Recently, the New York Times ran a front-page story reporting that Democrats running for Congress are reluctant to “run on Obamacare.” Instead, they are “running away from it, while Republicans are prospering by demanding its repeal.” The problem, according to the Times, is that discussions of the Affordable Care Act (ACA) tend to focus on “coverage for those of modest means,” and this “has led white voters to see the law as an act of government redistribution to the 15 percent of the population that is uninsured.”
As proof, the paper cites a five-month-old New York Times/CBS News poll showing that “just 17 percent of whites said the health law would help them while 41 percent said it would hurt; among blacks, 42 percent said it would help them while 15 percent predicted it would hurt.”
“Democrats could ultimately see some political benefit” from Obamacare the story acknowledges. But as candidates prepare for mid-term elections, “they are confronting a vexing reality: Many of those helped by the health care law — notably young people and minorities . . . tend to vote in midterms at lower rates than older and white voters.”
The reporter points to two Democratic candidates in Georgia who are doing their best to distance themselves from reform: “Jason Carter, the grandson of former President Jimmy Carter, who is running for governor, and Michelle Nunn, the daughter of former Senator Sam Nunn, a candidate for the Senate.. . . They have spoken in public about the law mostly to criticize it, did nothing to promote enrollment for insurance before last month’s deadline and declined interviews to even discuss the law.”
Who Benefits From Obamacare?
The Times describes those who will be helped by reform as people “of modest means.” This is a phrase that newspapers such as the New York Times, The Washington Postl and the Wall Street Journal often use to refer to the poor or the lower-middle-class –i.e., not you, dear reader.” (Try Googling this rather old-fashioned, faintly British phrase, along with the names of these papers, and you will be startled by how often it pops up.)
In this country, we do not like to talk about class. I recall that when I first became a journalist, I was told that if I wanted to write about “the rich” and “the poor,” I should refer to them as “the have’s” and “the have not’s.” Of late, “people of modest means” seems to have become the preferred euphemism for the working-class. That phrase makes it clear that these are plain, hard-working folks, and we respect them– or at least we would if we knew any of them.
What is peculiar about this story is that it overlooks the fact that there are a great many white, middle-aged Americans “of modest means” who now have affordable insurance, thanks to the ACA. Perhaps they don’t read the Times, but they do vote. Why wouldn’t they cast their ballots for candidates that support Obamacare?
As for “government redistribution” of income, the article seems to suggest that middle-class white Americans will be paying more in taxes in order to help “the 15% of the population that is uninsured.” In fact, only the wealthiest 2% (those earning more than $200,000, $250,000 for couples) face tax increases that will help fund universal health care for working-class, middle-class and upper-middle-class Americans of all ages and colors.
Obamacare Protects the Under-insured
Moreover, the group that benefits includes not just “the 15% who are uninsured,” but millions of Under-insured Americans who have been trying to get by on cheap policies that did not cover:
Subsidies for the Upper-Middle Class
Some readers may be surprised by my claim that the ACA helps not just the middle-class, but many in the “upper-middle-class.”
Admittedly, “middle-class” and “upper-middle class” are slippery terms. This is why I prefer to define them in terms of what an average household of a particular size living in a particular place earns.
For instance, according to the Census Bureau, “median income” for a family of four living in Indiana is $70,760: Half of all Hoosier households of that size bring home less than $70,760; half make more. In my book, this makes an Indiana family that clears, say, $68,000 to $78,000 solidly middle-class.
By the same measure, an Indiana family of four grossing $20,000 more than the median –or about $90,000–might reasonably be called “upper-middle-class.” (Let me be clear: I am not suggesting that they are “rich,” but they are, without question, living at the upper end of the middle-class.)
On the other hand, in Pennsylvania, where median income for a family of four is considerably higher ($82,078), a household probably would have to earn something north of $100,000 to be able to afford an “upper-middle-class lifestyle.”
These are, of course, very crude numbers; cost of-living varies in different parts of a state. But, while rough, these are real numbers based on what Americans actually earn. As this Census Bureau table reveals, median income for a family of four exceeds $85,000 in just ten states. And it tops out, in Maryland, at $108,915.
It turns out that in most states, a family of four pulling in somewhere between $64,000 and $80,000 is perched, however precariously, on a middle rung on the income ladder. The good news is that the Affordable Care Act provides subsidies to help a family of four earning up to $95,400 This is why I say that, in the majority of states, Obamacare helps upper-middle-class families purchase comprehensive insurance..
For example, a 40-year-old couple with two children living in Winston-Salem, North Carolina and reporting joint income of $90,000 would be eligible for a subsidy of $2,548. (Note: in North Carolina, median income for a family of four is $64,983; a family clearing $90,000 brings home $25,000 more than average.)
Do Americans Perceive Obamacare As “Social Welfare”?
The Times quotes David Axelrod, a long-time adviser to President Obama, saying : “I think [the ACA] is viewed more as a social welfare program than a social insurance program.”
“That contrasts sharply with Medicare and Social Security” the reporter adds, “which remain popular because almost everyone who benefits paid something into the system.”
Neither the Times nor Axelrod is saying that Obamacare is a “social welfare program.” But the story argues, “white Americans” perceive it as “an income transfer program from the better-off to the poor.”
The reporter explains: “The focus on the law’s expansion of coverage for those of modest means has . . . overshadowed popular, more broadly enjoyed benefits like allowing parents to keep their children on their plans until they are 26 and barring insurance companies from denying coverage because of pre-existing conditions.
He quotes Ezekiel J. Emanuel, formerly a White House healthcare advisor: “This is where the communications failure has been so problematic. We haven’t really alerted Americans to the fact that there is much more to this than the exchanges that’s going to be really, really positive for all of us, not just those getting insurance.”
But, the Times argues: “that view has not taken hold, especially among white voters.” The story then quotes Judy McDaniel, a mother in Atlanta Georgia. McDaniel confides that she had “mixed feelings” about Obamacare, “even after her 42-year-old son was finally able to sign up for health insurance under the law: ‘I’ve been lucky enough in my career to afford my own insurance, and I’m not sure how I feel about supporting others.’” The reporter notes that McDaniel “is white and said she had voted against Mr. Obama.”
The truth is that, as Emanuel stresses, the ACA helps all of us, even if we haven’t purchased insurance in an Exchange. Anyone with health benefits at work now knows that if he loses his job, he will not lose his insurance. He can immediately purchase coverage in the Exchange where he is very likely to qualify for a subsidy.
Moreover, anyone who buys a policy outside of the Exchange now knows that the insurer must provide free preventive care, and cannot cap how much it will pay out over a year, or over the course of a lifetime.On the other hand, the amount that a carrier can ask him to ever pay out-of-pocket, is capped. This is why the law is called the Patient Protection and Affordable Care Act
In Part 2 of this post, I will ask: Is Judy McDaniel representative of most white Americans? Wouldn’t most mothers be happy that the ACA helped their sons? Are Republicans “prospering” as the Times claims, by continuing to demand repeal?
To answer those questions, I will look at recent polls.
They reveal that when it comes to supporting the ACA, the biggest difference cannot be framed in terms of “older whites” vs.“minorities,” but rather in terms of Democrats vs. Republicans. And in the past couple of weeks,the polls make it clear that as exchanges hit their goals, Democratic support for the law has rebounded.
Pretending that Obamacare (or President Obama himself) does not exist will not be a winning strategy for Democrats facing mid-term elections. This will be the time for them to reap the benefits of being members of the party that has, at long last, taken a gigantic step toward reforming our fractured healthcare system.
Just as in 2006 and 2012, they will win if they bring their constituency out to vote: Registered Democrats, well-educated young Americans of all races, women of all races (particularly single women), African-Americans, Latinos, Asians and new immigrants have become the Democratic party’s new base. For many of those voters, the ACA is no longer an issue: it’s a done deal. Now, they want to hear about raising the minimum wage, immigration policy, equal pay for women, voting rights, making college more affordable, and expanding Medicaid in states that haven’t yet taken Washington up on its offer to pour millions of dollars into their states.