How the Obamacare made the cost of indifference too high
This is the story of one person who doesn’t need to die.
This is the story of one person who doesn’t need to die because a study has found that when you hear about one little starving girl with huge, wet eyes, you are most likely to help[i]. Add another little girl — for a total of two starving people — and you are far less likely to open your wallet. Find out about thousands of starved people and your mind becomes some mashed sweet potatoes. Even if you happen to discover that the one poor, cute little girl you were going to help is one of millions suffering from a famine, you’re suddenly checking your “other” Facebook inbox, that secret one you only check when you’ve been stranded in a broken elevator with nothing but your phone.
Some problems are just too big for our little brains.
So this is the story of one person who doesn’t need to die.
This one person could be Sherilyn Horrocks.
Sherilyn Horrocks is a 62-year-old woman who has the same autoimmune disease that killed her brother when he was 36. Despite her constant medical problems, Sherilyn Horrocks hasn’t had health insurance since her husband’s employer dropped spousal coverage in 2000. Sherilyn Horrocks’ condition is incurable.
“But there are medicines and procedures that would prolong my life if I could afford them,” Sherilyn Horrocks told the Salt Lake Tribune in September of 2013[ii]. “I have a feeling I’m going to be one of those who falls through the cracks.”
Sherilyn Horrocks would already have health insurance — if Republicans in Utah had accepted the expanded Medicaid coverage being offered to 57,000 of its residents under the Affordable Care Act.
A recent poll even showed that 76 percent of Utahans would like Sherilyn Horrocks to have Medicaid[iii]. But the state’s GOP refused to consider expansion, unless it got a special deal from the federal government. This special deal would allow private insurers to benefit from Medicaid expansion — even though this method is proving to be more expensive than conventional Medicaid — along with added burdens on those gaining coverage, including a requirement to be employed to looking for work, even though some of those who were eligible for coverage may be too ill to work. Like Sherilyn Horrocks.
Of course, Sherilyn Horrocks isn’t the victim of an incomprehensible tragedy — like famine, genocide or terrorism. She’s suffering from indifference.
It’s the same boring indifference that allows America to be the only industrialized country in the world without universal healthcare. And like too many Americans, she’s suffering even as we as a nation spend more on medical costs than any country in the history of countries or money. But please don’t think of all those people. Our brains just can’t handle it.
Do Republicans in Utah — or in any of the 23 states currently rejecting expansion — have actual reasons why they’re punishing Sherilyn Horrocks, beyond a chemical dependency to obstructing anything B’Iraq HUSSEIN #Nobama wants to do that doesn’t involve bombing Iraqis[iv]?
Sort of.
True blood libertarians want to junk our entire health care system and let the free market rise up like some uncorked genie to insure Sherilyn Horrocks —because everyone knows we just need an Uber for autoimmune diseases. These Republicans who own bongs would want to take away the tax break gives 141 million Americans employer-provided health insurance as tax-free compensation. They would also junk Medicare — the most popular thing[v] the federal government has ever done besides defeating Hitler and Tojo[vi].
So before they’d get Sherilyn Horrocks health insurance they’d raise taxes on about half of all Americans and get rid of Medicare, which will happen on the day we criminalize apple pie and cancel the Super Bowl.
Non-libertarian Republicans who have to win actual elections recognize that this extreme makeover of America’s health care system — which would likely start with cancellation notices for more than a 137 million Americans[vii] — is only slightly more likely than Michele Bachmann marrying Barney Frank. They also recognize that saying, “I think poor workers should suck it” doesn’t poll that well with soccer moms and people who can read.
So the GOP leaders of the states that haven’t expanded Medicaid are stuck with a lie that makes little-to-no sense, thus is rarely questioned by the media. They say the federal government is so broke from paying George W. Bush’s tab[viii] that it will never live up to its promise to reimburse nearly all costs of covering Sherilyn Horrocks.
And this, of course, is USDA Grade A horseshit.
We know this is some USDA Grade A horseshit because none of these states have rejected regular Medicaid, which makes up about 92.6 percent of the total Medicaid budget[ix]. None of these states are rejecting regular Medicaid and doing so would be ridiculous. In five decades of the program, the federal government has never missed a Medicaid payment. The program’s payouts to states have only been cut once, temporarily — thanks to Saint Ronald Reagan[x]. The Affordable Care Act also pays for itself with first new taxes on the rich, super rich and car elevator rich in a generation[xi]. And states pay these taxes whether they decide to help their uninsured or not.
Recognizing this is excuse is USDA Grade A horseshit, Republicans in Utah have recently argued that covering Sherilyn Horrocks will end up being too expensive for the state because employers will stop offering low-wage workers health insurance. And if that happened, some corporations would — be ready to gasp! — get a big tax break almost entirely funded by the federal government.
Utah’s 5 percent business tax rate is eleventh lowest rate in the nation. Apparently, the state’s Republicans hate taxes and love businesses tax cuts—as long as those cuts don’t help Sherilyn Horrocks get health insurance.
This brings us to the most repulsive reason Republicans give for why they don’t want Sherilyn Horrocks to have health insurance.
This argument is so offensive that only someone who has always had health insurance would ever make it in public. Some Republicans actually insist that having government-run Medicaid is worse for your health than having no insurance at all, which is like saying global warming is the best way to defrost your windshield.
Medicaid is far from perfect but its benefits are undeniable and most of its failings arise from the low reimbursement rates Republicans insist upon.
Still, this “zombie” Medicaid lie endlessly bobs to the surface the cesspools of cynicism known as right-wing think tanks[xii]. What’s truly amazing is that this lie won’t die even though we now know that people who gain Medicaid coverage are less likely to be admitted to a hospital. Their financial hardships and — coincidentally– depression go down within the first year of coverage. And we know this thanks to a recent study in Oregon that randomly gave poor workers Medicaid[xiii].
Swell! Having even bare-bones health coverage eases the most miserable symptoms of income inequality—especially for folks like Sherilyn Horrocks.
Is this what Republicans are trying to avoid?
In 1993, conservative ideologue Bill Kristol — who would latter become famous for the championing the two of the greatest disasters of the twenty-first century, the Iraq War and Sarah Palin — wrote a letter to his fellow Republicans that argued the Clintons’ health care reforms must be defeated entirely or the Democrats would “revive the reputation of the party” as “the generous protector of middle-class interests.” And just as they would do 15 years later, every Republican member of Congress refused to vote for any fix plan to a broken health care system that wastes a trillion dollars a year[xiv].
So are Republicans afraid that Sherilyn Horrocks would vote Democratic if she gets health insurance through Affordable Care Act?
They needn’t be.
Nine out of ten states that are most dependent on Washington D.C. voted for Mitt Romney while nine out of the ten least dependent states voted for President Obama[xv]. (A great irony of our time is that the states that made up the Old Confederacy are among those that are most likely to be dependent on the federal government.) The right wins all the time in taker states by running against “takers.” And no one who is getting insurance will ever be enrolled in a program that includes the words “Obama” or the “Affordable Care Act” so Republicans can grab credit for it the same way they demanded giant scissors to cut ribbons for Stimulus projects they voted against.
Republicans who either belong to or rely on votes from the party’s base are denying Sherilyn Horrocks health insurance coverage for a pretty simple reason: You never give voters something you’re planning to take away.
They want to keep Sherilyn Horrocks from getting hooked on that sweet Medicaid as long as possible, hoping that President Cruz, Huckabee, Paul, Rubio, Ryan or Trump will make his first act in the White House canceling the health care coverage tens of millions of Americans. Until then, they’ll do anything to keep the Sherilyn Horrocks uninsured, including closing hospitals and allowing health insurance premiums in Republican states to rise as much as 15 percent[xvi].
What would they replace Obamacare with?
While Republicans nearly all agree they want to repeal Obamacare, they haven’t once voted on a plan to replace it — even as they’ve voted to repeal the whole law or some part of it more than forty times. So the GOP will likely go back to the plan they offered under George W. Bush as 7.9 million Americans lost their health insurance[xvii]: Change or die.
For Sherilyn Horrocks, there is no choice. Without Obamacare, insurers are never going to offer an affordable useful policy that a 62-year old woman with an autoimmune disease. But what about the other five million Americans being denied Medicaid?
Obviously, few of them suffer from an incurable disease, as Sherilyn Horrocks does—even though the poor adults in states not expanding Medicaid are more likely to suffer high blood pressure, heart problems, cancer, stroke and emphysema[xviii].
Republicans make the case that the working poor can always get health care if they just decide not to be so working poor.
To the right, poverty is a life choice — like being gay or menstruating.
To protect the sanctity of their bias against the poor, the right must ignore the evidence that shows kids who are born rich tend to stay rich. Shockingly, poor kids tend to become poor adults no matter how many times you call a kid a “taker” because so much of our educational development depends on the first five years of our lives—when most kids are far too lazy to go out and get a job.
Poor infants start out with about the same abilities as rich kids. But by the age of four, the richest kids average at the 69th percentile in literacy and math while the poorest kids hit the 34th percentile in literacy and 32nd in math[xix]. And until we can get four-year olds to buckle down and dig John Galt’s speech, this de facto class system won’t change.
Sure, you can escape the shadow of your parents’ socio-economic status in America with the right education, opportunities and abilities or Instagram feed. You’re just more likely to do so in Denmark, Norway, Finland, Canada, New Zealand, Australia, Sweden, Japan, Germany, France, Spain, Pakistan and Switzerland[xx]. All of these countries—except Pakistan—have universal health care
I know. Too many people — and foreigners!
Your mind has been numb for a while. You can’t feel your hands. You’re going end up on I Didn’t Know I Was Pregnant because of me.
That’s why Republicans have been winning on this issue — because the enormity of their indifference is so huge.
More than four million hard-working Americans — one million in Texas alone — being denied health insurance for no good reason is such a catostrophuck that it’s almost impossible grasp — even if you’re just thinking of Sherilyn Horrocks.
While conservatives accuse President Obama of personally masterminding the death of four Americans in Libya or laughing about it as he golfs, Democrats rarely and say, “Republicans may kill poor Sherilyn Horrocks.” But it’s more true than any accusation of a Benghazi “stand down order.”
According to a study conducted on a little experiment called “Romneycare,” for every 830 people who gain insurance, the life of one whole Sherilyn Horrocks is saved[xxi]. So Republican-led states aren’t just purposely making sure Sherilyn Horrocks is more likely to be hospitalized, broke and depressed, they’re sending about 6,000 Sherilyn Horrockses to a preventable death each year.
Maximum brain numbness alert! Don’t think about 6,000 Sherilyn Horrockses[xxii]. Or five million Sherilyn Horrockses. Just think about poor Sherilyn Horrocks showing up to an emergency room, again, waiting for hours, finally getting help after midnight, going home as the sun breaks the horizon, eventually recovering then getting one of those THIS IS NOT A BILL notices that she owes thousands of dollars because she wasn’t just willing to sit home and suffer.
That’s better.
Of course, conservatives do not want to just keep Sherilyn Horrocks and 5 million others from getting insurance. They want to take coverage away from the more than 24 million Americans who have gained it due to the Affordable Care Act — at least ten million who would not be uninsured otherwise. They don’t admit this. They pretend that some magical fix will come along to cover the people who’ve gained coverage knowing that their party hasn’t been able to put a plan to the replace the president’s health reforms up to a vote, even as it’s vote to replace some or all over the law nearly eight trillion times. And they won’t. All of the proposed replacements contain far too many political landmines — like raising taxes on middle class workers or gutting Medicare — to justify doing anything until the moment they get repeal the law and find themselves with millions of Americans suddenly uninsured and pissed.
Without Obamacare, 12,000 more Americans to a likely death—or 24,000 since the law is expected to have reduced the uninsured population by 20 million by the time President Cruz takes office in 2016[xxiii].
The GOP will, of course, deny that these lives would be saved. Or they’ll get crazy cynical and actually suggest that the costs of saving them aren’t worth it—even though the federal government will spend less on Medicaid expansion over the next decade than it did on the Iraq War. They might argue: We could save more lives by bringing back prayer in school, banning the IUD, and cutting Mitt Romney’s taxes.
Just kidding. As if Mitt Romney actually pays taxes.
But you may have noticed that, suddenly, some Republicans have given up arguing against Medicaid.
In the past few few weeks, Tennessee, Wyoming and Utah have all moved closer to expanding Medicaid.
What happened this summer that helped Republicans recognize that their repeal fantasy is dead? It wasn’t the endless polls showing repeal is unpopular. It was Pennsylvania’s struggling Republican governor finally accepting expansion.
Now a Republican cannot be elected president in 2016 without having to win at least one purple state that has expanded Medicaid. The political costs of letting hospitals close and residents die are just no longer worth it for many Republicans, now that Obamacare is out of the headlines and even Ted Cruz has moved repealing the law down from the number one spot on his “fuckit list.”
I’m sure that it’s a coincidence that the vast majority states that haven’t budged at all on expansion just happen to be those who made up the Old Confederacy. But this fact makes difficult to argue that there isn’t some racial bias behind the refusal to expand Obama-branded health coverage to poorer Americans who are disproportionately minorities. Just as we have to note that Arizona, the last state that accepted the original Medicaid program, was also the last state to accept a holiday for Martin Luther King Jr.’s birthday.
Utah’s Republicans may decide to try to help Sherilyn Horrocks before it’s too late. (Honestly, it may already be too late. I cannot find any mention of her online since that September 2013 article in the Tribune.)
But it won’t be because they’re thinking of her. It will be because they’ll be thinking of the most important person in the world—themselves. And that’s a tribute to the design of the Affordable Care Act as it’s being implemented: The costs of indifference are higher than the costs of doing the right thing.
[Image by James D’Angelo | Flickr]
[i] Brooke Gladstone’s interviews with Nicholas Kristof “On the Media” (December 2009) https://www.facinghistory.org/journalism-digital-age/reading-4-media
[ii] “Dying for coverage: Utahn lobbies to expand Medicaid” by Kristen Stewart http://www.sltrib.com/sltrib/news/56910411-78/utah-health-summit-expansion.html.csp
[iii] “Poll: Utah voters favor expanding Medicaid” by Kristen Stewart http://www.sltrib.com/sltrib/news/57976813-78/utah-medicaid-health-percent.html.csp
[iv] As he is known to the great @RobDelaney https://twitter.com/robdelaney/status/493052558907162624
[v] “POLL: Clear Majority Want No Medicare, Social Security Or Education Cuts” by Jason Sattler http://www.nationalmemo.com/poll-clear-majority-want-no-medicare-social-security-or-education-cuts/
[vi] “Health Insurance Coverage of the Total Population” The Henry J. Kaiser Foundation http://kff.org/other/state-indicator/total-population/
[vii] “If the GOP Repeals Obamacare, 137 Million Americans Could Get Cancellation Notices” by Erika Eichelberger http://www.motherjones.com/mojo/2013/11/obamacare-repeal-cancellation-notice
[viii] “Economic Downturn and Legacy of Bush Policies Continue to Drive Large Deficits” by Kathy Ruffing and Joel Friedman http://www.cbpp.org/cms/?fa=view&id=3849
[ix] “Another argument against the Medicaid expansion just got weaker” by Jason Millman http://www.washingtonpost.com/blogs/wonkblog/wp/2014/08/11/another-argument-against-the-medicaid-expansion-just-got-weaker/
[x] “Medicaid: Health Care for the Poor in the Reagan Era” by D Rowland, B Lyons, and J Edwards http://www.annualreviews.org/doi/abs/10.1146/annurev.pu.09.050188.002235?journalCode=publhealth
[xi] “Why the super rich hate Obamacare and will never let the debate die” by @LOLGOP http://www.eclectablog.com/2014/04/why-the-super-rich-hate-obamacare-and-will-never-let-the-debate-die.html
[xii] “Zombie Medicaid arguments” by Austin Frakt and Aaron Carroll http://theincidentaleconomist.com/wordpress/zombie-medicaid-arguments/
[xiii] The Oregon Health Insurance Experiment http://www.nber.org/oregon/
[xiv] “Clinton’s Simple Case For Obamacare: ‘It’s Better Than The Current System’” by Jason Sattler http://www.nationalmemo.com/clintons-simple-case-for-obamacare-its-better-than-the-current-system/
[xv] “States Most and Least Dependent on the Federal Government Share” by John S Kiernan http://wallethub.com/edu/states-most-least-dependent-on-the-federal-government/2700/
[xvi] “Romneycare/Obamacare Architect Jonathan Gruber Blasts ‘Disgusting’ Refusal To Expand Medicaid” http://www.nationalmemo.com/romneycareobamacare-architect-jonathan-gruber-blasts-disgusting-refusal-to-expand-medicaid/
[xvii] “More Americans gained insurance in the first half of 2014 than lost it under 8 years of Bush” by @LOLGOP http://www.eclectablog.com/2014/06/more-americans-gained-insurance-in-the-first-half-of-2014-than-lost-it-under-8-years-of-bush.html
[xviii] “Characteristics of Uninsured Low-Income Adults in States Expanding vs Not Expanding Medicaid” by Sandra L. Decker, Genevieve M. Kenney and Sharon K. Long https://archinte.jamanetwork.com/article.aspx?articleid=1857090
[xix] “Thirteen Economic Facts about Social Mobility and the Role of Education” by Michael Greenstone, Adam Looney, Jeremy Patashnik, and Muxin Yu, The Hamilton Project http://www.brookings.edu/research/reports/2013/06/13-facts-higher-education
[xx] “Thirteen Economic Facts about Social Mobility and the Role of Education” by Michael Greenstone, Adam Looney, Jeremy Patashnik, and Muxin Yu, The Hamilton Project http://www.brookings.edu/research/reports/2013/06/13-facts-higher-education
[xxi] “Changes in Mortality After Massachusetts Health Care Reform: A Quasi-experimental Study” http://annals.org/article.aspx?articleid=1867050
[xxii] Telling you not to think of 6,000 Sherilyn Horrockses is ridiculous because that’s all you’ll think of. Read Don’t Think of an Elephant!: Know Your Values and Frame the Debate–The Essential Guide for Progressives by George Lakoff to understand why.
[xxiii] “Could Obamacare save 24,000 lives a year?” by Harold Pollack http://www.healthinsurance.org/blog/2014/05/05/could-obamacare-save-24000-lives-a-year/
