Have We Learned Our Lesson Yet?

By Sue Saltmarsh

It has always been a mystery to me as to why certain people living in the South seem determined to display the flag of the Confederacy on window decals, t-shirts, bumper stickers on their pick-up trucks, or, in S. Carolina’s case, in front of their state Capitol as some sort of badge of honor. Do they not know what that flag stands for? Do they not realize that they might as well be proclaiming their allegiance to racism, stupidity, and an army of losers? And why is it that the people most tied to it seem to indeed be stupid, racist losers?

As S. Carolina prepares to emerge from the burden of its dark past, I believe it serves as not just a wake-up call, but as cold water in our national face. Two weeks ago, the possibility of removing the Confederate flag from the Capitol seemed about as likely as, well, single-payer healthcare being passed unanimously overnight. But today, the impossible is becoming probable. And the “why” of that is also worth examining.

Cynics would say Governor Nikki Haley’s current stand on the issue comes from nothing more than her desire to be a candidate for Vice President. And the Republicans who’ve jumped on the bandwagon of doing “the right thing” after 150 years of the opposite are just courting the black vote, one that they know they’ll need if they’re to have any hope of surviving the 2016 election.

But I think it’s bigger than that. As President Obama has said, we’ve had too much of this. Evidence that our society is self-destructing is now perhaps too plentiful to ignore. Those of us who don’t use the First Amendment to justify hatred or the Second to justify murder are sick of it and perhaps, finally, we’re going to get off our whiney asses and DO something about it!

The deaths at Columbine, Ft. Hood, Aurora, Sandy Hook, Boston, and too many other places that the corporate media ignores may now be consecrated by the deaths of those nine churchgoers in Charleston. A symbol of the worst of human nature may now be relegated to a museum rather than elevated as if it was something to be proud of. And those who survived Dylann Roof’s sickness may not spend the rest of their lives paying the bills for the medical care they need.

The point is, we never know what the last straw will be. We never know the tipping point that will ignite a bonfire that burns away the unjust, the wrong. We can analyze, predict, and gamble on possibility, but the end result is never certain until it happens.

In September last year, no one knew that 400,000 people would come to New York from around the world to shake world leaders by the shoulders and demand they do something about climate change. And there was no one betting on the probability that those 400,000 would be the catalyst to real change, but politicians pay attention when crowds are that big and thanks to the Peoples’ Climate March, dialog has opened up and continues from the Rockefeller Fund divesting in fossil fuels, to Brazil capping carbon emissions, to the Pope asserting – as a scientist – that climate change is real and we’re responsible.

Now, as the Confederate flag droops and falls from over the S. Carolina Capitol, the NRA’s usual justifications for people like Dylann Roof to have guns in the first place are not working quite so well. Have we really had enough this time? Will the deaths of those nine victims serve to right several wrongs?

As a society, we have the right and responsibility to “stand our ground,” to protect the civilization we created, to improve it, to make it a safe, healthy, happy place for us all to live. But we must understand that “freedom” cannot be a part of that society as long as it allows corruption, hatred, fear, and violence to dominate. And we have the right and responsibility to say, “No more!” when they do.

Freedom to speak should be protected, but not if it hurts or destroys lives; bearing arms is a matter of choice except for the military and law enforcement – if you choose to have a gun, you should have to apply for a license, state your reason for wanting one, be cleared by a background check, and be limited to the type of weapon you need for your stated purpose. If you need an assault rifle to prove you’ve got the balls to walk into Wal-Mart, you also need mental health help. Roof had a handgun – imagine the destruction he could have wrought with an assault rifle.

I can’t say it any better than Aaron Sorkin said it through Will McAvoy’s explanation of why America is not the greatest country in the world:

“We used to be. We stood up for what was right. We fought for moral reasons, we passed laws, struck down laws for moral reasons. We waged wars on poverty, not poor people. We sacrificed, we cared about our neighbors, we put our money where our mouths were, and we never beat our chest. We built great big things, made ungodly technological advances, explored the universe, cured diseases, and we cultivated the world’s greatest artists and the world’s greatest economy. We reached for the stars, acted like men. We aspired to intelligence; we didn’t belittle it; it didn’t make us feel inferior. We didn’t identify ourselves by who we voted for in the last election, and we didn’t scare so easy… The first step in solving any problem is recognizing there is one. America is not the greatest country in the world anymore.”

But we could be. It takes courage to buck the trend, to challenge the status quo. Ask Bernie. And as those fighting for social justice of all kinds know, it takes time and tenacity and sometimes, loss.

The loss of lives in Charleston will become another thread in the tapestry of the United States’ journey to national adulthood. I hope it will prove to be not just a thread, but a wide, bold stripe that signifies our growing from teenage apathy, selfishness, and hubris to the adult activism, unity, and humility that will prove we’ve learned our lesson.

Posted in Uncategorized | Leave a comment

What About Us? (2014)

by Sue Saltmarsh

Hope. That’s what I’m left with as I watch MSNBC at night or the Sunday shows before football. And it’s not hope for some shining Camelot to emerge from the sewer of poverty, ignorance, violence, and hatred that dominates this country’s life today. No, it’s hope that all those talking heads are wrong, that in the seemingly infinite battle between the best and worst of two evils, the American people will prove the prognosticators wrong and, for once, vote in their own best interests.

After all, here in red downstate Illinois, there are just as many Republican farmers and business owners who are finding themselves unable to pay the inflated premiums and deductibles for health insurance for themselves or their employees as there are in blue Chicago; just as many conservative teachers struggling to make up for budget cuts by spending their own meager salaries on supplies as liberal ones; just as many people of all political stripes who are sick of the petty negative ads that have nothing to do with a candidate’s ability to do the job as there are in any other state in the union. So why shouldn’t we show up and prove that the part-time, never-take-a-vote-on-anything-important Congress we have now is NOT ACCEPTABLE?

No, I’m not saying throw them all under the bus. I’m saying get rid of the ones whose first (and sometimes only) priority is their own bank balance and setting themselves up with a lucrative lobbying job for when they finally lose their seat.

Imagine the Congress we could have if each of us A) knew who our representatives and senators are B) paid attention to how they vote and C) let them know when they did something we like or something we were opposed to. Too much work, you say? Politics doesn’t matter to you? Here are some of the things your elected officials decide “for you”:

  • How much money you make per hour
  • If you can see a doctor, dentist, or mental health provider
  • How much you pay for a train or plane ticket
  • Whether or not you’re a terrorist
  • What kind of food you eat
  • How much you pay in taxes
  • Where your kids can go to school
  • Who you can marry
  • When you can get protection from abuse, stalking, or harassment
  • If you can have access to the Internet

If everyone stopped to think about the things in that list that are important to their lives, I’d venture to say there would be plenty of Republicans who

  • start out at McDonald’s and would like to make a living wage
  • would like to be able to go to the doctor without going bankrupt
  • search Expedia, Travelocity, other travel sites, plane and train websites for the lowest fare
  • may have an Arabic-sounding last name but aren’t terrorists
  • are concerned about genetically modified or toxic food
  • gladly accept their responsibility to contribute to society by paying taxes
  • hate that their kids’ school was shut down due to budget cuts
  • are gay, lesbian, bisexual, or polygamous and would like to marry the people they love
  • live their lives in constant fear and are told that there’s nothing the police can do until they are victimized
  • can’t afford to pay for an Internet connection and/or access is limited by censorship (as in public libraries)

If voters could somehow stop caring (or even knowing?) whether it was a Democrat or a Republican who initially sponsored raising the minimum wage or excluding education as a source of “saving,” or providing healthcare for all and just asked themselves, “What’s best for me and those I care about?” we would live in a truly representative democracy.

But that’s selfish, you argue? There are always going to be people who only care about themselves and their family. But for many others “those I care about” encompasses the entire population, including people they will never know. They are the ones who keep society on the right track and we need more of them! Or maybe they just need to come out of hiding.

I have hope that before and on November 4, we WILL wake up and defeat the dirty tricks they’ve tried this time to keep us down. We’ll talk to our Republican neighbors and ask them to name what’s best about the Republican candidate over the Democrat or Independent (and thank gods there are more Independents with each election!). Find out what issues are important to them and do some campaigning yourself! Not only may you win a vote or two for the good guys (and you might even find out that yours isn’t the good one), but you’ll get to know your neighbors!

I’m no feminist for sure, but women, if you don’t get out there and vote to protect your and every other woman’s right to NOT have a child you can’t support or which threatens your own life; if you allow religious ideology as misogynistic as that of ISIS terrorists to dictate how you live your life; if you accept lower pay, sexual harassment, or domestic violence as the status quo, you deserve exactly what you vote for. There are voting records of legislators on all those issues – look yours up! Don’t know who they are? Look them up!

I am so inspired by the courage and dedication of the people who marched in the Climate March in NYC and who fill the streets in Hong Kong. I’m also encouraged by the number of actually viable candidates I’ve found from the Green party as I visit candidates’ websites for the DUH 2014 Candidates page on our website – in 2010, there was one who had a professional website with the necessary information and photos of her looking like she could hold her own among Washington politicians. This year, so far there are six (and I’m only through Missouri) who have earned DUH’s endorsement over Rs and Ds.

So I do have hope. But I’m trusting and perhaps naive enough to believe that there will be more than just a handful of single-payer activists at the Healthcare Justice March on the National Mall next summer. I guess time will tell on both fronts.

For now, realize that by sticking your head in the sand, you can only be identified by what an ass you are.

Posted in Uncategorized | Tagged , , , | Leave a comment

Citizens Divided

by Sue Saltmarsh

One of the issues that people on the Left are coalescing around is the overturn of Citizen’s United. I doubt there’s a moderate or liberal person out there who hasn’t heard the battle cries, seen the political cartoons, or listened to political candidates declare their determination to get corporate money out of our election process.

But no one is talking about the other side of the Citizens United coin – the responsibility and crucial importance of each and every one of us exercising our right to vote before that right is taken away from us.

From the very Left-leaning citizens whose blood pressure spikes along with their angry frustration at the mention of corporate personhood also come such statements as, “Vote? Oh, what’s the use? The game is rigged!” or “They have all the money and money is power – there’s no way we can win against that.” Or, perhaps worst, “Eh, if I don’t vote, somebody else will do it – I can’t change things with one little vote.”

Shame on us! We should have danced in the streets when people stood in line for hours to vote in 2012 and all but one of the big-money-supported Republicans LOST, proof undeniable that when the people are determined enough, we can beat the big money and perhaps we’re not all as stupid and malleable as those Koch brothers think. But, as is too often the case on the Left side of the fence, we didn’t celebrate and use that victory to fuel a sea change in voter attitude. So now, just two years later, instead of preparing to celebrate the Senate gaining more Democrats and the useless House coming under Democratic control, we humbly look at our shoes and concede that turnout, especially on our side, will be pitiful so of course the Senate will go red.

We have so many chances for victory if only we were as good as the Right at mobilizing our side. North Carolina women should see to it that Kay Hagan keeps her seat. Democrat Mark Pryor in Arkansas could easily be held up as a perfect example of a skilled politician representing all his constituents, not just the liberal ones – could Democratic voters make the mistake of declaring him “not liberal enough” like Republicans do with their moderate candidates or will we be smart enough to recognize that until Arkansas is “liberal enough,” Pryor is just doing his job, unlike so many other elected officials? The same could be said of Mark Begich in Alaska and Mary Landrieu of Louisiana, both of whom come from red states and who have successfully navigated the thorny path of not being able to please all of the people all of the time. But the one major one we simply cannot lose is the Kentucky race between Minority Leader Mitch McConnell and Alison Lundergan Grimes. McConnell is the guy who said the Republican job was to deny President Obama a second term. Well, we prevented that goal from being reached – now we must deny him a sixth term, which will require Kentucky voters to go to the polls. He currently leads Grimes by 5.2 points, a small enough number that turnout could change it. Kentucky people! Donate, volunteer, register, and VOTE!

In House races, incumbent Dem Jim Matheson from Utah is considered the most vulnerable, with N. Carolina’s Mike McIntyre running a close second. Since NC voters already have a good reason to come out for Kay Hagan, I hope the 7th district also shows up to re-elect McIntyre. And voters in both candidates’ districts should be donating, putting signs up, and talking to their neighbors.

In South Dakota, Democrat Corinna Robinson has practically been dismissed by Tea Party incumbent Kristi Noem, but the DCCC never spent a penny on Robinson while Noem not only had NRCC support but raised four times Robinson’s money from PACs. This could’ve been a competitive race – Robinson is a 25-year Army vet – but name recognition isn’t possible if your own party abandons the campaign before it even starts.

Same with Darrell Miller in Illinois’ 18th. He’s running against incumbent Republican narcissist Aaron Schock who loves to publish beefcake photos of himself on Instagram. Seriously? And the DCCC didn’t want to support the campaign of a former Republican farmer with truly moderate views in a mostly conservative district?

If you’re like me, you’ve been inundated with manipulative, fear-mongering demands from the DCCC for money. They even use the language of bill collectors, screaming that this is your FINAL NOTICE – before what? Are they going to turn off my water, take me to court, what? I have “unsubscribed” five times and am still getting these things daily. Even if I had any money to give, they won’t get it until they start supporting candidates that, while maybe not perfect, at least give voters a choice instead of discouraging them from voting at all since victory has already been conceded to Republicans.

So yes, let’s definitely fight to overturn Citizens United and the raft of voter suppression laws that the Supreme Court’s ideologues are violating our constitution with. But let’s also remember that WE have the last word if we’ll only get our heads out of the sand and realize that politics DOES matter, that the multiple domino effects that we set off by not voting can be destructively dangerous to those of us who want a society that is civilized, fair, just, healthy, innovative, and happy.

There is always going to be corruption among the “powerful.” There’s always going to be bad behavior, violence, and hatred. It’s naïve to deny those squalid aspects of human nature. But they don’t have to be the dominant way of life and we’re the ones who decide what we as a society will not accept. It’s high time we decided that it’s unacceptable both to allow corporations to control our government and to shirk our responsibility as citizens of a democracy to participate fully in the democratic process.

Turn the channel away from the so-called “reality TV” that just caters to the worst of what we’ve become and watch CNN or PBS or MSNBC long enough to see footage of the people in Hong Kong pouring into the streets and demanding what we already have. Do you think any among those defying their Communist government will fail to vote once they win the right to free elections?

The United States is the teenage bully on the field with the world’s older, wiser nations. While they play soccer with no protective gear necessary, we play smash-mouth football and end up brain-damaged (though I do love smash-mouth football!). We may have been “the greatest country in the world” at one point, but the last 12 years have ensured that we’re a long way from it now. There is no president, certainly not one who is the target of racism and irrational hatred, who could begin to fix all the wrongs we’ve allowed and perpetuated through our apathy. There is no Majority Leader or Speaker of the House or elected official of any title who can single-handedly change things. WE are the “crisis in leadership,” we recuse ourselves from the responsibility of creating the government and the country we want with each decision not to get involved, not to know what the three branches of government are or who our representatives are or what Congressional district we live in. “It’s too haaard,” we whine. And before you accuse me of being unpatriotic, ask yourself who is the strongest all – the one who repeats platitudes and tells you what you want to hear or the one who tells you the truth, no matter how hard, inconvenient, or ugly?

So go back to watching Duck Dynasty or The Bachelor from Hell or whatever TV show you think is showing you good examples of what you should do, think, say, and be. But set the alarm for November 4, because we need to WAKE UP!

Posted in Uncategorized | Tagged , , , , | 1 Comment

Standing Up for Aaron

In my failed attempt to find some, ANY, coverage of the People’s Climate March by mainstream media (yes, even MSNBC), I unfortunately clicked on a tantrum Melissa Harris-Perry was having against Aaron Sorkin. I have previously expressed my awe for the man’s breathtaking, prescient writing, so it will come as no surprise that upon hearing the Harris-Perry soft sibilant in “Sorkin” uttered in her little-mean-girl tone, my hackles went up. Nobody messes with my Aaron.

It has become absurdly taboo for white people to stand up for each other, especially when there’s a black person involved, so fair warning – I’m not ashamed to be doing just that. When Harris-Perry first got her show on MSNBC, I was a fan. I respected her seeming unbiased, honest discourse, the interesting guests (of all races) she had, and her willingness to let us viewers know her as a person more than most talking heads.

But then, ironically, she got pissed. Maybe it was the national obsession with Trayvon Martin, the tragedy in Ferguson, MO, or the domestic violence scandal in professional football, but whatever the reason, I suddenly felt “too white” to watch her show.

I say “ironically” because her rant about Sorkin was that he creates angry white men characters, like Will McAvoy of The Newsroom or Toby Zeigler of The West Wing, though her ability to perceive character development is flawed there, since Toby is not so much angry as he is sad. In any case, Harris-Perry evidently never learned the first rule of effective writing – write what you know. Aaron IS an angry white man, or at least he has been, and who is she to criticize him anyway? What award-winning movies or TV shows has she written lately? And if she’d written any, would they be filled with angry black women or would she write about angry white men?

The things that Sorkin’s multi-dimensional characters are angry about are things everyone should be angry about. There were plenty of white people marching in “hoodies” over Martin – though no one of any color marched for white 10-year-old Tiffany Long, brutally raped and killed by three black teens. There was abundant media outrage over the killing of Michael Brown by white cop Darren Wilson – though the Salt Lake City killing of white, unarmed, 20-year-old Dillon Taylor by a black cop (whose name has not yet been released, though the killing happened on August 11) got minimal mention in local media. Shouldn’t we all be angry over the murder of any fellow human? But I digress.

As for her purposely accented wish that Sorkin’s angry white men would meet up with some angry black women, she evidently didn’t watch the show enough to see National Security Advisor Nancy McNally (played by Anna Deveare Smith) hold her own in the Situation Room. Sure, there aren’t many black women, or men for that matter, in Sorkin’s work, but as much as Harris-Perry would like to see as many blacks, Asians, Latinos, Native Americans, and other representatives of the variety of colors human beings can be as there are whites, reality is that there just aren’t an equal number, especially in Washington.

But if you look at Sorkin’s black characters, you see people with intelligence, integrity, confidence, authority, and the respect of their colleagues. Even Charlie, who could have been rejected because of the “optics” of “a young black man carrying the president’s luggage or opening doors for him,” proves on his first day to be someone the president trusts and respects.

Sorkin does not write the stereotype-perpetuating, low-expectation characters of Tyler Perry movies or shows like Sanford & Son or What’s Happening. And maybe that’s the problem. Sorkin’s characters aren’t stuck in poverty or the ghetto. They’ve gotten out. They are more equal in their “white world” than residents of urban housing projects are in their gang-dominated world. They speak, as Harris-Perry does herself most of the time, in articulate, correct English. They dress well, as MHP does, and carry themselves with confidence and dignity. They don’t have to try to be strong or to earn respect – they already just are strong and respected. But maybe MHP is like the black people who said they wouldn’t vote for Obama because they “knew it would never happen” – breaking out of the victimhood mentality requires optimism.

Maybe she’s just jealous – I doubt she’ll ever have three Emmys, a Golden Globe, and an Oscar among the many other awards sitting in a trophy case.

Whatever her motivation, she needs to keep her scornful, soft sibilants away from Aaron Sorkin and pick on Shonda Rhimes who writes Scandal, a show that was hyped as presenting a strong, powerful black woman as its lead and which seems to have become (from previews I’ve seen – I admit I don’t watch it) just another pathetic soap opera to placate the lowest common denominator. The idea that Olivia Pope is a fitting role model is perhaps one of the reasons that bad behavior has become the norm.

It’s been one of my greatest frustrations that I haven’t been able to watch Newsroom – I can’t afford HBO – but when it finally comes out on Netflix, I will turn off the lights and my phone and settle in with my laptop to binge-watch all three seasons, joyfully luxuriating in “Sorkin-ese.” In the meantime, I won’t be tuning in to MHP – I’m an angry white woman.

Posted in Uncategorized | Leave a comment

Transcending Greed

“Transcending” Obamacare? Seriously? Perhaps Avik Roy’s article in the National Review may be a leak of the Republican strategy for backpedaling on their “Repeal and Replace” plan for destroying the ACA. Perhaps they finally began to hear the cries of, “Replace it with WHAT?” that came from every direction. Continue reading

Posted in Uncategorized | Tagged , , , , , | Leave a comment

Now What?

by Sue Saltmarsh

“Despite several lost weeks out of the gate because of problems with the website, 7.1 million Americans have now signed up for private insurance through these marketplaces,” the president said in the Rose Garden on April 1.

317,792,123 million people live in the United States as of 4:12 pm CDT on April 1st and that’s no joke. Of course, many of them, including the two that were born as I typed this sentence, are infants and children, not alive long enough to even know what health insurance is, let alone know that they qualify for Medicaid or a subsidy, being unemployed and all. But, then, their loving parents will surely buy health insurance for them, right? And even if that insurance carries such high deductibles and co-payments and co-insurance that they dare not take their feverish kid to the doctor, there are places that take care of kids for free, right?

On the other end of the spectrum are the seniors, retired if they ever worked, most of them sicker and poorer than they ever thought they’d be when they paid month after month into their pension fund only to find it was non-existent when they finally retired, after age 65 because they couldn’t afford to quit. Many more are postponing doctor visits or refilling their prescriptions because Medicare doesn’t cover everything 100% and they can’t afford a “supplemental.”

And in the middle somewhere are people who get their insurance through their employer, millionaires and billionaires who can afford to pay for “Cadillac” policies, and those 7.1 million who don’t get insurance through their employer, who previously were denied because of pre-existing conditions, for whom insurance was nothing but a luxury for rich people or they didn’t need it anyway because they were young and healthy and intended to stay that way. So now they have insurance, whether they want it or not. But they do not have health care.

What happens to them if they have complicated chronic conditions that require specific medications that aren’t included on the formulary of their plan? What happens when the specialist they’ve seen for five years, who knows their history and whom they trust is not included in the network of providers for their plan? What happens if they go on vacation somewhere “out of network” and need an emergency appendectomy? What happens when the $250 premium they can just scrape together now turns into $500 next year?

You see? Health insurance is not the same as health care. Sure, there are going to be many people with nothing but good things to say about the ACA – obviously, if they can afford the premiums, deductibles, co-pays, and lack of complete coverage, it’s great and they will certainly be grateful for it. But for those of us who make “too much” to qualify for subsidies and too little to pay for even just the premiums, it’s nothing but throwing our hard-earned money away on something we’ve been forced by the law to buy and getting precious little in return.

I listened, incredulous, as President Obama took his “victory lap” in the Rose Garden on April fool’s Day—perhaps a foreshadowing of what is to come. I heard him actually say, “It is making sure that we are not the only advanced country on Earth that doesn’t make sure everybody has basic health care.” Could he seriously believe that? What about the millions who live in states that refuse to expand Medicaid, who have no hope of being able to afford exchange plans? What about the millions who were always going to remain uninsured? What about the underinsured? Healthcare is no more a human right in this country than is a woman’s right to have a safe, legal abortion in Texas.

I heard him ask, “Why are folks working so hard for people not to have health insurance?  Why are they so mad about the idea of folks having health insurance?” and I responded to my TV, “You’re wrong, Mr. President. We’re not working for people not to have insurance – we’re working for people to have health care. We’re not mad about the idea of folks having health insurance – we’re outraged at the fact that even with insurance, people still do not get the care and treatment they need because they can’t afford the deductibles, co-pays, and co-insurance.

I know the handlers are telling him, “No matter how bad it gets, do not waver from your statements of confidence, optimism, and insistence that it’s working!” But oh how wonderful it would be to have a president who realizes that most people live by the common sense rule that when you fuck up, you own up, and you work to make it right. I get the feeling that a President Biden would do so. So might a President Christie, though “Bridgegate” has given him an opportunity that he’s squandered so far.

Imagine what a relief it would be to hear, “I apologize to the American people. I’ve tried and tried to make this work, but it’s time to go back to the drawing board. Too many of you are suffering without the care and treatment you need and too many of you are still going bankrupt. I don’t know if I have time to get a more comprehensive, fair reform passed, but I’ll do my best to lay the groundwork for the next president if you’ll vote for the one who’s most likely to see it through.”

Imagine the stunned silence from the Wrong Right, at least for a day or two. Imagine the panic among those who are puppets of the medical industrial complex. Imagine the re-energization of the Democratic base. But best of all, imagine no one ever again having to choose between medical care and food, housing, transportation, childcare, or water and electricity. Imagine.

Posted in Uncategorized | Tagged , | Leave a comment

Unfulfilled Promises

by Sue Saltmarsh

As the flaws of the ACA become easier to see (and harder to live with), there seems to be a need for some perspective. Admittedly, my perspective is not unbiased. As I listen to the stories of my HIV-positive colleagues and my cancer-fighting friends, as I struggle with being trapped in my job because of the insurance, as more and more people sign up for the DUH Facebook group or volunteer to help with a DUH event, it seems crucial to me that the truth, not spin, must be available to those willing to learn it.

There are so many little details of the language of the ACA that we will never know about, let alone the additions, deletions, and changes that are made to it along the way. But there is a fair amount of information available about things that affect us “average” Americans. Below are some of the things you should know – things will keep changing so this is not complete. You can always find out more by scouring the Internet—stay away from healthcare.gov and go instead to the Kaiser Family Foundation or the American Public Health Association, among others, or just Google “ACA implementation news” and see what you get.

The point is that, just like with any disease or condition you may have, knowledge is power. The more you know, the less likely you are to agree to a faulty treatment plan or a worthless insurance plan. So behold, Grasshopper, read and increase your power!

Provisions not in effect

Grants to establish wellness programs – This would have provided grants for up to five years to small employers that establish wellness programs. But then the Prevention and Public Health Fund was destroyed.

Medicare Independent Payment Advisory Board – This was to establish an Independent Payment Advisory Board (IPAB), comprised of 15 members, to submit legislative proposals to reduce the per capita rate of growth in Medicare spending. Republicans blocked it.

Financial Disclosure – Requires disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies.

The Center for Medicare & Medicaid Services (CMS) issued a proposed rule on December 19, 2011 and a final rule on February 8, 2013. The final rule delayed the start of the initial data collection period from January 1, 2013 to August 1, 2013 and the initial report to the Secretary of the Department of Health and Human Services to March 31, 2014 (from March 31, 2013). If you don’t have the data, you can’t disclose it. Hmmm…I’ll be watching to see if that report actually does land on Kathleen Sebelius’ desk on the 31st.

Medicaid Disproportionate Share Hospital Payments – Reduces states’ Medicaid Disproportionate Share Hospital (DSH) allotments based on the theory that the Medicaid expansion would result in more people becoming insured. Guess again!

The President’s recent budget proposal calls for an additional $3.26 billion in cuts to Medicaid disproportionate share hospital payments. Under the ACA, Medicaid DSH payments were supposed to be cut by $18.1 billion from 2014 to 2020. However, the Bipartisan Budget Act of 2013 delayed some of those cuts and extended the duration of payment reductions through FY 2023.

Medicaid Expansion – The original law requiring states to expand Medicaid to cover those making up to 138% of FPL, including childless adults, was a major part of increasing the number of insured people. The cost of the expansion was to be paid 100% by the federal government for the first three years. The Supreme Court ruled in 2012 that instead of the expansion being mandatory, each state could decide for itself whether or not it would accept the extra money and expand Medicaid.

As of March 7, 25 states and D.C. have chosen to expand Medicaid. The others—mostly Republican-controlled—have either refused or haven’t decided yet. All of the Southern states with the highest populations of working poor, black, Latino, or unemployed residents have refused to expand.

A study by the Kaiser Family Foundation describes how those vulnerable groups are affected by the lack of expansion.

Provisions delayed

Out-of-Pocket Spending Cap

Supposed to go into effect January 1 of this year, the Department of Labor has delayed the consumer protection cap on out-of-pocket expenses. The ACA capped annual out-of-pocket expenses at $6,350 for an individual and $12,700 for a family. Now, the cap will not take effect until 2015. This means that consumers may pay more out-of-pocket than expected in 2014 and perhaps beyond.

And while some may think the delay might mean that premiums won’t increase as fast, the delay gives insurance companies a whole year to jack up the premiums before the cap is in effect. That’s IF the cap is ever in effect. I predict that we’ll never see it back in full effect.

Employer Mandate

The Treasury Department pushed back a provision requiring businesses with more than 50 employees to provide health insurance to their full-time employees and their dependents. Companies failing to do so would pay a penalty. This part of the ACA, called the “employer mandate,” was to take effect January 1, 2014. Employers’ complaints about the cost to their bottom line have led to a delay until January 2015.

In addition, on February 10, the Treasury Department released a final rule regarding the Employer Mandate. Some employers will now have more time before they have to offer insurance to their full-time workforce.

The new rule stipulates that employers with 50-99 workers will have until 2016 to comply with the mandate. For businesses with 100 or more workers, the mandate will now take effect more gradually. Employers will have to prove they offer coverage to at least 70% of their full-time workers or face a penalty in 2015. They now have until 2016 to provide coverage to all 95% of full-time employees required under the initial regulations.

Under the new rule, volunteers do not count as employees, so they do not count against the full-time workforce. All you volunteer firemen out there, you’re SOL – but it’s not like fighting fires might lead to medical problems, riiight?

The ACA defines full-time as at least 30 hours per week. Since the mandate will not take effect in 2014, there is no reason to cut employee hours to avoid it. There is no employer mandate for part-time employees working less than 30 hours per week. Which is why some employers will wriggle out of the mandate by only hiring part-time employees.

Again, I predict that none of these employer mandate “delays” will result in any of these provisions being restored. Business will get what it wants because their demand will be relentless. The individual mandate which hits the healthy, young working poor harder than any business could be hit remains in place, though Congress is set to vote on delaying or repealing it and there’s bipartisan support for doing so.

Small Business Health Options Program Delay

The Department of Health and Human Services has delayed part of the Small Business Health Options Program (SHOP) until at least 2015. SHOP is the online insurance marketplace, or exchange, for small businesses. Employees of small business were supposed to have a choice of health plans through the small business marketplace in 2014. This delay means that small businesses using the SHOP will choose a single plan for all their employees in 2014.

Keep Your Plan

By now an infamous mistake, President Obama told us that if we had a plan we liked, we could keep it. But evidently, many of us liked plans that didn’t meet even the minimum requirements of the ACA’s insurance exchange plans. In other words, if you were young and invincible, you could pay your $50 a month for a “catastrophic” plan with a $15,000 deductible, never go to the doctor, and know that if you were hit by a bus, you’d only have to pay 30% of the medical bills. Why pay almost 10% of your too-high-for-a-subsidy-too-low-for-premiums income for stuff you didn’t need? In March, it was announced that the “fix” to that (allowing people to keep their inferior plans) would be extended to the end of the Obama presidency.

Insurers’ Escape Routes

Back in 2010 when the ACA first began to go into effect, I predicted that the most meaningful of its provisions would somehow be avoided by insurance companies. It seems I was right, though I wish I wasn’t.

No child uncovered – First there was the provision that no child with a pre-existing condition could be denied coverage. Lo and behold, on the day after that went into effect, nine major insurance companies “suddenly” decided not to sell any children’s policies. The ones that did stay in the business of covering sick kids, could then justify exorbitant premiums, deductibles, and co-pays to the parents who naively thought the “coverage” they were finally able to get equaled the care their child needed.

No more pre-existing conditions – As of January 1, no one with a pre-existing condition can be denied coverage. What they can be denied, however, is access to the medications they need and the specialists they see. On January 2, the practice of “lemon-dropping” began to replace the former “cherry-picking.” While people with HIV, cancer, diabetes, and acne were certainly not turned away, they began to find that if there was more than one company offering plans on the exchange, the one they chose might have a drug formulary where expensive HIV, cancer, or other costly drugs weren’t listed. But, oh, don’t worry, that other company (with a more expensive plan) includes those drugs, though you might have to take multiple generic pills instead of brand name co-formulations.

Free preventive care – This seemed like a no-brainer. Catching potentially catastrophic conditions when treatment would be faster, easier, more successful, and cheaper than at later stages would be good for everybody, patients, providers, and profiteers alike. But it seems the insurance companies didn’t even want to pay for exams and screenings. A friend who recently got a mammogram after becoming aware of her cancer risk found that because the doctor’s office didn’t “code” the test as preventative, her insurance refused to pay. Ask your providers to make sure they code the preventive tests the right way!

Keep your doctor(s) – Upon finding a plan that covered the necessary medication, people would look to see if their trusted provider(s) were in that plan’s network. Uh-oh, sorry, no HIV specialists, no diabetic dieticians, only two oncologists located in a sketchy part of town and affiliated only with the public hospital. But look! The platinum plan includes all your drugs and two of the three doctors you already see. So, much as in the sub-prime mortgage crisis, someone who can’t even afford a bronze plan is funneled into a plan they have no hope of paying for. Only this time, bankruptcy may also come with death instead of “just” homelessness.

Implemented Fully

Kids under 26 can stay on their parents’ policies – Yep, this one works.

Individual mandate – Once again, business gets the break, while people have to pay the price. Having seen the amount I’d have to pay just in premiums and deductible for insurance that would do me no good, I’d much rather pay the $95 penalty and have money for food. But that’s just me.

The sum of the parts

So the truth is that we’ve gone through years of “debate,” almost 50 attempts to repeal, a truckload of propaganda and we’re left with being forced to pay through the nose for insurance that does not provide care, as well as 25-year-old kids who lose their insurance on their birthday…if we have kids at all. How stupid are we?? If ever there was a DUH moment, this is it!

Posted in Uncategorized | Leave a comment