The Question for Lawmakers Who Might Backtrack on Expanded Health Coverage: Seriously?

With two weeks left in the second enrollment period for Affordable Care Act health coverage, marketplace enrollment is projected to reach between 9 million and 9.9 million people this year. That’s a net increase of between 2 and 3 million people gaining coverage through the marketplaces. Millions more will gain coverage through Medicaid expansion.

That’s something to celebrate – but the celebration could be short-lived for many people. Instead of figuring out how to get more people health coverage in 2015, many newly-elected and re-elected state legislators and governors are actually plotting how to take health care away from people who just received it for the first time.

It’s a real threat to people who’ve just gained coverage through Medicaid expansion – especially in states where incoming lawmakers are openly hostile to anything related to the Affordable Care Act. Those at greatest risk of losing coverage are women and people of color.

In Arkansas, where 211,000 people recently gained coverage, the state legislature must reapprove the Medicaid expansion plan by a three-quarters majority again in 2015. The incoming Republican governor is unenthusiastic about the plan – and expansion opponents won seats in the legislature. That doesn’t bode well.

In Ohio, where more than 400,000 people have coverage under Medicaid, the state legislature is also required to reauthorize the program in 2015. And in New Hampshire, where more than 20,000 people enrolled in just three months, the new Republican majority in the NH House of Representatives will also take a fresh vote on the program as well.

The continuing failure of more than 20 states to adopt any expansion plans at all, and the prospect of newly elected legislators revoking expanded coverage for hundreds of thousands of residents, represents a serious health threat to women.

A recent 50-state report card on women’s health by the Alliance for a Just Society clearly shows that most of the states that rejected Medicaid expansion have poor or failing records on women’s health. When it comes to ensuring that women have access to health care, the majority of legislators in these states have turned their backs on women.

Being denied access to health care is the latest Jim Crow.

The 2014 Women’s Health Report Card ranks and grades every state in the country on 30 distinct measures of women’s health. The results: 17 of the 21 states that rejected Medicaid expansion received final grades of C, D or F – and 13 of those states received a D or F.

Politicians in these states are failing women, but they are especially failing women of color who are more likely to be working low paying jobs, not covered by health insurance, and are least likely to have access to medical care.

The number of black women without health insurance is at least 20 percent higher than for women overall in 17 states. The uninsured rate for Latina women is at least 50 percent higher in 44 states. Black, Latina, and Native American women without access to health care have dramatically higher rates of hypertension, diabetes and infant mortality than other women.

While it’s encouraging news that Wyoming, Montana, and even Idaho seem to be moving toward Medicaid expansion, it will also leave our nation with a disturbing illustration of how alive and well racial segregation is in America. Take a look at the map of states that are refusing coverage to their most vulnerable residents: being denied access to health care is the latest Jim Crow.

Lawmakers in states that haven’t expanded Medicaid yet should move quickly to adopt expansion plans this year. If they don’t, they will bear the responsibility for their states falling even further behind on women’s health, and worsening racial disparities in our health care system.

As for lawmakers considering a vote to take health care away from thousands of their constituents, all I can ask is: Seriously? Do you really want to do that?

It’s one thing to stand in the way of people gaining access to quality, affordable health care. But it’s something else when people have just experienced quality, affordable health care for the first time, and then you snatch it away from them.

I can’t imagine that many will take kindly to it. And just in case anybody’s forgotten, there’s another election just a couple years away.

You probably don’t know about it, but you should: there is a huge “retirement savings gap” in America. The gap is the difference between the assets available to families and the assets that they need to retire at age 67 without incurring a significant lifestyle change. A 2013 study by the National Institute on Retirement Security found that among working households ages 25-64 the collective gap is between $6.8 trillion and $14 trillion.

Really more like a gorge than a gap.

This shortfall is distributed among a very broad swath of workers. In fact, the median retirement account balance for working-age households is $3,000. In other words, the typical working family is on a path to severe retirement insecurity.

Some of the causes of this crisis have to do with economic transformations we’ve undergone in recent decades. For one thing, stagnating—and in many sectors, declining—wages make it hard for workers to devote adequate resources to retirement. Additionally, the much-noted transition in the private sector from defined benefit pensions to defined contribution retirement schemes like 401(k) plans has shifted massive amounts of risk to workers, and, in many cases, decreased the value of retirement benefits — especially for workers who don’t begin putting money in their accounts early in their working life.

The typical working family is on a path to severe retirement insecurity.

On the other hand, one cause of the crisis has been around for decades. Throughout the many changes in the American economy, labor market, and retirement system, the share of workers lacking access to employer-based plans has been alarmingly high, usually hovering between 40 and 50 percent. Though workers whose employers offer no plan could theoretically open an Individual Retirement Account (IRA) on their own, the data are overwhelmingly clear that far too few of them do. A number of reasons fuel this phenomenon. First, sitting down and making one’s own financial plans for a retirement that might be many decades away is difficult and counter-intuitive. Second, the array of investment products available in today’s marketplace is complex and bewildering. Finally, low- and middle-wage workers often wind up paying very high fees.

Fortunately, the Illinois Secure Choice Retirement Savings Program, signed into law on January 4^th, addresses several of these problems. Through this legislation, many workers will now be automatically enrolled in a Roth IRA with a 3% payroll deduction. All workers qualify who have worked for a company with at least 25 employees that has been in business for at least 2 years, and offers no retirement plan. Workers may opt out, or select a contribution level other than 3%.

In many ways, this is a modest idea: it doesn’t require employers to fund these accounts, and it doesn’t involve any government subsidy. On the other hand, it tackles some major issues. First and foremost, it directly takes on the problem of access to employer plans. Secondly, by enrolling people by default unless they want to opt out, it will increase participation. Finally, by pooling a huge number of participants into a single program, workers—especially those who have low wages and work for comparatively small firms—will benefit from fees that are far lower than many would have otherwise paid.

The idea of the automatic enrollment IRA for workers without access to employer plans has been around for nearly a decade. It was invented by Mark Iwry, then of the Brookings Institute (now at the U.S. Treasury Department), and David John, then of the Heritage Foundation (now at AARP). It was supported in 2008 by the presidential campaigns of both Barack Obama and John McCain, and has been introduced in dozens of state capitols. However, due to opposition from the financial industry, no state was able to enact a law implementing such a program—until we passed Secure Choice in Illinois.

Interestingly, after years of battling with special interest groups over this legislation, most of the concerns recently expressed are focused on the question of why the law doesn’t go further. Some have asked why the employee contribution level is only 3%, or why it doesn’t escalate incrementally every year. Others point out that by exempting businesses with fewer than 25 employees, we’ll leave too many workers without coverage. These points are all sound. Indeed, the Illinois Secure Choice Program, while a major step, will not entirely solve the problem of retirement security for workers in the state who currently lack access to workplace plans. What’s more, it makes no progress on wage stagnation or most of the challenges associated with the shift to defined contribution retirement plans.

So we still have much more work to do if we are to create truly adequate retirement security for all workers. But after many years of changes in retirement policy that have usually meant bad news for American workers, I’m proud to have played a role in moving our society in a new direction, and I’m energized to build on this momentum and strive for progress in the years to come.

TalkPoverty.org is proud to collaborate with BillMoyers.com as it focuses exclusively on poverty coverage over the next two weeks. Every day, visit BillMoyers.com to discover a new action you can take to help turn the tide in the fight against poverty

Martin Luther King Jr. said, “America is going to hell if we don’t use her vast resources to end poverty and make it possible for all God’s children to have the basic necessities of life.”

Today, 150 years after the end of slavery, every other black baby in America is poor. Every third Hispanic baby is poor. Nearly every fourth rural child is poor. All told, there are 14.7 million poor children and 6.5 million extremely poor children in the United States of America. It is a national disgrace that such an unconscionably large number of children are homeless, hungry and living in poverty in a country with the world’s largest economy.

It doesn’t have to be this way.

It is way past time for a critical mass of Americans to confront the hypocrisy of America’s pretension to be a fair playing field while almost 15 million children languish in poverty. Sadly, politics too often trumps good policy, moral decency and responsibility to the next generation and the nation’s future.

Politics too often trumps good policy, moral decency and responsibility to the next generation.

But the Children’s Defense Fund has just released a groundbreaking report, Ending Child Poverty Now, showing how — for the first time — we can massively reduce this scourge. The CDF’s plan would cut child poverty overall by 60 percent, shrink black child poverty by 72 percent, and improve economic circumstances for 97 percent of poor children – all at a cost of $77.2 billion a year, a relative pittance.

By pursuing these policies immediately, we would not only improve the lives and futures of millions of children; over the long term, we would save taxpayers hundreds of billions of dollars annually. Child poverty costs our country about half a trillion dollars a year, six times more than what it would cost to significantly reduce child poverty and improve the future for millions of children, their parents and the country.

In its report, the CDF has identified multiple ways to pay for these changes without increasing the federal deficit, such as closing tax loopholes and cutting corporate subsidies. The report concludes that by investing another two percent of the federal budget to improve programs and policies we already know work – such as parental employment, making work pay and ensuring that children’s basic needs are met – the solution to ending child poverty is within reach.

Children have only one childhood — they can’t wait. It’s time to act with urgency and, together, ensure that all God’s children have the opportunity to reach their potential. If we love America, and we love our children, we must all stand against the excessive greed that tramples the millions of children entrusted to our care.

Read the report at the Children’s Defense Fund website, and sign up to receive updates about how you can fight for a real plan to reduce child poverty by 60 percent right now.

Sargent Shriver, President Johnson’s personal choice to lead the War on Poverty, was once asked which anti-poverty program he considered the most important.

“My favorite is Head Start because it was my idea,” he answered. “But I am proudest of Legal Services because I recognized that it had the greatest potential for changing the system under which people’s lives were being exploited.”

Legal services, also known as civil legal aid, has indeed been a potent anti-poverty tool in two ways. First, through individual case work that enables poor people to gain access to the rights and benefits from state and federal service agencies, health care providers, and schools to which they are entitled. Second, through large, class-action lawsuits and advocacy efforts that change laws and governmental policies that adversely―and overwhelmingly―affect poor people.

With the 50^th anniversary of the War on Poverty in 2014, we have been treated to numerous assessments of the effectiveness of Johnson’s (and Shriver’s) program these past 12 months. It is indisputable that tremendous progress has been made and that much work remains.

To continue progress, civil legal aid must be deployed more broadly in future efforts to combat poverty, and public resources for legal assistance must be increased greatly.

With regard to class action lawsuits, we have seen how civil legal aid has resulted in significant legal victories. In 1970, legal aid attorneys successfully argued before the U.S. Supreme Court in Goldberg v. Kelly that state welfare departments cannot terminate benefits without first providing applicants with a fair hearing. In 1973, California Rural Legal Assistance successfully sued to stop large agricultural operators from requiring migrant farm workers to use short-handled hoes while working in fields. (The short-handled hoes forced workers to stay bent over for long periods of time; field managers required their use because if they saw workers standing up, then they knew that they were resting and not working. After these hoes were banned, back injuries among farm workers dropped by more than 30 percent. ) More recently, a federal lawsuit by Greater Boston Legal Services resulted in changes in policy by the Massachusetts Department of Transitional Assistance which had improperly denied benefits to people living with disabilities.

A look at how civil legal aid case work for individuals struggling with homelessness and/or unstable housing, as well as those who are victims of intimate partner violence, is also instructive.

Civil legal aid yields a measurable―and significant―return on investment.

Numerous programs around the country demonstrate that civil legal services can help poor people keep their housing, or negotiate exits from housing that prevent immediate evictions, and ensure a smooth transition to safe, affordable housing. A pilot program launched in 2009 by the Boston Bar Association showed conclusively that poor people fighting eviction notices in housing court in Quincy, Massachusetts fared much better when they were represented by attorneys. Two-thirds of those with full representation kept their housing; only one-third of those who went through housing court without an attorney were able to do the same. Similar results have been found in New York City, San Francisco, and San Mateo County in California.

Meanwhile, a landmark 2003 study published in Contemporary Economic Policy showed that legal services is one of the most effective ways to help women living in poverty escape intimate partner violence. Amy Farmer and Jill Tiefenthaler, researchers at the Carnegie Mellon Census Research Data Center, were intrigued by a U.S. Department of Justice report noting that rates of domestic violence had significantly declined during the 1990s. They analyzed data from the National Crime Victimization Survey and the U.S. Census to tease out the reasons for the improvement. Their conclusion? Access to civil legal services ensured delivery of protective orders; assistance with child custody and support; and divorce and property distribution that victims needed to begin rebuilding their lives. Civil legal assistance was also critical for resolution of domestic violence-related legal disputes around immigration, housing, and public benefits.

While services provided by emergency shelters, counselors, and hotlines are vital in the short-term, Farmer and Tiefenthaler wrote, services provided by civil legal aid “appear to actually present women with real, long-term alternatives to their relationships.” (It is also interesting to note that between 1994 and 2000, the period during which incidents of domestic violence declined, the availability of civil legal services for victims of domestic violence increased 245 percent—from 336 such programs to 1,441).

Despite these clear successes, many people do not understand what civil legal aid is, and surveys regularly find that most Americans erroneously believe that poor people have a right to free counsel in civil cases. Meanwhile, state and federal funding for legal assistance is well below what it needs to be.

This fall, the Boston Bar Association’s Statewide Task Force to Expand Civil Legal Aid in Massachusetts released Investing in Justice, a report showing that more than 60 percent of those who are eligible for civil legal aid in Massachusetts and seek services are turned away due to lack of resources. (Full disclosure: I am a member of the task force.) The Task Force proposed that the Commonwealth’s investment in civil legal aid be increased by $30 million over the next three years to begin to address the unmet need. Currently, the state invests $15 million annually in civil legal aid.

The irony, of course, is that the civil legal aid yields a measurable―and significant―return on investment. Looking at work solely related to housing, public benefits, and domestic violence, three independent economic consulting firms which did analyses for the Task Force found that every dollar spent on civil legal aid in eviction and foreclosure cases saved the state $2.69 on services associated with housing needs such as “emergency shelter, health care, foster care, and law enforcement.” Every dollar spent assisting qualified people to receive federal benefits brings in $5 to the state. Every dollar spent on civil legal aid related to domestic violence is offset by a dollar in medical costs averted due to fewer incidents of assault.

This summer, Philadelphia resident Tianna Gaines-Turner became the first person actually living in poverty to testify before Congressman Paul Ryan’s Congressional hearings on the War on Poverty. In her strong and moving testimony she spoke of the need for increased state and federal funding to end poverty, saying, “People living in poverty―those who were born into it, and those who are down on their luck―want to get out of poverty. We want to create our own safety nets, so we never have to depend on government assistance again.”

Civil legal aid is a powerful tool. It helps people living in poverty build a foundation of stability so they can create a better future for themselves, their families, and our communities.

When Congress reconvened earlier this month, House Republicans wasted no time in attacking the Social Security program. They passed a rules package that includes language to prevent the House of Representatives from taking a commonsense, fiscally responsible action that would prevent a needless, across-the-board benefit cut of almost 20 percent.

This commonsense step is called reallocation, a simple budgetary fix that temporarily changes the share of the payroll tax dedicated to each of the Social Security trust funds—the retirement fund and the disability fund. It’s a common procedure that has helped the Social Security programs deal with temporary shortfalls in both funds 11 times in the past. The current shortfall to Disability Insurance was long-anticipated—a result of changing demographics which include aging baby boomers and women entering the workforce in greater numbers in the 70s and 80s.

Reallocation offers a sure fix that has worked time and again. That’s why leading aging and disability organizations all strongly oppose the new rule – including AARP, the National Committee to Preserve Social Security and Medicare, Social Security Works, NOSSCR (of which I am the Executive Director) and more. A group of Senators immediately responded by sending a letter to Senate Majority Leader Mitch McConnell, urging him to “forcibly reject” the House Republican rule.

“Holding hostage the Social Security benefits of any American, particularly those of the 9 million Americans with disabilities who are at risk in the coming years, is an untenable proposition.”

Congressional politicking comes at the expense of the millions of Americans who rely on the Social Security Disability program.

The truth is that this Congressional politicking comes at the expense of the millions of Americans who rely on the Social Security Disability program, established over half a century ago to serve as a vital lifeline for those with serious illnesses and disabilities.

One recent story from a beneficiary illustrates clearly how people will be affected if automatic benefit cuts kick in as a result of the House rule. Abby (name changed) was diagnosed with Type I diabetes and started requiring insulin when she was 15 years-old. Even with her health challenges, she graduated from high school and had a successful, decades-long secretarial career.

Although Abby stayed very fit, paid close attention to her diet and managed the disease for 40 years, diabetes began to interfere with her ability to work due to the onset of new complications, including episodes of extreme confusion and passing out due to hypoglycemia. As a result, Abby was no longer able to work and consequently lost her medical insurance. Despite repeated attempts to return to work, she was unable to keep her blood sugar under control.

Abby initially filed for Social Security coverage and was denied. While her case was pending, she had many more blackout episodes and made the hard decision to stop driving for safety reasons. She did not have enough money to pay for a specialist who could get her symptoms under control. She feared passing out in public and having to pay for an ambulance, so she rarely left her home. She passed out on a regular basis, waking up with no recollection of what happened or how long she’d been out.

After two years of waiting, Abby had her Social Security hearing, and, with the help of an experienced Social Security Disability attorney, she was approved for coverage. This life changing decision means that she can now get health coverage, allowing her to see a diabetic specialist. And, she can afford an insulin pump and other supplies she needs on a daily basis.

Abby worked and paid into the Social Security system for decades, and tried to keep working for as long as she could. Her story is one of millions, and shows why we need to protect the program from harmful cuts and politically motivated changes.

Congress needs to enhance and strengthen this vital program for the 11 million individuals who rely on it to help keep them out of poverty. In addition to reallocating money from the retirement and survivors’ trust fund, Congress also needs to fully fund the Social Security Administration. This will alleviate backlogs in processing claims and ensure sufficient funding for program integrity work. People like Abby shouldn’t have to wait two years for basic healthcare.

Social Security has been a hallmark of our nation’s social infrastructure for decades, and its values go well beyond dollars and cents. The program strengthens economic security and dignity for all Americans. It also provides a boost to local economies across the country. We’re calling on the new Congress to take action to preserve and fortify the program – for current and future generations – not by partisan politicking, but through sensible, commonsense reforms to support the American people. Consideration of any changes to this vital system must include the voices and views of people with disabilities as well as all Americans who may need Disability Insurance in the future.

The Question for Lawmakers Who Might Backtrack on Expanded Health Coverage: Seriously?

A Solution to America’s Devastating Retirement Shortfall

We Can Reduce Child Poverty by 60 Percent Right Now

Civil legal assistance saves money and helps people escape poverty

Related

Related

Related

Related

Get TalkPoverty In Your Inbox

Related