Obamacare is Delivering Some of the Goods in Poor States

Screen Shot 2016-08-14 at 10.37.59 AMNew Orleans   There are now some thirty states that have expanded eligibility for Medicaid under the Affordable Care Act. There are twenty states – and a lot of the Republican Congress — that are still dragging their wagons through the dirt, and, if researchers are right, putting their people under the ground as well.

Researchers connected with Harvard’s Public Health School conducted an important experiment. They surveyed people in Kentucky and Arkansas before Medicaid expansion in 2013, again after the first full year in 2014, and finally at the end of 2015 with another year under peoples’ belts. They used Texas as the so-called control state for comparison, since Texas refused to budge on the Obamacare Medicaid expansion for lower-income, working families. Bottom line: 5% more people in Arkansas and Kentucky, too very different states with different approaches on the expansion, felt that they were in “excellent” health compared to do-nothing-much Texas.

Reading about the researchers work on the Harvard Public Health website and its lead author, Dr. Benjamin Sommers, an assistant professor there, offered a good summary that goes deeper than 5%:

Sommers and colleagues surveyed approximately 9,000 low-income adults in Arkansas, Kentucky, and Texas from late 2013 to the end of 2015. The results showed that, between 2013 and 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with a much smaller change in Texas (39% to 32%). Expansion also was associated with significantly increased access to primary care, improved affordability of medications, reduced out-of-pocket spending, reduced likelihood of emergency department visits, and increased outpatient visits. Screening for diabetes, glucose testing among people with diabetes, and regular care for chronic conditions all increased significantly after expansion. Quality of care ratings improved significantly, as did the number of adults reporting excellent health.

Debate over? Of course not. Many will wonder, and wait, until larger studies, including the government’s own, provide more data on whether or not people really are healthier or just feel healthier.

Regardless, how people feel may not answer the medical questions fully, but could start to provide answers for the political questions. As we find every day, particularly in the Age of Trump, people vote on how they feel, not based on the facts of the matter. If everything were equal, politicians would see that the trend line of how people feel about their own health and Medicaid expansion is now improving annually. If it continues along these lines, politicians will start playing “duck and cover” which might mean more expansion in the twenty holdout states.

There’s a big “if” though. These same politicians would actually have to care about the poor families that are the beneficiaries of Medicaid expansion, and believe, regardless of the evidence, that they vote, and that some of these poor are their voters.

It might be easier to deliver better healthcare than to convince elected officials of the value of the poor and their votes.

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Kentucky’s Big Sandy Coal Fired Power Plant Brings Memories of Arkansas White Bluff Fight

New Orleans    A picture in the Times of “Big Sandy,” the 1100 megawatt coal-fired power plant in Eastern Kentucky being shutdown finally over the next three years by the giant utility company, American Electric Power, brought back memories of a great fight 40 years ago in and around Pine Bluff, Arkansas where what is now Entergy and then was the Arkansas Power & Light (APL) Company was trying to build a similar mega-plant at White Bluff on the Arkansas River.  This was ACORN’s first campaign that broke nationally in 1972 and propelled the organization from an interesting community organizing experiment in a state most people had to look on the map to locate to something that folks could see had potential and range on a larger scale.

In dealing with the issue of the proposed plant construction we were worried about the increase cost on the rate base for our lower income, working consumers who were fighting off various utility increases almost as a daily matter in the early 1970’s, but to go toe-to-toe with APL we had to move strategically and tactically on a number of different fronts and that meant organizing farmers on both sides of the river that were downwind of the plant on one side and their biggest investors at super elite Ivy League colleges like Harvard, Yale, and Princeton on the other hand.   This whole fight would take a lot longer to tell than time or space allows today, so back to “Big Sandy.”

The company public relations flacks didn’t care if we moved their investors particularly though a mention on the front page of Arkansas Gazette and picked up by the New York Times didn’t make them very happy.  This was going to be decided by the elected members of the Arkansas Public Services Commission, so they felt if they could convince the farmers to be happy about all of this, they were good to go.  They hatched up a brilliant idea.  They would invited some of the leaders of the ACORN Protect Our Land Association to fly on a small charter plane over to Kentucky for the day and look at a similar (though smaller) coal fired plant there so they would know how great it would all be.  The company’s argument in those days before climate change and globe warming were much understood was that the sulfur emissions from the plant would be “free fertilizer” for the farmers soy beans, rice, and cotton, and therefore a bargain too good to beat.

Early in the morning a handful of APL executives, farmers, and me crawled into a plane for the quick trip to Kentucky.  We didn’t know exactly where we were going until the last minute, but we knew we would be looking at a coal-fired plant.  In those unimaginable days before the internet, it took some real skill to do a lot of the campaign based research that evened the odds on some of these campaigns.  Our research director was a young (hell we were all young!) Harvard student taking a year off from school, Steve Kest, who managed to piece together some information on the various plants in Kentucky and, very importantly, some records from that state and the feds on citations that Big Sandy had earned for pollution.  Couple that with the fact that the coal was mined locally straight out of some of the horror of Muhlenberg County, well known in song and legend for labor fights and environmental devastation, and the farmers and I had all the ammunition we needed to turn APL’s junket into a disaster for their proposals and catch them flatfooted.  Reporters were on the plane and in addition to our press releases we were able to feed them facts on top of facts about the problems that came with Big Sandy.  Big Sandy was something for sure, but it was scary in size and scale which also increased our credibility.

At the end of the day we beat the plant back without beating the plant.  White Bluff originally proposed as the largest coal-fired plant in the world requiring transport of coal in 100-car trains from the Powder River Basin deposits in Wyoming (we beat back a slurry line!), ended up about half that size.  We didn’t win scrubbers which experts around the world argued were needed to offset the pollution, but we did win some modifications that did a good piece of the work.

It is amazing that 40 years later Big Sandy was still belching its way around Kentucky.  The Times reported that the retrofit was too dear for AEP to finance despite its captive minds and pro-coal backers in Kentucky.  The Sierra Club reports that the number of coal-fired plants has dropped over the last dozen years from 522 to 395 or so.

ACORN may have been ahead of its time 40 years ago in Arkansas, but there’s still a lot left to do.  The fact that the internet has made the information more available would have made Steve’s job easier back then, but it’s still all about organizations with people and power in fighting and winning on this front and so many others.

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