Inside the fight to *finally* win the health care battle
Deep in the South, activists rise
Welcome to a Wednesday night edition of Progress Report.
In late April, I received word that Progress Report had been nominated for Best Political Newsletter at the annual Powerful IDEA Awards. GAIN Power, the progressive organization that hands out the awards, encourages nominees to ask people to vote, which I haven’t really done thus far. But voting closes Friday and Thursday is my birthday… so hey, I’d be deeply appreciative if you register on the awards site and voted for Progress Report in the Best Political Newsletter category.
There a number of really strong candidates, so my only real goal is to avoid finishing in last place. You can vote here — let me know if the site is at all confusing and you need a screenshot or two to guide you:
OK, there’s a fair amount to address tonight, so let’s get to it!
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1️⃣ Over to you, Dick: Supreme Court Justice Samuel Alito informed Congress that he will not recuse himself from pending cases concerning Donald Trump and the Jan. 6 insurrection, brushing aside questions about his political allegiances and ability to remain impartial after several Trump-coded flags were spotted flying above his homes.
Alito blamed his wife, whom he called “fond of flags,” for the scandal, which began with the flying of an upside-down American flag in after the insurrection. “She makes her own decisions, and I have always respected her right to do so,” Alito, the man who authored the Dobbs decision, wrote without irony.
It’s key to note that his letters never deny the meaning of the upside-down flag nor that his wife supports them. They simply try to distance him from her decisions as something so basic on the outside.
Alito was never going to even spend a moment considering recusal at Democrats’ behest, but now that they’ve spent a week on this charade, it’s time for Durbin to start issuing and enforcing subpoenas to probe Alito’s support for the insurrection and the vast corruption scandal that has engulfed the court for more than a year.
Durbin will desperately resist doing it, though, because he’s a coward who is either too naive or lazy to do anything about the egregious corruption and ethics violations — Amy Coney Barrett’s husband is now representing Fox in a major lawsuit, by the way — that now define the court and imperil democracy and our fundamental rights. Fingers crossed that he reads Rep. Jamie Raskin’s new op-ed and feels so embarrassed that he takes action.
2️⃣ Chiseling away: Illinois will soon become the latest state to begin purchasing and cancelling medical debt held by its working class residents. The legislature this week passed a bill that will set aside $1 billion to buy the medical debt of people making within 400% of the federal poverty rate, with the aim of ultimately providing relief to one million Illinoisans.
Cook County, where Chicago is located, already has its own $350 million program for medical debt cancellation. Los Angeles County just launched a multi-point plan to identify, reduce, and cancel the medical debt owned by hospitals. A survey conducted last fall found that 100 million Americans held debt connected to health care, and it is by far the biggest driver of personal bankruptcy.
3️⃣ This man needs a primary: Bronx Congressman Richie Torres represents the poorest district in the United States, so naturally he’s devoted almost all of his time these past eight months fanatically talking about Israel and defending the brutality of its far-right, bloodthirsty government. Not only has he sworn off his ties to progressive Democrats, now Torres is spending his evenings hanging with some of the most vicious alt-right goons in Trumpworld.
4️⃣ What a pity: Bad news for bigots, bullies, and obsessive weirdos in California.
5️⃣ Keep pushing: Knowing that a few seats flipping this fall would preclude any ore big legislative accomplishments, Michigan Gov. Gretchen Whitmer is determined to get everything she can out of her paper-thin Democratic trifecta before November. Whitmer continues to push the legislature for a budget deal that includes universal pre-K for four-year-olds and two years of free community college for people who graduated high school in Michigan.
It’s been a decade since states began expanding Medicaid to more lower-income residents, and thanks to a mix of ballot initiatives and grassroots energy, there are now only ten holdout states that have yet to accept free money and better health outcomes.
Nearly all of the hold-out states are in the deep South, and unsurprisingly, study after study show that they tend to rank at the bottom of health care access, treatment metrics, and outcomes.
What’s vexing about this deep inequity is that unlike so many other major policies, expanding Medicaid is wildly popular with voters across the political spectrum. Yet in places like Alabama, where 70% of voters support an expansion that would immediately cover 300,000 more people, lawmakers do not seem all that interested.
It’s up to people like Debbie Smith, the campaign director for Cover Alabama, to make them care. And fast.
Cover Alabama is a coalition of over 80 organizations across the Yellowhammer state, from nonprofits and churches to unions and hospitals, that have come together to press the state’s Republican leadership to acquiesce to finally expanding the program. It’s an uphill battle, but as she told Progress Report earlier this month, momentum is slowly beginning to build.
Smith sounded optimistic, if very cautiously so, about the trajectory they are on, but there’s plenty of more work to do. What follows is a lightly condensed and edited version of our conversation about the politics and grassroots push to instantly help change Alabama.
So this legislative session is over and you’re looking to the future. Do you feel like positive steps were taken?
Smith: We did have some progress. In the last year or so, there has been different options floated around, like possibly looking at the Arkansas model of Medicaid expansion with the private-public option. We also had people from North Carolina, who expanded just a year ago, come in and talk about the success that they had there. Our point to the governor is that you have plenty of options, so find a way to close the coverage gap now, because people have waited long enough and suffered long enough.
Do you have a preference between traditional Medicaid expansion and the Arkansas model?
I think we all agree that straight Medicaid expansion is the best solution. It's gonna be the cheapest, quickest option for the nearly 300,000 people who are in the coverage gap to to get coverage. But we also know that it may be more politically feasible for another type of option, like the public-private option, to be more considered.
The benefits are obvious and the costs are low, but it’s still an uphill struggle with state leaders. Do you think it’s ideological or is it a matter of people somehow just not knowing that the federal government covers 90% of the costs?
A little bit of both. I do think that there is still a lot of education that has to be done on closing the coverage gap and Medicaid expansion. A lot of [lawmakers] really do not realize just how low the income limits are. We've shared it in commercials and everything, but it’s $4,475 a year per year. That’s 18% of the federal poverty level, and they have to have a child. [Childless adults do not qualify at all for Medicaid in Alabama]. And if you're adult making less than about $20,000 a year, you're just not gonna have any options.
How do you spend so much of your day working with people who can’t seem to get this? I’d lose my mind.
I've worked a lot with our grassroots and I'm very frank with them. But yeah, a lot of self-restraint.
North Carolina just finally got expansion done, and with a GOP legislature. What have you gleaned from them?
Have you heard of the Southerners for Medicaid Expansion? The insight they gave us was a lot of people power. For some important groups, like doctors, they actually did a couple different things. They had a more business-focused coalition and then they have their grassroots coalition. And so two different different ways. And whereas the grassroots, the grassroots was able to really focus on that, and the business was really able to focus more on the conservative talking points. So that was really successful.
Alabama has lost 11 rural hospitals over the past decade. How much does expansion — or lack thereof — make a difference with have it be real?
It's a huge concern. There are about 19 rural hospitals at immediate risk of closure within the next year. I mean, they really are hanging on by a lifeline and just doing whatever gymnastics they have to do to stay open. And we know that Medicaid expansion would really help those rural hospitals survive in those communities. Because Medicaid expansion would help with the uncompensated care costs that they're currently taking on.
A big elephant in the room here is work requirements, which many conservative states want to implement. Have those been floated?
Well, during the public joint Senate Health Committee hearing a couple of weeks ago, they did bring up work requirements as a question, but it wasn’t really harped upon. I want to I want to keep it that way.
Where is the governor on this? Has she responded to your letter?
Not yet. But in previous times that the governor has been asked about closing and coverage gap, expanding Medicaid, she has said that she wants to find a way to help the people of Alabama, but she doesn't know how we would pay for it long-term.
I think it’s obvious — it would cost less per head to fully expanded Medicaid than to run the system as it is today. So what do they mean?
We were just like, “What's long term?” Because there's a report from the Public Affairs and Research Council of Alabama that was done a couple of years on the economic impact of Medicaid expansion. It only looked at a six-year period. And it said that it could pay for itself for that six years.
If we did a Medicaid savings trust account, you could go for even more years with the savings that were accrued in the in the first few years. The hospital association has seen he this public private option out there that they've said it would pay for itself for 16 years. So what the heck of long term?
We can definitely look at other states that have already expanded Medicaid and look at their health outcomes. We have one of the worst first infant and maternal mortality rates in the country. And I believe that expanding Medicaid, making sure that when folks get their coverage before they're even pregnant, could really help with with those rights because people need to be healthy before they even get pregnant. And we also have a little bit of a lag time right now,
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