't homicides, but accidental shootings. How do they compare to other causes of accidental death and injury? We all know that vivid individual cases, no matter how vivid, don't necessarily give an accurate impression what's happening overall. So let's delve into the statistics, shall we? The first thing to understand is that accidental shootings make up a relatively small proportion of all the different ways Americans find to stumble, metaphorically speaking (though sometimes not) to their...

The Citizens United of the Culture Wars

Flickr/Mark FIscher
Flickr/Mark FIscher E ven a broken clock is right twice a day. Heeding calls from gay-rights supporters, business groups, and Republicans like John McCain and former presidential candidate Mitt Romney, on Wednesday Arizona governor Jan Brewer vetoed a "religious liberty" bill that would have allowed for-profit businesses to refuse service to gays and lesbians so long as they were motivated by "sincerely held religious belief.” A nearly identical law failed to advance in Kansas last week. Now, in light of the blowback, anti-gay discrimination bills in conservative legislatures—including Mississippi, Georgia, and Oklahoma— have stalled , and even lawmakers who voted for such measures are stepping back their support. The failure of these anti-gay discrimination bills amounts to a stern rebuke to the religious right, which sees defeat on the horizon in the gay-marriage fight. Just in the past two months, judges have overturned bans on same-sex marriage in Oklahoma, Virginia, Texas, and...

The Political Failure Behind the Healthcare.gov Debacle

You haven't heard much about healthcare.gov lately, and that's because it's working pretty well. So this is a good moment to think back on both what went wrong and how it got fixed, which we get in a timely article from Steven Brill. The fixing story is an interesting one, but before it's too late, I want to do a little more blame-placing. It goes without saying that much of the responsibility lies with the contractors who did such a terrible job of creating the site. Another way to think about the problems is that there was a missing middle: you had people who understood the technology but didn't grasp the politics, and people whose job was politics who didn't understand the technological challenges. That's intuitively appealing, but I think it lets the political people off the hook. Their screw-up wasn't a result of their unfamiliarity with technology. It was a political failure, full stop. What I mean by that is that the people who are supposed to understand politics should have...

Should We Call the Midwife?

AP Images/Katie Collins
E arlier this month, a bill advanced in the Arizona state legislature that would ban the use of midwives in the state during births where the mother has had previous caesarean sections, is delivering multiples or might face breech birth. How best to give birth is, needless to say, a topic of perennial interest. What follows is a conversation between two Prospect staffers who stand on different sides of the midwife debate. Amelia Thomson-DeVeaux: So basically, last year, Arizona overhauled its licensing protocols for certified professional midwives, allowing them to perform high-risk births at home. Vaginal births after cesarean sections, breech births, twins, etc. And now Kelli Ward, an Arizona state senator, wants to ban midwives from attending high-risk births. She says it's a pro-life issue. Choice quote: “I see the mom and the baby as two separate entities,” Ward said. “I would love to preserve the choice of the mother for their home birth, but that child also needs to have a...

The ACA Can't Fix Our Mental Health Crisis

AP Images/Bob Wands
AP Images/Bob Wands A s more people sign up for insurance under the Affordable Care Act, the next few months will usher in a fundamental change in mental health care. Under the ACA, insurers are for the first time required to cover mental health and substance abuse treatment as one of ten “essential benefits.” This is good news for the millions of Americans who suffer from some form of mental illness but don’t seek treatment. The question now is whether the country’s mental health infrastructure is equipped to deal with an avalanche of new patients. The answer? Probably not. Mental health care is saddled with two problems: It’s expensive and inaccessible. A 2012 survey by the Substance Abuse and Mental Health Services Administration found that more than 18 percent of American adults suffered from some form of mental illness in the past year . Of the forty percent who sought treatment, more than one-third paid for it out-of-pocket. To put this in perspective, only about 16 percent of...

Arkansas's Medicaid Folly

AP Images/Brian Chilson
On Tuesday, the Arkansas state legislature failed to renew a bill authorizing its expanded-Medicaid plan, an innovative approach to Obamacare that allowed the state to use federal funds to purchase private insurance for the state's low-income residents. Arkansas's unique plan was a compromise between the state's Democratic governor, Mike Beebe, and the Republican-led legislature, and made the state one of the few ultra-conservative ones to bother expanding Medicaid. In the 25 states that didn't expand, many of the poor are still doing without insurance, because the federal subsidies weren't designed to kick in until people made above a certain threshold. If Arkansas doesn't renew its Medicaid program, more than 87,000 people who've gotten insurance this year will suddenly lose it again. Opponents are complaining that the plan is expensive. To begin with, the entire cost is paid for by the federal government until 2016, and after that the state will never chip in more than 10 percent...

Pages