The Young and the Uninsured | Jackson Free Press | Jackson, MS

The Young and the Uninsured

Photo by Amanda Rohde

Amanda Starnes, 24, is in duress. She learned a few months ago that she suffers from Type 1 diabetes. She is a Holmes Junior College student and unemployed, with no federal or state health aid. Her doctor warned her to quit her job as an assistant manager of housekeeping at the Holiday Inn in Pearl, and apply for disability after her last collapse and subsequent emergency room visit. But she soon discovered that disability doesn't easily apply to people in their 20s, and now she can't find a job, despite signing on with several employment agencies. The medical bills of a 24-year-old unemployed diabetes patient, however, are mounting fast.

"I've got about $10,000 in medical bills," Starnes said. "... I've had two hospital stays, plus I have to go to a doctor once a month, plus all the medical supplies I have to get. Monthly, I have a running bill of about $1,500, because my doctor is nice and is friends with my grandmother and lets us slide on the bill for a minute, though they are starting to hound us about it."

Starnes' mother passed away last year. Her dad lives in another state. Except for her brother and her boyfriend, Jesse Lindsey, she admits she's pretty much alone. Except for the bills—they are always around to keep her company.

"I need special insulin that lasts me throughout the day, but that's $78 a bottle for a two-week supply. So we're talking about $160 a month. My doctor's been giving me free samples of that to sustain me, but she recently ran out of samples, and I can't afford it, so I ended up in ICU," Starnes said.

With no money or means, Starnes resorted to avoiding the ER by manually influencing her sugar level and using only her regular insulin, a tactic that failed miserably last month.

Starnes is brooding and fearful: "I still have some samples of the regular insulin, but I need so much, because my pancreas does not work at all, so without that 24-hour dose of special insulin I'm constantly registering high numbers on my glucose meter. They're so high, it doesn't even register any number. It just says 'high,' which is up at stroke level."

That constant monitoring requires test strips costing between $25 and $50 for a 10-day supply. It is yet another bill that proves too much for an unemployed college student.

She relies heavily on Lindsey, who is lucky if he sees $160 of his $600 two-week paycheck after Starnes' doctors and pharmacists are through with it. It's a situation that keeps Lindsey living with his mother, Ramona Khanifer, well into his 20s.

"I can't say where we'd be right now if it weren't for the bills. I can't say if I would still be living here," Lindsey said. "With that mass of money I could've fixed my truck, and taken care of any number of things. I'm paying $1,000 in medical bills alone, but then I have to work extra to get food. I mean, we haven't even talked about food or Amanda's utilities."

Lindsey then chuckles bitterly. "Amanda's special zero-sugar food costs big money, let me tell you. I'm basically transferring my paycheck to a bunch of doctors and drug-makers."

Starnes and Lindsey offer the younger persons' perspective of the national health-insurance debate raging across the country. Theirs is the nightmare of the more than half-million Mississippians who have no insurance, and no option other than to hope they don't get sick enough to need medical help.

It's an option that falls flat as soon as the virus bursts open its first blood cell, however, or the high-speed car in your left lane crosses over without seeing you.

The Stats

The Kaiser Foundation, a non-partisan health studies group, reports that Medicaid and the Children's Health Insurance Program (CHIP) are the primary sources of safety-net coverage available to low-income and disabled individuals in the United States. But the availability of this coverage varies terribly, depending on age and parent status due to "historic categorical restrictions embedded in the Medicaid program."

As of April 2009, all but seven states covered children through Medicaid or CHIP up to at least 200 percent of the federal poverty level ($14,570 for a family of two). A total of 28 states provide coverage to parents at or above 100 percent of the federal poverty line. Out of these, 19 offer coverage at or above 200 percent of the FPL. However, only 16 of the 28 states offer the full scope of benefits available in the regular Medicaid program. The remainder offer coverage that has more limited benefits or requires greater cost sharing than regular Medicaid.

The standard rule, however, is that non-disabled, low-income childless adults have the most limited access to public coverage. Sure, 24 states provide some form of coverage to childless adults, but only six, according to Kaiser Foundation information, provide the full scope of Medicaid benefits to this segment of the population. And in many states, childless adults are not eligible for any form of Medicaid, no matter how low their income—even if there's no income whatsoever.

Mississippi, one of the poorest states in the union, falls into that last category. Roy Mitchell, program director for the Mississippi Health Advocacy Program, says state leaders have been content to let people like Starnes die for decades.

"The state could potentially be receiving grants for millions of dollars to cover adults and we've repeatedly rejected those options, even though not one of them would cost our state anything," he said. "The governor has a lot of authority over our state Legislature and has worked steadfast against any effort to include coverage for our most vulnerable."

Mitchell said Starnes represents the truth behind a misconception pushed by the anti-Obama crowd pouring into town-hall meetings to shout down reform-minded politicians.

"There's been a longstanding myth that people can get some form of government health care in this state, that there are actually no uninsured. I've even heard a lot of high-ranking policy-makers mistake who the uninsured actually are," Mitchell said. "One of the main fallacies is that if you're a poor adult, you can get on Medicaid, which is absolutely not the truth."

Mississippians like Starnes are everywhere, voiceless and politically unaware while the debate that could decide their fate rages around them. "I know it's hard to believe, but even in a country like ours, it's completely plausible that (Starnes) has no options, unless she's disabled. Type 1 diabetes doesn't count as a disability. And even if she met the listings of SSI (Supplemental Security Income) eligibility, the burden of proof is on her, and sometimes it's difficult to prove that without an attorney."

Starnes is one example of the uninsured in the younger age bracket, but the "uninsured" label also extends into the older set. Reform opponents often portray the uninsured as young and in good health, but the Urban Institute Health Policy Center says the reality is not so simple.

On a national scale, the uninsured may be concentrated into younger age groups, but a considerable share is middle-aged or older. Slightly more than a quarter, 25.9 percent, are 45 to 64 years of age—just old enough to feel the aches in their bones and arteries, but still not old enough to reach the happy plateau of socialized health care we all call Social Security.

The majority of people surveyed without health coverage purport to be in excellent, very good or good health status. But 11.1 percent say they are in fair or poor health.

That 11 percent are out of luck unless they're willing to, as Lindsey puts it, "cheat the system." "This system is so broken, if I were to get Amanda pregnant and start a household, she could drain the government system and get anything she wants regarding health care. Pregnancy is a preventable thing that the government will pay for, but they offer nothing if you can't keep your pancreas working," Lindsey said.

Starnes agrees: "When I was in the hospital, social-care workers would come around to see if I qualified for any kind of assistance. They'd ask if I have any kids and I'd say no. Then they'd find out that I'm a certain age, and that pretty much ends the questions right there. I've applied for disability, but they told me the only way I could qualify for that was if I had some horrible psychological disorder. I'm dying, but I'm not physically debilitated enough for help. Isn't that strange?"

Advocates of health insurance reform and a consortium of doctors, including the American Academy of Family Physicians and the American Medical Association, say the current system removes the element of choice for many Americans.

Most of the uninsured, like Starnes and Lindsey, are not making a conscious decision to remain uninsured. Only about 30 percent of the uninsured are eligible for public health insurance programs, but about half of that 30 percent are children. The adults are largely on their own, with very little access to either Medicaid or CHIP. Insurance companies refuse to insure close to 70 percent of the uninsurable, either because the customer carries too much of a history of health problems to cover, or the companies consider them enough of a risk to impose premiums that gobble down more than 10 percent of the would-be customer's income.

The Bill

The U.S. House and Senate are debating how to reform health-insurance coverage for American citizens, with a major goal being the ability to offer reasonably affordable health insurance to millions of currently uninsured Americans.

The president is currently reviewing different versions of health-care legislation approved in four of five congressional committees with jurisdiction over the issue. Each is a separate document, but they all have a similar general approach. The proposals released by the Senate Finance Committee, Senate Health, Education, Labor and Pension (HELP) Committee, and House Committees on Ways and Means, Energy and Commerce, and Education and Labor (Tri-Committee) all expand Medicaid to individuals up to a specific income level and then provide subsidies for low- to middle-income individuals to purchase health insurance coverage. Obama has not proposed his own bill, yet, but is expected to Sept. 9 when he addresses a joint session of Congress to lay out his vision.

HB 3200, the combined version of the Democratic congressional bill that Republicans are disparagingly referring to as "Obamacare," seeks to expand health-insurance coverage to 40 million Americans who are currently uninsured by lowering the cost of health care and making the system more efficient. It creates a health-insurance exchange under the guidance of the federal government that creates a marketplace for individuals and small employers to compare insurance plans, and issues affordability credits to help low-income and middle-income customers buy insurance. States may later opt to operate the exchange, but they'll have to follow federal rules to do it.

H.B. 3200 also contains a new government-run insurance plan, known as "the public option," to offer competition to insurance companies who boast huge profits by cherry-picking from a list of mostly healthy customers with few medical risks.

Customers with higher health risks and a history of medical problems usually get shown the door or get saddled with huge monthly payments or co-pay demands. The bill prohibits denying coverage to customers for pre-existing conditions.

HB 3200 also contains a requirement that all American citizens have some form of health insurance, be it private insurance, the new public option or the traditional coverage offered through Medicaid or Medicare.

The program is funded three ways: a tax on people who don't accept insurance through their job and aren't eligible for Medicare or Medicaid; a tax on businesses over a certain income who refuse to offer insurance to their employee; and a tax on the richest Americans, essentially reversing some Bush-era tax cuts.

The personal tax amounts to the government subsidizing the cost of buying insurance, based on a sliding scale that is clearly more generous to people with annual incomes around $14,400 but doesn't apply to those making more than $43,320. The government will charge people based on either the national average cost of a basic health care plan or two percent of their adjusted gross income—whichever is less. A person employed only part of the year pays the tax based upon a reduced rate proportional to the time they worked.

Starnes' unemployment represents a complicated category considering she has no money to pay for insurance. Under H.R. 3200, however, someone who loses their job is eligible to enter the exchange and can purchase private or public insurance with affordability credits provided by the legislation.

There is an exemption out of this for religious purposes, most likely a reference to members of the Amish community who have strong views against things like Social Security.

A business tax, meanwhile, applies to businesses who choose not to supply their employees with some form of insurance that meets federal standards. (Insurance with a $10,000 deductible could fall into the "beneath federal standards" category.) Only businesses with payrolls exceeding $250,000 have to face the new tax, and only then if they choose not to offer coverage to their people.

If you have a payroll between $250,000 and $400,000, and you don't provide insurance, you get taxed comparable to 2 percent of your payroll if it is less than $300,000. The charge goes up to 4 percent of your payroll if it's between $300,000 and $350,000 and 6 percent if the payroll falls between the $350,000 and $400,000 mark. All businesses with payrolls above $400,000 that don't provide insurance for their employees get stuck with the full 8 percent rate.

The third tax falls to the rich—an easy target these days for those sitting unemployed on the couch. The bill imposes three tax rates of 1 percent, 1.5 percent and 5.4 percent on the income of high-income households. The 1 percent rate applies to incomes between $350,000 and $500,000. The 1.5 percent goes to people with a modified adjusted gross income between $500,000 and $1 million, while the 5.4 percent rate falls to all modified adjusted gross incomes of $1 million or more.

Aside from providing and financing a public option and requiring insurance, the bill also offers guaranteed coverage and insurance market reforms, according to a July 14 bill summary by the House Committees on Ways and Means, Energy and Commerce and Education and Labor.

"Insurance companies will no longer be able to engage in discriminatory practices that enable them to refuse to sell or renew policies today due to an individual's health status. In addition, they can no longer exclude coverage of treatments for pre-existing health conditions," the summary states. "The bill also protects consumers by prohibiting lifetime and annual limits on benefits. It also limits the ability of insurance companies to charge higher rates due to health status, gender or other factors. Under the proposal, premiums can vary based only on age (no more than 2:1), geography and family size."

The most effective means the bill offers to penalize insurance companies who turn away potential customers with a history of illness is likely to be the public option, which could draw away potential customers who otherwise would be forced to accept a private plan charging ridiculously high premiums.

At a recent pep rally against H.B 3200 at Lemuria Books, Jackson Drs. Pat Barrett and Phillip Ley lauded an alternate proposal offered by Sen. Tom Coburn, R-Okla. His bill would limits access to Medicaid coverage to people who meet eligibility requirements, offer no additional coverage to low-income families and non-disabled childless adults, like Starnes, and leaves the determination of eligibility to states.

Ley described the Coburn bill as "a much more logical approach than socializing health care."

The bill, which offers no public option, would create incentives and tax credits that would supposedly give people enough extra cash to be able to seek health care in the private industry. "I think (Starnes) would qualify to get enough insurance vouchers, pre-tax dollars to be able to afford insurance. It says anybody just over the poverty level would be helped by the government even if they had to come out and give them enough money to afford health insurance," Ley said.

When told that Starnes has a pre-existing condition that would likely exclude her for coverage, Ley said the bill contains enough regulation to push insurance companies to include even the most sickly customers: "One of the things in this bill is enough insurance regulator reform to where pre-conditions can not exclude people for a lifetime."

The bill actually creates a state-level health-insurance exchange that customers could use to purchase private insurance plans. The bill contains a requirement to limit "exorbitant premiums" offered through the state-run exchange but contains no specific penalties that would discipline insurance companies for turning away sickly customers.

The HIV Health Care Access Working Group, warns that Coburn's plan merely continues existing rules applicable mostly to group plans that limit the use of pre-existing condition exclusions in plans offered by state exchanges.

"We are concerned that the bill's proposed structure for state health insurance exchanges makes its likely effectiveness in promoting affordable access to comprehensive quality care highly uncertain," a report by the group states. "...ntil disincentives for covering individuals with costly health care needs are removed, it is unlikely that private health insurance issuers will consistently remove such barriers."

Most of the beneficiaries of HB 3200 live in one of two national regions—both of them, oddly, are rife with opponents who would seemingly rather see the reform simply go away. According to UIHP statistics, 44.3 percent of people who have no health coverage whatsoever reside in historically economically depressed areas in the South, like Mississippi, with another 24.3 percent residing in the West.

The Kaiser Foundation reports that funds resulting from health reforms currently being batted about in Congress this summer would disproportionately flow to states in these regions—though you would not know it, listening to the crowd of mostly older, white southerners and politicians opposing it.

The Lies

"We'll probably be covering all illegal aliens right across the board. That's my opinion," said one participant at an Aug. 22 "tea party" with U.S. Rep. Gregg Harper. "I've attempted to read it, but I can't make head or tails of almost any page in here. Obfuscation is at play here. Nobody knows what anybody's doing so how can we be fully accountable? In the confusion of this, illegal aliens can slip in pretty comfortable."

This was one voice among many given a microphone over the last few weeks. Mississippi representatives have been setting down all over the South, seeking input from supporters and critics of proposed health-insurance legislation. The resulting rallies, many numbering thousands of participants, vary depending on the party hosting it. The rallies for conservative representatives tend to be filled with audience members who already side with Republicans in keeping the uninsured steadfastly uninsured, while the Democratic rallies, like the recent town hall discussion of Democratic U.S. Rep. Bennie Thompson, tend to boil with very intense questions.

Washington Republicans are mostly dead set against any option that might cut the bottom line for insurance companies, and with good reason. Nobel Prize-winning economist Paul Krugman says the lobbying industry is so powerful in Washington that it's practically a branch of government all to itself, with few politicians ready to cross it.

"Our corporate-cash-dominated system is a relatively recent creation, dating mainly from the late 1970s," Krugman wrote in his New York Times column. "And now that this system exists, reform of any kind has become extremely difficult. That's especially true for health care, where growing spending has made the vested interests far more powerful than they were in Nixon's day. The health-insurance industry, in particular, saw its premiums go from 1.5 percent of G.D.P. in 1970 to 5.5 percent in 2007, so that a once minor player has become a political behemoth, one that is currently spending $1.4 million a day lobbying Congress."

Though Democrats certainly benefit from insurance lobbying money, the Republican Party gets a bigger take, and Harper, a quintessential southern Republican, can find endless flaws with the bill.

For example, Harper was happy to stoke speakers' fears of coverage for undocumented workers, even as he waved about a House bill that offered no expanded coverage whatsoever for non-U.S. citizens. He offered no counter response to one person's accusation—that health-care reform involved virtually handing some Mexican immigrant his own doctor to take back home with him. While Harper admitted that no aspect of the bill appeared to address immigrants, he added that the administration of Democratic President Barack Obama has "said there is a moral imperative to provide for illegal immigrants."

It was the same misinformation launched acrimoniously at Rep. Thompson on the night of his recent meeting at NAACP headquarters in Jackson. "You can't make any promise to me that this bill will not provide free health care for immigrants," one audience member shouted into a microphone before the Second Congressional District representative.

"I can tell you that this bill has nothing in it that offers health-care coverage for a non-citizen," Thompson eventually replied. The bill, he said, expands coverage of current government health-care plans, which already require citizenship for participation.

Media Matters, a nonprofit research and information center, explains that the disputed Section 152 of HR 3200 includes a generic nondiscrimination clause, which says insurers may not discriminate due to "personal characteristics extraneous to the provision of high-quality health care or related services." It says nothing about non-citizens or immigrants, legal or otherwise. The legislation states that undocumented aliens will not be eligible for credits to help them buy health insurance, in Section 246, on page 143 of the bill.

Meanwhile, other bill opponents are playing the abortion card. Harper admitted that the House version under construction made no reference to funding abortions, but opines to supporters that the bill could be a gateway drug into federally funded abortions.

"There's nothing expressly in the bill that provides for abortions. ...(B)ut the scary thing is there is so much left up to bureaucracy that will be created though this bill, and it's important to know that there have been amendments proposed that would eliminate the ability for this option to provide abortions, and those amendments have not been adopted," Harper told the crowd.

"Look at that, and it gives you some idea of the intent of the people pushing it. They're clearly leaving the door open so that somewhere down the road acceptable coverage for the nation could include abortion."

Harper claimed that Secretary of Health and Human Services Director Kathleen Sebelius, appointed by Obama this year, is a supporter of the late Dr. George Tiller, who performed abortions until he was assassinated by an abortion-rights opponent at his clinic.

"That gives you an idea of the mindset of the people that will be in charge of this program. That is part of what makes this thing so totally onerous and has to be thrown out in its entirety," Harper said.

Catholics for Kathleen Sebelius report, however, that Sebelius has no connection to Tiller, that he only bought a table for the reception in a fund-raising auction. "Gov. Sebelius did not invite him to attend. Gov. Sebelius has not taken financial contributions from Tiller as a gubernatorial candidate or as governor," the Web site explains.

But the lies don't stop there. The insurance lobby is using last-ditch scare tactics, spreading myths that might help block the major reform Obama promised during his campaign. "The insurance companies know if a public-funded insurance option ever gets here, it'll never go away because people will love it," said Mississippi AFL-CIO President Robert Shaffer, who suggested Republicans agree to a sunset clause for the public-health option if they think it will be such a failure.

"But they wouldn't do that, because they know that we Americans love the hell out of our socialized health care. Take Social Security. It hasn't gone anywhere since it got here. And if any politician tries to overtly take it away, they'll beat the hell out of him."

If Shaffer is right, insurance companies have good reason to battle this effort now—after all, there's no second fight if the option is popular. The insurance lobby has plenty of cash to wage war, however, and with that kind of loose money they're able to try every possible tactic. It's no surprise then that one of those tactics would include an artificial escapade into the grass-roots movement, appropriately called "astroturfing." Reform supporters say corporate backers are handing out mindless talking points and steering participants toward town-hall meetings to shout down the debate, bringing an end to serious conversation. reports that "astroturfing"—the use of front groups to organize fake grass-roots political efforts—is particularly rampant in the insurance-reform debate, though it appears to be a bipartisan endeavor. Conservative group FreedomWorks astroturfs when it uses corporate funding to support "tea party" protests. Of course, Health Care for America Now, which is largely comprised of union members, supports the Obama administration's call for reform and frequently sent audience members to various town hall meetings with signs supporting reform, as well.

Astroturfing probably isn't new. Even the Boston Tea Party had some organization. However the Astroturf movement lately has included pushing out trash topics, like the creation of government "death panels" to encourage old people to hurry on into the afterlife, an outright lie. Such lies prevent serious debate on such matters as what insurance reform and a possible government-supported health option would really mean to the national debt.

One 25-year-old-looking audience member at the Thompson town hall meeting, who claimed to be 16 years old, explained that he was not old enough to vote, but worried that Thompson—who supports the public option—was willing to send his generation into more debt for the sake of reform.

Thompson replied that he understands "what's right and what's wrong" with the argument that a public option would allow the trimming of enough fat out of the health-care system to account for the investment.

The congressman also emphasized opponents' lack of consistency on the debt debate. "I wish when I was voting against (Bush's) deficit budgeting every time that somebody like you would have said, 'Bennie Thompson, you're doing the right thing because you're not helping to put this country in debt.' But nobody called me," Thompson said.

But money is serious, and reform opponents like Harper are using the issue to try to rebuild party unity: "The Democrats complained about deficit spending (during the Bush years), and now the Republicans are complaining about it. Wouldn't it be great if everybody was complaining about it?"

Expect plenty more high-quality mileage out of the money-concern side of the argument. It's a serious talking point, but it has also been a successful argument launched by white, southern politicians for the last 80 years.

The History

History has a curious way of repeating itself, according to Pam Shaw, senior policy consultant with the Children's Defense Fund.

"For decades our politicians down here in the South have derailed any effort to keep people from dying of illness. If there has ever been a vote to help the masses, our politicians have been against it, and we've never held our people accountable," she said, before launching into a history lesson that makes our southern politicians look heartless.

The years 1935 through 1939 saw the beginnings of the National Health Insurance debate with the New Deal. Like today, the president and Congress together brought some kind of financial relief to an ailing populace falling victim to a worldwide depression.

President Franklin Roosevelt pushed for national health reform throughout his two terms, with a second push after the passage of the Social Security Act. But Congress, by then, was suffering the same brand of cold feet experienced by today's congressional conservatives after the passage of the American Recovery and Reinvestment Act. It lost its zeal for FDR's government expansions; even the ones that potentially extended health-care coverage.

President Harry Truman's election mirrored Obama's, by appearing to be a mandate for some form of national health-care coverage. In his Nov. 19, 1945 address, he called for the creation of a national health insurance fund to be run by the federal government.

Information from the Harry S. Truman Library and Museum describes the fund as being open to all Americans, but remaining optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for services rendered by doctors who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.

Truman brought his health proposals to Congress in the form of a Social Security expansion bill, co-sponsored by Sens. Robert Wagner, D-N.Y., and James Murray, D-Mont., along with Rep. John Dingell, D-Mich. For this reason, the bill was known as (go on, smile at the irony) the W-M-D bill.

The American Medical Association, which today advocates for HB 3200, launched an attack against Truman's bill, capitalizing on rampant paranoia at the spread of communism. The AMA characterized the bill as "socialized medicine," and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line." Then the Korean War kicked into gear and forced Truman to abandon the W-M-D Bill altogether.

Defeat didn't happen without the help of local boys, however. Southern whites knew well that the northern states had little appreciation for the apartheid system they had imposed upon the black population. Southern politicians, naturally, bought into the argument that any federal role in health care might require some form of desegregation. The argument was that them-damn-yanks out of Washington would make you go to the same doctor as your Negro neighbor, so white southerners worked to block all proposals.

The proposals stayed blocked until the U.S. population found itself getting slightly older, and consequently discovered a new sense of altruism toward the elderly. President Lyndon Johnson signed the bill incorporating Medicare and Medicaid in 1965, stating proudly that the whole endeavor "all started really with the man from Independence," an obvious reference to Truman—who stood at his side at the time of the signing.

Johnson also signed the Civil Rights Act, essentially signing the South away from Democrats for decades to come and helping instigate the infamous southern race strategy.

The tug of war over health care has continued since then with the stagflation and unmitigated increases in health-care costs of the 1970s driving Massachusetts Sen. Ted Kennedy to propose national health insurance. Then-President Richard Nixon, a Republican, offered his own Comprehensive Health Insurance Plan (CHIP)—an endeavor that most Republicans would not dare attempt today.

Nixon's proposal for health-care reform actually closely resembled today's Democratic proposals. Harper, for example, is furious over a Democratic proposal requiring businesses making more than $500,000 to offer health insurance or cough up an annual payment to defer the government's costs. Nixon proposed requiring all employers offer insurance.

The Nixon era seems to pre-date the laissez-faire ideology of Barry Goldwater and today's GOP. Nixon also called upon stronger regulation for insurance companies, and sought to give more police powers to the states to oversee rates and impose annual audits.

Kennedy never joined forces with Nixon's proposal, and Nixon's career ended soon with the Watergate scandal, effectively derailing the health-insurance reform debate.

President Bill Clinton took another whack at national health reform in his first term, proposing a package containing universal coverage, increased competition between insurers and active government regulation to contain costs, which had been spiraling out of control since the 1970s.

But the insurance lobby had moved into Washington by then. The Health Insurance Association of America joined with small business associations to oppose the Clinton plan. Together with the growing anti-Democratic sentiment coming from the South, the national debate took a turn and toppled.

"It is now as it was then, and I'm amazed at the similarity," Shaw said. "... Do you know how few families in this state actually make more than $250,000 a year and qualified for that tax cut? Fewer than 15,000 families—and that's the combined incomes of husband and wife. ... You've got to work hard to be 50th in this many things, be it health, education, income, quality of life, you name it."

The Future

Yet the debate rages on, with the old familiar battle lines between the North and South still plain, despite the apparent popularity of expanded health-care coverage nationwide, according to polls.

A recent Survey USA poll found that 77 percent of Americans said they want a public option, when asked, "In any health-care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance?" Fifty-eight percent rated it as "extremely important," 19 percent rated it "quite important," and 23 percent felt it was "not at all important," "not that important," or just "not sure."

Regardless of public sentiment, Republicans are freshly invigorated over the issue, and the Senate is looking to reclaim an advantage. The Aug. 20 Wall Street Journal claims Senate Majority Leader Harry Reid is considering putting the issue up to a reconciliation vote, although not likely "until we have exhausted efforts to produce a bipartisan bill."

Use of reconciliation means the Democrat majority only needs 51 votes to pass health-insurance legislation in the Senate, rather than the 60 votes ordinarily needed to advance legislation.

Jim Manley, a spokesman for Reid, added that "patience is not unlimited, and we are determined to get something done this year by any legislative means necessary."

Senate leaders will be weighing their options as Congress reconvenes after Labor Day. Democrats have a majority in the Senate, despite the political fence-jumping of some southern Democrats. So apparently there was enough fear of the impending tactic for the conservative group Americans for Limited Government to issue a warning to Reid.

Americans for Limited Government President Bill Wilson issued a Sept. 1 statement advising Reid against invoking reconciliation to "ram ObamaCare down the throats of an unwilling populace at the cost of representative, two-party governance."

"This is the beginning of the end of the time-honored filibuster, and is Reid's attempt to solidify one-party dictatorial rule in the U.S. Senate for the first time in American history," Wilson stated, repeating the 80-year-old conservative mantra that an attempt to expand health care is "a complete takeover of the nation's entire health care system."

Lindsey, like many under-30 Americans, says he has no fear of expanded government, or of Wilson's fear-mongering.

"Am I afraid of 'socialized' health care? Are you kidding? What could be worse than not having any health care at all? Those of you with health care, your options are still out there. Insurance companies aren't going anywhere, as long as you want to pay them their price, and they'll have you. The only difference would be is we'll get a chance to have an option, too," Lindsey said.

Starnes grew testy at the question of whether or not a public option would require her to see a select number of doctors who have opted or who qualify to work with the new system: "I won't complain if they send me to a certain clinic, just so long as it's a clinic that will actually take care of me, which is more than I'm getting right now," she said.

A Very Good Policy
Drastic Change
'Massive' Pre-Existing Condition
Delaying Treatment
Myths v. Truth: The Truth Behind HR 3200

Previous Comments


This story needs to be shouted to the rafters and sent to anyone who will listen - starting with the Diabetes Foundation of Mississippi and going up to the American Diabetes Association. We know first hand about the bills for a type 1 diabetic: even though they are covered by the Americans with Disabilities Act, they can't be declared disabled when it comes to assistance. We have had to scrounge for test strips the last few days because our endocrinologist's office was closed. There are only two pediatric endocrinologists in the Jackson area, and the regular endocrinologists will not see a child: so if you're dissatisfied with yours (like we are) you either have to wait months to get in to see the other, or you have to try to get in the clinic in Tupelo or Hattiesburg. And the one we go to will not refill your prescription if you have a back balance: they will only write for enough to get to your next monthly doctor appointment. If something happens, and you can't make that, and you call in to tell them, you're screwed. Amanda Starnes has my sympathy and my prayers. This is why we have to fight for a better health care system, people. You can get no better example than what she has gone through. JFP, thank you for bringing this kind of atrocity to light.

Lady Havoc

The standard rule, however, is that non-disabled, low-income childless adults have the most limited access to public coverage. Sure, 24 states provide some form of coverage to childless adults, but only six, according to Kaiser Foundation information, provide the full scope of Medicaid benefits to this segment of the population. And in many states, childless adults are not eligible for any form of Medicaid, no matter how low their income—even if there's no income whatsoever. I'm soooo glad that SOMEBODY brought this up. I've been without insurance more than once, and it is not fun. I remember a few years ago when I was doing temp work and I got sick. I just started there, and the agency only offered health insurance to certain employees who've been there for a while. I applied for Medicaid and was turned down because I was not pregnant and did not have children. I thought that was insane. Thankfully, I went to a clinic that had a sliding fee scale, so I paid a small copayment. I couldn't afford the prescription, so I got a sample. If it weren't for that clinic, I would have had to go to the ER, which I detest. That situation managed to work out, but what if I had a more catastrophic issue that was beyond what the clinic could do? What would have happened then?


Great Article. However, let me offer two additional items for consideration. #1: Mississippi is not a poor state. By any national or international measure Mississippi is wealthy in resources, infrastructure and capital. Mississippi does, however, have more than its' share of poor design and public policy. I am continually amazed that the JFP keeps repeating this incorrect statement without research, thought or clarification. Ms. corporate and individual tax structure is so regressive that the wealthy land owning individuals (and mostly corporations), professional service providing and entrepreneural class are paying much less than. their fair share of taxes. Like the individual income, corporate and sales tax, the unemployment taxes in this state are regressive and placed on the backs of the poorer citizens. We can argue about the concept of fair on another blog, but is it fair for the vast majority of Mississippi workers, all of whom make minimum wage and all of whom have unemployment taxes deducted from their paychecks every week, will NEVER be eligible to receive unemployment checks? #2: When was the last time you were asked to pay a national defense insurance premium? If its improtant let the cost be covered like most IMPORTANT national defense programs of the Federal Gov't programs and stop nit pickin. I remember way back in the 50's and 60's when the Russian Sputnik scare resulted in the National Defense Student Loan, funded through the Dept of Defense, to get more students into math and science. It worked..although it has been since far as I know. Lets go to the moon..yet again, no moon insurance premiums were required or even discussed. Thanks again for the in-depth article on the White face of the health care crisis on America.


Whoa! The president just said that health care reform will not cover people who are in the U.S. illegally and somebody just hollered out, "LIE!" Obama just coolly came back and said, "No, it's not" or something to that effect.

golden eagle

That was the distinguished redneck from South Carolina, Joe Wilson. Nicely done, cowboy.


Sen. McCain just demanded that the South Carolina redneck apologize for shouting out that the president was lying. That could go down in history as the moment when health-insurance reform finally became a reality. Cheers to McCain for trying to help his party scrape itself off the floor and become a respectable party again. Others should fall his lead, find their inner class and have the balls to talk back to the wingnuts.


I was just about to report that. A distinguished redneck, huh? I didn't even know who he was until tonight. First, Mark Sanford and now another embarrassment to the people of South Carolina.

golden eagle

Amanda's story isn't that unusual really, lots of people have trouble with buying medicine and getting proper care. For her, I would suggest if she hasn't already, apply for the drug company indigent program. Most pharmaceutical companies have programs that give free medicines for indigent patients but there is paperwork to be filled out at the doctors office. If Amanda hasn't done this she should do so immediately. 2 links to companies that make the insulin she needs.


That's the point, GLewis. It's not unusual. But even doing what you suggest wouldn't get her the *health care* she needs. Someone should go to jail for denying her coverage.


The AARP is everywhere today busting the myths and scare tactics spread by Big Insurance and Republican opponents of heath-insurance reform. Go check it out, and call your grandparents. The schmucks out there need to stop trying to scare our elderly. They deserve more respect than that.


Thanks so much for the article. This case is all too familiar. America can do better and if we continue to let our Representatives and Senators know just how concerned and serious we are about a reformed health care provision to include a public option, this can become a reality. Joe Wilson from South Carolina really showed his butt last night. He has already submitted a written apology. We also had the Superintendent of Public Schools for South Carolina reporting that he would not allow their children to watch the President's message to school children. According to him, the issue is "too controversial."


Yes, he apologized Justjess, but he still tried to make it sound like he was mad because he "disagreed." Meantime, what he was yelling about was hard, cold fact; he and his ilk are the liars about illegal immigrants benefitting from health-insurance reform. Call the lies out, folks, everytime you hear them. We can put this thing on a high ground. The president paved the way last night, as did Rep. Wilson's ignorant caveman behavior.


Two places that might help for Ms. Starnes if she hasn't already tried them: Central Mississippi Healthcare Services and Jackson Hinds Comprehensive. They're both community health centers and have some more options for payment than traditional clinics.


BTW, all, here are numbers released by the Mississippi Health Advocacy Program: Here is how our broken health care system affects people in Mississippi: * 130 residents of Mississippi are losing health insurance every day, and 14,000 Americans nationwidelose insurance daily. * The average family premium in Mississippi costs $800 more because our system fails to cover everyone-and $1,100 more nationally. * Our broken health insurance system will cost the Mississippi economy as much as $2.6 billion this year in productivity losses due to the uninsured-and up to $248 billion nationally. * In Mississippi there has been a 10 percent increase in the uninsured rate since 2007. * 550,000 are uninsured today in Mississippi. * The average family premium will rise from $11,288 to $19,261 by 2019 in Mississippi without health care reform. * In Mississippi, without health care reform, 85,180 will have lost coverage from January 2008 to December 2010. * In Mississippi, 284,000 people would gain coverage as a result of the House health care reform bill by 2013, and 457,000 would gain coverage by 2019.


I sympathize with the story, believe me. My sister is 41, three heart attacks and several strokes leaving her unable to work or drive. She has been systematically denied disability even with the numerous doctors and surgeons stating that she is disabled and the stroke sight is inoperable. However, I don't believe that mandated governmental healthcare is the answer. How about fixing the flaws in disability law that keeps denying those that legitimately deserve it. Let's fix the clusters we have in the programs in place before we create another program to cluster. If my sister and Amanda were approved as they should have been, there would not be a need for the other healthcare. They are disabled. Let's take of them as we should, with the programs we have.


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