December 13, 2018

Disability advocates helped save ACA

Sen. Chris Murphy (D-CT), accompanied by children with preexisting conditions covered under the Affordable Care Act, speaks at a press conference about the Senate health care bill. July 12, 2017. Photo by Aaron P. Bernstein/REUTERS.

During the recent health care insurance fight in Congress, public attention was tightly focused on the early morning cliffhanger on the Senate floor with Sen. John McCain (R-Ariz.) dramatically voting against the so-called “skinny repeal” of the Affordable Care Act (ACA), also known as Obamacare, but many people didn’t realize that disability advocates also played a key role in rolling back the efforts to repeal the ACA.

One of the more searing images from the monthslong “repeal and replace” efforts in the House and Senate was a video of protestors from the disability rights group ADAPT, many in wheelchairs, outside of Senate Majority Leader Mitch McConnell’s office chanting “No cuts to Medicaid, save our liberties” as they were physically lifted and removed by the Capitol police. ADAPT is a grass-roots disability rights organization that started in 1974 in Denver to get wheelchair accessible lifts on buses. Since then, the group has created 30 chapters across the country and broadened its mission to advocate for community support for people who have disabilities so they can live outside of assisted-care facilities and other institutional centers.

Joined by Disability Action for America, a political action committee, along with many other disability and patient organizations, hundreds of advocates descended on Washington, D.C., over the past few months at their own expense, many with severe physical and medical challenges. They engaged in nonviolent civil disobedience and held vigils, waiting for marathon meetings to end and staying up for middle-of-the-night votes even if it meant sleeping in their wheelchairs.

Parents from across the political spectrum who have children with chronic diseases and disabilities also jumped into the fray, speaking out against the proposed changes to the ACA on social media and in phone calls, meetings and town halls with their congressional representatives. Of utmost concern were the proposed cuts to Medicaid — a crucial lifeline for the poor, elderly and people with disabilities — not only for medical treatments and prescription drugs, but also for a long list of other ancillary services such as in-home care, special education-related programs in public schools and durable medical equipment such as wheelchairs. Mental health advocates worried that therapy and treatments now covered by Medicaid would be curtailed, reduced or even eliminated in sparsely populated regions if Medicaid became a “block grant,” as proposed in the House-approved version of the health care bill.

Families who rely on the ACA were also spurred into action. A June 28 Time magazine article featured Ali Chandra, a former pediatric nurse in New Jersey who has a son, now 2, born with a rare health condition that included nine heart defects, two left lungs and five spleens. Before the 2016 campaign she wasn’t even registered to vote, but after the health care debate started in the House, she became an outspoken advocate to save one of the key elements of the ACA — a ban on lifetime limits for insurance payouts.

Before the ACA became law, many plans set limits on what they would spend for covered benefits during the entire time a person was enrolled in that plan, such as a $1 million maximum. Patients were required to pay the cost of all care exceeding those limits, which often forced them into bankruptcy. And to make her point that lifetime limits could be reached all too soon, Chandra tweeted a photo of her son’s medical bill from his most recent heart surgery at Boston Children’s Hospital with a total cost of close to $250,000. Her insurance carrier paid for all but $500 of that operation and recovery.

“We’re the ones who make sure they get their meds on time, we hold them down for painful procedures and comfort them afterward: The only thing we know how to do is fight,” Chandra told Time magazine. “We’ve been fighting since the moment we heard our kid’s diagnosis, since the moment they were born. This is just a regular day for us.”

Even rock star Rod Stewart, 72, got into the act, donating $30,000 to Trach Mommas of Louisiana, a Baton Rouge group supporting children with severe disabilities, to travel to Washington, D.C., in July to protest potential cuts to Medicaid. Stewart said that, as a father of eight, he felt compelled to help after seeing a CNN news story on the group’s need for funds to make the trip.

As a parent and advocate, I was glued to the ongoing media coverage and the daily, sometimes hourly, breaking news. Would the ban on pre-existing conditions stay? How deep would the Medicaid cuts go? Would the GOP-controlled Congress take away health insurance from the poorest and sickest among us to give the wealthy a tax break?

And even with McCain’s decisive vote, who knows what will happen next week or next month?

Disability advocates and their allies would be wise to remember what our tradition teaches us from Pirkei Avot 2:21 (Ethics of the Fathers): “It is not incumbent upon you to complete the work, but neither are you at liberty to desist from it.”

MICHELLE K. WOLF is a special needs parent activist and nonprofit professional. She is the founding executive director of the Jewish Los Angeles Special Needs Trust. Visit her Jews and Special Needs blog at

Hunk hawks hideous health bill

Sen. John Thune (R-S.D.)

John Thune is the most handsome man in the U.S. Senate. Square jawed, gleaming smile, cowboy tan, the 6’4” South Dakota Republican’s rugged good looks are antipodal to the mien of majority leader Mitch McConnell, whom Jon Stewart has definitively established is Yertle the Turtle’s doppelgänger. If the human brain’s positive bias toward attractive people didn’t cue me to infer that Thune is a great guy, a real straight shooter, I’d be as outraged by the assault on Americans’ health that Thune and his co-conspirators are currently waging, and by the subversion of American democracy they’re using to ram it through, as I am when its public face is McConnell’s.

Thune is a member of the all-white, all-male “gang of 13” staunchly conservative Republicans whom McConnell tasked two months ago with secretly writing a new GOP health bill in the Senate.

Because a parliamentary tactic will embed this Affordable Care Act (ACA) repeal — and alleged replacement — into a budget reconciliation bill, it’s exempt from being filibustered by Democrats. That means the bill will need only 50 of the 52 Republican senators, along with Vice President Mike Pence’s tie-breaking vote, in order to pass, instead of the 60 votes it takes to shut down a filibuster, which would require at least eight Democrats to defect.

Because the House also must pass the bill with only Republican votes, it needs to be mean enough to win over the House’s far right Freedom Caucus, “mean” being President Donald Trump’s new description of the formerly “beautiful” House health bill he fêted in the Rose Garden in May. That’s why the American Health Care Act (AHCA) that McConnell and House Speaker Paul Ryan want Trump’s signature on before July 4 likely will deprive 23 million Americans of health insurance; end Obamacare’s minimum benefits, like mental health services and maternity care; deny coverage for pre-existing conditions; permit lifetime benefit caps; cut $800 billion from Medicaid and turn it into block grants to states, effectively killing the program — oh, and give the top 0.1 percent of households an average tax cut of nearly $200,000.

I say “likely,” since the actual content of the bill has been shrouded in secrecy. Because a majority of Americans oppose those changes to a law that a majority of Americans support, McConnell knows that his only chance to pass it before the public catches on and rises up is a total blackout of information as they write the bill, which is what’s happening now, and once they reveal it, a blitzkrieg without committee hearings or time for town halls, hurtling toward a final vote within a matter of hours.

This is not normal. It’s not how a bill affecting one-fifth of our economy is supposed to be considered. McConnell’s plan is to make it seem normal, which is why they’re deploying the credibility of John Thune’s chiseled cheekbones: to sell a coup d’état as if it were a “Schoolhouse Rock!” civics lesson.

The day after a gunman opened fire on a Republican congressional baseball practice, prompting calls to for a return to civil discourse in our politics, Thune was on MSNBC’s “Morning Joe” saying we all must do our part to achieve the unity that this moment requires. Speaking of unity, journalist Mike Barnicle piped up, what about the health care bill being written in secret? “Nobody knows what’s in this bill,” Barnicle said. As a starter, he asked, in the spirit of reaching across the aisle, of bipartisanship and openness, “How about … telling us what’s in this bill?”

Thune’s answer made me marvel that a man with such good hair could deceive so baldly.

There’s really no bill to share, he said. What’s going on now is just discussions, just policy options. It will be openly shared when it’s reduced to legislative language, he said, as though that’s just how the lawmaking process works.

It’s not. Drafts of bills are routinely made public long before legislative language is locked in. They’re distributed as outlines, memos, letters, emails, talking points, PowerPoints, lists, charts, conference calls, cut-and-pastes, works in progress, principles, summaries, overviews, abstracts. They’re the basis for innumerable meetings with constituents, stakeholders, interest groups, media, members of both parties, think tanks, analysts and experts. That’s American democracy in action. What’s happening now is not.

Besides, Thune added, there’s been so much discussion of health care over the past decade, “it’s like any of us are unfamiliar with what the issues are.” We’ve already discussed them.

The ACA was the subject of hundreds of committee hearings and markups, hundreds of hours of congressional debate, hundreds of town halls and public forums and two years of news coverage. But that discussion was about expanding Medicaid, not eliminating it; about increasing benefits, not cutting them; about providing health insurance to millions, not giving tax cuts to millionaires. If the media were to give the AHCA’s issues the kind of scrutiny and airtime it gave Obamacare, Republicans would now be running from it like a dumpster fire.

To be sure, John Thune would make one handsome fireman. But I doubt even he could convince his colleagues in Congress to bunk in a burning building.

MARTY KAPLAN is the Norman Lear professor at the USC Annenberg School for Communication and Journalism. Reach him at


President Donald Trump gathers with Congressional Republicans in the Rose Garden of the White House on May 4. Photo by Carlos Barria/Reuters

So it turns out that not even late-night TV host Jimmy Kimmel’s emotionally wrenching story about his newborn baby’s heart defect and subsequent life-saving surgery was enough to persuade three more GOP House members to vote against the latest version of the American Health Care Act (AHCA). Kimmel’s baby, like millions of other Americans, now has a “pre-existing condition” that insurers traditionally have treated almost as a badge of shame, and subject to increasingly high insurance premiums and deductibles.

That’s because the AHCA, as it presently stands, will allow states to apply for a waiver to the Obamacare requirement that insurers must charge all people the same rates, no matter their medical histories. Removing that requirement means that insurers will be able to charge exorbitant premiums if you have a pre-existing condition and have let your insurance lapse, which, in practical terms, can lead to financial ruin in trying to keep purchasing insurance coverage.

The “big 10” of patient advocacy groups, including the American Cancer Society Cancer Action Network, American Diabetes Association and American Heart Association, came together to oppose AHCA, saying in a joint release, “Weakening protections in favor of high-risk pools would also undermine the ban on discrimination based on health status. The individuals and families we represent cannot go back to a time when people with pre-existing conditions could be denied coverage or forced to choose between purchasing basic necessities and affording their health care coverage.”

The last-minute GOP solution to address the issue of people with pre-existing conditions was to add in $8 billion more for patient “high-risk pools,” which were used by 35 states before Obamacare and often came with high premiums, high deductibles and sometimes capped enrollment. A just-released independent analysis from the health consultancy firm Avalere Health showed that the $23 billion earmarked by the bill for those pools would cover only 110,000 Americans, a mere 5 percent of the 2.2 million enrollees in the individual insurance market today with some type of pre-existing chronic condition.

With such a large gap between the available funding and the number of impacted Americans (that will only grow as our population ages), it means that if one of the larger states receives a waiver, there will be even less money to go around. As the summary of the Avalere Health study states: “For example, Texas alone has approximately 190,000 enrollees in its individual market with pre-existing chronic conditions, nearly 80,000 more people than the funds earmarked for the entire country would cover. Florida has 205,000, nearly 95,000 more than the funds allotted nationally amounts would cover.”

What exactly are these pre-existing conditions? Sen. Sherrod Brown (D-Ohio) took to Twitter to list many of them, from AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer’s/dementia, anemia, aneurysm and angioplasty to skin cancer, sleep apnea, stent, stroke, thyroid issues, tooth disease, tuberculosis and ulcers. In the hours after the House vote, the No. 1 trending hashtag on Twitter was #IAmAPreexistingCondition, with individuals listing their diagnosed conditions, such as TashiLynnCA writing, “In 2010 my 10 year old brother was diagnosed with stage III Hodgkin’s Lymphoma. This is for him.” Older adults and veterans also shared. “‘I’m a disabled veteran that suffers from PTSD” tweeted RedTRacoon.

Friends of mine on Facebook are sharing that some doctors already are getting calls from worried patients, asking that their diagnoses be expunged from their medical records because they are fearful of having a paper trail documenting their conditions. People will be scared to go to emergency rooms, afraid that they will be identified as having one or more conditions on the list.

For the 20 percent of Americans who have some type of disability covered under the Americans With Disabilities Act of 1990 (ADA), this potential change in how much people with pre-existing conditions can be charged for health insurance hits hard. @LCarterLong from Washington, D.C., wrote, “Born three months premature. Weighed 2 lbs. Alive b/c of an incubator. Have cerebral palsy. Use orthotics to walk.” Alice Wong, founder of the Disability Visibility Project in San Francisco, tweeted, “Wheelchair and vent user. Born with spinal muscular atrophy. Docs told my parents I wouldn’t live past 30.”

This sharing of pre-existing conditions is paradoxically bringing together a very disparate group of Americans who may not have felt much in common before this vote, and who now are being prompted into action. Disability advocacy groups that usually find themselves competing with one another for attention and funding are finding common cause in opposing the ACHA. Republican House members who voted for the bill will be wearing targets on their backs in the 2018 election. As Japanese Admiral Isoroku Yamamoto said after the 1941 attack on Pearl Harbor, “I fear all we have done is to awaken a sleeping giant and fill him with a terrible resolve.”

MICHELLE K. WOLF is a special needs parent activist and nonprofit professional. She is the founding executive director of the Jewish Los Angeles Special Needs Trust. Visit her Jews and Special Needs blog at

The stigma of the unworthy unhealthy

President Donald Trump, middle, gathers with Vice President Mike Pence, right, and Congressional Republicans at the White House on May 4. Photo by Carlos Barria/Reuters

There was something sublimely degrading about the beer bash President Donald Trump threw May 4 for House Republicans who passed his health care bill by the narrowest of partisan margins.

Start with the host, who will say or do anything. By now it’s apparent that the president is untethered to reality. If he were to be impeached, a compassionate chief justice might declare him incompetent to stand trial because he lacks the mental capacity to be responsible for his words or acts. But the Republicans who sniffed his musk last week aren’t blissed by the clueless stupor his narcissism affords him. They’re fearful of their constituents. No wonder that, of the 217 congress members who voted his way, only two — one in Idaho, one in upstate New York — held district town halls this past weekend. They did not go at all well. When the rest of the cowering Republican conference is forced to face their voters, it will be similarly ugly.

They must be baffled by how devoid of mojo their old battle cries have become. “Jobs-killing Obamacare” packs no punch in an economy that’s added more than 10 million jobs since the Affordable Care Act passed. “Disaster” and “death spiral” sound demented to someone who’s gone from no insurance to comprehensive coverage. “Higher premiums, higher deductibles, higher co-pays” may in some cases be accurate, but for Americans long suffering from rising prices, the real news is the slowing of the rate of increase.

Republican capitulation to the Freedom Caucus’ demand to torpedo Obamacare’s coverage of pre-existing conditions has prompted hundreds of heartbreaking — and televised — stories of congenital defects, deadly tumors, chronic ailments, addictions and mental illnesses, whose long-term treatment was until recently made affordable by irrevocable insurance, but which now is slated for sacrifice in exchange for a trillion-dollar cut to Medicaid and a humongous tax cut for the wealthiest. Not only will those stories, juxtaposed with Rose Garden revelry, make for mercilessly effective ads in the coming midterm campaign; they also sound the death knell for the most toxic trope in the Republican rhetorical armory: the stigma of the unworthy unhealthy.

The label descends from the widespread distinction, as recent as a century ago, between the worthy and the unworthy poor. The worthy poor — widows, orphans, the blind — were indigent through no fault of their own, victims of random misfortune, life’s vicissitudes, circumstances beyond their control. But the unworthy poor were the cause of their own impoverishment. Lazy, morally weak, addled by drink, gamblers: They had only themselves to blame. The worthy poor deserved charity; the unworthy, a kick in the pants.

The Depression altered the presumption that bootstrapping is the royal road to success. If there aren’t any jobs, it doesn’t matter how much moxie you have. From our common catastrophe came a new compact. Every person is worthy of basic human decency, a safety net to catch us, a freedom from want we pledge to one another. To secure it? Not the market, not inheritance, not the luck of our genes — the government. And so from Social Security to Medicare, unemployment insurance to food stamps, we committed public resources to promote the public good.

Universal health care was always the outlier in America — not just the notion that government should provide it, but the idea that it’s an inalienable right. You could see that wariness, stoked by decades of propaganda, in a Wall Street Journal-Harris poll two years before Obama was elected. Asked whether unhealthy people should pay more for insurance, a majority of Americans – 53 percent – said yes. You can hear that same animus today in Alabama Republican Rep. Mo Brooks’ defense of Trumpcare: “It will allow insurance companies to require people who have higher health costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives. They’re healthy, they’ve done the things to keep their bodies healthy, and right now, those are the people who have done the things the right way that are seeing their costs skyrocketing.”

“Moral hazard” is how economists describe the ability to evade the bad consequences of risky decisions. The Wall Street bailout, which prevented a global meltdown, absolved the banks of having hell to pay. I get why House Republicans almost sank it; it maddened me, too. To them, the ACA’s passage two years later reprised that escape from accountability. It didn’t penalize people enough for being addicted to nicotine, for consuming the sugar and fat marketed to them, for escaping a stressful day with a sedentary night.

The ACA has helped millions of Americans with illnesses unrelated to personal decisions get access to health care. At the same time, it established a no-fault policy for having made choices that are bad for you. Under current law, your right to treatment doesn’t depend on how or why you became dependent on opioids or alcohol, or whether your high blood pressure or cholesterol might have been prevented by behavior change. All that counts is that you’re seeking a path to health. We don’t punish the sick for being unhealthy; life has done that enough. There are not the worthy unhealthy and the unworthy unhealthy. All there is is us.

Marty Kaplan is the Norman Lear professor at the USC Annenberg School for Communication and Journalism. Reach him at

Jewish elderly advocates take aim at GOP’s proposed changes to health care

U.S. House Majority Leader Kevin McCarthy, House Speaker Paul Ryan, and Representative Greg Walden hold a news conference on the American Health Care Act. March 7. Photo by Eric Thayer/REUTERS.

Two Jewish agencies charged with elderly care sharply criticized the new Republican health care bill.

B’nai B’rith International, which sponsors low-income housing for the elderly, and the Jewish Federations of North America, which advocates for funds for the poor and the elderly, took aim changes contained in the American Health Care Act, the bill Republican leaders hope to pass as a replacement for the Affordable Care Act, known as Obamacare.

“Congress and the Trump Administration appear to be moving quickly to pass potentially devastating cuts to Medicaid,” JFNA said in an action alert sent this week to its constituent groups, urging them to lobby Congress against the cuts.

The organization said the cuts “would greatly impact Jewish federation partner agencies that provide health, long-term care and home and community-based care,” noting that federation partner agencies get about $6 billion from Medicaid each year.

Medicaid is the government program that supports health care for the poor. The bill proposes to cap Medicaid funding to each state according to the number of eligible participants at the beginning of the fiscal year. B’nai B’rith and JFNA said such caps would not take into account changes in enrollment numbers and other unexpected health care cost increases.

“Changing any portion of the Medicaid funding to a per capita cap proposal would have a significant negative impact on seniors, because capping federal funding for Medicaid would add an additional layer of pressure to state budgets, and put the health care and financial security of millions of older adults at risk,” B’nai B’rith said in its March 8 statement.

B’nai B’rith also took aim at a component of the bill that would reduce premiums for younger, healthier Americans, citing studies predicting “low-income adults in their 60s could see dramatic increases in premiums.”

The cruelest cuts of all

U.S. House Majority Leader Kevin McCarthy, House Speaker Paul Ryan, and Rep. Greg Walden hold a news conference on the American Health Care Act on Capitol Hill. March 7. Photo by Eric Thayer/REUTERS.

Many Americans were no doubt pleased to hear that the Donald Trump administration’s first budget proposal spared Social Security and Medicare, but the health and well-being of 74 million vulnerable, lower-income Americans who receive Medicaid are still very much in jeopardy. In fact, the means-tested Medicaid program now is directly in the bull’s-eye of cuts and drastic changes the Trump administration and Republican leaders are considering as part of their vow to replace the Affordable Care Act (ACA), also known as Obamacare.

Created in 1965 as part of President Lyndon Johnson’s “War on Poverty,” Medicaid is our country’s largest health care insurance program, with 74 million enrollees, or about 1 in 4 Americans, surpassing the better-known health insurance Medicare program with its 55 million-plus enrollees. Medicaid provides health care services for low-income individuals, including families with children, seniors, people with disabilities, those in foster care, pregnant women and low-income people with specific diseases, such as tuberculosis or HIV/AIDS. Chances are, you probably know many people on Medicaid, such as a 54-year-old woman who is without private insurance, too young for Medicare, who then developed breast cancer; or a young adult who developed a traumatic brain injury after an automobile accident.

Some 60 percent of Medicaid’s spending is for the elderly and the disabled. For many people with disabilities, Medicaid services are the only way they are able to live and work in the community with friends and families. Medicaid helps children and adults with a significant disability — such as autism, cerebral palsy or intellectual disabilities — to remain at home and avoid placement in costlier and harmful segregated nursing homes or institutions. Medicaid also provides services, such as personal care aides who help people in their own homes with everyday needs like bathing, dressing, eating and managing medications. And because adults with disabilities have such a low employment rate (30 percent), they don’t have any other health insurance options for their ongoing and acute medical needs except Medicaid. Under the ACA, there has been a large expansion of Medicaid, although some Republican governors declined that Medicaid expansion.

In California, the program is called Medi-Cal, and as is the case in every state, the feds pay close to 60 percent of the program’s overall expenses. Under the current structure, the federal government has a commitment to help states cover costs, and in turn, states must provide specific benefits to certain groups of people, including people with disabilities. Although Medi-Cal has issues, including a very low reimbursement rate, which prompts many specialists and other providers to limit or simply stop taking on Medi-Cal patients, it is nevertheless a crucial and lifesaving program.

Currently, Medicaid is an open-ended entitlement for states — if residents meet strict income and asset criteria and other health/disability-related criteria, then they can enroll. During economic recessions, more people enroll; other factors, such as expensive new lifesaving prescriptions drugs, also can increase the costs of administering the program. The “block grants” being touted by the Trump administration as a way of giving states more control over their state Medicaid program will translate into a whole new definition of pain, as each state would receive a fixed amount of money based on a predetermined formula, most likely at a per-capita rate. A recent editorial by The ARC (formerly known as the Association for Retarded Citizens, started by parents who had children with disabilities in the 1950s) analyzed the problem: “Unlike the current funding system, the amount provided under a per capita cap will not automatically increase when the cost of providing covered services to eligible individuals goes up. The intent of the per capita cap is to reduce federal spending by restructuring the program and significantly cutting the cost to the federal government. Using this technique, the federal government limits spending, regardless of the needs of the people receiving Medicaid services.”

State governments will be forced to make decisions from an array of bad choices, such as increasing state taxes, limiting services to existing Medicaid patients, reducing eligibility or cutting already low reimbursement rates even further. Health outcome disparities between states will grow as wealthier states can help backfill some of these cuts but poorer states will not be able to do the same. Without early intervention, many infants and toddlers with disabilities will be denied therapies that can change their lives’ trajectories. Without community services and support, too many adults with disabilities will be stuck at home, dependent on aging parents and even forced into unnecessary institutionalization, a huge step backward in the civil rights of people with disabilities. Many Medicaid patients will suffer from delayed or denied medical treatment, and some people may even die.

Kellyanne Conway, counselor to President Trump, has said publicly that moving to Medicaid block grants will ensure “that those who are closest to the people in need will be administering the program,” but what kind of freedom is choosing between bad, worse and terrible? 

Michelle K. Wolf is a special needs parent activist and nonprofit professional. She is the founding executive director of the Jewish Los Angeles Special Needs Trust. Visit her Jews and Special Needs blog at

California and the rust belt: A health care bridge

Donald Trump upset the apple cart, pulling off a victory in the Electoral College by sweeping the Rust Belt states. He ran a brutal, hard-edged campaign on trade, jobs and resentment of immigrants. The shock has not yet worn off. 

Meanwhile, California went totally the other way, giving Hillary Clinton a 4 million-vote margin of victory that was bigger than even Barack Obama’s victory in 2012. 

California meets the Rust Belt.  A multiethnic state that is overwhelmingly Democratic where the economy has done well contrasted with a white, working-class and middle-class region in more isolated states with slower economies turning to the right. Like exploding planets, they are spinning off in opposite directions.

For many Jewish voters, who are concentrated in urban counties in big states such as New York, California, Florida, Illinois and Pennsylvania, there’s a feeling of being isolated in national politics. They are not alone. Throughout the Western world, from the U.K. to France to Poland to Italy, cosmopolitan, modernized urban communities where economies are dynamic are being challenged politically by non-urban, traditional working-class voters.

The difference is that in the United States, the metropolitan coalition commands a popular but not effective majority in our state-dominated system. California’s status as a blue stronghold, in a state where 1 in 8 Americans live, symbolizes the situation. California may guarantee popular vote majorities for Democratic presidential candidates for years to come and still be on the losing end in the Electoral College. Conversely, voters in the Rust Belt may find their hopes dashed if key programs on which they depend are reduced or eliminated. Hard as it is, some bridge building is called for.

I am hearing and seeing a lot of attempts to deal with the Rust Belt and with this shattering election. They vary from pop sociology, anger and contempt, to guilt and self-recrimination. Some say Trump’s voters don’t know their own self-interest and, if so, they deserve to lose their health insurance. Conversely, some are willing to toss out decades of progressive policies to win favor. None of this is ultimately productive.   

But there is another avenue that needs more attention. It starts with health care. The repeal of the Affordable Care Act (ACA) would affect both California and the Rust Belt. But to turn that impact into a bridge, California’s progressives will have to keep an open mind about the Rust Belt voters, including those who went for Trump.  

Never pick a fight with the voters — only with politicians. It would be better to fight with Trump and congressional leaders in Washington, D.C.  

In 2016, Democrats took a gamble by focusing the campaign on Trump and his appalling attitudes and utterances. Instead of drawing a contrast with an increasingly libertarian conservative movement that explicitly promised to shred major elements of the health care system, Democrats tried and failed to drive a wedge between the “unfit” Trump and, by implication, the fit conservatives. 

While all eyes were on Trump, who was making ambiguous noises about repealing the ACA but preserving its levels of access, House Speaker Paul Ryan was quietly laying plans to repeal the ACA, and to privatize Medicare to boot. Consider that eliminating the ACA makes Medicare more vulnerable, since its improved financial status is in part due to the ACA.

In truth, Democrats today are less focused on the daily issues of health care than on social issues. Those social issues are critical to modern politics and I could not imagine the Democratic Party without them. They have helped to build a popular majority, so that the modernizing Obama coalition, with its “identity politics” is far bigger and more consequential than Bill Clinton’s narrow, defensive alliance. But this is not enough without a down-to-earth message that goes beyond identity politics in a political system that provides extra boosts to the representation of nonurban, homogeneous states. 

California, where a great part of the Affordable Care Act’s implementation took place, and where its gains are at most risk, can lead the way. The same state-based system that frustrates popular majorities provides numerous pathways to resist and reshape change.

Retirement and health care security are great assets for progressives in American politics.  Protecting them starts with telling their story.  Voters tend not to believe campaign threats to their health care (“Look at this punim!  Would I kick my own mother off Medicare?”). The looming possibility of the loss of the Affordable Care Act may create an attentive audience.

Social Security, passed in 1935 and signed by President Franklin D. Roosevelt, became the vehicle for later expansions of health care. The Medicare and Medicaid laws signed by President Lyndon B. Johnson in 1965 were actually amendments to the Social Security Act.  President Richard Nixon further expanded Medicare coverage to those who are disabled and under the age of 65.  Medicare, a broad social insurance system like Social Security, became the link between retirement security and health care.

These concrete foundations helped cement the link between Jewish voters and the Democratic Party. My own family history tells a bit of that story. I was born in Washington, D.C., because my father, Israel Sonenshein, was an attorney in the Truman administration working in the Federal Security Agency, the precursor to the Department of Health, Education, and Welfare, that included Social Security. He helped draft a model law for the states to extend protection for those with mental illness, a group that had been left in the dark corners of American society. Naturally the New Deal was a big part of my family’s DNA. I watched LBJ on television in 1965 as he signed the Medicare law in Independence, Mo., with Harry Truman by his side, and learned that Johnson had handed Truman and his wife, Bess, the first two Medicare cards.

The ACA has become the largest expansion of health care coverage since Medicare. It has reached across racial lines, including communities of color and whites (many of whom voted for Trump), and added more than 20 million Americans to the insurance rolls. Except for the requirement to buy insurance, its provisions are very popular. While it does not enjoy the broad support of Social Security and Medicare, there is nowhere near a majority that favors repealing it without replacement, according to a recently released poll from the Kaiser Family Foundation.  

With the ACA, we are inching toward universal coverage. That goal, first articulated by Harry S. Truman in 1945, is visible on the horizon.

If Democrats are searching for a theme to tie together white, working-class voters in the Rust Belt and communities of color, they could start by fighting to protect the extension of health care through the ACA, and linking it to defending Medicare and Social Security against privatization. Just as Medicare linked Social Security to health care, the ACA links the broad social insurance of Medicare to the extension of health coverage to the hardest to reach precincts of America.

It’s time to stop talking about deplorables (unless they are in public office) and start fighting on behalf of voters. You never abandon the groups and communities and issues that are your base, but you find things that cross the lines. One thing leads to another, and more such issues will appear.

Don’t say, “I told you so” to Trump’s voters who may lose their health coverage. You can’t wait until these voters are nicer and more politically correct before fighting for them. And if they write letters to Trump, you can believe it will mean something. 

Don’t expect an immediately favorable response, because there are wide gulfs between communities, but it’s a start. Unlike in European democracies, our debates about government programs are not just practical. They get into perilous moral arguments about who is “deserving” and who is “undeserving,” even when someone is benefiting from a program. That is the hardest thing about the bridge-building I am proposing, and it will take time and patience.

Hold Trump accountable with the people who elected him. Let Red State Senate Democrats take the lead. It may be the only way they can survive. 

Fighting against an assault on health care expansion not only gets public attention, it is also a way to explain it. There are millions of people out there who still don’t know that Medicare is a government program. Every day that Congress debates the ACA or Medicare or Medicaid is an opportunity for civic education.

Health care has many civic benefits, including freedom to change jobs, and confidence that no catastrophe will destroy a family’s finances. In a nation beset with stress and worry, much of it economic, having health care in place may help us navigate the perilous days ahead. A more widely available health insurance system might even start to bring poor people back into the political system from which they have been massively absent.

The future of American politics is up for grabs, as electoral rules give extra advantages to areas of the country that are torn between popular conservative imagery and popular liberal programs. While a popular majority wants to preserve the tentative gains made in recent years, electoral rules make the imposition of the majority’s will a challenge. If the decades of progress made toward universal health coverage are lost in a fog of misinformation and distraction, there will be decades more to regret it.

Raphael J. Sonenshein is executive director of Cal State L.A.’s Pat Brown Institute for Public Affairs.

Voters will choose prescription for health care

Surprisingly, one issue that affects most of us — the high cost of health care — has remained in the background of the presidential campaign so far, even though large numbers of Americans will soon face insurance premium increases for plans purchased from the exchanges created by the Affordable Care Act (Obamacare).

One reason may be that the program is so complicated. Navigating through Obamacare makes shopping for a new car seem easy.

Still, Chris Jacobs, CEO of the Juniper Research Group and a Republican consultant in the presidential primaries, thinks the matter will emerge from the background at some point during the campaign. Jacobs wondered in The Wall Street Journal whether rate increases could become “an October” surprise, helping the Republican nominee, Donald Trump, to win. I doubt it. Health care is too complex for Trump, who seems intent on winning by using the raw emotion generated by his diatribes on crime, terror in the streets and immigrants.

Still, Trump is the candidate of discontent. Anything that makes the electorate mad is fuel for his outrage.

In a close election, every percentage point counts, especially in the 10 or so states considered battlegrounds. One of them is Iowa. There, the big insurance company Wellmark Blue Cross and Blue Shield is telling about 30,000 of its customers buying policies on the exchanges — marketplaces available on the internet — that their premium rates will go up by 38 percent to 43 percent next year, The Des Moines Register reported. There will be smaller increases for another 90,000 people.

The same thing is happening elsewhere in the country, although not to such an extent. Avelare Health, a consulting firm, told Kaiser Health News that insurance companies are seeking rate increases for the exchanges’ popular silver plan by an average of 11 percent in 14 states. In California, Obamacare premiums will increase an average of 13.1 percent next year.  

The exchanges currently are used by 13.7 million Americans not covered by employer plans, according to the authoritative website In California, this amounts to 1.57 million. Those who are insured through their employer are not affected, nor are those who avoid the exchanges and shop for insurance on their own.

The big advantage to buying through an exchange is that policies may be cheaper than those on the open market. And those with lower incomes are eligible for federal subsidies that can greatly reduce the cost of insurance.

To help understand the system, I ran examples through the rate chart on the website of California Covered, which runs the California insurance exchange.  I created a mythical family of four — husband, wife and two children with an annual family income of $60,000. I picked the most popular of the Obamacare offerings, the silver plan, which provides a wide range of care but includes deductibles. Benefits vary according to the price of the plan.

The monthly premium for the most expensive silver plan is $1,285. But the family’s income would make it eligible for a federal subsidy, bringing the premium down to $513 a month. For the cheapest silver plan, the monthly premium would be $1,087, reduced to $316 by the subsidy.

In addition, the two children might be eligible for free care through Medi-Cal, the state program heavily subsidized by federal Obamacare funds. Medi-Cal has been a big help — in many cases, a life saver — for children like the ones in my example and to the poor and working poor.

Medi-Cal was created decades ago for the very poor. Obamacare extended it to the growing ranks of the working poor. Medi-Cal offers free or low-cost health coverage with most recipients receiving care through managed health plans or HMOs.

As a result of the Obamacare exchanges and Medi-Cal, the number of uninsured Californians has dropped from 17 percent of the population to 8.1 percent.

These numbers are evidence of a great improvement in health care accessibility.  

The Republicans, however, including Trump, don’t think so. They want to repeal Obamacare and replace it with a system that would turn medical care for the poor over to the states, many of which are hostile to helping their impoverished residents. Federal subsidies would disappear. 

At the heart of the GOP plan is something that has been floating out of conservative think tanks for years — health savings accounts. The GOP wants most Americans to finance their own health insurance by putting aside money and depositing it in health savings accounts. These are like regular savings accounts, except that your money is not taxed when deposited. But it’s a question of whether there would be enough money in the family health savings account if cancer, heart disease, diabetes, mental illness or any number of long-term debilitating illnesses were to strike.

Moreover, the Republican plan would make it easier for insurance companies to refuse to issue policies to people with pre-existing conditions.  Before Obamacare, such refusals were a familiar story, often driving uninsured families into bankruptcy and poverty. 

The Republicans also advocate giving parents the right to refuse immunization for their children. And, of course, as an important part of its health care agenda, the party “stands firmly” against abortion.

The Democratic presidential nominee, Hillary Clinton, has proposed a number of changes in Obamacare. While keeping its current structure, she would create a government-financed insurance operation in addition to private companies on the exchanges. Theoretically, this would provide competition for the insurance companies and force them to lower rates.

Another change would greatly increase federal aid for community health clinics, which provide medical care for the very poor. And she would make everyone 55 and older eligible for Medicare, which now dispenses health care to those 65 and older. 

Her opponent in the primaries, Sen. Bernie Sanders, wanted to put everyone on Medicare, thereby assuring that all Americans would have the same decent medical coverage now available to the 65-plus set. But he has said he believes Clinton’s proposals would be a big step forward in providing health care to all Americans.

Both Clinton and Sanders have been addressing the complexities and challenges of improving America’s health care, a crucial step in creating a more equal society.

Trump and the Republicans offer a simpler prescription to the sick: You should have saved for a rainy day. 

BILL BOYARSKY is a columnist for the Jewish Journal, Truthdig and L.A. Observed, and the author of “Inventing L.A.: The Chandlers and Their Times” (Angel City Press).

U.S. Supreme Court upholds key Obamacare insurance subsidies

The U.S. Supreme Court handed President Barack Obama a major victory on Thursday by upholding tax subsidies crucial to his signature healthcare law, with Chief Justice John Roberts saying Congress clearly intended for them to be available in all 50 states.

The court ruled on a 6-3 vote that the 2010 Affordable Care Act, widely known as Obamacare, did not restrict the subsidies to states that establish their own online healthcare exchanges. It marked the second time in three years that the high court ruled against a major challenge to the law brought by conservatives seeking to gut it.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote in the court's decision, adding that nationwide availability of the credits is required to “avoid the type of calamitous result that Congress plainly meant to avoid.

Roberts was joined by fellow conservative Justice Anthony Kennedy and the court’s four liberal members in the majority.

Shares of hospital operators, health services providers and insurers rallied broadly following the court's decision to uphold the subsidies. Top gainers included hospital companies Tenet Healthcare Corp., up 8.8 percent, and Community Health Systems Inc., up 8.5 percent.

The decision means the subsidies will remain not just in the 13 states that have set up their own exchanges and the three states that have state-federal hybrid exchanges, but also in the 34 states that use the exchange run by the federal government.

The case centered on the tax subsidies offered under the law, passed by Obama's fellow Democrats in Congress in 2010 over unified Republican opposition, that help low- and moderate-income people buy private health insurance. The exchanges are online marketplaces that allow consumers to shop among competing insurance plans.

The question before the justices was whether a four-word phrase in the expansive law saying subsidies are available to those buying insurance on exchanges “established by the state” has been correctly interpreted by the administration to allow subsidies to be available nationwide

Roberts wrote that although the conservative challengers’ arguments about the plain meaning of the statute were “strong,” the “context and structure of the act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”


Justice Antonin Scalia took the relatively rare step of reading a summary of his dissenting opinion from the bench.

In his reading of the statute, “it is hard to come up with a reason to use these words other than the purpose of limiting credits to state exchanges,” Scalia said.

“We really should start calling the law SCOTUScare,” he added, referencing the court’s earlier decision upholding the constitutionality of the law. SCOTUS is the acronym for the Supreme Court of the United States.

Conservative Justices Clarence Thomas and Samuel Alito joined Scalia's dissent.

The ruling will come as a major relief to Obama as he seeks to ensure that his legacy legislative achievement is implemented effectively and survives political and legal attacks before he leaves office in early 2017.

The current system will remain in place, with subsidies available in all 50 states. If the challengers had won, at least 6.4 million people in at least 34 states would have lost the subsidies whose average value is $272 per month.

“The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis,” said Dr. Steven Stack, president of the American Medical Association.

Rich Umbdenstock, head of the American Hospital Association, said the subsidies have allowed people to more easily seek care, calling the ruling “a significant victory.”

A loss for the Obama administration also could have had a broader impact on insurance markets by deterring younger, healthier people from buying health insurance, which would lead to premiums rising for older, less healthy people who need healthcare most, according to analysts.

The Democratic-backed law aimed to help millions of Americans who lacked any health insurance afford coverage.

The Obama administration has hailed the law as a success, saying 16.4 million previously uninsured people have gained health insurance since it was enacted. There are currently around 26 million people without health insurance, according to government figures.

Leading up the high court's ruling, Obama warned of far-reaching consequences of overturning a law that he said had become “woven into the fabric of America.” In a June 9 speech, Obama said taking away health insurance provided under the law to millions of people who need it the most “seems so cynical.”

Conservatives have fought Obamacare from its inception, calling it a government overreach and “socialized medicine.”

Opponents repeatedly but unsuccessfully sought to repeal it in Congress and launched a series of legal challenges. In 2012, Roberts, a conservative appointed by Republican President George W. Bush, cast the deciding vote in a 5-4 decision that upheld the law on constitutional grounds, siding with the court's four liberals.

The current case started as a long-shot legal challenge by conservative lawyers that oppose the law. Financed by a libertarian Washington group called the Competitive Enterprise Institute, the lawyers recruited four people from Virginia to be the plaintiffs. The lead plaintiff was a self-employed limousine driver named David King.

The plaintiffs said they were “deeply disappointed” with the ruling. The law “unfairly restricts the health insurance choices of millions of people, and it threatens their jobs as well,” they added.

A district court judge ruled for the government, as did the federal appeals court in Richmond, Virginia. But the Supreme Court then agreed to hear it.

The challengers said that the four-word phrase in the law indicates that only people who have bought insurance on state-established exchanges qualify for the tax-credit subsidies.

The Obama administration, backed by the healthcare industry, said other provisions in the law made clear that Congress intended the subsidies to be available nationwide regardless of whether states set up their own exchanges or leave the task to the federal government.

The case is King v. Burwell, U.S. Supreme Court, No. 14-114.

Obamacare will be Obama’s second big takeaway

We tend to use shorthand to talk about our presidents. Lincoln saved the Union and freed the slaves. Kennedy committed us to the moon landing and built the Peace Corps. FDR ended the Depression, created Social Security and won World War II.  

It’s hard to know in the middle of a presidency what will be remembered, and even then it may change. Right now, LBJ is getting a new look beyond Vietnam, to include civil rights, poverty and Medicare. Someday Nixon will move beyond Watergate, and negotiations with the USSR and China will have their due. Even poor Jimmy Carter may someday get some props for the Middle East peace agreement. Can’t hold out a lot of hope for George W. Bush, though, unless painting becomes a historical test of presidents.

In the moment, presidencies are so eventful, it’s hard to guess what will last. The killing of Osama bin Laden? Who talks about that anymore?  More people talk about Monica Lewinsky, which sadly will loom large in remembering Bill Clinton, an otherwise very successful president.

It’s clear, though, that for Barack Obama, the Affordable Care Act (ACA) is going to be the second takeaway after the first African-American presidency. Not so many weeks ago, people were talking about the collapsed Obama presidency and his limited role in history. The ACA was on its last legs. That, however, may be about to change.

Historians will surely note how many turns there were, how many debatable choices and some mistakes, mostly preventable, this White House made before the turnaround. Making health care priority No. 1 in 2009 reduced the Obama administration’s ability to fight more aggressively for a larger economic stimulus, costing his party massive losses in 2010 and resulting in Congressional gridlock that deepened the economic recession. Letting a group of Senate centrists delay passage of the health care law until the summer of 2009 allowed the Tea Party to negatively define the law, an image that only now is being challenged as Obamacare’s implementation finally takes shape.  

Of course, the utterly foreseeable catastrophe of the health care rollout in September completely squandered the Democratic gains that might have come from the government shutdown.

But through it all, the president held onto his path and has been rewarded with results that are simply stunning. His bet on a flawed, complicated half-loaf health care program that not only enraged his opponents but also demoralized many of his supporters may yet pay off in the long run. The new numbers of enrollees are concrete evidence that this has happened, and it is big both governmentally and politically.  Nearly 10 million Americans have a crucial benefit they didn’t have before, yielding virtually unlimited personal stories for political debate.  

If the law continues to expand its reach within the red states that have blocked Medicaid expansion, millions more will be added to the rolls of those with assured health care. It’s really remarkable that in most cases this law drives the cost of benefits lower rather than higher and that Democrats were not afraid of its anti-poverty elements. This will be the first broad working-class and lower-middle-class law that Democrats have implemented since the 1960s.  

In fact, this is so big that, as in the past, previous presidencies will now be seen in a new light. When LBJ signed the Medicare Act in 1965, he went to the Truman Library in Independence, Mo., so that Harry S. Truman, who had tried and failed to win such a law, could witness the signing. As we continue to revise our understanding of LBJ’s presidency, his 1965 victory on Medicare will be amplified by the success of the ACA.  And reminders of Republican opposition to Medicare are already making the rounds of the political world, to suggest to voters how history might be repeating itself.

It’s also remarkable that the long-cherished goal of widespread health coverage has taken a perhaps irreversible step at roughly the same moment that the Supreme Court decided to further open the floodgates for oligarchy in campaign spending, leading to claims that American democracy is dead. And even more oddly, the Supreme Court is also the one institution that could have stopped the ACA, and despite its right-leaning tendencies, it was the one, by a 5-4 majority, that allowed the law to survive — on Chief Justice John Roberts’ vote.  Talk about dramatic stakes. I wonder if Roberts worried that the court’s conservative majority could not do to the ACA what an earlier court did to Roosevelt’s early New Deal without setting off a political war it could not win, and that might jeopardize its other goals.  

The ACA is not out of the woods yet. In fact, the next obstacle in the long and winding story of the ACA is the potential for a Supreme Court decision to block subsidies for health care under the ACA in states that did not set up exchanges. If people already have insurance and subsidies, the court may be wary of taking them away. There may be a race against time to get those benefits locked in before the High Court rules.

If the ACA keeps going, much of Obama’s remaining time in office may focus not only on an economic agenda (minimum wage, equal pay and other measures) but also on working through the ramifications of the new health care law and fixing problems that arise. The impact of expanded health insurance is going to expand beyond health care. A new study for the Rand Corp. contends that the ACA will have the effect of lowering the cost of liability for auto insurance. Unbound from restrictions on pre-existing medical conditions, people may also feel freer to leave bad jobs and look for new ones, competition that may drive up wages and strengthen coalitions for a higher minimum wage. And the Medicaid expansion alone puts Democrats back on a path they have veered from since the days of Lyndon Johnson: directly helping low-income and lower middle-class Americans to survive and thrive. 

In theory, Democrats would be more likely to get the active votes of working people who need things that they don’t have (a belief that animated much of the Romney camp’s explanation for his defeat). But it often doesn’t work that way. Being hopeless and overwhelmed can make the act of voting seem to be a waste of time.

Latinos, working-class voters, young people and unmarried women all are widely known to be stay-at-homes in off-year elections like 2014 — and then they get hammered in public policy, including the voter suppression laws aimed at keeping them away from the polls that passed after the 2010 Republican sweep.  

 For folks who are struggling, it’s more important to gain something worth protecting than to have to dream of getting it. As Obama is discovering with Latinos with regard to deportations, Democrats are foolish to think they will win votes by saying, “Look how hard we are trying to get you what we need, while those mean Republicans keep it away from you.” 

A little security can do wonders. Having the ability to see the doctor without going bust may make enough of an impression to create a bit of that sense of “political efficacy.” What opponents of the ACA have called “dependency” on government is really something quite different — the creation of confident people who are more likely to play their role in the governance of American democracy.

Raphael J. Sonenshein is executive director of the Edmund G. “Pat” Brown Institute of Public Affairs at California State University, Los Angeles.

Letters to the editor: ACA, mitzvot, fair trade chocolate and Noble Prizes

First, Practice Mitzvot

In “No Faith, No Jewish Future” (Nov. 6), Dennis Prager has it backward. The assiduous practice of mitzvot results in recognition of their foundation, not visa versa. Halachic adherence remains the key to growth in Orthodox Judaism. A 3-year-old child learns what we do, i.e., wear tzitzit, when he puts them on and recites a bracha. A yeshiva student gains an understanding as to why we wear them, while studying talmudic tractate, Brachot. Contrary to Dennis’ suggestion, few, if any, outside Orthodoxy who “scrupulously follow halachah” reject the divinity of the Torah. The problem is not a failure to accept the divinity of the Torah; Rather, it is a failure to practice its dictates. Practice of halachah is a precursor to growth and understanding. We cannot be expected to comprehend that which is beyond our own practice and experience.

Mark Herskovitz, Los Angeles

Dennis Prager responds: 

Mr. Herskowitz and I differ. No problem. But his statement, “Contrary to Dennis’ suggestion, few, if any, outside Orthodoxy who ‘scrupulously follow halacha’ reject the divinity of the Torah,” is rarely, if ever, the case. The belief of non-Orthodox Jews who keep halacha was perfectly summarized by the past chancellor of Jewish Theological Seminary: “The Torah is the foundation text of Judaism … not because it is divine, but because it is sacred.”

More on the Affordable Care Act

David Suissa’s article “Lies and Consequences” (Nov. 15) is long on rhetoric and short on facts. Lying requires at least some degree of intent.

When President Barack Obama assured citizens they could keep their policies, he was referring to the grandfather clause included in the Affordable Care Act (ACA). That clause allowed policyholders to keep plans that were in effect as of the date the ACA was enacted in 2010.

The major reason the grandfather clause did not work is that the insurance companies kept creating plans after 2010 that they knew would not be valid after the launch of the ACA, something of which their customers were not cognizant. The insurance companies made use of that lack of sophistication among their customers. As a result, the vast majority of canceled policies were those written or amended between 2010 and 2013. For people who bought insurance plans prior to 2010 when ACA was enacted, President Obama’s statement that you can keep your plan was true and remains true. 

Is President Obama guilty of underestimating the insurance companies? Absolutely. But that does not rise to the level of a lie. It would be appropriate for the author of this column to research and write a follow-up article, this time with facts, on the real culprit, the billion-dollar, for-profit medical insurance industry.

Aaron Rubin, Los Angeles 

David Suissa responds: 

Merriam-Webster defines a lie as “to create a false or misleading impression.” In February 2010, at the health care summit with Republicans, President Obama acknowledged that 8 million to 9 million people “might have to change their coverage.” Knowing that, for three-plus years thereafter, and especially during his re-election campaign, the president promised Americans that “if you like your health care plan, you’ll be able to keep your health care plan. Period.” That’s why The Washington Post’s The Fact Checker site gave that statement its worse possible ranking — four Pinocchios.

Buy Fair Trade First

I read with great interest Deborah Prinz’s fascinating account of the role of chocolate in Jewish history (“Chocolate Freedoms of Chanukah and Thanksgiving,” Nov. 29). To really reinforce the notion that chocolate eaten at Chanukah symbolizes the freedoms won by the Maccabees, one should go one step further. Since most of the world’s chocolate is made from cocoa beans picked by children in the Ivory Coast, buying Fair Trade chocolate (certified to not involve children in the production) would really show how much we value freedom for all.

Mark Elinson, Los Angeles

A Wonderful Abundance of Nobel Laureates

The use of the term obnoxious to describe recognition of Jewish accomplishments in Nobel Prize history (“This Week in Jewish History,” Nov. 22) is regrettable. This phenomenon, a proportionally large representation of Nobel laureates attributed to the Jewish population, is a wonderful achievement that should be proudly and frequently referenced, in part to encourage our children to pursue careers in the sciences, liberal arts and engineering. It would have been preferable to have had the Jewish Journal staff edit the offending paragraph accordingly before recirculating it.

Jeff Gold, Rancho Palos Verdes

Pew finds Jews mostly liberal

One of the most interesting findings of the respected Pew Research Center’s poll of American Jews was the continuing theme of Jewish liberalism and approval of Barack Obama’s performance — a vote of confidence in the president exceeded only by that of African-American Protestants and Hispanic Catholics.

“Jews are among the most strongly liberal, Democratic groups in U.S. politics,” the Pew report said. “There are more than twice as many self-identified Jewish liberals as conservatives, while among the general public, this balance is nearly reversed. In addition, about seven-in-ten Jews identify with or lean toward the Democratic Party. Jews are more supportive of President Barack Obama than are most other religious groups. And about eight-in-ten Jews say homosexuality should be accepted by society.”

The survey is a landmark in research on the Jewish states of mind, the first such major survey since the National Jewish Population Survey of 2000-2001. It digs deeply into religious practice, participation in community activities, educational and economic attainment, demographics, and social and political views. It will help shape writing, commentary and research on Jewish American life for years to come.

It was taken between Feb. 20 and June 13 of this year, including a diverse sampling of 3,475 Jews, who are representative of the 6 million-plus American Jews. 

The pollsters were aware of the difficulty of defining who is a Jew. “This is an ancient question with no single, timeless answer,” they said. They divided Jews in two ways. One was by religion — those who “say their religion is Jewish (and who do not profess any other religion).” The other was “Jews of no religion — people who describe themselves … as atheist, agnostic or nothing in particular, but who have a Jewish parent or were raised Jewish and who still consider themselves Jewish in some way.” Interestingly, the survey found that the overwhelming majority of Jews considered themselves Jewish by religion.

The findings on Jewish attitudes toward Obama come at a significant time. While the Pew pollsters were in the field, the president was under fire for his policies on Syria, Iran and Israel, and Prime Minister Benjamin Netanyahu clearly didn’t like the way he was going.

In addition, he was headed toward yet another brutal confrontation with Republicans, especially the GOP in the House of Representatives. His approval ratings in national polls had dropped sharply since his 2012 re-election.

That drop wasn’t the case among Jews. A total of 65 percent of those surveyed by Pew said they approved of the way Obama was doing his job. Both women and men felt the same way, by just about the same percentage — a contrast to surveys of the general population, which show Obama more popular among women. The same is also true among age groups — with 64 percent of Jews over 50 approving of him and 66 percent of those under 50 agreeing.

Only African-American Protestants, with 88 percent, and Hispanic Catholics, 76 percent, give the president higher approval ratings.

However, the same percentages of Orthodox Jews do not share these beliefs, particularly the ultra-Orthodox, the survey found. For example, 82 percent of Jews overall feel that homosexuality should be accepted by society, while 58 percent of the Orthodox Jews felt it should be discouraged, with that sentiment reaching 70 percent among the ultra-Orthodox. And just 33 percent of Orthodox Jews gave Obama a favorable job-performance rating, with the number even lower among the ultra-Orthodox, 28 percent.

This minority is growing. The Orthodox Jewish community has double the birthrate of the rest of the Jews, and it is substantially younger. Those trends add up to increased Orthodox influence in the political world if they chose to use it. 

Jewish Republicans have tried to mobilize them in past presidential elections, but, so far, each time the Democratic candidate has received a solid majority, the numbers hardly wavering from one election to the next. 

But in recent weeks, their efforts have been damaged by the cadre of radical Republicans in the House, and by Sen. Ted Cruz (R-Texas), who closed down the federal government in their effort to kill the Affordable Care Act (ACA), also known as Obamacare.

You might think the Republicans are on the right track after the Obamacare Web sites’ troubled introduction, and after months of conservative attacks on the ACA, with polls showing that, while negative sentiment is declining, the Affordable Care Act is still unpopular.

But that’s not the case with Jews. They back Obamacare. The American Jewish Committee’s Web site noted that most public opinion polls show a majority of Jews favor the ACA. The Pew survey explains why. 

The poll shows that even among the irreligious, Jewish identity is intertwined with feelings of obligation to society and remembrance of how Jews have been persecuted. Jews worry about the underdogs, who are on the difficult road that they, their parents or grandparents traveled.

The Holocaust is deep in Jewish consciousness. Pew reported that roughly seven in 10 U.S. Jews (73 percent) say remembering the Holocaust is an essential part of what being Jewish means to them. Nearly as many say leading an ethical and moral life is essential to what it means to be Jewish. And a majority of U.S. Jews say working for justice and equality in society is essential to being Jewish.

The hard-hearted Republican conduct of the past weeks, plus the House Republicans’ willingness to shut down badly needed government services run counter to those feelings. That will likely shape how a majority of Jews vote in the 2014 midterm election, as well as in 2016, when the country picks a successor to Barack Obama.

Bill Boyarsky is a columnist for the Jewish Journal, Truthdig and L.A. Observed, and the author of “Inventing L.A.: The Chandlers and Their Times” (Angel City Press).

Affordable Health Care Act explained

As key features of the Patient Protection and Affordable Care Act (PPACA) — otherwise known as ACA or Obamacare — continue to go into effect, Shana Alex Lavarreda, a research scientist at the UCLA Center for Health Policy Research, is hopeful. She, more than many, understands the need that Angelenos face.

As Lavarreda told an audience of about 300 people during a Yom Kippur panel discussion at Temple Emanuel of Beverly Hills, there are more than 2 million people in Los Angeles County who are currently without health insurance — a pool that’s “bigger than the population of many states.”

These remarks came as part of the Contemporary Issues Forum, held annually at Temple Emanuel over the High Holy Days. This year’s took place on Sept. 14 and was titled “Shedding Light on Federal Health Care Reform — What the New Law Means for Me, My Family and My Country.” 

Joining Lavarreda in the panel discussion was Herb Schultz, regional director of the U.S. Department of Health and Human Services (HHS), who said the new law requiring everyone to have health care goes beyond politics.

“Health care is not a partisan issue — health care and health care reform affect all of us, as Americans.” 

Schultz drew on previous experience working in the cabinets of former California Govs. Arnold Schwarzenegger and Gray Davis as he spoke about health care in California and how the new federal law will change lives locally, noting that “5.5 million Californians … will be eligible, many of them for the very first time, for comprehensive, affordable health care coverage,” he said.

Meanwhile, Lavarreda spoke as director of the Health Insurance Studies program at the UCLA Center for Health Policy Research, a resource for health insurance information in California. She explained that many factors have contributed to the current state of affairs in the Golden State.

Not only did the recession of 2008 result in fewer people with job-based coverage — “just under half of California has job-based health coverage,” according to 2011-2012 data collected by UCLA, she said — but Medi-Cal, the state’s version of Medicaid, has stringent rules about income that can be a barrier to enrollment, she said.

Not only can private insurance be “prohibitively expensive,” she added, but some people don’t know it exists at all. Their thinking, Lavarreda said, is, “I can get it through my job, or I don’t get it at all.”

Who are the uninsured in Los Angeles County? About 85 percent are either U.S.-born citizens, naturalized citizens or legal permanent residents, despite myths that illegal immigrants make up a disproportionate amount of the uninsured, she said. 

Another commonly heard talking point — that children comprise a sizable chunk of the state’s uninsured — also is untrue, she said. Lavarreda gave credit to both sides of the political aisle for this, explaining that Democratic and Republican officials in California have supported public and private partnerships that have been successful in providing coverage to kids, including those of undocumented immigrants.

Schultz focused on what will happen now that one of the key features of Obamacare — health-insurance marketplaces for individuals — has opened for enrollment. On Oct. 1, 50 health insurance exchanges opened nationwide as part of reforms aimed at increasing access to health care. This includes Covered California ( in this state, where Californians can compare health plans and shop for an insurance provider. Open enrollment continues through March 2014, and those who sign up before the New Year will see their plans going into effect on Jan. 1.

 Because the ACA is funded by mandatory appropriations, it “will be up and running” despite the government shutdown, according to Kate Migliaccio, a public information officer at HHS. 

“A funding lapse does not go into the core of what we are doing,” Migliaccio wrote to the Journal in an e-mail.

During the discussion at Temple Emanuel, Schultz said there’s plenty to be optimistic about in regard to the ACA, which was signed into law by Obama in 2010. Those who are ages 18-34 — a group sometimes labelled as the Young Invincibles, who often believe they can live without health insurance — now will be able to afford it, he said. 

“[They] want to get health insurance and can’t afford it because of the broken health care system,” Schultz said.

Also, seniors already have saved billions of dollars on prescription drugs, due to ACA-instituted Medicare drug discounts that have been in effect since 2011, he said. 

Schultz praised the ACA’s Patients’ Bill of Rights, which guarantees consumer protections, including a provision that makes it illegal for insurance companies to deny coverage to children with pre-existing conditions. It is also illegal for a provider to drop from a plan an individual who has made a technical error on a customer application. These rules have been in effect since 2010.

Schultz and Lavarreda’s presentations, which lasted approximately 60 minutes, took place following Temple Emanuel’s afternoon services. It was followed by a 20-minute Q-and-A. Afterward, congregation members made their way back to Emanuel’s sanctuary for evening Neilah services. 

Temple Emanuel’s Rabbi Laura Geller gave brief introductory remarks kicking off the event. She delivered the Jewish argument for providing health care to the needy at an affordable price.

“It is completely clear that Jewish law and tradition places a high priority on caring for the sick in our midst — Jews and gentiles alike — and demands collective responsibility,” she said.

This year’s talk marked more than 15 consecutive years that the congregation has held a Contemporary Issues forum on Yom Kippur — a day when it is important to focus on both tikkun nefesh (“repairing our souls”) and tikkun olam (“repairing the world”), according to Geller. Previous events have covered topics such as immigration and Supreme Court issues. Last year, California Gov. Jerry Brown spoke during a discussion titled “California Matters.”  

Temple Emanuel board member Diane Vanette — who is active in the congregation’s partnership with community organizing network OneLA — moderated last month’s discussion. Another congregant, Scott Redston, who sells health insurance for a living, spoke briefly. They co-chaired the forum.

And their work isn’t over. On Nov. 3, the synagogue — in partnership with Temple Beth Am and OneLA — will host Schultz again. He will join community outreach and education experts in helping young adults, individuals under age 65 and small-business owners enroll in insurance plans offered by Covered California. For more information about the event, contact Vanette at

HEALTH CARE DECISION — Jews React: Chief executive officer of Bend the Arc

“This is a huge win for the American people,” said Alan van Capelle, chief executive officer of Bend the Arc, a Jewish social justice organization. “The Supreme Court has validated the ACA [Affordable Care Act].”

The court’s decision is good news for everybody, including the Jewish community, Capelle said. “The Jewish population is not immune to poverty, and there are many Jews in this country who are living just above the poverty line, so our community is affected in the same way that every other community is affected,” he said.

Instating the health care law will also lead to a more equitable distribution of medicine that reflects Jewish values, Capelle believes. “Jewish law, practice, has always considered health care a communal responsibility,” he said.