The Court's cramped view of Medicaid expansion means that low income people will bear the individual mandate 'tax' disproportionately. Upholding the requirement that individuals buy private insurance while allowing states to opt out of Medicaid expansion is the worst possible outcome. Achieving universal coverage by compelling low income Americans to purchase private insurance will protect health industry profits at the expense of people most in need of health care for all.
The precise consequence of the Court's ruling on Medicaid expansion is not yet knowable, as states have the right to accept the federal terms of expansion. States that do accept Medicaid expansion will cover people whose incomes fall below 133% of the poverty line, including people who are categorically excluded under most state Medicaid programs today -- individual adults between age 19 and 65.
But as 26 states challenged the Medicaid expansion provision of the Affordable Care Act, it is reasonable to anticipate that some states will opt out the Medicaid expansion program now that they have the right to do so. HALF of the 32 million people the Affordable Care Act promised would achieve health care coverage were slated to secure their coverage through expanded Medicaid. A sizeable subset of the 16 million who would have been covered under expanded Medicaid may be opted out by their states, depending on where they live. This pulls the legs off the structure of "universal coverage" under the Affordable Care Act, leaving economically vulnerable people, disproportionately of color, out in the cold world of medical impoverishment.
In the worst case, 16 million low wage workers who do not have health insurance where they work will be forced into the health care exchanges where they must obey the individual mandate to buy insurance. A system of hardship exemptions and graduated, income-based subsidies and rebates will attenuate some of the economic burden that befalls low income American -- assuming the subsidies are fully funded and that the current funding formula stands. But this won't mitigate the fact that the currently uninsured -- overwhelmingly because they cannot afford insurance -- will be the most vulnerable, unequal participants in the new system.
For a critical consideration of the inequality effects of the Supreme Court's Obamacare decision, see: http://colorlines.com/archives/2012/06/how_the_supreme_courts_obamacare_ruling_may_lock_in_racial_inequity.html
For a discussion of the attitudes of states toward Medicaid expansion, see: http://www.propublica.org/article/mystery-after-the-health-care-ruling-which-states-will-refuse-medicaid-expa
For a general review of the Obamacare decision, see: http://www.sfbg.com/politics/2012/06/28/obamacare-ruling-good-news
For an example of how the health insurance subsidies will be calculated, see: http://healthreform.kff.org/SubsidyCalculator.aspx
Friday, June 29, 2012
Sunday, June 24, 2012
Friday, June 22, 2012
Title IX was enacted as part of the Education Act Amendments of 1972. Its promise was simply this: educational institutions, programs, or activities that receive federal funds may not discriminate on the basis of sex. The promise applies to all levels of education, from elementary schools to undergraduate colleges, professional schools, and vocational programs.
Enactment of Title IX was one of the first policy victories of the 2nd wave women’s movement, and as such was the focus of controversy. The Washington Post and New York Times opposed it in editorials; college presidents decried it; college football coaches demeaned it; and many members of Congress tried to figure out ways to weaken it.
The attack on Title IX intensified soon after it became law. The loudest assault came from the male athletics lobby – the NCAA, and legions of college football fans. Although Title IX was not enacted with women’s athletics primarily in mind, the male sports establishment certainly predicted correctly that under Title IX, women would flourish as athletes.
Despite their fierce efforts, naysayers lost their legislative battle to undermine Title IX by limiting its scope. As a result, educational opportunities for girls and women expanded exponentially, dramatically opening up whole fields of endeavor.
The most obvious barriers to women's full and equal educational opportunites began to disappear with Title IX's passage. But Title IX's champions knew that inequalities run deep, permeating school practices and peer cultures. Title IX advocates anticipated that the road to full equality would be slow going and that navigating that road successfully would require never-ending vigilance to ensure that implementing regulations are not diluted, that compliance is robust, and that girls and women throughout the educational process know their rights and remedies.
The history of Title IX over forty years is really the story of millions of bold and resilient girls and women who have enforced Title IX by their actions -- by resisting exclusion; demanding fairness; exposing sexual harassment; and challenging educational institutions to change because of the contributions of women.
So, kudos -- and thank you -- to everyone who has dared to struggle for equality. Title IX will continue to be important only if it continues to advance that struggle. Going forward, we must all hone Title IX to pierce and transform the culture of educational institutions, to dispel stereotypes that impede women's incorporation on equal footing, and to undermine the gross disparities in money and other resources that make it difficult for many girls and women to pursue the opportunities that Title IX assures.