Feature

Want More Americans to Work? Give Them Medicaid.

| Laura Kiesel
Gov. Scott Walker proposes adding work requirements to the state's food stamp program, Monday, January 23, 2017 in Madison, Wisconsin. Wisconsin has not expanded Medicaid under the Affordable Care Act. (AP/Scott Bauer)

Here in the United States, we are obsessed with work. We collectively clock 25 percent more working hours every year than people in Europe. Working hard is still considered one of the top American values, even as longer hours are no longer equated with greater wealth and have been tied to significant increases in adverse health effects such as heart disease, stroke, diabetes, and depression.

This mindset is also reflected in our national politics and apparent in the rhetoric employed by the Trump administration and the GOP in their 2018 budget proposals, which would severely cut safety-net programs.

“There’s a dignity to work, and there’s a necessity to work to help the country succeed,” White House Budget Director Mick Mulvaney told CNN at the end of May. Mulvaney added that the United States should measure its success “by the number of people we help get off of those programs and get back in charge of their own lives.”

The Department of Health and Human Services has used the same rhetoric to justify specific attacks on Medicaid. Only hours after she was sworn into her post, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, and her boss, Health and Human Services Secretary Tom Price, sent out letters to all the nation’s governors urging them to impose insurance premiums on Medicaid recipients and provide work incentives.

Statements like these—and other calls to add work requirements to Medicaid eligibility guidelines—ignore the realities of who the program serves and its actual impacts. For those able-bodied people on Medicaid, the majority are already working. And for the 7 million nonelderly adults with disabilities for whom Medicaid offers primary or supplemental coverage, expanded access to Medicaid contributes to higher employment rates.

Only 19 percent of part-time workers have access to medical care benefits.

I’m one of those people. Eight years ago, I completed my master’s degree with one plan in mind: to launch a successful multi-decade career in environmental policy that would require regular overtime, frequent travel, and at least eight hours a day sitting at a desk and staring into a computer. I made this plan despite a history of sporadic health issues that tended to lay me out completely for several days every month, and debilitating headaches a few evenings every week. It wasn’t until a few years ago, when new diagnoses explained my daily struggle with overwhelming pain and fatigue, that I finally admitted to myself that my health status would prevent me from pursuing full-time work. Since then, I have survived by working a patchwork of part-time positions and freelance gigs, which has lowered my income and made me eligible for Medicaid.

And I am not alone.

According to recent data from the Bureau of Labor Statistics, 34 percent of workers with a disability were employed part-time in 2016, compared with only 18 percent of workers with no disability. Part-time jobs in the United States usually pay low hourly wages and tend not to offer crucial benefits such as health insurance: only 19 percent of part-time workers have access to medical care benefits.

For millions of disabled people in this position, the Affordable Care Act has filled a crucial need by expanding Medicaid coverage. Medicaid expansion significantly raised income requirements (by more than double) for approximately 11 million people living in the 31 states and the District of Columbia that adopted it. It also opened up enrollment to some childless adults, and dropped stringent asset limits. This meant that many more disabled people were now able to work—or work more hours and make higher wages, as well as have more savings—than prior to the expansion.

This was confirmed by a collaborative study released earlier this year that found that working-age adults who identify as having disabilities were much more likely to be employed in Medicaid expansion states than in non-expansion states.

“Having access to comprehensive insurance without having to go through a lengthy and demoralizing disability determination process is very important,” says Jean Hall, Director of the Institute for Health and Disability Policy Studies at the University of Kansas and lead author of the study. “Medicaid expansion allows people with disabilities to work more, and accumulate assets, without fear of losing their eligibility for Medicaid coverage.”

The recently-won expansion has been under continuous threat as Trump and Congressional Republicans have tried to follow through on years of promises to repeal and replace the ACA. The most recent effort, the Graham-Cassidy bill, would slash Medicaid funding and allow insurers to charge higher premiums for those with pre-existing conditions. These changes could have particularly severe consequences for people with chronic health conditions who have Medicaid through the expansion.

'My medications would cost more than I make in a month'

Kelly O’Brien of Sandusky, Ohio, has myalgic encephalomyelitis, postural orthostatic tachycardia syndrome, and peripheral neuropathy. She works part-time in a bridal shop that offers her flexible scheduling and other accommodations while she builds up a freelance writing business on the side.

“My medications would cost more than I make in a month,” says O’Brien. “Yet without my medication, I wouldn’t be able to work at all and thus wouldn’t have any income.”

Even for those who can work full time and have access to so-called comprehensive health insurance through their jobs, the price of their co-pays and deductibles for treatments to manage their conditions can erase most—if not all—of their income gains.

Take the case of 38-year-old Valéria Souza, who recently moved from Missouri back to her home state of Massachusetts. Souza has multiple sclerosis and was spending an average of $6,000 to $10,000 annually out of pocket on co-pays and deductibles to manage her illness. This was despite having what was considered a “good” health insurance plan with her former position in academia. These expenses comprised between 30 to 50 percent of her yearly income, eventually forcing her to work several part-time jobs in addition to her full-time career and forcing her to work in excess of 60 hours a week to compensate for her financial losses.

“This situation is not sustainable for someone with MS as a long-term life plan,” says Souza. “At some point, I won’t be able to work this much.”

This is one of the main reasons why Souza moved back to her home state: Massachusetts expanded Medicaid, while Missouri did not.

“I would like to know that Medicaid is available to me if and when I need it,” she says. Though, if Graham-Cassidy becomes law, that would threaten Souza’s plans.

For those of us with medical conditions that limit our ability to work full time, Medicaid is often our only option. If our government officials want more of us to have jobs, maintaining and building on Medicaid expansion is one proven way to do that. But if they cut it or scale it back in any way, the consequences for us will be severe.

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First Person

Fighting for My Life, Again, Under Trump

| Angela Rosa
AP/John Minchillo

Content Warning: The following article contains graphic depictions of domestic violence. 

For 22 years, I did what many Americans do: I worked, I attended college, and I worked some more. I paid my taxes, I voted with my heart just as much as with my mind, and I obtained a career. I did everything right.

Then, on June 30, 2016, my fiancé shot me in the back of my head at point blank range.

As I lay dying, I watched the man I loved turn his gun on himself and take his own life. I was left for dead, but I fought for my life through unimaginable darkness, hurt, and pain. I survived. I am broken, but alive.

I think about that night a lot. I think about it because it shapes everything about my life now, and not just because the bullet fragments in the back of my head and neck leave me in pain. I think about it because the disability I have now, that I acquired with a one-second pull of a trigger, turned my life upside down.

I used to be a senior court clerk within the New York State Unified Court System. My fiancé was a New York State Court Officer-Lieutenant. Together we earned well over $150,000 per year. My career offered great benefits, a pension, and health insurance—and I was privileged enough to take them for granted.

I lost everything because my fiancé decided my life was not worth living. For the past 14 months, I fought to prove that it is: first by surviving, then by working to regain my dignity, self-worth, and independence.

Now, I find myself fighting the same battle with a different opponent. Once again, someone is deciding my life is not worth living. Except this time, it’s my president, and it’s the senators and representatives of my country telling me I have no worth.

Right now, President Donald Trump and congressional Republicans are working to pass a budget that takes desperately needed resources from the people who need them the most. In his 2018 budget, Trump proposed cutting $70 billion from Social Security Disability Insurance (SSDI), which would take away income from up to 1 million Americans with disabilities like me. The House budget, which lawmakers are trying to pass this fall, isn’t as specific but the effects could be the same.

This is not the life I worked for.

Mick Mulvaney, Trump’s budget director, justified these cuts by calling SSDI “very wasteful” and suggesting that not everyone on it is “truly disabled” and people need to “go back to work.” The thing is, I’d love to. This is not a life I wanted, this is not the life I worked for. It is the life that was forced upon me. But I’m at the mercy of those who think this was a choice.

There are a lot of things about what happened to me that I won’t ever understand. I don’t understand why my fiancé got his service weapon back after he’d struggled with his mental health, or why he decided to shoot the person he said he loved. And I don’t understand why any intelligent, self-aware individual would think that my life was a choice—a choice to live a life where food is not a guarantee, where I am never quite sure if I’ll be able to visit the doctor for life-saving treatment or if I’ll have to suffer in pain forever, until the pain paralyzes me.

I live in fear every single day that the people I elected to help me, to help America, will take my life and the lives of millions of other Americans. We are failing as a nation if we continue down this path, if we take from the weakest to feed the strong.

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Feature

Not Guilty in St. Louis: The Cycle of Verdict, Protest, and Police

| Linda Tirado
AP/Jeff Roberson

Jason Stockley, the former St. Louis cop charged with murder for killing a suspect at point-blank range, was found not guilty on Friday. The verdict was announced at 9:00 a.m. on September 15, 37 days after the trial closed and six years after Stockley killed Anthony Lamar Smith. Protests began immediately and don’t look as though they’ll end anytime soon.

There are events morning and night: People have staged die-ins, blocked intersections, and marched for miles every day in the sweltering Missouri heat. There is always someone with water or sandwiches or voter registration forms nearby, and a volunteer medic every few hundred feet. There are legal observers and a drum line, but no hint of reconciliation in the air.

Annie Smith, the mother of Anthony Lamar Smith, gave a press conference on Friday at the site of her son’s death. “I didn’t get justice, so I can’t have any peace,” she said.

The weekend has been split, as it usually is in St. Louis, between massive demonstrations that are angry but peaceful and smaller nighttime protests that devolve into broken windows and tear gas. The property damage has been in a different section of the city every night, led by younger and angrier protesters, and there is tension between people who think breaking windows is violence and people who argue that it’s not as violent as killing people. The chant “you kill us, we kill your economy” is a two-edged sword, and in the daytime it sounds like thousands of people making commerce inconvenient and at night it sounds like dozens of people making commerce disappear.

A fully militarized police force had seized control again, chanting, 'Whose streets? Our streets!'

On Sunday morning, people gathered in the Delmar Loop, which had seen the worst of the damage, to help clean up and board up storefronts and paint murals on the plywood. Then they went to protest. That’s how St. Louis has been since 2014 at least, when this cycle ingrained itself into the city.

By Sunday night a fully militarized police force had seized control again. They chanted, “Whose streets? Our streets!” after arresting dozens of people—media, legal observers, and protesters alike. An undercover police car reversed through a crowd marching through a street in downtown St. Louis on Sunday, after which a line of riot police protected the car while protesters de-escalated the situation.

A funny thing about new normals is how easily people accept them; most people seemed upset but not shocked by these incidents. They expected the not guilty verdict and were ready for it—and for the police response. Journalists have been arrested at St. Louis protests before, the most famous example being Wesley Lowery and Ryan Reilly while they worked from a Ferguson McDonald’s in 2014. And on Saturday, a woman named Pat Washington was hit by a truck during a protest, though her injuries were minor and she finished the march. Two other times this weekend I’ve seen cars simply keep driving through the crowd.

If you are looking for a 2017 dystopia, it’s in St. Louis. It is entirely usual and patently unacceptable for the police force to do many of the things they’ve been doing on video over the last few days: firing projectiles toward residents at random, macing people who came out of a bathroom, knocking over and kicking elderly women before arresting them on spurious charges, running cars into crowds, using strobe lights on crowds of protesters at night knowing there were epileptics in the area, and putting a synagogue under siege on Shabbat. It is messy and complex here. There are shades of 2014, with the same protesters demanding the same changes and the same authorities quelling the unrest. But is it also three years later, and as a nation we are debating whether it’s appropriate to have Sean Spicer on the Emmys or whether it’s okay for the president to tweet a video of himself hitting Hillary Clinton with a golf ball.

On Monday morning, protesters arrived downtown by 7:00 a.m. Protests are expected to continue into Tuesday evening. Police and news helicopters circle above, and people wonder aloud why they don’t just admit a cop was guilty for once instead of putting everyone through all this again.

Editor’s note: This is the second in a three-part series on the trial over the killing of Anthony Lamar Smith. Read part one.

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Analysis

Inequality Is Probably Costing You a Lot of Money

| Nick Buffie
(AP Photo/David Goldman, File)

When political scientists Jacob Hacker and Paul Pierson released Winner-Take-All Politics in March 2011, it made headlines. The book’s vivid descriptions of how moneyed interests had come to dominate the Washington political scene captured media attention and helped shape conversations around public policies affecting economic inequality.

But while Winner-Take-All Politics got a lot of attention, the media missed a crucial part of the book: Rising inequality comes at a high cost to individual workers. In the book, Hacker and Pierson presented calculations showing that if inequality had stayed constant from 1979 to 2006, the bottom 90 percent of Americans would make up to 36 percent more per year than they currently do.

Half a decade later, inequality is still growing. It also still isn’t getting the media attention it deserves, even though it’s making a massive impact on Americans’ lives. It’s like climate change: There is nothing “new” about growing inequality, so it gets pushed out of the news in favor of White House scandals and presidential tweets. But just like global warming, economic inequality is slowly but surely destroying the livelihoods of many Americans.

You can see this quite clearly when you look at how the distribution of household income has changed over the past 50 years. I extended Hacker and Pierson’s original calculations to include incomes from 1968 to 2015, giving us about two decades’ worth of additional data beyond other recent calculations. The wider timeframe shows an even deeper decline in income than the authors originally reported.

The table below breaks this down by income bracket. The second column shows what each group’s average household income was in 2015; the third column shows what the group’s average income would have been if inequality had stayed the same between 1968 and 2015.

table 1

Source: Author’s calculations based on 2016 data from the U.S. Census Bureau.

If it weren’t for the increase in inequality, the bottom 40 percent of households would be making more than 35 percent more today.

The 'winners' from increased inequality are really a small group of incredibly rich Americans.

The gains, of course, have gone to the very wealthiest Americans—especially those in the top 5 percent. Due to the rise in inequality, higher-income households—those in the top 20 percent of the income distribution but not in the top 5 percent—have seen a 9 percent increase in their annual incomes. But incomes for households in the top 5 percent are 26 percent higher—an increase nearly three times as great. This reveals something important about the nature of rising inequality: The “winners” from increased inequality are really a small group of incredibly rich Americans, who are taking increasingly large shares of the total national income.

table 2

The findings are pretty difficult to refute. Conservatives have long argued that household income statistics are unreliable because they fail to account for differences in household size. But the increase in inequality appears just as real even when we look at “equivalence-adjusted income shares,” which control for differences in household size and composition.

In fact, the figure below shows that households in the bottom 40 percent of the income distribution have actually seen their share of national income decline more when we use the equivalence-adjusted household income that addresses conservatives’ concerns.

table 3

The poorest fifth of households saw their share of national income decline from 4.2 percent in 1968 to 3.1 percent in 2015, a drop of 1.1 percentage points. However, if we instead look at equivalence-adjusted income, their share of the national income dropped more than twice as much (from 5.8 percent to 3.4 percent, a drop of 2.4 percentage points). Conservatives are right to say that normal household income statistics can be misleading; but that’s because the normal statistics understate the rise in inequality, not because they overstate it.

The rise in inequality is no statistical mirage. It is undoubtedly real—and its effects have been pernicious. Our country’s poorest households lose more than $4,000 every year as a result of the growth in inequality; lower-income families lose more than $11,000; and middle-class families lose around $13,000. That money could pay for real things that families have to do without, whether it’s better food or new shoes, a trip to the doctor or a great summer camp.

If the rise of economic inequality is going to be the great untold story of our time, then reducing inequality should be the greatest progressive objective of the 21st century.

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Analysis

This Year’s Poverty Data Look a Lot Different When You Break Them Down by Race

| Valerie Wilson & Janelle Jones
AP/Seth Wenig

Yesterday’s Census release of data on income, poverty, and health insurance demonstrated two things: There are policies that work for people who are struggling, and there is still a lot of work left to do—especially for people of color in America.

It is encouraging that the people who saw the worst losses in the years since the Great Recession—specifically African Americans and Hispanics—saw the biggest earnings gains for the second consecutive year. Real median incomes increased 5.7 percent to $39,490 among African Americans and 4.3 percent to $47,675 among Hispanics. But the racial income gap is still stark—the median income among non-Hispanic whites stands at $65,041.

image

Source: Economic Policy Institute.

The racial wage gap also persists as black men earned 71 cents for every dollar earned by white men in 2016, and Hispanic men earn 66 cents on the dollar. Among women, it has actually grown worse since 2007: Black women now earn 79 cents for every dollar earned by white women, and Hispanic women earn 69 cents on the dollar.

It is therefore not surprising that although poverty rates for all groups were down, they remain highest among African Americans (22 percent) and Hispanics (19.4 percent), compared with whites (8.8 percent). African American and Hispanic children continue to face the highest poverty rates at nearly 31 percent and 27 percent, respectively. African American children are three times more likely to be in poverty than white children.

image (1)

Source: Economic Policy Institute.

While the Census releases new data every September, it is notable that the solutions remain the same every year: People need investments in quality training and good jobs in their communities; they need a safety net that protects our basic living standards for food, housing, health care, retirement (Social Security); they need access to good schools and higher education; they need child care that doesn’t cost more than a year of college tuition; and they need a minimum wage that isn’t a poverty wage.

The solutions remain the same every year.

Many of the key policies that helped people in poverty achieve some gains are at stake in upcoming congressional debates on the budget. Conservatives will continue to go after the investments that cut poverty in half year-in and year-out, such as Medicaid and affordable health care. They will call for tax cuts for the wealthiest Americans, even though the wealthiest 5 percent already captured 22.5 percent of all income last year. Nowhere on the agenda is there discussion of a just minimum wage and a real jobs plan that would target those who continue to struggle at the economic margins—disproportionately people of color—doing low-wage or unpaid work.

Recent gains need to be protected in the current political environment, but we also need to stay focused on a vision of how every man, woman, and child has the opportunity to fully participate in our economy and thrive.

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