But as Republican lawmakers continue to stoke outrage over the people who have been harmed by Obamacare’s troubled rollout — the people who are still struggling to sign up for coverage on the exchange websites, and more recently, the people who are receiving cancellation notices from their insurance companies — there is one obvious point of comparison. It doesn’t have anything to do with the political career of the sitting president, though. It has to do with the privilege that continues to dominate the United States’ political priorities.
It’s about who is worth rescuing.
After the embarrassingly slow federal response to Hurricane Katrina left thousands of people stranded on rooftops and in overcrowded shelters, the victims pointed out that it might have had something to do with race. The people in power may not have prioritized the needs of the poor, black people in New Orleans above all the other things that demanded their attention. That lack of attention may reveal itself not just in the immediate aftermath of the hurricane, but also in the decades of policy that shaped New Orleans’ urban infrastructure and safety net system. Kanye West distilled this attitude into one infamous line that sparked a widespread conversation about enduring racial tensions in America: “George Bush doesn’t care about black people.”
Obviously, the issues spawned by Katrina aren’t really about one man’s personal feelings about African Americans. But they do speak to some version of that concept writ large. At the heart of Kanye’s outburst is a legitimate question about the collective group of men who set the political priorities in our country, and whether those privileged people are using their power to serve historically disadvantaged communities with relatively little political capital.
If we return to Obamacare’s rollout, the current political environment suggests the answer to that question is no.
The beginning of the open enrollment period for Obamacare’s health insurance exchanges has been decried as an absolute disaster. HealthCare.gov, the national website intended to allow Americans to sign up for plans offered in the new state-level insurance exchanges, has been so glitchy that it’s prevented many people from completing the enrollment process. It’s not exactly a great start for the roll-out of a new policy that aims to expand access to health care to millions of people who don’t currently have it.
To make matters worse, Obamacare isn’t being fully implemented across every state. The law was designed to extend coverage to the uninsured in two major ways: Through the new state-level exchanges, which will offer federal subsidies to help Americans buy private insurance, and through an expansion of the Medicaid program, which will increase the number of Americans eligible for public insurance. But the Supreme Court ruled that the Medicaid expansion should be optional. All of a sudden, the policy intended to insure some of the most economically disadvantaged people in the nation was transformed into a political tool. Intent on resisting Obamacare at every turn, Republican legislators in over 20 states have refused to expand Medicaid, leaving many of their low-income residents with no good options. Just this Friday, Alaska became the latest state to turn it down.
According to the Kaiser Family Foundation, about five million poor Americans will have no access to basic health benefits under Obamacare because they fall into a “coverage gap” created by this fight over Medicaid. Without expansion, they make too much money to qualify for their state’s Medicaid program, but too little money to qualify for subsidies on the individual market. They’re left out of Obamacare altogether. A New York Times analysis estimated that number to be a little higher, concluding that 8 million low-income people will be locked out of health reform.
This group includes much of America’s working poor who struggle to make ends meet with their jobs in the service sector. It consists of thousands of cooks, janitors, nurses’ aides, truck drivers, and waiters. And just like in the aftermath of Hurricane Katrina, many of the people left behind are the poor, black Americans who live in the South.
“Blacks are disproportionately affected, largely because more of them are poor and living in Southern states,” the New York Times reported last month. “In all, 6 out of 10 blacks live in the states not expanding Medicaid.”
Millions of people locked out of Obamacare? Hardworking Americans struggling to get by who can’t realize the promise of affordable health coverage? That seems like a political scandal. But the main focus of the political and media outrage over Obamacare’s troubled rollout hasn’t really focused on those people. As a whole, the political system isn’t incredibly worried about the fact that low-income and uninsured Americans — the people without much political influence to begin with — are victims of a partisan divide over the health law.
Instead, the current discussion is centered on a relatively small group of people who do currently have insurance, but whose plans don’t meet the minimum standard for benefit requirements put forth by the health reform law. Those people are receiving notices that their insurance plans are being canceled and they must purchase a new plan under Obamacare, one that will include the full range of consumer protections that the law now requires insurers to provide. If the United States is poised to shift to a system that doesn’t put insurance profits above all else — and therefore leave behind an old system that charged sicker Americans more than healthier ones, locked out people with pre-existing conditions, and offered no guarantees that coverage would be affordable or comprehensive — it’s an unavoidable aspect of reform.
Nonetheless, the people receiving cancellation notices aren’t exactly pleased about this development. They want to keep their current insurance, and they feel like the president misled them when he repeatedly assured Americans that Obamacare won’t force people to switch plans. Republicans, who have staunchly opposed the effort to extend insurance coverage to millions of underprivileged and uninsured Americans for the past three years, are all too happy to take up their cause.
GOP lawmakers are outraged about the “Obamacare victims,” the people who are supposedly being penalized by a health law that doesn’t take their needs into account. In a dramatic video uploaded by House Majority Leader Eric Cantor (R-VA) on Friday, Republicans aren’t mincing words about the moral obligation to protect these Americans. “This is about real people in our districts who are being harmed by Obamacare,” Rep. Andy Barr (R-KY) said. Cantor urged his colleagues to “put their constituents above politics.”
These victims look very different than the cooks and cashiers who don’t qualify for Medicaid in red states. In Cantor’s video, as lawmakers hold up photos of these families on the House floor to illustrate their point, it’s a sea of white faces. These people aren’t the working poor; they’re small business owners, architects, psychotherapists, even members of Congress. And many times, even though they’re labeled as “victims,” they’re not actually upset about the new coverage they can get under Obamacare. They still have some good options available to them under health reform.
At the beginning of this month, the New York Times’ editorial board published an exasperated piece pointing out that the “overblown controversy” has “obscured the crux of what health care reform is trying to do.”
Nonetheless, the political scandal over the Americans losing their current health plans reached a fever pitch this week. Republican lawmakers rushed to come up with several different policy “fixes” to preserve those people’s access to their existing coverage, and their proposals are winning the support of a growing number of Democrats. The Obama administration released a new administrative rule to slightly tweak the health law, essentially a concession to the growing concerns on both sides of the aisle.
Meanwhile, the low-income Americans who are arguably the real victims of Obamacare’s rollout, the people who will continue to live in a country that does not provide any path to health coverage, haven’t gotten congressional hearings and several pieces of legislation in their names. They haven’t gotten a “fix.” No one is clamoring to rescue them. The administration did work to exempt them from the individual mandate — but that move didn’t actually address the fact that they don’t have access to affordable insurance. It simply ensured they won’t be dealt an additional financial blow because of their lawmakers’ decision to deny them Medicaid coverage.
President Obama, who is not blind to many of the aspects of privilege that Kanye West accused his predecessor of overlooking, does talk about these people a lot. He has consistently urged Republican lawmakers to accept the generous federal funding to expand Medicaid. He has criticized them for failing to do so. He continues to press them on the issue; last week, Obama asked Gov. Rick Perry (R-TX), who heads a state with one of the highest rates of uninsurance in the nation, to “not deny people healthcare because of ideology.”
But the political outrage machine — driven by powerful players with access to media platforms, as well as the lawmakers elected mainly by people who are privileged enough to avoid being disenfranchised by our voting system — hasn’t really listened. It’s perhaps not very surprising. When it comes to civic participation and political voice, our country has a long history of inequality. It’s easier for economically advantaged people to enter into our systems and make their voices heard, therefore driving the country in the direction that most benefits them. It’s much more difficult, on the other hand, for underprivileged populations to organize, vote, and exert the same kind of influence in the political sphere. That’s what allows less fortunate people to be left behind.
At a very basic level, the middle-class small business owner who received a cancellation letter from his insurer is likely to have some media savvy, and he’ll be able to leverage his skills to contact reporters to tell his story. He’ll believe his story is worth telling. But the single mother who’s working two part-time jobs in Louisiana and still doesn’t qualify for Medicaid probably hasn’t had enough time to keep up with the raging Obamacare debate, let alone feel like she has a voice in it. She’s not launching a campaign to get on Fox News, and they’re not calling her, either.
If we must draw comparisons between Obamacare and previous national disasters, consider this one. As a collective society, we still haven’t really learned the lessons of Hurricane Katrina — but not because of a broken website or a broken promise about keeping your plan. We haven’t figured out how to prioritize that Louisiana mother’s life.