Stephanie Mencimer

Stephanie Mencimer

Reporter

Stephanie works in Mother Jones' Washington bureau. A Utah native and graduate of a crappy public university not worth mentioning, she has spent the last year hanging out with angry white people who occasionally don tricorne hats and come to lunch meetings heavily armed.

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Stephanie covers legal affairs and domestic policy in Mother Jones' Washington bureau. She is the author of Blocking the Courthouse Door: How the Republican Party and Its Corporate Allies Are Taking Away Your Right to Sue. A contributing editor of the Washington Monthly, a former investigative reporter at the Washington Post, and a senior writer at the Washington City Paper, she was nominated for a National Magazine Award in 2004 for a Washington Monthly article about myths surrounding the medical malpractice system. In 2000, she won the Harry Chapin Media award for reporting on poverty and hunger, and her 2010 story in Mother Jones of the collapse of the welfare system in Georgia and elsewhere won a Casey Medal for Meritorious Journalism.

Why It Doesn't Matter If People Aren't Signing Up for Obamacare Yet

| Tue Oct. 8, 2013 5:00 AM EDT

Republicans have been insisting for a week now that Obamacare is a failure because immediately following its official debut on October 1, few people actually signed up for subsidized insurance plans through its new health exchanges. "Error message after error message. Failed security standards and 60 hours on website hold for just this one Kansan. It is clear, Obamacare is failing — an embarrassment, particularly for the former Kansas governor who is now in charge of Obamacare," Rep. Tim Huelskamp (R-Kan.) complained on the House floor last week.

But it doesn't really matter whether many people enrolled in Obamacare last week. Healthcare.gov saw 8 million unique visitors in the first four days the exchanges were open. It isn't especially surprising that not all those people managed to get covered on Day 1. The coverage people are seeking isn't even available until January 1. Uninsured Americans have until December 15 to sign up for coverage that starts the first of the year, and another three months to sign up during the open enrollment period that ends March 31. (People can still sign up after March 31 if they have a change in status, such as losing employer-based coverage.) If people weren't able to sign up October 1 or even October 5, that's not the end of the world. It's just the beginning.

Experience shows that getting lots of uninsured people into private health plans and new Medicaid plans is maddeningly difficult and time-consuming. Massachusetts has already done this, after all. In 2006, Gov. Mitt Romney signed into law a health care reform bill that is essentially the model for the Affordable Care Act. Like the ACA, Romneycare expanded the state's Medicaid program and then opened the Massachusetts Health Connector, the prototype of Healthcare.gov, to provide a marketplace where state residents could purchase subsidized individual health insurance plans.

What happened in Massachusetts is pretty much exactly what's happening right now with Obamacare. After the law went into effect in Massachusetts, state offices were totally overwhelmed by the number of people clamoring to sign up for insurance, or what the state's Medicaid director dubbed the "stress of success." Lost paperwork, computer glitches, confusion over who was eligible for what, and not enough staff to handle the workload meant that in those early days, consumers could wait several months after submitting an application to finally get coverage. So many people were trying to enroll in the expanded Medicaid program that the Medicaid agency ended up with a months-long backlog of applications. In the first two months, only 18,000 of more than 200,000 potentially eligible people had successfully signed up through the connector, according to Jonathan Gruber, an MIT professor who helped design the Massachusetts system and served on the Connector board. And all of that happened in a state with only 300,000 or so eligible applicants and without a well-funded opposition trying to derail the law at every turn. 

But guess what? Eventually the kinks got worked out and people got covered. Enrollment opened in October 2006, and by the deadline for getting mandatory coverage, July 1, 2007, the Boston Globe reported, 20,000 more people had signed up for insurance on the exchange than the state had expected—12,000 of them in just the two weeks before the deadline. Total enrollment went from 18,000 in December 2006 to 158,000 a year later, says Gruber. Today, Massachusetts has the lowest rate of uninsured residents in the entire country—less than 4 percent—and polls show that people are generally happy with how everything worked out. The conservative Massachusetts Taxpayers Foundation has called the state's health care reform law “a well thought-out piece of legislation.”

The federal exchange is fielding vastly more work than the Massachusetts Health Connector, and if it's having trouble with the workload, that's largely thanks to Republican opponents. The drafters of the ACA never envisioned the federal government running health care marketplaces for most of the country. The ACA was specifically designed to respect the state's rights that Republicans claim to care so much about. It empowered states, which already regulate the sale of insurance, to run the exchanges. Healthcare.gov was supposed to be a backstop for states either too small to run their own or that dropped the ball on setting up their own exchanges. Instead, Republican governors across the country, and mostly in the South, abdicated the job completely. So instead of running a marketplace for a couple of states as planned, Healthcare.gov is having to do the work of 70 percent of them, including big states like Florida, Texas and Virginia (and also, ahem, Kansas). Of course the site was going to have some problems!

The first real measure of how well the system works is still a few months away. Given the human propensity to procrastinate, the surge of actual enrollments will probably come, as it did in Massachusetts, in the week or two before the first coverage deadline on December 15. That's when people will realize that coverage starts within days—not months or years—and start making decisions in earnest. Bronze plan or silver? Blue Cross or Aetna?

If only a handful of people have successfully enrolled by then, it won't be just conservatives who are freaking out.

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Now the Government Shutdown Is Stopping Blood Drives

| Thu Oct. 3, 2013 11:49 AM EDT

Here's how the government shutdown may literally be killing people: by causing blood shortages.

For all the scorn heaped on government employees, some people forget that the faceless bureaucrats who populate Washington are often, in fact, a bunch of do-gooders—people who genuinely believe in the notion of public service. As such, they contribute to the public good in a lot of ways that are taken for granted, like their immense contribution to local blood banks. Thirty-eight percent of the population is eligible to give blood, but only 5 percent actually does so. A lot of that 5 percent apparently works for the federal government. Thanks to the shutdown, in just two days, four federal agency blood drives scheduled by one DC-area health care system have been canceled. The regional Red Cross has had to cancel six others in the Washington region.

Inova Blood Donor Services projects that the cancelations will result in its projected loss of 300 donations that would have helped 900 patients in DC, Maryland, and Virginia. Inova's donated blood collections supply 24 hospitals, which bank much of the blood for inevitable disasters or, say, terrorist attacks. The Red Cross is suffering from similar disruptions, projecting the loss of 229 donations, each of which could potentially save up to three lives. A single major trauma event can easily deplete a hospital's entire blood store. The longer the shutdown goes on, the worse the situation is likely to get.

Rebecca Manarchuck, marketing director for Inova Blood Donor Services, says the Washington area supplies were already low, thanks to reduced collection rates that historically happen in the summertime. The shutdown is only compounding the shortage. Blood drives are carefully scheduled and planned well in advance. Doing them at government offices requires a host of logistical arrangements because of tight security and other considerations, meaning that rescheduling the drives for a later date won't be an easy task. And even then, donated blood can't even be used until three days after it's given to allow time for all the screening tests, resulting in some lag time before it can be given to patients in need.

Inova is attempting to make up for the loss by encouraging people to donate blood at their three centers in Virginia. (The Red Cross is also encouraging people to donate at local chapters.) Members of Congress are encouraged to make an appointment here and here

Snail-Mail Health Insurance Campaign Gets Overwhelming Response in Arkansas

| Wed Oct. 2, 2013 11:27 AM EDT

Direct mail is a staple of dying print magazines and donation-seeking nonprofits. Such campaigns generally rely on sending enormous quantities of junk mail in the hopes of getting maybe a 3 percent return on the effort. So when the Arkansas Department of Human Services recently sent out 132,000 one-page letters to uninsured, low-income folks in the state offering them free health insurance through Arkansas's new privatized Medicaid program (a red-state version of expanding Medicaid under the Affordable Care Act), tea partiers in the legislature derided the effort as a waste of time and money. 

But as a sign of how desperate people are for affordable health care, the department ended up getting more than 55,000 responses to the snail-mail campaign—an unheard of 40 percent return. The Arkansas Times reported that not only did all those people want to enroll in the health care plan, but the outreach effort identified more than 2,500 kids who were eligible for traditional Medicaid but weren't enrolled. They are now signed up.

The state is fortunate that direct mail is working out so well, as other efforts to let people know about their new health insurance options are being sabotaged by Tea Party GOP state legislators. Backed by the Koch-funded Americans for Prosperity, these elected officials are still trying to prevent the state's human services department from using $4.5 million in federal funds to advertise the offerings of Arkansas's new insurance exchange, where starting this week, people can sign up for subsidized private health plans.

AFP, whose affiliate has been buying creepy ads telling young people not to get health insurance, has been lobbying hard to keep the state from advertising the new insurance offerings available under the Affordable Care Act, complaining mightily that "Arkansans are being forced to pay for advertising that tries to convince the state to give-in-to Obamacare." They fret that the federal funds will pay for ads in such places as—gasp!—the Arkansas Times and generate irritating pop-up ads on social media, search engines, and sites like Pandora radio. But pop-up ads can't hold a candle to the irritations of being uninsured. It's clear that, as the direct mail effort proved, AFP is mostly afraid that once people know they can get insurance, they're going to take it, and happily.

Obama Official May Run Against Florida's Anti-Obamacare AG

| Tue Oct. 1, 2013 4:28 PM EDT
Florida's attorney general Pam Bondi, up for reelection next year.

Florida attorney general Pam Bondi has been a lightning rod in a state that's got quite a few of them. A tea party favorite and occasional Fox News commentator, Bondi played the lead role in Florida's attack on the Affordable Care Act. Bondi's office filed suit, later joined by other states, to challenge the law's constitutionality. While the suit failed to derail the entire law, Bondi was wildly successful in helping prevent millions of poor people from getting health insurance through an expansion of Medicaid provided in the law. (The Supreme Court ruled that the Medicaid expansion could not be forced on the states and only expanded voluntarily. Florida and 12 other states then rejected it.)

On that stellar record, Bondi has been campaigning hard for reelection, even going so far as to postpone an execution so she could attend a fundraiser last month. Democrats would clearly love to kick her out of office along with Republican governor Rick Scott, who's facing a tough race next year. Polls are scarce as Democrats have yet to identify a challenger for the AG job (though Bondi seems to come out ahead in a TMZ "Who'd You Rather?" poll matching her up against California AG Kamala Harris, dubbed the "best looking attorney general in the country" by President Obama.) But one person thought to be lining up against Bondi is George Sheldon, currently the Acting Assistant Secretary for Children and Families at the US Department of Health and Human Services.

HHS Secretary Kathleen Sebelius announced last week that Sheldon would be stepping down and returning to Florida this month, and he has reportedly been feeling out donors and state politicos about the prospect of a Bondi challenge. TMZ is not likely to feature Sheldon in any "who's hotter" polls, but he knows Florida politics. Sheldon began his career in the state legislature and later served as deputy attorney general and head of the state's department of children and families. At HHS, he's been involved in campaigns to combat human trafficking and pushed to limit the use of psychotropic drugs on juveniles in foster care. Unfortunately, none of this is particularly sexy, and Sheldon himself would make a very mild-mannered foil to Bondi's firebrand.

His "hot" problem may extend to fundraising. Sheldon has made two previous efforts at winning statewide office, including a run for attorney general in 2002 in which he finished third in the Democratic primary. His tenure in the Obama administration may raise his profile a bit this time around, but given his own role in defending Obamacare, that may not be much of a credential with Florida's conservative voters. 

 

 

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