Healthcare Ping Pong for the Poor

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Harold Pollack reports today on an issue with the healthcare reform law that seems trivial at first but turns out to be anything but on closer inspection. The problem is this: a certain number of poor and working class families have highly variable incomes, which means they might be eligible for Medicaid one month but healthcare exchanges the next. So do they ping pong back and forth between the two? Or what?

At first this might not seem like a big deal. How many of these kinds of families can there be? The answer, it turns out, is a lot. Nearly a third of all families have incomes less than 200% of the federal poverty level, and Benjamin Sommers and Sara Rosenbaum, using longitudinal survey data, conclude that a whole lot of them have highly variable incomes:

We estimate that within six months, more than 35 percent of all adults with family incomes below 200 percent of the federal poverty level will experience a shift in eligibility from Medicaid to an insurance exchange, or the reverse; within a year, 50 percent, or 28 million, will.

Harold comments:

States need to account for this in their design health insurance exchanges, and to allow a more permeable boundary between the new exchanges and Medicaid. Sommers and Rosenbaum provide some pretty sensible policy suggestions. I’ll let you read their take and decide for yourself.

The Affordable Care Act is pretty silent about how these issues should be handled. For all the juvenile criticisms of passing a many-paged bill, a few-thousand pages provides only a basic structure and roadmap for health reform. Much of the hard work resides in the yet-to-be-written administrative and regulatory Midrash that goes along with it.

The policy suggestions Harold alludes to are behind a paywall, so I can’t comment on them at the moment. But I don’t doubt that they’re pretty sensible. Hopefully state-level administrators will start thinking about this, even if their political masters are busy covering their ears, shouting “la la la,” and trying to pretend that the healthcare reform law doesn’t exist and will never go into effect. It will, and this is a problem every state will need to address.

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WHO DOESN’T LOVE A POSITIVE STORY—OR TWO?

“Great journalism really does make a difference in this world: it can even save kids.”

That’s what a civil rights lawyer wrote to Julia Lurie, the day after her major investigation into a psychiatric hospital chain that uses foster children as “cash cows” published, letting her know he was using her findings that same day in a hearing to keep a child out of one of the facilities we investigated.

That’s awesome. As is the fact that Julia, who spent a full year reporting this challenging story, promptly heard from a Senate committee that will use her work in their own investigation of Universal Health Services. There’s no doubt her revelations will continue to have a big impact in the months and years to come.

Like another story about Mother Jones’ real-world impact.

This one, a multiyear investigation, published in 2021, exposed conditions in sugar work camps in the Dominican Republic owned by Central Romana—the conglomerate behind brands like C&H and Domino, whose product ends up in our Hershey bars and other sweets. A year ago, the Biden administration banned sugar imports from Central Romana. And just recently, we learned of a previously undisclosed investigation from the Department of Homeland Security, looking into working conditions at Central Romana. How big of a deal is this?

“This could be the first time a corporation would be held criminally liable for forced labor in their own supply chains,” according to a retired special agent we talked to.

Wow.

And it is only because Mother Jones is funded primarily by donations from readers that we can mount ambitious, yearlong—or more—investigations like these two stories that are making waves.

About that: It’s unfathomably hard in the news business right now, and we came up about $28,000 short during our recent fall fundraising campaign. We simply have to make that up soon to avoid falling further behind than can be made up for, or needing to somehow trim $1 million from our budget, like happened last year.

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