Dr. Michael Shepherd has a really interesting dissertation chapter on the value of blame in US health politics and healthcare. Presidentialism limits the ability of the American public to place blame on the right actors which means expecting policy wins with long and variable lags to be beneficial is a hope more than a plan while partisan opponents can cheaply inflict pain without getting blamed for their acts of agency.
The ACA was written to cover the vast majority of the <138% Federal Poverty Level population with Medicaid Expansion. The federal government over the long run would pick up 90% of the costs and states would cover 10%. The Supreme Court said that this was too coercive because of REASONS!
So Medicaid Expansion became a voluntary program. In 2014, 25 states expanded eligibility for Medicaid for January 1, 2014 enrollment. Since then 16 additional states have expanded Medicaid, including North Carolina in December 2023. Concurrently, we have seen a tremendous number of rural hospitals closed. The biggest predictive factor for rural hospital closure has been if the state had not yet expanded Medicaid. States less likely to expand Medicaid are conservative dominated or have conservative in critical-path veto positions. Institutions matter a lot here.
Dr. Shepherd asks a really simple question — who do voters blame when their local hospital closes?
More broadly, who do voters hold responsible for social and public policy failures that limit access to basic needs? These questions strike at the foundation of democratic government. How and which voters respond to government failure directly affects who holds power and how social problems are handled (Malhotra and Kuo, 2008). More theoretically, answers to these question have important implications for our understandings of political accountability and policy feedback in the US….
I collect data on the location and timing of all rural hospital closings in the US from 2010 to 2018 and merge this information with data on county-level public health indicators, demographics, and economic outcomes. To hone in on whether voters hold local Republican politicians or the federal Democratic Party for local health conditions, I restrict my sample to only the rural hospital closures that occurred in states that did not expand Medicaid and with Republican state governments. With this sample, I create a matched set of the most similar rural communities affected and not affected by hospital closings during the period. After merging these matched county-level data with the geolocation of survey respondents from the 2010-2018 CCES waves, I analyze the impact of a hospital closing on the probability that individual respondents in affected areas vote for or against the incumbent president and for or against the Republican gubernatorial candidate in elections from 2012-2018.
Statistical analyses of county-level data reveal that hospital closings between 2012 and 2016 likely cost the Democratic Party 1% of the presidential vote in affected communities. Survey data imply that hospital closings led rural independents to vote against the incumbent Democratic party (or for Donald Trump) in the 2016 presidential election, suggesting that voters hold the president accountable for changes to health care environments. Consistent with classic retrospective and policy feedback accounts, rural independents responded to hospital closures in their communities by perceiving the economy to be worse off under President Obama, being less supportive of the Affordable Care Act, and ultimately voting for Donald Trump…
At the state level, I find no evidence that these rural hospital closings influence gubernatorial voting (or approval) for independent, Republican, or Democratic voters. Consistent with recent work on blame attribution errors in political accountability due to federalism (Malhotra and Kuo, 2008; Sances, 2017; Rogers, 2017), I show that independent voters respond to local hospital closings by blaming the president, but not by holding more proximate officials accountable.
State politicians making the active decision to not expand Medicaid eligibility is not connected in voters minds to hospital closures. Most politicians respond to pressure and incentives with a goal to minimize the number of pissed off at them likely voters. Since this connection is not made, Medicaid Expansion can be abstracted away.
Blame is critical to a healthy feedback loop to provide strong incentives of very pissed off voters to politicians to run from or actively seek to please.
Baud
Diffusion of blame and accountability has been the prime objective of elite US political discourse for as long as I can remember.
Mousebumples
I’m still mad at Wisconsin Republicans that we haven’t expanded Medicaid yet.
Hopefully new maps will fix that.
Zelma
This is a result of the “nationalization” of American politics which is such a faulty approach to reality. In countries like Britain with a strong Parliamentary system, it makes sense to blame the party in power at Westminster for local failures because they are by and large responsible. But in the US, it is wrong headed. I don’t know how the Democrats break thru to assign blame given the disappearance of local media. I think it can be done; the abortion votes in red states shows how. But it is tough.
rikyrah
@Mousebumples:
That’s what I believe. This November’s elections and a new map will change things.
Starfish
It is worse than this. Voters in some non-expansion state were blaming the ACA for rising drug prices
WereBear
@Baud: The part Sun Tzu left out.
As long as we have weaknesses propped up by special treatment… we have weakness.
Anonymous At Work
Blame and the counterpart of Shame are important in both politics and academics. I seek ways to attach blame to the parties most responsible. That said, federalism and Presidentialism are both responsible for disconnecting “politics” (meaning “National executive-branch decisions”) from local problems.
A state-run hospital closing for lack of state funds isn’t blamed on state politicians making (or even worse, “not making”) decisions. The best I’ve been able to do is slowly convince a libertarian that “states’ rights” doesn’t work and was never a good faith argument. Right now, in Florida, Amendment 4 is out-performing Democrats at every level. A lot of voters not understanding or pretending they don’t understand that Democrats are pro-choice, Republicans are anti-choice, and Amendment 4 is pro-choice.
How to deal with that in terms of Medicare expansion and health care funding, I dunno but am eager to see what, if anything, works.
Fake Irishman
Hmm… Didn’t Sara Gollust guest edit a guest issue of some Health Econ journal about 7-8 years ago where a few studies found increases in the Democratic vote for state and local candidates based on Medicaid Expansion?
Not saying that those Findings were right and these were wrong, or that they can’t fit together somehow, but these are contested, messy ideas.
catclub
Who blames the Secret Service that the PA shooter missed?
catclub
That seems perfectly typical in US politics. A large group reflexively hates the Democrats, but agrees with the Democrats’ positions on the issues.
WereBear
Republicans have shiny shoes and social status. They like to pretend they are the grownups in the room and attract poseurs and wanna-bes.
We… don’t. We get the job done with little credit. I think we’re flipping the script.
p.a.
Don’t want to blame the victim, but are there no Dem pols in these states to point this out? Or are they denied platforms?
soapdish
They were going to blame the Democrats anyway.
FDRLincoln
@p.a.: I live in Kansas, which has not expanded Medicaid and has severe pressure on rural hospitals, some have closed, others are in danger of closing.
The governor is a Democrat, Laura Kelly, but the legislature is dominated by the GOP, with a veto-proof majority.
Kelly and the few Dems in the legislature have been banging the Medicaid drum for years. The Kansas Hospital Association, even the Farm Bureau and other normally conservative organizations, have been pushing hard for Medicaid expansion.
Over the last two legislative sessions, it has become clear that there are actually enough GOP votes in both the Kansas House and Senate to pass Medicaid expansion. And Kelly would certainly sign it.
So why doesn’t it pass if there are enough votes?”
The leaders of the Kansas House and Senate are hard-core MAGA-types and refuse to bring the bills up for a vote. Kansas doesn’t have a discharge-petition thing like the US Congress does, so if the House and Senate leadership won’t bring something up for a vote, there is no way to force them to do so.
Medicaid expansion in Kansas has 70+ percent support in opinion polls, enough votes from the GOP rank-and-file to pass, and a governor who will sign it. But it won’t happen because the top leaders are extremists.
The same thing is happening with pot legalization. It’s popular with the public, there are enough votes to pass, the governor would sign it (at least a medical version), but the top leaders won’t bring it to the floor.
Chris
In general, the fact that “checks and balances,” federalism, and other forms of divided government, make government power so diffuse that there’s no way for voters to know who to blame unless they’re super-politically-engaged in a way that most people never will be is one of the biggest problems with our system.
It’s increasingly what’s convinced me that a unicameral parliamentary system is the way to go, honestly. Representative government doesn’t work without a clear sense of who’s accountable for what.
Baud
@FDRLincoln:
At some point, voters are responsible for their government.
FlyingToaster
FWIW, it’s not just rural hospitals; we’re going through this with the Steward (for-profit) Hospitals sell-off/closures here in Eastern Mass.
Cerberus Capital bought the MA Catholic hospitals — Caritas Christi Health Care System — back when the Archdiocese was selling everything. They proceeded with the standard M&A pump and dump, and sold off the system to Steward (a physicians group) and now the hospitals are flat broke.
6 of the hospitals in Massachusetts are under agreement to sell; however, Steward was unable to get bids for 3 — Carney Hospital in Boston/Dorchester and Nashoba Valley Medical Center in Ayer are closing in September. Norwood Hospital was already closed, having been flooded out in 2020, and the reconstruction was halted last winter.
Did Federal hijinks with the ACA and Medicare/Medicaid hurt this system — Yes! And our state politicians, most notably Governor Healey, are fighting the closures. Carney’s closure is survivable (Boston has a LOT of hospitals, though none at that end of town), but Nashoba Valley is a serious hole in our statewide healthcare coverage. We have been working around Norwood, but it’s a pain in the ass and would be far better if it were to reopen.
Carney is an urban hospital; I’d categorize Norwood and Nashoba Valley as exurban.
From up heah in the Commonwealth, this looks like a combination of greed from Cerberus, incompetence and grift from Steward, and ratfucking by the Feds. Namely, Republicans. I don’t think we can punish the MA GOP more than we already have.
FDRLincoln
@Baud: Oh, I know. The Dems have been trying for years to get people to make the connection between the collapse of services (hospitals, schools) in rural areas and the GOP that makes it worse.
There has actually been some progress in some areas…Johnson County, which includes the rich Kansas City suburbs, used to be super-GOP but is now purple and becoming more blue in each election.
But as the cities get bluer, the rural areas become redder, in part because of brain drain…the smart kids move to KC or Lawrence (or Colorado) for jobs and college. My own son fled to Denver after graduating college and I can’t say I blame him.
The rural areas are essentially destroying themselves with their cultural resentments. The same thing is happening in Iowa.
Kelly, the Democratic governor, won because of the voters in the cities. But the legislature is gerrymandered enough to keep the rural areas dominant in the legislature. The GOP leaders are from extremely red districts and won’t be voted out anytime soon. They are funded by Koch Industries and are able to resist pressure from other lobbying interests that want to expand Medicaid.
Citizen Alan
@Baud: A significant part of my decision to move to California is so that I could feel that my vote matters in a way it never did in Mississippi for any election since I came of voting age.
TBone
This Pennsylvania voter blames private equity hedge funds and medical malpractice insurers.
Private health insurers also suck.
lowtechcyclist
@Chris:
At least at the national level, ending the filibuster would be a big step in the right direction. A big majority of voters don’t understand why Dem majorities can’t pass legislation, so they just assume the Dems don’t really want to do those things they ran on, so there really isn’t much difference between the parties after all, and Dem turnout takes a hit.
raven
When Piedmont took over Athens Regional Hospital they took away retirees health care because the agreement was with ARH not Piedmont. I know people who had to go back to work so they could survive.
Tony G
A big reason for the failure of this “blame feedback loop” in the case of local hospital closures is the fact that the majority of the white working class in these areas have ALLOWED THEMSELVES to believe the propaganda that programs like Medicaid are programs that only benefit Those (non-white) People. Yes, they are being lied to by right-wing politicians and the right-wing media — but nobody is forcing them at gunpoint to seek out and to believe the propaganda. They believe it because they want to believe it, and they want to believe it because it corresponds to their pre-existing bigotry. There, I said it. My father was a white blue-collar worker and we lived in a white blue-collar town in New Jersey. For a man of his generation, my father was pretty progressive on economic and non-economic issues — but the town in general voted for Nixon and Reagan and (probably) Trump. I feel like I know the mentality of white, blue-collar bigots because I lived with them.
Matt McIrvin
The transformation of the filibuster into a de facto Senate supermajority requirement for nearly all legislation allows so much mischief to occur. A minority can effectively keep anything from being done by Congress, and the majority and/or the President gets blamed for it.
It can also keep Congress from plugging accidental loopholes and gaps in laws that the minority doesn’t want to be successful, or that they want judges to overturn. The judges can argue that it’s Congress’s job to fix the law, and then all Congress has to do is nothing, and nothing is a lot easier to arrange than something.
Matt McIrvin
@Citizen Alan: I suppose your vote has the most power to make a difference if you live in a purple swing state. But it’s an anxiety-provoking situation to live in.
Ruckus
@Anonymous At Work:
How do you get someone to understand a reasonably complex subject if they are willing to pout and hold their breath till they turn blue (Not politically blue, actually blue), rather than use any amount of logic in their thinking and policies?
The conservative side of the aisle is grasping at straws here, dangerous straws, to hold on to power as the modern world finds better ways to live than with one’s head up one’s exhaust port. The world is changing, like it or not and one of those changes is better healthcare and not screwing the pooch with illogical reasoning, like “Just Because!”
Matt McIrvin
@FlyingToaster: When the COVID pandemic hit I recall these charts showing shortages of hospital beds that made me realize that my part of Eastern Mass. was struggling with a chronic shortage even without the pandemic. We were so close to the edge even when there weren’t a lot of COVID patients taking up beds.
Ruckus
@FDRLincoln:
In a democracy I call this – not democracy.
20% of the people holding the other 80% hostage is not democracy.
Adam Lang
I mean this was pretty clearly part of the calculation. The more they immiserate their constituents, the more misery they have to work with when attacking their opponents. And because they know that the media finds it much more interesting to report on who is attacking whom than on who is actually at fault, and because they know that the Democrats are pretty bad at attacking in general, they know they’ll get away with it.
Given those incentives, why would they want to allow anyone to do anything positive for their constituents? Even if they can take the credit — hell, even if they deserve the credit! — that’s much less potent than not doing it, and then blaming someone else.
WereBear
The book, Dying of Whiteness, was written by a physician who toured these areas in an effort to understand.
He found people refusing medical help from the ACA, even though they were dying as a result. Reaching for a gun instead of making a therapy appointment. Drowning in substances instead of seeking help.
White identity meant that much to them. These were all solutions that had liberal cooties all over them.
So they know. Some of them hate too much.
Sister Machine Gun of Quiet Harmony
@WereBear: @catclub:
Fixed.
ArchTeryx
@Baud: Exactly. Those “top leaders” are often in safe, gerrymandered districts, specifically to make them very difficult to vote out. But ultimately, nobody has a gun to these voters’ heads forcing them to pull the level for the Republicans. Brownback proved: You fuck up hard enough and obviously enough, even hard core Rs will start refusing to pull the lever for you just because you have an (R) next to your name.
They need to vote single issue, and vote against the extremist leadership. It’s that simple. Or primary enough of the GOP MLs that new leadership is elected.
Tony G
@WereBear: Yes, I should read that book (I haven’t yet). I’m describing a particular town (North Arlington, New Jersey) at the time when I lived there as a kid (sixties and early seventies). It might be better now; I don’t know. Many of the people there were Nixon’s “Silent Majority”, later “Reagan Democrats” and now (probably) “MAGA Republicans”. My parents were about as progressive as people from their generation could be, but the town as a whole was pretty narrow-minded. (Ten miles away from New York City, but a lot of the town’s residents had never been to New York City — too many of “those people” there.). Rush Limbaugh and, a little while later, Fox News found an eager audience in those type of people.
Tony G
@Adam Lang: That’s a very good point. People in misery (physical, psychological, economic) can be more easily manipulated to hate the Wrong People. (The German Hyperinflation followed by the Great Depression provided a large pool of voters who were ready to elect Hitler in 1932.)
Steve LaBonne
My wife’s 43 year old son has had a series of devastating health crises over the last two years, the later ones all related to the first which was a massive aortic dissection. He had recently lost his job before that. I never thought I would live to say “Thank God for John Kasich” but without Ohio’s Medicaid expansion… I don’t even want to think about it.
FDRLincoln
@ArchTeryx: What makes the Kansas situation especially egregious is that even normally-conservative lobbying groups with strong ties to the GOP have come around on Medicaid expansion and support it.
The exceptions are Koch Industries, and a few out-of-state lobbying and think-tank creeps that prop up the extremist leaders. I note that the worst of the extremist leaders comes from a district around Wichita that is made up of very rich suburbs that, unlike the KC suburbs, haven’t turned purple. He doesn’t have to worry about the local hospital closing, he has all the campaign $$ he needs from Koch that he doesn’t need to worry about pressure from other conservative groups that support Medicaid expansion. Unless his constituents decide to dump him, which seems unlikely, he can block things for the rest of the state.
In Kansas, Johnson County (KC) is trending purple-blue, Lawrence (college town) is extremely blue, Manhattan (another college town) is purple-blue, Topeka (the capitol) is purple-red.
Wichita, unlike the other cities, remains red, probably because that’s the headquarters of Koch Industries
It’s damn frustrating. Kansas voters made sure to keep abortion legal here with the constitutional vote in 2022, but aside from constitutional amendments, we don’t have the same kind of ballot initiative system that other states have. If we did, Medicaid (and pot) would have been dealt with years ago.
WereBear
@FDRLincoln: I spent a month in Wichita one weekend, a while back.
It was a normal business trip, except a man in the elevator had a full color t-shirt with some kind of dismembered fetus on it. A cashier played a cruel trick on one of our group and made them burn their tongue on hot coffee. We were scolded for laughing in the bistro one night.
But that is what made us realize no one else was.
It was a starchy place that rolled up the sidewalks at nine or something. Then, we were told by fellow expats, the real action shifted to the private clubs.
And, since I was brought up in small town Florida, I declined.
Baud
@WereBear:
And they get upset when we call them weird.
schrodingers_cat
@Baud: Aren’t voters in a democracy always responsible for their government.
OT:An important group just declared their support for Harris 24.
Lyrebird
@FlyingToaster: Even in places where the hospitals were all bought up by supposed non profits, the effect has been awful, and there are few alternatives – no, let’s say zero alternatives offered.
No way is the state of NY gonna outlaw repro health care or what have you, but we are seeing more and more areas where, boom, no you can’t get – believe it or not – a vasectomy! Bc Trinity Health or something bought all the hospitals.
FDRLincoln
@WereBear: For reasons that aren’t entirely clear to me, Wichita is also a hotbed of anti-abortion sentiment, far more so than other urban areas. Both the Catholic Church and fundamentalist churches have a large amount of power in that area. They have congregations and power in other areas too, but for some reason in Wichita there are fewer countervailing factors.
Wichita also has a very extensive underground kink community, made up of many of the same people who go to those churches on Sunday.
There’s lots of kink of course in KC and Lawrence but the vibes of those areas are not as hypocritical.
Lawrence has been a mecca for LGBTQ+ people since the mid-90s and KC is moving that way. Wichita and the rural areas are still very homophobic, and LGBTQ+ kids growing up in those areas often move to Lawrence or KC (or Denver or Chicago or Minneapolis) as soon as they can.
Lyrebird
NICE! Did you see, even one of the golf carts in the pro-Kamala procession at the Villages had a big fierce kitty cat graphic on the back. ANother one had “, la” to help with pronunciation.
edgefigaro
Color me skeptical of the value of blame. I’m suspicious of thesis.
The political thought market is flooded with blame. Its a deluge, a firehose. 99%, poor people, insurance companies, russians, chinese, liberals, gays, techbros, oligarchs, your boss, your lazy coworker, your subordinate, you.
Very few people sort through blame by consideration. They sort blame by their own personal identity.
What kind of voter responds data like this? Where is grounding blame in empiricism useful in forming, shaping, changing identity? A charitable explanation is “on the left” but I’d want to see even that justified.
BellyCat
The finding of only 1% loss for Democratic presidential votes is actually a LOT lower than I suspected.
Given the timeframe of the study, it is quite possible that rural hospital closures prevented even higher Democratic presidential losses among the rural population. Testing this would require the same study in rural areas with hospitals remaining open.
Going further, one could even theorize that those seeking medical treatment (whether a rural hospital exists or has closed) might make political choices which differ (and are more to the benefit of Democrats) from those who don’t, whether they need it or not.
Related, medical care in rural areas is often provided by doctors of foreign origin. For many who get medical treatment and see them in the community, this is their first exposure to “others”. A hospital closes and the foreign medical providers move away. Double whammy, both medical and cultural.
Rural places can be bizarre and incredibly insular. I grew up in a rural town of 13k and could not wait to get out after high school. Probably 1/2 to 2/3 of my H.S. classmates did the same. Lots of resentment by those who stayed toward those who left.
chemiclord
When a massive chunk of the country already views the President like they are a king, I guess it’s not surprising that the populace really doesn’t understand the problem with the Supreme Court effectively saying so.
WereBear
@FDRLincoln: KC! Too hot & humid for me to live there, but I do love that town.
The Eternal Kansas City
chemiclord
@Baud:
The harshest truth for us to accept isn’t that out government doesn’t represent us.
It’s that our government DOES.
WereBear
If we brought broadband to rural places, they could at least do telehealth. Maybe a shuttle to get sick people to an MRI. There’s so many these residents could do, if they would only let us.
Fake Irishman
@FDRLincoln:
There are some really interesting political structural variables at work behind when a GOP-dominated state expands Medicaid and when it doesn’t. Here’s an academic (no regression analysis) paper on the subject, in which Kansas gets some discussion.
(Sort of full disclosure, this one is pretty close to my heart)
Chief Oshkosh
@WereBear: Yep. I know one of these fine folk. The guy has a condition that requires occasional transfusions. Last year he started refusing them because the blood might be from a blah person. And his health is now declining.
Now THAT is seriously fucked up. Oh well.
WereBear
@Chief Oshkosh: They kill their own voters.
That’s so deeply weird.
Chief Oshkosh
@schrodingers_cat: Great image. My cat-lady SiS loves it. :)
Minor quibble, I think “weirdo” is misspelled (“wierdo”).
Citizen Alan
@Matt McIrvin: Alas, I’m at present in Tom McLintock’s district and that SOB ain’t going anywhere. I actually checked the apartments I looked at against the districts that include Fresno in the hopes that I might play a role however small in helping Dems retake the House. Unfortunately, the only apartment that suited my needs on short notice was in CA-5.
Matt McIrvin
@Sister Machine Gun of Quiet Harmony: Yeah. On the pocketbook stuff and even some of the identity/religion/sex stuff, they’re with the Democrats, but there’s some bigotry-based thing that makes them go berserk. It’s undocumented immigration, or “they’ll make your kids trans”, or *some* thing that scares them to death and that’s the lever.
schrodingers_cat
@Chief Oshkosh: Ah you are right! Thanks for the correction. I don’t know how I missed it.
CliosFanBoy
@FDRLincoln:
Does Wichita kink involve corn, BBQ, or both? ;)
VFX Lurker
True.
This reminds me of an Isaac Asimov short story called “Franchise” where one computer-selected person (“Voter of the Year”) represents the entire electorate in the future. In bad times, the public blames the voter for making bad choices.
ArchTeryx
@Lyrebird: The difference is, if that gets widespread enough, New York State can pass laws ordering those hospitals to provide those services on pain of prosecution or getting eminent domain’d. There’s already a big push to make reproductive health services a NYS constitutional right. In Kansas, the state government would do exactly the opposite.
gVOR10
I’ve been saying the Tories lost because Brits aren’t happy with the state of the country (with much better reasons than Americans have) and after 14 years of Tory rule, in a parliamentary sytem,there’s no confusion of who to blame. As Dr. Shepherd says, in our system it’s much easier for conservatives to screw everything up and point blame at Dems.
Scout211
Wrong thread. Oops
Sister Golden Bear
@FDRLincoln:
Godbotherers in extremely conservatives are often the absolutely most twisted kinkiest MF around—they’d make the most hardcore Folsom Street Fair* attendees blush. (Don’t ask me how I know, but I know.) Not kink shaming but I am hypocrisy shaming.
*Do not Google if you’re at work.
Lyrebird
@ArchTeryx: Thanks for the explainer!
Another advantage of NYS at the moment compared to OH, IN, TX, OK etc is that the doctors don’t feel like they have to flee the state.
Gretchen
@FDRLincoln: I live in Kansas too. I don’t suppose that we have a chance of replacing the MAGA leadership. Here in the Kansas City suburbs we have wonderful progressive reps and senator. I don’t know what to do to get the rest of the state moving.
Ruckus
@WereBear:
I’ve lived in a semi rural area of OH just over a couple of decades ago. There is a completely different structure to that of large population areas in most any part of this country. (also have traveled extensively around this country – worked full time in professional sports for a decade) It is in some ways nicer in more rural areas and in some ways not nearly as nice. I believe there is a reason so many people like to or at least do live in bigger metropolitan areas.
Gretchen
@WereBear: Dying of Whiteness, by Metzl, explains a lot. It was really eye-opening to see a guy dying of kidney failure refusing to sign up for Obamacare because that’s for those people. His dad was my children’s pediatrician and he grew up in Kansas City. He studied school funding Kansas, guns in Missouri, and healthcare in Tennessee/Kentucky. He went to focus groups of survivors of suicide, and people didn’t connect loose gun laws with their losses. Fascinating book.
WereBear
@Ruckus: I’ve found the best of both worlds in this little mountain town. But it’s because this is NY, a blue state.
I have benefits and protections.
WereBear
@Gretchen: It was a sad but insightful read. I keep trying to understand but then it runs into a deep dysfunctional rift.
David Anderson
@FlyingToaster: nashoba is suburban
Disclosure: my mom worked for 20 years at facilities last owned by Steward
wasdeaconblues
David:
Congratulations on your recent degree, even if it was from the wrong institution!
I should note another source of blame among lower income users.
My brother-in-law is an immigrant whom I have directed into Obamacare the past three or so years. He has worked to begin as a grocery clerk in a local Harris Teeter, earning next to very little for his full-time steady work (around $27,000 last year).
As we understand them, our tax laws require that he pay federal tax on the monthly benefit provided by Obamacare in the form of the insurance premium paid on his behalf to his chosen insurance company (boo!).
This has added a significant amount to his annual federal taxes, for a benefit (health insurance) that he as a healthy young man (thank God) has not had to use!
Earning $27,000/year does not leave a lot of room for additional taxes, particularly when he sends money home to his family abroad every month.
I can imagine that soon he will ask, “why do I need Obamacare?”
Even though health insurance is a necessary evil, the assignment of tax liability for this benefit undercuts general political support for the program.
I must confess that I do not readily follow most of the content of your postings.
Still, I should ask, is there an answer to my brother-in-law’s situation? Particularly when I, a State employee, do not incur tax liability for my monthly insurance bill.
(He has recently graduated to a trucker’s license, so hopefully this situation will not continue as he can (?) opt for different insurance.)
My apologies for incorrect terminology.
Thanks so much for whatever reply you could provide.
Paul W.
Is there a look at the counterfactual of states where it is passed the Dems got credit for improvement? Or is this like crime where negatives are the only thing that register and persist regardless of circumstances…