The reality for the 80% of Americans who live in and around cities, particularly the largest urban concentrations wherever they may be, pay more for just about everything than their rural counterparts. Everything from housing to insurance to transportation to food… and usually also taxes… costs more. A business has to pay for the land where it is located. Remember: location, location, location? The salaries paid to that business’ employees reflect the local cost of living. The same is true for non-profits located in those communities. If you are a legal assistant in San Francisco – where $1 million buys you an average 800 square foot home – you are barely able to survive even if you make a whopping $80 thousand or more dollars a year. But at $40-$50 thousand, in Biloxi, Mississippi, a charming beach town, you can live quite comfortably, thank you.
This looks like a big “duh,” but this economic reality, combined with the impact of gerrymandering shifting voting power in the House of Representatives to rural voters many of whom resent city-dwellers, is at the core of why those nasty lingering efforts by conservative Congress-people are deeply anti-urban, anti-blue state bent to the point of being genuinely punitive. The thrust of the White House and the “we can still kill Obamacare” (the Affordable Care Act – ACA) GOP Congressional majority is to shift the federal healthcare program to the states with block grants effectively giving every recipient of federal support dollars exactly the same amount. This would save the fed tons of money that these Republicans openly admit they will use to reduce tax rates for the wealthiest Americans.
That “equality” may sound good at first, but this notion is laden with pain. This accords those recipients with rural costs of living – heavily in GOP-strong, white majority red states – more than they need to secure decent local healthcare coverage and deprives urban dwellers – a more diverse population heavily in Democratic-strong blue states – from trying to secure the same (“equal”) level of healthcare coverage very much short of real costs. States that are heavily urbanized – like New York, California and Massachusetts – which already have heavy local taxes (on sales, income, property), would have to tax their residents even more to make up the difference.
And here’s the “one more blow to the blue state head” sitting in the GOP tax reform package: by eliminating or severely limiting the proposed home interest deductions (a vastly bigger personal budget item in costly urban markets) and state income taxes (again, disproportion blue state costs) from federal taxation, the effective cost of living in those heavily-urban blue states will skyrocket even higher while red state residents can smile and watch their blue state brethren squirm and suffer. So killing the ACA is still a priority for too many in the GOP.
“Senator Bill Cassidy, Republican of Louisiana, said [at a Senate committee hearing on September 7th] that he had White House support for a bill that would repeal much of the Affordable Care Act and replace it with lump-sum payments to states that could be used for a variety of health insurance programs….Mr. Cassidy said Vice President Mike Pence was encouraging senators and governors to support the proposal for block grants, which he drafted with Senator Lindsey Graham, Republican of South Carolina.
“Kellyanne Conway, a top adviser to Mr. Trump, said on Fox News: ‘The president is ready. He’s ready with pen in hand to sign health care reform if, say, Graham-Cassidy moves forward. A lot of the governors seem to be supportive of that.’” New York Times, September 7th. Simply, the White House and the right wing side of Congress do not want to “fix the ACA;” they want to repeal it and replace it with those block grants noted above.
Ultra-conservatives, like House Freedom Caucus chair Rep. Mark Meadows (R-North Carolina), are even looking to oust House speaker, Paul Ryan (R-Wisconsin). Meadows: “has openly expressed displeasure over the GOP’s legislative progress [under Ryan’s leadership], saying at a recent Bloomberg News event, ‘If we get to December and we have not repealed and replaced Obamacare…it’s not going to be pretty.’” AOL.com, September 8th.
However, many GOP state governors, in red states like Ohio that do have larger cities, know these GOP proposals will decimate their constituents, of either party. They are joining with the state’s congressional delegates to join the Democrats, to push for repair of the ACA… not repeal, which most Americans thought was a dead horse when the Senate defeated the effort in late July.
“Testifying at a hearing of the [above-noted] Senate health committee, governors from Colorado, Massachusetts, Montana, Tennessee and Utah endorsed proposals to stabilize health insurance markets by providing federal money for continued payment of subsidies to insurance companies to offset the cost of discounts provided to low-income people.
“They also urged Congress to give states more latitude to modify some insurance requirements in the Affordable Care Act and to devise their own coverage programs. The subsidy money and the flexibility for states are the two main components of a bipartisan consensus emerging in the Senate.
“‘Congress should take steps now to prevent the total collapse of the health insurance market’ by providing money for the ‘cost-sharing’ subsidies, said Gov. Bill Haslam of Tennessee, a Republican.
“Gov. Steve Bullock of Montana, a Democrat, said, ‘If this committee is genuinely concerned with stabilizing the individual marketplace, the most important step it can take in the near term is ensuring funding for the cost-sharing reduction payments for at least the next two years.’” NY Times.
But here’s the rub: President Trump has repeatedly told the world that “Obamacare” will implode on its own, and then he will foist this limited (remember his “better and cheaper healthcare” campaign promise?) and deeply-flawed “let the states do it for a lot less” program on the entire nation. Trump wants his implosion prediction to come true and has a done a lot to push it over the edge. But aside from Trump’s very active efforts to destabilize the healthcare insurance market by depriving them of any notion of necessary business-planning predictability, the ACA is and was showing signs of stabilizing and working. Trump needs insurance companies leave the ACA exchanges (as many have done) to force the ACA to fail. If there is a bipartisan “fix” for the ACA, the markets will stabilize and that hope-for implosion will not happen.
The ACA can and must be fixed. “Senator Lamar Alexander, Republican of Tennessee and the chairman of the health committee, is working with the senior Democrat on the panel, Senator Patty Murray of Washington, on legislation that would finance the cost-sharing subsidies through 2018 and perhaps 2019 as well…
“Insurers that want to participate in the federal insurance marketplace are supposed to sign contracts with the federal government by Sept. 27. The fifth annual open enrollment period, when consumers can sign up for coverage, is scheduled to start on Nov. 1 and end on Dec. 15.
“To shore up insurance markets before then, Mr. Alexander said, lawmakers will need to compromise… ‘It’s pretty easy to be for extending the cost-sharing payments,’ Mr. Alexander said. But ‘to get a Republican president, a Republican House and a Republican Senate just to vote for more money won’t happen in the next two or three weeks unless there’s some restructuring’ of insurance market regulation to address Republican concerns.” NY Times. Will this happen in time? While there are nascent signs of budding bipartisanship, getting where we need to be takes a pretty massive leap of faith.
I’m Peter Dekom, and unless we add a whole lot more empathy to our legislative mix (did hurricane aid help move that needle?), the polarization that has gripped our country for way too long… may finally begin to destroy it all.
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