Minnesota and New York are getting to the levels of universal coverage that most European nations have. They are tweaking their systems and prepping waiver requests to extend coverage to currently excluded populations and improve affordability.
We get graphs like the following:
MN Uninsurance at 4.3%-Lowest ever! @kenneygm @larry_levitt @larryrjacobs @publichealthumn https://t.co/O35K66lET9 pic.twitter.com/t8nzrFAKRR
— LynnBlewett (@LynnBlewett) February 29, 2016
And then we have Texas (via the Texas Tribune)
For the first time in more than a decade, Texas’ uninsured rate dipped below 20 percent, analysts said Wednesday following the release of U.S. Census data.
Slightly more than 5 million Texans were uninsured in 2014 — a 700,000 decrease from the year before. That represented a 3-point dip in the percentage of Texans without health insurance, to 19 percent — the largest gain in health care coverage in Texas since 1999, according to the left-leaning Center for Public Policy Priorities….
the Census sampling, known as the American Community Survey, lends new credibility to earlier claims that Texas continues to lead the nation in the raw number — and rate — of people without health insurance.
We have a framework that can reduce the ranks of the uninsured to near OECD (Organization of Economic Cooperation and Development — the industrialized countries of the world) standards. It can be implemented and it can work. It mainly requires political elites to give a shit.
Roger Moore
I think you’re doing the Republicans a grave disservice. They aren’t indifferent to people going without insurance; they actively support it.
Cermet
But they need to see people dying in the streets in order to feel loved by the great stupid masses called THUG VOTERS … .
JPL
@Cermet: That’s when they passed EMTALA, which all of us are still paying for.
C.V. Danes
Indeed. And which of these elites do the good people of Texas predictably vote for? The ones who have achieved 4.3%, or the ones who are calling a drop to 20% a good deal because the government is evil?
agorabum
I get angry with all the people who have decided to attack Obama for not magically transforming the country, when all he had was a two year window that had to accommodate a lot of Blue-dog conservative Dems. When despite that headwind, if he hadn’t faced constant sabotage – and if Republican elites actually cared about helping people – we could have an uninsured rate at 4%.
You say you want a revolution? Well, you know, we’re all doing what we can.
Poopyman
@Roger Moore: I think the term “political elites” is doing a lot of work in that sentence, especially when referring to Texas politicians (e.g. Louie Gohmert, Raph Cruz, et al). “Elected officials” might be a better term.
Brachiator
But. But. I heard Terrible Cruz say on one of the Sunday shows that socialized medicine is bad, and must be stopped.
Cacti
Obligatory:
Public option! Single payer! He didn’t even try!
Redshift
Richard, if appreciate it if you could write something about Medicaid in KY. Wingnuts in Virginia are making hay over the fact that Medicaid in neighboring Kentucky is running a budget deficit, and of course it’s all the fault of Obamacare and proves it would be a disaster if we enacted it in Virginia.
I’m pretty sure from what I’d read earlier that Medicaid costs were expected to go up, but would be more than offset by other state health expenses going down. However, since those are more diffuse and many of them are not separate budget items, it makes it easy to BS on the subject (or be willfully misinformed, for those who aren’t smart enough to BS.) I wouldn’t mind having a clearer picture, though.
Mnemosyne
@JPL:
I sometimes wonder if they passed EMTALA knowing that it would disguise the bad side effects of our for-profit system, or if that was just a happy accident. Since I think Congress was solidly Democratic at that point, I’m assuming it was an unforeseen side effect, but it’s been a very harmful one.
Matt McIrvin
I was in an interesting argument recently on Google+ over contraception; someone mentioned that contraception was essentially free in First World countries today, and I argued that birth control pills could actually be prohibitively expensive for poor American women. Another commenter, an American conservative, spoke up and said that this was silly, since anyone so poor that they couldn’t afford $30 a month for birth-control pills would be on government-supplied healthcare anyway.
That didn’t sound right to me. I looked it up, and confirmed that in nearly all of the non-Medicaid-expansion states, childless adults poor enough to land in the Medicaid hole get $0 of government-supplied health coverage.
But I think many people actually don’t know this. They just assume that poor people are already getting all kinds of handouts.
MomSense
@agorabum:
And instead of fomenting disappointment against the President and the Democratic Party when so much is at stake, we could all be pushing for closing the Medicaid Gap in states like Texas. This would get help to people who need it right away.
Jeffro
Hey, whoa Whoa WHOA there, young man…I suppose you’d like a pony too?
Patricia Kayden
“It mainly requires political elites to give a shit.”
It also requires voters to vote only for politicians who care about their constituents’ healthcare access.
gene108
@Mnemosyne:
I think it was mostly trying to solve an immediate problem.
The problem with the U.S. healthcare system is that until recently people with employer based coverage had pretty good coverage; the insurance paid for damn near everything with very little out of pocket.
And most people had (and have) employer based coverage.
Trying to get them to give up something that was pretty good, while you had it, for something unknown has always been a tough sell.
Uninsured individuals are still a small, but substantial, portion of the population, so you have to convince people to get beyond IGMFY to get them to care about the less fortunate.
Richard Mayhew
@gene108: I would modify your very astute comment just slightly:
And most
peoplevoters had (and have) employer based coverage…..chris9059
“Minnesota and New York are getting to the levels of universal coverage that most European nations have.”
What they don’t have is a level of actual healthcare provided that is anywhere near what most European nations have, and until we abandon this nonsensical idea of”skin in the game” and get rid of deductibles and co-insurance we never will.
the Conster, la Citoyenne
@Matt McIrvin:
Poor people of color, and that’s the attitude that which explains why we can’t have nice socialist things, and why Bernie would lose 45 states when everyone starts to understand how his programs would work, and be paid for.
OzarkHillbilly
Obviously this is the end of America.
piratedan
@Patricia Kayden: but Patricia, we’re busy having the media tell us what is REALLY important, like is Ted Cruz really a Canadian and how high the immigration barrier wall will be and how Hillary Clinton is evil personified for using the same methodology for handling her e-mails like her predecessors. Besides, the GOP said that they would replace the ACA with something bigger and better and yuuger than Obamacare, they’ve had six years and I’m sure that it’s almost ready, promise! It’s sitting there with the secret paperwork regarding the fast response navy seal team that was stood down at Benghazi and Saddam’s super secret nuclear arms programs.
cmorenc
@Roger Moore:
Not just that – Trump, Rubio, and Cruz are explicitly promising to dismantle the structure that has made such reductions in the uninsured population possible, without any concrete or specific proposals to replace it beyond selling junk insurance policies across state lines and health savings accounts. Absolutely NO proposals to maintain insurability with existing conditions or how to pay for the sicker portions of the patient population – the actual unstated premise is that those who cannot afford adequate insurance don’t deserve to get health insurance.
mdblanche
Minnesota and New York, you say?
Snarkworth, short-fingered Bulgarian
Richard, some of your stupider readers (looks in mirrors) aren’t familiar with all acronyms. I hope the ranks of the uninsured soon match the standards of the Ottoman Empire Camel Distributors.
Skippy-san
Great points but I still live with people who think they are paying for other people to eat bacon. So many Americans don’t understand the facts they way they are-and have the balls to say “Health Care is not a right”.
I hate them.
Ruckus
@gene108:
The problem with the U.S. healthcare system is that until recently people with employer based coverage had pretty good coverage; the insurance paid for damn near everything with very little out of pocket.
My disbelief of this comes from personal experience. Work for a medium sized company in OH that had good health care insurance till 2000. At that time we were told that our insurance company (and all others for that matter) would no longer sell us the what we had been getting, no copays, $200/yr deductible, extremely good coverage (my laser eye surgery was paid for – doc said only 2 companies in OH had that), even if the company wanted to pay the cost difference. We went to copays, a higher deductible, and much less coverage and a higher cost to us and the company. Yes we had insurance but it was dramatically less useful and cost a hell of a lot more. The insurance companies had been trying to get the company to change over for a number of years and the only way they could was to just not sell that product. Now as Richard would probably say, such a narrowly aimed product would probably lose money hand over fist so it is understandable but it had been profitable until enough companies were convinced to move to reducing their costs by screwing their employees. So my point is that crappy employer provided insurance has been around for a number of years and the push to make it that way was around for even longer. And I also know this as I used to pay for group health insurance for my employees decades ago and the process was just as fucked up then as it is now. And as it was not mandatory for employers to provide, there really was a huge percentage of uncovered people.
Richard Mayhew
@Snarkworth, short-fingered Bulgarian: Updated :)
Snarkworth, short-fingered Bulgarian
@Richard Mayhew: Thanks, Richard!
Skippy-san
I was admitted to a German hospital in November. I just got my bill for a 4 day stay. It was well, well below what a US hospital would have charged.
And yet, when I posted this article I got this.
Mnemosyne
@Skippy-san:
I still wonder where these mythical grocery stores that let you buy anything you want with food stamps are located. At the one I go to, they had to send someone to get a package of Monterey Jack cheese for a WIC customer because the pepper jack cheese she had in her cart was not eligible.
I’m assuming part of the confusion is that I’ve seen people with food stamps separate things into eligible and non-eligible transactions, so they use food stamps for the eligible items and use another form of payment for the non-eligible stuff. But, of course, finding that out requires actually paying attention to what people are doing and not just making stupid assumptions.
Gerald
Yeah …what Snarkworth said!!!!
What do those acronyms mean????
OECD
Also …GOP/Republicans want to privatize EVERYTHING!
If there is NO profit in it for them and/or their cronies …then whatever it is …should not exist …in their world view!
If you are too poor to afford health care …well …GOP/Republicans think …hummm …can we harvest your body parts? Pretty sure someone can create a profit model for that scenario.
After the Crime bill pushed by Clinton in the 90’s promising to put more police on the streets (Jobs) and get the criminals( Blacks) off the streets. The Job creators created “private” prisons and “sold” beds to the city/counties (for a profit) to house these newly created criminals!
They are creative that way …
Peale
@Ruckus: Yeah. I think the watershed years though were really when Gore lost and the insurance companies no longer had to worry about reform for 8 years. May have been part of trends in general, but in the 2000s I think is when you really started to see the effects of the failure of HMOs and other “fixes” to take hold. That’s when the insurance premiums started going through the roof such that almost every raise I got seemed to be eaten immediately by health insurance. That’s also when medical bankruptcies started to increase. Yes, people get sick and then can’t pay bills because they are no longer working and that’s part of life. That’s always going to happen.
But you had these situations where even people who were covered through work ended up bankrupt. That was the new feature of the 2000s.
Miss Bianca
@Peale:
you know, that is a really interesting point that I’ve been brooding over for some time – how when I got my first jobs out of college in the 1980s, my employer-based insurance was really good, covered an amazing number of things (heck, it covered three months of therapeutic massage and chiropractic work when my back got screwed up, which is something I can’t even imagine now). Even into the 90s when I was first, a student, and then, working, had HMO coverage, it wasn’t bad – tho’ when I had a bad accident I had to fight tooth and nail to get certain things paid for, and my credit suffered because I was being dunned for medical bills that my insurance was supposed to be covering. Maybe Richard can weigh in on this – what *did* happen to insurance and HMO coverage in the 90s -2000s pre-ACA?
Ruckus
@Miss Bianca:
Well of course it is more complex than one simple paragraph but money and where it stays when your health insurance company gets their hands on it and 2000 was a watershed year for the political concept that big business is god and everything not building that up shall be beaten down. It brought us a president who was appointed, not elected, a president who waged a sham war and made lots of big corps and people richer doing so, of course at the cost of many, many lives (but those were people who didn’t count, they weren’t in the top 10%). 2000 was the start of sinking a lot of economies around the world (which manifested itself late 2007/early 2008) and the culmination of years of big corps/rich to figure out how to screw the most people out of the most money without being quite so obvious at the time of the screwing. It goes on but that’s the gist.
sigaba
@Mnemosyne: I was only dimly aware of what was going on at the time, but I seem to recall EMTALA was passed after a panic over patient dumping, where a hospital would take some poor (usually minority) pregnant woman in labor, or homeless person in CHF, and stuff them on an ambulance to send them to the nearest county hospital so they didn’t have to get stuck covering the tab. Or worse they’d take someone who was critical, get them to stable and then put them in a taxi and get them the hell out of the hospital before anyone got the idea to send them to the ICU.
I just remember there being a lot of news coverage of the problem in the late 80s… I know in LA County the county hospitals had to treat you regardless of ability to pay, as a matter of county and state health policy, so Kaiser and Cedars and everyone else would just dump poor people from their EDs on County, sometimes killing them in the process of transit, but also sticking the county with all the costs. EMTALA just made it so EDs couldn’t dump people after they were screened. That’s when private hospitals started closing their EDs :P
WJS
This exceptionally proud native Minnesotan would like to point out that Mark Dayton has been a kick ass governor, providing America with a clear contrast against the insanity of Scott Walker and Sam Brownback. And I can still remember when my mother lost her Minnesota health insurance plan to the ass-backwards agenda of that other failed Republican presidential candidate, Tim Pawlenty.
Yes, you CAN raise taxes and yes, you CAN invest in education and hell yeah, you CAN provide for the citizens of your state and everything won’t go to hell on you. In fact, if Walker and Brownback had Minnesota’s record for job growth and economic success, they’d be formidable politicians right now instead of the washed up sad sacks that they are.
Minnesota. Heck ya.
pseudonymous in nc
It’s almost as if the US is an entity that contains some of the world’s most developed small nations and a bunch of countries with levels of inequality and fucked-up public services that you’d expect to see in what used to be called the Third World…
pseudonymous in nc
@Redshift:
The idea that there might have been a fucking healthcare deficit in Kentucky — the result of people letting treatable shit go untreated, so they’ve either endured something fixable or things have become untreatable — is lost on those kinds of people. Or perhaps it isn’t, and they like the idea of people suffering and dying early because they had the wrong sort of jobs and weren’t blessed by PPO Jesus.
mclaren
Mayhew’s claim is once again highly deceptive.
But what’s the cost?
What kind of co-pays are you talking about? What level of deductible?
You’re typically talking about $7000 deductibles with sky-high copayments, and the typical sick person in America can’t afford to pay those kinds of costs, so when people with that kind of coverage get sick, they can’t use their coverage.
Source: “Dilemma over deductibles: Costs crippling middle class — Rather than pay so much out-of-pocket, many skip checkups, scrimp on care,” USA Today, 1 January 2015.
Mayhew keeps trying to convince us that we can move to European-style coverage in America merely by tinkering around the edges of the existing horribly broken American for-profit medical-industrial system, but it’s just not true.
We need two components to get to the European-style system: [1] universal coverage, and [2] cost control.
You don’t get cost control as long as profit is a basic part of the U.S. medical system. Mayhew keeps trying to suggest otherwise, but he’s being deceptive.
What he is saying is just not true at a basic level.
Raven Onthill
“It mainly requires political elites to give a shit.”
But isn’t that the problem? They don’t. That’s what democracy is supposed to do, but US democracy is paralyzed.
WJS
@mclaren: Whatchoo talkin’ bout Willis?
The Minnesota Health Care Programs benefit summary (PDF) gives you an idea of costs you may have to pay.
There are no copays for:
Pregnant women
Children under 21
People living in a nursing home or other long-term care facility for more than 30 days
People receiving hospice care
Some American Indians
Services covered by Medicare (unless Medicare has a copay)
Refugees who have coverage through the Refugee Medical Assistance Program
Preventive services as defined by the United States Preventative Services Task Force (USPSTF)
Family planning services
Certain prescriptions used for the treatment of mental illness
Go look it up for yourself. And what’s really been hurting Minnesota is the fact that the Mayo Clinic in Rochester, which controls numerous regional hospitals now, has been fundamentally opposed to Obamacare and has done whatever it can to throw a spanner in the works. And Minnesota still kicks ass compared to your garden variety red state.