December 12, 2018

Trump’s ACA Order Creates Health-Care Chaos

US President Donald Trump (L) and White House senior advisor Jared Kushner take part in a bilateral meeting with Italy's Prime Minister Paolo Gentiloni (not seen) in Villa Taverna, the US ambassador's residence, in Rome on May 24, 2017. Photo by Mandel Ngan/AFP/Getty Images

So now we face yet another assault on the health and safety of our nation due to the barrage of efforts by the current administration to dismantle certain provisions in the Affordable Care Act (ACA). This creates great risk and chaos within a system that is aimed at providing both proactive and reactive care to individuals in our country.

As a Jewish community, we should be outraged at the callous attempt to shirk society’s obligation to care for one another, both in terms of last week’s decision to cut subsidy payments to insurers (“cost-sharing reduction payments”) and the ruling to withhold the ACA’s promise of no-cost contraceptive coverage. As conversations and negotiations change by the hour, we are both encouraged to learn of bipartisan cooperation to save the cost-sharing reduction payments while at the same time disappointed with the administration’s insensitive statements and recommendations to eliminate someone’s health care.

This supersedes all other commandments, as it is inferred from one of the most well-known rabbinic teachings, the concept of pikuach nefesh, saving a soul, found in Mishnah Yoma. The text suggests that saving the life of yourself or another is so great that one is permitted to break the laws of Shabbat for the safety of human life. We must interpret this to modern day and protect the lives of millions who will be affected by attempts to cripple the Affordable Care Act. To dismantle a life-saving system is antithetical to the concept of pikuach nefesh.

Furthermore, the book of Leviticus (19:16) teaches that one should not stand idly by the blood of their neighbor. Many among us acknowledge the ACA is not a perfect system and does not go far enough to provide adequate health care to our entire society. Yet, to make provisions that seek to strip health care from any individual is to create a situation in which we as a society will be standing by the blood of our neighbor.

Although negotiations are ongoing, last week’s initial decision by the Trump administration to sign an executive order sends a signal to the insurance companies that their participation in the ACA is not cost-effective for their company. As insurance companies cease their participation in the ACA, it places many people in our society at great risk of losing their health care, putting their lives and the lives of their loved ones at risk.   

The Jewish community must look at the current health care debate and ask ourselves: Is the Trump administration seeking to save lives, or, by suggesting that we eliminate the cost-sharing reduction payments, are its actions creating a risky environment that will harm lives?

The answer is clear. We as Jews have a responsibility to care for one another. If the future health care of an individual is unknown, then we are ignoring our commandment of pikuach nefesh, to save lives.

It is the responsibility of us all to ensure the health and safety of one another.

The administration is taking a further step by issuing rules that would allow employers and insurers to withhold the ACA’s promise of no-cost contraceptive coverage. This is a direct attack on women, who should be the only decision makers for their bodies. Many have celebrated this recent ruling as a win for religious freedom but many organizations have a contrary view.

Any government-backed initiative that allows for discrimination based on religious belief is an affront to our religious freedoms. A provision in Trump’s order puts women’s reproductive health decisions in the hands of their employers and insurers. Our country has a long legacy of religious freedom, and recent attempts to incorporate discrimination into the legislative process based on religious freedom are antithetical to the core beliefs of our religion and the core beliefs of this nation.

We have a strong and healthy tradition of debate and dissent within the Jewish framework, but it seems clear that the dismantling of the ACA creates a dangerous situation in which the health care of many in our society will be in the balance. We must go beyond offering a misheberach for those in need of healing. The ACA and other initiatives that seek to provide sustainable and reliable health care to all link our prayers to our actions as we seek to truly heal those in need. 


Rabbi Joel Simonds is the founding executive director of the Jewish Center for Justice.

Trump’s Changes to ACA Are Worth Celebrating

President Donald Trump on July 24. Photo by Joshua Roberts/Reuters

On Oct. 12, President Donald Trump signed an executive order rolling back a handful of Obamacare’s regulations.

Patients and employers should celebrate the move. The administration is taking action where Congress could not, increasing the number of insurance choices available to Americans — and reducing their cost.

The order directs the Departments of Health and Human Services, Labor and Treasury to come up with regulations that would allow for three key changes.

First, Trump’s order aims to expand access to association health plans, or AHPs. These plans allow small, like-minded employers to join forces to purchase a large-group insurance policy together.

The Obama administration cracked down on AHPs by decreeing that small employers banding together under the banner of an association would not be eligible to buy a large-group policy to cover them all.

That was crucial, because Obamacare imposed many costly regulations and mandates on individual and small-group insurance but not on policies issued in the large-group market.

The administration is … increasing the number of insurance choices available to Americans.

Among those regulations are the essential health benefits mandates, which require all policies to cover 10 benefits, regardless of whether employers or beneficiaries want them.

These mandates inflate the cost of insurance. Many small businesses and employees would gladly take lower premiums and deductibles in exchange for policies that don’t cover expensive services.

But they don’t have that option; their only choice is expensive, comprehensive insurance. So it’s no wonder that only one-third of businesses with fewer than 50 employees offer health insurance — or that just one-third of 1 percent of employees at such firms have coverage through Obamacare’s Small Business Health Options, or SHOP, exchange.

Crucially, those with pre-existing conditions will be protected if their employer opts for an AHP. The executive order emphasizes that employers cannot exclude employees from joining the plan, nor can they charge different premiums to different individuals covered by the plan.

Trump’s executive order also relaxes restrictions on low-cost, short-term health insurance plans. Obamacare set the maximum term for such plans at three months; the executive order will probably extend that term to just under a year and allow the plans to be renewed.

Obamacare slapped strictures on short-term plans to try to force people into the insurance exchanges. But exchange plans have proven too expensive for many individuals, thanks to the many mandates governing them. 

The third component of Trump’s executive order would boost the power of health reimbursement arrangements, or HRAs. These accounts enable employers to allocate tax-free dollars to employees to help them with qualified healthcare expenses.

HRAs are particularly popular with small businesses. Under Obamacare, those with fewer than 50 employees are not obligated to offer health insurance to their workers. Many do so anyway. Others may not be able to afford to provide coverage, especially if their only options are on Obamacare’s expensive marketplaces. HRAs can allow them to give their employees at least some help paying for care.

Under the executive order, the administration is likely to broaden the definition of qualified health care expenses to allow for HRA funds to cover insurance premiums. That could help scores of people who previously could not afford coverage pay for it.

Republicans have promised for the better part of eight years to expand access to low-cost coverage by repealing and replacing Obamacare. President Trump’s executive order finally makes good on that promise, albeit to a small degree.

And, on Oct. 13, President Trump announced that he would immediately stop paying the illegal CSR (Cost-Sharing Reduction) subsidies to insurers.  These payments of $7 billion a year were never appropriated by Congress.  A specific instruction to pay that money is required by the U.S. Constitution before federal money can be paid. 


Sally C. Pipes is president, CEO and the Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute.

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 jewishjournal.com/jews_and_special_needs.

L.A. rabbi arrested in Washington for protesting health care bill

Rabbi Sharon Brous being arrested July 18 in the Russell Senate Office Building. Photo courtesy of Sharon Brous

Rabbi Sharon Brous of the Los Angeles congregation IKAR was arrested July 18 with about a dozen other faith leaders outside the Washington, D.C., office of Senate Majority Leader Mitch McConnell (R-Ky.) while protesting Republican efforts to dismantle the Affordable Care Act, also known as Obamacare.

Brous and the other clergy members were arrested for refusing police orders to disperse, according to United States Capitol Police. They were singing, praying and giving speeches before they were arrested, Brous said.

“I did find it to be ironic that it is illegal to stand in the hallway of the Senate building and it’s not illegal to plot how to make cancer patients lose their chemotherapy,” Brous told the Journal in a phone interview.

Brous said she traveled to the nation’s capital to protest Republican health care legislation because she felt obligated as a person of faith, but also because both of her parents are cancer survivors and another close relative is fighting cancer, and she believes proposed bills would deny vital services to cancer patients and others facing grave illnesses.

The most recent Congressional Budget Office review of Republican health care legislation estimated that the Obamacare Repeal Reconciliation Act of 2017 would result in 32 million people losing health care. As Senate majority leader, McConnell is responsible for steering Republican efforts to pass the legislation.

“As people of faith, we are called to operate in a way that is just and right and compassionate in all cases, but we’re asked to have special care for the most vulnerable,” Brous said. “And this does exactly the opposite.”

Brous said the protest was organized by members of the interfaith Auburn Senior Fellows program, including the Rev. William Barber II of Greenleaf Christian Church in Goldsboro, N.C., and Sister Simone Campbell, executive director of Network, a Catholic social justice lobby.

Among those also arrested was Rabbi Alana Suskin of Americans for Peace Now, a group that opposes Israeli military control of Gaza and the West Bank.

Brous said there will be more demonstrations if Republicans persist with their efforts. The July 18 arrests came as one of several waves of protest. At least 11 faith leaders were arrested five days earlier, also in front of McConnell’s office.

“You call yourself religious people and you put your hands on a Bible when you swear the oath of office,” she said of Republican lawmakers. “And you’re undermining everything that we as people of faith hold to be true.”

She and the other protesters arrested with her were released the same day after paying a $50 fine, according to Capitol Police.

Jewish groups urge Senate to oppose health care bill

Protestors gather during a demonstration against the Republican repeal of the Affordable Care Act, outside the U.S. Capitol in Washington, D.C., on June 21. Photo by Aaron P. Bernstein/Reuters

A coalition of Jewish organizations led by the Religious Action Center of Reform Judaism urged members of the U.S. Senate to oppose the bill that would repeal the Affordable Care Act, or Obamacare.

The letter sent to all 100 senators Tuesday, signed by 14 organizations, says that the Better Care Reconciliation Act of 2017 would undercut Medicaid, the federal program that currently pays for half of all births in the United States and about 62 percent of seniors who are living in nursing homes.

The Senate bill would lower government spending on Medicaid by capping the per capita cost of serving various groups, such as children, adults, people with disabilities or the elderly. According to the Congressional Budget Office, the Republican-backed bill would reduce projected Medicaid spending by $772 billion in the coming decade, and 15 million fewer people would be covered by Medicaid in 2026 than under the current law.

“Among other harmful provisions, transforming Medicaid into a per-capita cap system would not only take away health care from those who have benefited from the ACA’s Medicaid expansion, but would harm populations that have been covered by Medicaid since its inception,” according to the letter. “States will face impossible choices prioritizing among people with disabilities, low-income Americans, and children and will have no option but to slash services that are essential for the daily lives of millions.”

Signers of the letter include Bend the Arc-Jewish Action, Jewish Federations of North America, National Council of Jewish Women, the Network of Jewish Human Service Agencies, and Reform, Conservative and Reconstructionist groups.

Jewish Federations of North America estimates that the care providers affiliated with Jewish federations receive $6 billion from the Medicaid program annually.

Reform movement decries Senate Republicans’ health care bill

Senate Majority Leader Mitch McConnell in Washington, D.C., on June 6. Photo by Aaron P. Bernstein/Reuters

The Reform movement sharply criticized a Republican bill in the Senate that would repeal and replace major parts of the Affordable Care Act and make severe cuts to Medicaid.

On Thursday, Senate Republicans revealed a draft of a measure that would get rid of the legal requirement that most Americans have health coverage and offer federal tax credits to aid Americans in paying for health insurance.

The Reform movement called the proposed measure “deeply harmful.”

“The Senate bill revealed this morning is a major undermining of American health care that will hurt Americans most in need: the elderly, the poor, children and people with disabilities,” Barbara Weinstein, director of the Commission on Social Action of Reform Judaism, said in a statement on behalf of the Reform movement. “Jewish tradition’s emphasis on caring for the sick and lifting up those in need inspires us to call on Senators to reject the Better Care Reconciliation Act of 2017.”

Weinstein alluded to the Jewish prayer for healing in her statement.

“In the Jewish ‘Mi Sheberach’ prayer for the ill, we ask for the Holy One to be filled with compassion for the sick and to swiftly provide a complete renewal of body and spirit. As we pray for all those in need of healing, let us also act with compassion and wisdom,” she said. “We call on Senators to reject this deeply harmful legislation and work instead to expand access to affordable health care for all.”

Bend the Arc: Jewish Action also decried the measure.

“We must call the Senate’s ACA repeal bill exactly what it is: a moral travesty — a tax cut for the rich financed on the backs of the most vulnerable members of our society,”  the group’s CEO, Stosh Cotler, said in a statement. “This legislation will result in millions of Americans losing their health care.”

In May, the House of Representatives passed a similar bill backed by Republicans and President Donald Trump. Jewish groups, including the Reform movement, the Jewish Federations of North America, B’nai B’rith International, the National Jewish Democratic Council, the National Council of Jewish Women and Jewish Women International denounced that measure, while the Republican Jewish Coalition praised it.

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 martyk@jewishjournal.com.

#IamAPreexistingCondition

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 jewishjournal.com/jews_and_special_needs.

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 martyk@jewishjournal.com.

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 jewishjournal.com/jews_and_special_needs.

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.

Hillary vs Bernie: ‘It’s the ego, stupid!’

Bernie Sanders’ and Hillary Clinton's voting records on women's issues may be — as Sanders claims — very similar. But experienced women know what qualities ultimately determine whether someone will be good or bad for them. And when it comes to personality traits, the two candidates couldn’t be more different. Watching them in the last few debate rounds, town halls, and TV interviews clarifies for me why I, a mature female voter, want to see Hillary Clinton as the next President of The United States. To borrow from an old phrase popular during a previous presidential election, “It’s the ego, stupid!”

He is rigid; she is flexible. He is dogmatic; she is inquisitive. He is theoretical; she is practical.  He is abrupt; she is measured.  He reduces; she enlarges. He simplifies; she qualifies. He has an unequivocal answer for every question. She pauses, ponders and often follows a question with a question.  He sees the world in black and white. She sees the world in shades of gray.

A woman complains that in her case, The Affordable Care Act resulted in higher, less affordable rates. What kind of health plan did you have previously? Hillary asks. She listens; she probes; she offers several practical alternatives. Bernie, on the other hand, always responds instantly.  He will fix everything. His single payer health program will provide adequate free care for all.

As far as he’s concerned, the solutions are crystal clear; they always were: “We live in a rigged economy.” Our enemies are “Wall Street,” and “the billionaire class.” “Can you name one billionaire you like?” a man in one town hall asks him. Maybe Oprah, or Gates, or Buffet, I hope. “Oh no,” Bernie answers.  “This isn’t personal.” I should have known. Marxist theory divides the world between “class friends,” and “class enemies.”  Those labels are never personal. If Secretary Clinton used her education, knowledge, and experience to speak to the enemy and got well paid for her work, her checks must have been tainted. Such accusations bring bad memories. In The Socialist Republic of Romania, where I grew up, if you got caught talking to or buying from a “class enemy” – a Western tourist, for example – you could get arrested.  

Bernie will lead the revolution to tear down the ancient capitalist structures and erect novel ones according to his theories and specifications. In a recent interview with the Los Angeles Times editorial board, Sanders claims that no president can “literally do anything for the American people, unless there is a political revolution,” against “the ruling class — that is Wall Street, that is corporate America, that is the wealthy contributors, that is corporate media…” And how exactly will President Sanders work with the other side, let's say during the first 100 days of his revolution, editor Goldberg asks him. Bernie responds that he will tell Mitch McConnell, “Hey Mitch, look out the window. There's a million young people out there, now!”

Hillary, by contrast, limits her claims.  Obamacare isn’t perfect care, but she will work hard to expand our choices and improve our alternatives. She will encourage non-profits to join the competition, and she will pressure insurance providers to lower their rates. “I don’t know if my answer will solve everything,” she says, “but I am going to take them on.” As far as she is concerned, we live in a complex, volatile, ever changing world; she will lead efforts to improve, modify, evolve, elevate, learning from past failures and building on past successes; if we elect her, she will create an environment that will increase the incentives and opportunities that will empower more of us to maximize our chances for success. This is the American way – not the Swedish or Russian or Cuban way.

Bernie reminds me of Aylmer, the scientist in Hawthorne’s, “The Birthmark,” who wants to perfect his wife, as Bernie wants to perfect his country, by cutting out her birthmark, and ends up killing her in the process. Hawthorne was a champion of women’s rights and many of his male reformers, like the utopian Hollingsworth, in The Blithedale Romance (“the bond slave” “to that cold, spectral monster, his philanthropic theory”), end up favoring theories over people and harming those they mean to help.

But then Bernie appears sincere, while Hillary seems studied. He is passionate, and she, reserved. Isn't a charismatic idealist with noble dreams preferable to a cautious pragmatist with mundane plans? Some Millennials think so. I think about my father, who joined the communist underground in Romania during World War II, believed in the worker's paradise, rose to become Vice-Secretary of Defense in the new, socialist government only to discover that the nouvelle elite used its power to enrich itself and oppress the rest. He exposed the truth in his book, Gulliver In The Land of Lies, which earned him a sentence of 25 years in prison. Today, his country recognizes him as a hero, “The Romanian Solzhenitsyn.”

As a young woman, I glorified him over my mother, the way young women sometimes glorify their charismatic fathers over their dependable mothers. But it was she, the pragmatist in the family, who had to pick up the pieces of her husband’s shattered dreams, put bread on her children’s table and start a new life from scratch, alone with two children.  And I wonder: How many experienced, resilient, pragmatic women and mothers, married and single, are choosing Hillary Clinton over Bernie Sanders because they know the difference between dreams and reality, fact and fiction, words and deeds?

Listening to Secretary Clinton’s thoughtful answers to the complex questions raised by Wolf Blitzer after the Brussels attack (“I’m a very strong supporter of Nato. It’s the best international defense alliance I think ever,” but “we have to keep adjusting and changing its mission to meet the new threats that we, as members of Nato, face”), I have faith that this intelligent, experienced, resilient woman has the capacity to bring peace and prosperity to our embattled land.


Irina Eremia Bragin is chair of the English Department at Touro College, Los Angeles. She is the author of the memoir, Subterranean Towers: A Father-Daughter Story

Trump or Cruz? Republicans face tough choices as primary race churns forward

Republicans desperate to stop Donald Trump from capturing the party's presidential nomination may have to unite behind Ted Cruz, a polarizing figure who has made many enemies within the party.

Cruz, 45, a senator from Texas, won nominating contests in Kansas and Maine on Saturday, bolstering his argument that he is the leading alternative to Trump, 69, the blunt-spoken billionaire businessman.

Many mainstream Republicans are reluctant, however, to rally behind Cruz, whom they see as too conservative for the general electorate in the Nov. 8 election to succeed Democratic President Barack Obama.

Cruz has run as an outsider bent on shaking up the Republican establishment in Washington. A favorite of evangelicals, he has called for the United States to “carpet bomb” the Islamic State militant group and has pledged to eliminate the tax-collecting Internal Revenue Service and four Cabinet agencies.

But he angered many Republican colleagues when he led an unsuccessful effort to repeal President Barack Obama's Affordable Care Act that shut down the government for 16 days in 2013.

Republican pollster Neil Newhouse said Cruz had not yet shown an ability to appeal beyond the most conservative voters.

“The way things are going, I think it's extraordinarily unlikely that Senator Cruz becomes the focal point for Republicans who want to stop Trump,” said Newhouse, who was lead pollster for 2012 Republican presidential nominee Mitt Romney.

Kim Reem, a member of the executive committee of the National Federation of Republican Women, said three factions were emerging among Republicans: those supporting Trump, those backing Cruz, and supporters of the party establishment. None are inclined to compromise, she said.

“I don’t see a path to making everybody happy,” she said.

Former U.S. Senator Trent Lott of Mississippi said he would have a hard time supporting a Cruz nomination. “He'd have to change his tactics and his conduct an awful lot,” he said.

Cruz has feuded with party leadership, including Republican Senate Majority Leader Mitch McConnell, and has often accused fellow Republicans of selling out conservative principles.

Although he has been in the Senate for four years, Cruz has not won a single endorsement from any other senator. He touts that on the campaign trail as evidence he is an outsider.

RUBIO FLORIDA HOPE

To win the nomination, 1,237 delegates are needed. According to The New York Times, Trump leads with 384 delegates and Cruz has won 300. U.S. Senator Marco Rubio, 44, of Florida, an establishment favorite still seen by some in the party as an option to Trump, has won 151 delegates and Ohio Governor John Kasich trails with 37.

Some establishment Republicans say the best way to stop Trump would be for Rubio to win the 99-delegate Florida contest and Kasich the 66-delegate Ohio primary. Opinion polls show Cruz trailing in both states, which award all their delegates to the top vote-getter on March 15.

Michigan, Mississippi, Idaho and Hawaii hold nominating contests on Tuesday. Recent opinion polls show Trump leading by a wide margin in Michigan, the day's biggest prize.

If Cruz, Rubio and Kasich can collectively prevent Trump from getting the needed majority of delegates, they could force a brokered Republican Party convention in July in Cleveland, aimed at producing a compromise candidate.

Even if Cruz gets the second-highest vote total, he may have trouble claiming the nomination at the convention over Trump.

If nothing else, the debate reveals deep divisions within the party.

Slater Bayliss, a Florida Republican who raised money for former Florida Governor Jeb Bush before he dropped out of the race, said: “From my perspective, Senator Cruz's views are indicative of only a very small cohort in our party.” 

Republican donors, unhappy with Trump policies like his calls to deport 11 million illegal immigrants and temporarily bar all Muslims from entering the United States have poured millions of dollars into attack ads over the past week. 

The Club for Growth, an advocacy group that pushes for lower taxes and spending, said on Monday it would spend $2 million on TV ads questioning Trump's conservative credentials in Illinois, one of six states or territories that holds a nominating contest on March 15.     

Outside groups have spent more than $10 million on anti-Trump advertising in Florida and $23 million in other states, according to federal records.

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.”

SCALIA DISSENTS

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.

Tea Party hero Ted Cruz announces presidential bid

Texas Sen. Ted Cruz cast himself as a leader of a grassroots conservative army on Monday as he became the first major figure to jump into the 2016 U.S. presidential election on Monday.

Speaking at Liberty University, an evangelical Christian school in Virginia, the Republican firebrand spoke about his religious faith and said he wanted to “reignite the promise of America.”

“The answer will not come from Washington. It will come only from the men and women across this country: from people of faith, lovers of liberty, from people who respect the Constitution,” he said.

The Canadian-born son of a Cuban immigrant, Cruz, 44, would be the first Hispanic in the White House if he won the November 2016 election.

He has built a reputation as an unyielding advocate for conservative principles in his two years in the U.S. Senate, making enemies in both parties on Capitol Hill even as he has become a hero to the grassroots Tea Party movement.

He pushed his party to force a 16-day government shutdown in 2013 in an unsuccessful effort to deny funding to President Barack Obama's healthcare law, the Affordable Care Act. He led a similar effort this year, also unsuccessful, to block Obama's effort to remove the threat of deportation for some undocumented immigrants.

More than a dozen potential presidential candidates are already courting donors and voters in states like Iowa and New Hampshire that vote early in next year's primary season.

As the lone official candidate, Cruz will get extra attention from the media and voters for several weeks.

Cruz was supported by 8 percent of self-identified Republicans in a Reuters/Ipsos tracking poll. Former Florida Governor Jeb Bush leads the poll with 21 percent and Wisconsin Governor Scott Walker ranks second with 16 percent.

Several other potential candidates are statistically tied with Cruz, including Florida Senator Marco Rubio, Kentucky Senator Rand Paul, New Jersey Governor Chris Christie, former Arkansas Governor Mike Huckabee and retired neurosurgeon Ben Carson.

The Democratic field is shaping up to be far leaner. Former U.S. Secretary of State Hillary Clinton has yet to declare her candidacy but is viewed as the front-runner for her party's nomination.

The I-word isn’t impeachment – it’s idiocracy

Is he – finally – the one we’ve been waiting for?

Just days after the midterm election, President Barack Obama made a big climate change deal with China, asked the F.C.C. to regulate Internet service providers as if they were public utilities and pledged to address the immigration mess on his own instead of continuing to wait for Congress to arise from its dysfunctional deathbed.

The president’s inaction on these issues until now was intended to prevent the electoral debacle and partisan caterwauling that happened anyway.  His previous patience has proven to be time squandered, and his search for common ground with folks who wanted his head on a pike turned out to be a case study in bad poker playing, if not wishful thinking. 

This post-election Obama is the one voters thought they put into office in 2008, but who spent the next six years being called naïve for projecting their civic hopes onto a cypher.  Whatever triggered his transformation – legacy clock ticking, nothing left to lose, stopbullying.gov – it’s a heartening moment for his base.  The challenge now for him is to deliver on that change; the challenge for his supporters is to rescue the stakes of these changes from soap opera.

We loves us our political melodrama.  “Will the Republicans force a government shutdown by baiting Obama to veto a budget that defunds immigration reform?” is the Washington equivalent of “What will Lance do when Kimberly tells him his lover is actually his sister?”  “Will the House impeach Obama?” is as effective a cliffhanger as “Will the train slice Pauline into pieces?”  The same narrative toolkit that makes stories entertaining – conflict, suspense, danger and rescue, power and perversion – also makes democracy theatrical and casts its citizens as spectators.   

The news media cover politics like a long-running serial in chronic need of crisis.  It doesn’t matter whether they caused this or merely reflect it.  Politicians are so accustomed to being performers that wondering whether Ted Cruz actually believes the things he says is as misbegotten a mission as searching for the real Justin Bieber.  It’s not our fault that the political characters angling for our attention seem no more authentic than the Punch and Judy roles they play – their words are scripted, their images are cosmetic and their stories hew to the genre conventions that spawned them.

The downside of storified self-government, and of experiencing pretty much everything else as entertainment, too, is that we relinquish our grip on reality.  In a series of 36 tweets (the perfect vehicle for such an argument), Grist.org columnist David Roberts, “>typographical error in the law – calls this “postmodern conservatism.” The right’s “nihilistic oppositionalism,” he says, makes its own reality.  They have “realized that if you just brazen it out, there’s no… ref to make the call.  In this way, every dispute, even over matters of fact, becomes a contest of power – loudest, best funded, most persistent voices win…. Epistemology becomes competing tantrums…. So there will only be increasing impetus for cons[ervatives] to retreat into fantasy, into simple morality tales… [which] always yield more motivated, organized constituencies than ‘it’s complicated’ ever will.”

Conservatives, of course, accuse the left of worse than fantasy.  The title of a book by James Inhofe, the Oklahoma Republican about to chair the Senate Environment and Public Works Committee, depicts it as deceit:  “The Greatest Hoax: How the Global Warming Conspiracy Threatens Your Future.”  But all he’s really doing is reframing the left’s strategy – to inform voters about scientific data – as the plot of an airport thriller.  “The bad guys are gunning for you!” is much more entertaining than, “May I please explain this graph to you?” And the studio funding that storyline – the fossil fuel industry – has the largest marketing budget in the world.

It’s in the economic self-interest of the news media to make politics as fun as wrestling and as risky as a high-wire act.  That’s what drives ratings.  But we pay a steep price for the pleasures of circus and spectacle.  The most critical problem American society faces right now is, arguably, inequality, and the plutocracy that benefits from it, and the corruption that puts remedies for it beyond our constitutional reach. Every breathless story about impeachment occupies bandwidth not given to exploring the structural problems that Naomi Klein addresses in ““>Idiocracy”?  It projects contemporary commercialism, anti-intellectualism and the showbizzification of everything into a dystopian America five centuries from now.  Five minutes is more like it. “

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Uncovered California

For those who have just perked up, whose eyes opened wide, sorry, this column contains no nudity or salacious content.  Parts of it may be obscene, yes, but not for the reason the words “Uncovered” together with “California” might portend. This is a family website, after all.  (It is, right?)
 
California’s Obamacare exchange is known as Covered California, and the Golden State, being the most populous, has the highest number per state of Obamacare marketplace enrollees at 17.5%, or 1.4 million people.  Because open enrollment is less than a month away, and Covered California is allowing early renewals, the airways, at least here in Los Angeles (so I am sure elsewhere in the state) have been inundated, it seems, by ads promoting the exchange, and by definition, Obamacare.  (And where is Covered California getting all that advertising money anyway?  Commercials here cost a fortune.) 
 
The president’s signature achievement, whose official name is the Affordable Care Act (ACA), is off the front page, but absolutely not off the kitchen table. Remember Politifact’s 2013  “Lie of the Year?”  “I intend to keep this promise, if you like your doctor, you will be able to keep your doctor, if you like your health care plan, you will be able to keep your health care plan.”  Thirty-seven times President Obama or a top administration official made that claim, along with other untruths about lower costs.  Well, and forget the healthcare.gov website fiasco, many people found out the president lied, because it became public he was aware of what would eventually happen.  NBC News reported a year ago, “… the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.”
 
 
So what happened?  In 2013, millions of plans were canceled as insurance companies moved to comply with new federal requirements and subsequent increased costs.  And as individuals and families scrambled to find plans that worked for them, they discovered they would get less coverage for higher premiums, not the lower ones promised, and not be able to even keep their doctors in some way.  The small company mandate of new requirements was delayed, not the individual plan mandate, and some did benefit for sure, those getting government subsidies and others who never had insurance.  But, and the government still will not release all demographic data, the Department of Health and Human Services did admit that only 8 million became newly insured (not 10 million as some have reported), when the main point was to insure the 30 million+ uninsured.
 
The much ballyhooed goal of 7 million enrollees necessary to pay for the program was publicized for months, and when it was reached there was White House celebration, but even that so-called fact was not definitive.  According to the RAND Corporation's comprehensive Obamacare study, only a little over a third of the enrollees were previously uninsured.  The vast majority were those whose plans they preferred were canceled, and who had to get a new plan many of them just did not like.
 
Companies, insurance companies and insurance brokers have found all kinds of ways, some even illegal, to get around the new requirements of Obamacare, and so, the much higher associated costs.  Also, laying off workers or turning full time employees into part-time ones, or hiring part-time employees, to stay under the requisite number of 50+ employees when insurance must be offered, became a nasty by-product of Obamacare that harmed families and the economy.
 
For larger companies, the bad news is coming.  In fact, some of it is already here. This made the news last week: “Wal-Mart Stores Inc. is cutting health insurance for another 30,000 part-time workers and raising premiums for its other employees, as U.S. corporations push to contain costs in the wake of the federal health-care law.”  And, as delayed parts of the ACA (done so for political reasons) get close to implementation, other companies and insurance companies have already done the same as Walmart, and more will.  And many health care companies will just shut down operations or leave states where costs are just too prohibitive.  Some have already done so or announced they will, and they are even pulling their non-Obamacare plans.
 
And speaking of politics, watch this exchange from last week between Jonathan Karl of ABC News and Josh Earnest, the White House spokesman.  Karl asked, “Why is it that last year Oct. 1 was the (start of the Obamacare enrollment period) date, and this year it’s Nov. 15?  Why is it that people have to wait until after the election to find out whether they have a premium increase or decrease? And, as Earnest danced, this from Karl, “Can people be forgiven for thinking this looks like a political move?  People will not find out how much they are going to have to pay for their health insurance until after the election, whereas last year they found out on Oct. 1. Doesn't it seem a little bit convenient that people now have to wait ten or eleven days after the election to find out how much their insurance was going to cost?”
 
And Investor’s Business Daily just reported a couple days ago,“ObamaCare shoppers in search of the lowest-cost plan may come down with a mild case of rate shock when 2015 exchange enrollment begins next month.  An examination of next year's rates in the biggest city in 15 states and Washington, D.C., reveals that the cost of the cheapest bronze plan will jump an average of 13.9% for 40-year-old non-smokers earning 225% of the poverty level ($26,260).”Some cities will have lower costs, most higher, Seattle a whopping 64%.  Los Angeles will have an increase of 27%.  Do you think premiums for the more expensive silver, gold and platinum plans, across the board, won’t jump as well?  And what about non-exchange marketplace private and company-associated plans?  Do you think that when the new regulations mandate delay completely expires, their premiums won’t go higher? Much higher?
 
Look, universal health care is a noble and important goal, and I am glad there is coverage for people who would otherwise go without. I also think it was a good idea to allow young adults up to age 26 to remain on a parent’s plan.  But I wish both major parties could have settled their differences to make things work, because turning the whole system upside down was unnecessary, reckless, not carefully and completely thought out, and disastrous.
 
And unlike a number of private market plans such as Anthem and Blue Shield, Obamacare exchange plans including the same and other insurers, ration hospitals and doctors, making it very difficult to keep or find a health care provider that is available and affordable.  To make matters worse, many providers who are allowed to be included within exchange plans are deciding, or will decide, to exclude themselves or opt out, because in an atmosphere where provider business monetary return is being squeezed more and more, reimbursement for Obamcare exchange plan services is just way too low. Providers can’t be blamed for trying to stay profitable, but this adds to the feeling of anxiety and abandonment by subscribers, the patients who have lost their personal practitioner comfort zone.
 
Also, Obamacare was supposed to promote competition among those insurers who joined the exchanges, but there are states and counties where only one insurer is available. In fact, as reported by Forbes magazine, “In one of every six counties in America (17 percent), the state exchange offers only one insurer – a monopoly.  For another 35 percent of counties, only two insurers offer coverage. In another 25 percent, only three insurers are selling coverage.  To recap, consumers in more than half of the nation’s counties can “pick” from only one or two insurers on an Obamacare exchange. In more than three of every four counties, competition is limited to three or fewer insurers.”  And sadly, residents of some of the poorest counties in the country, where affordable health care is so desperately needed, are now at the mercy of only one insurer from which to choose.
 
Everyone wanted the uninsured covered.  And everyone agreed that pre-existing condition bias was unfair and needed to be eliminated.  Mandates and certain new requirements on everything and everyone, as well as shifting around moneys and existing federal health insurance programs, such as Medicare, only caused the baby to be thrown out with the bath water.
 
Very simply, most everything should have been left alone.  There were many things that worked but got scrapped, or were adequate enough but made dysfunctional, because liberal ideology frustrated what was really best for the country, snowballing into more and more bureaucracy, and in many cases resulting in mandatory, silly health care plan additions, whether needed or wanted or not, increasing costs and throwing everything into turmoil.  Many blame insurance companies for plan and coverage cancellations, but could insurers be trusted to keep everything the same and not try to recoup moneys that would be lost, at least for a short period of time?
 
Regarding a couple major points in the debate, Republicans should have given up, at least for the interim, their push for tort reform, which would limit lawsuit judgment dollars, something the Democrats and their trial lawyer supporters are vehemently against. Democrats, at least for the interim, should have agreed to allow consumers to shop for a health care company in any state, the kind of laboratory test competition which could drastically lower overall costs, but success would dash any hopes of a government-run, single-payer option, which is what the Democrats really desire.
 
Maybe over time, more uninsured than only the current 10% will enroll, but the turmoil that continues to this day has been horrible. Ask anyone in the health care industry – and I don’t mean the insurance companies – what they think about what has happened, not only with Obamacare exchange plans, but with the system as a whole.  You will find even the most ardent Obama supporters admitting that what may have been bad became a heck of a lot worse.  Ask doctors, billers, health care workers and of course patients, and especially the husband and wife sitting around the kitchen table trying to pick a plan that gives their family the coverage they want and need at a reasonable cost.  Most of the country has been spared the nightmare others have endured, but soon, the horror show will affect everyone.
 
So there you go.  There are many more problems related to Obamacare that I could note, but I think this has been enough.  Even my own eyes are glazing over, as I get more disgusted at what has been happening; I have been personally affected, and in a negative way. The parties could not come together to do what was best, what was right, so a pox on both their houses.  But who knows? Maybe, just maybe, in the coming months and years, the errors will be corrected.  But don’t hold your breath.  And I don’t just mean that as an idiom.  With whatever plan you have, you may not be able to find a doctor in your area, should you damage your lungs or heart.

Must my boss’s religious freedom trump my own?

On June 30, the United States Supreme Court enabled business owners to make decisions about their employees’ religious freedoms and reproductive and healthcare rights. The court once again expanded the powers of corporations in this country when it allowed Hobby Lobby, a for-profit craft store chain, and Conestoga Woods Specialties Corporation, a for-profit furniture manufacturer, to deny access to certain family planning services, specifically emergency contraception and IUD’s, through employer-based health insurance. The court overruled the Affordable Care Act’s (ACA) requirement to include access to all family planning services in employer-based health insurance.

The ruling was based on the claim that some employers have personal religious objections to those forms of contraception and that, therefore, their religious rights are violated by the ACA requirement. As a Jewish woman and an advocate with the National Council of Jewish Women, I find the court’s ruling to be unjust, discriminatory and erroneous.

What’s clear is that the court is favoring the religious rights and freedoms of the companies’ owners over those of the employees of these companies.  The owners of Hobby Lobby and Conestoga are individuals who have the right to practice their religious beliefs. However, health insurance is a form of compensation to employees, and just as employers are not permitted to control how their employees use their wages, they should not be able to control how employees use their health insurance compensation.

The United States is a diverse nation, with varying practices and religious traditions even within individual religious groups. But even among those religious groups commonly referred to as anti-abortion, there is overwhelming support for contraception among the religions’ followers as a necessity for family planning and women’s health. Ninety-eight percent of sexually active Catholic women say they have used a contraceptive method prohibited by the Vatican “>89 percent of adults in the U.S. view contraception as morally acceptable. This is why women’s rights advocates, as well as faith-based, and social justice organizations fought so hard to include coverage of contraception in the ACA.

The so-called Hobby Lobby ruling, while intentionally narrow in its language,  already has moved beyond the companies who brought the case to the Supreme Court. It has already been broadened in its application to Wheaton College, which has objected to the fact that filing a form required by the ruling made the school complicit in providing contraceptives. So the court allowed the college to simply file a letter with the federal government stating its objections as a means of complying with the law.

It is clear that the court’s interpretation of the Religious Freedom Restoration Act easily could lead to the exclusion of other healthcare practices from employer-based health insurance plans, including employers who hold religious beliefs against blood transfusions, psychiatric care, medically necessary abortions and hysterectomies, and even vaccinations. The Hobby Lobby ruling could be used as a precedent to exclude such essential forms of care from company health insurance plans.

The owners of Hobby Lobby and Conestoga could have easily paid a tax penalty for not providing their employees with health insurance that meets the ACA requirements. This would have cost them less than half the price of insurance.  Hobby Lobby asserted that they would not be able to attract quality employees if they did not offer health insurance and so were “forced” to take the issue to court. But polls have shown that more than 85 percent of employees would stick with their employer, even if their employer-sponsored health insurance were to be dropped. 

On July 9, Democratic lawmakers in Congress introduced legislation that would effectively reverse the Hobby Lobby ruling, preventing for-profit companies from seeking exemptions to the ACA mandates. (Religious organizations would remain able to opt out.) The Senate bill, sponsored by Patty Murray (D-Wash.) and Sen. Mark Udall (D-Colo.), won support from three Republican Senators, but that wasn’t enough for the measure to advance.  The prospects for its passage in the Republican-dominated House of Representatives are even dimmer. 

Yet the necessity of such new legislation should not be questioned. Women should not be denied the right to have coverage for the health and their reproductive choices. The Jewish community needs to speak out on behalf of this new legislation with a loud and clear voice. 

Maya Paley is the Director of Legislative and Community Engagement for the National Council of Jewish Women/Los Angeles.

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.

Why isn’t this night different?

Predictably, the 2015 House Republican budget released by House Budget Committee chairman Paul Ryan (R-Wis.) on April 1 proposes devastating and monumental cuts to programs designed to help those among us who need it most. It would slash Medicaid; it would change the funding, eligibility standards and structure of SNAP (Supplemental Nutrition Assistance Program); it would repeal the Affordable Care Act. The same harsh proposals couched in the same tired rhetoric. 

And just as predictably, progressives are wringing their hands and describing the cuts as immoral. They invoke images of the seniors, children and disabled people who have done nothing to deserve their terrible lot but will feel these cuts most deeply. They cite independently verified statistics intended to dispel persistent myths about who actually needs these programs, because, the progressives proclaim, the political tides would change if they could just get everyone to actually understand the truth. The same hitherto ineffective counterpunches couched in the same tired rhetoric.

This is the time of year when we ask a very pointed question: “Why is this night different from all others?” The Passover seder is actually replete with questions — most of them ages old. But these questions, by their very nature, challenge us to stop and think, and to consider the range of possible answers to pinpoint why this night is different from all others — those during this year, or any other year. So I’m struggling to understand how this Republican budget and this progressive response are different from all others.

The facts about the astounding prevalence of hunger have remained essentially the same since the recession began in 2008: 

• 14.5 percent of American households were food insecure in 2012. That means 45 million Americans — nearly 1 out of every 6 of us — struggled to put adequate nutritious food on the table. 

• The rate of food insecurity in California — our great state where nearly half of the nation’s fresh produce is grown — is higher than the national average (15.6 percent).

• 1.7 million Angelenos are food insecure. That means the number of people struggling to feed themselves in our county is greater than the population of twelve individual states, and larger than that of the District of Columbia.

Despite the supposed recovery of our economy, the struggle of these vulnerable Americans continues to be the same. But the sameness of their struggle does not merit the same polarizing responses.

I have always embraced the rich Jewish tradition of asking questions, a custom that seems amplified during Passover. So especially now, when I consider the recent actions of our policymakers and lobbyists in Washington, I feel compelled to demand answers to questions that too often go unasked. 

Why, today, do the rhetoric and the overblown caricatures of “left” and “right” continue to remain so predictably the same? 

Why has it become more important for one or another side to be “right” than it is to do the right thing?

Why can we not be more courageous and willing to compromise?

What would it take for us to try a new and creative approach or framework that may yield a better result? 

How can we make today different from yesterday and all the days that came before it?

Albert Einstein defined insanity as doing the same thing over and over again and expecting a different result. Today, we must stop the insanity. We cannot travel the same path and expect to reach a different destination. 

It is not in our Jewish DNA to blindly accept the status quo. We are a people that takes action to create change when we encounter injustice. And there is no greater reversible injustice than the oppressive persistence of hunger in our county, our state and our nation. That so many struggle to survive means that our policymakers are failing us. Our job is to continue to ask questions. It is their job to provide different answers.


Abby J. Leibman is president and CEO of MAZON: A Jewish Response to Hunger.

Obamacare enrollment exceeds 7 million target despite setback

President Barack Obama's national healthcare program signed up more than 7 million people by the end of March, the president said on Tuesday, notching a rare victory after a months-long, glitch-filled rollout of the law.

Appearing in the White House Rose Garden, the president said 7.1 million people had signed up for coverage under the law, known as Obamacare, and called for Republicans to end their bid to repeal it. House of Representatives Speaker John Boehner repeated his pledge to repeal the law on Monday.

[Related: Obamacare: At 29, covered and faithless]

“This law is doing what it's supposed to do. It's working,” Obama said, with Vice President Joe Biden standing at his side. “The debate over repealing this law is over. The Affordable Care Act is here to stay.”

His remarks represented a victory lap for the administration, which suffered from the botched unveiling of the program's primary website, HealthCare.gov, and wavering support from Americans some three years after the U.S. Congress passed the healthcare law over Republican objections.

Health and Human Services Secretary Kathleen Sebelius, who has taken the brunt of the criticism for the shaky rollout, sat beaming in the front row during the Rose Garden ceremony. White House chief of staff Denis McDonough gave her a hug before Obama's remarks.

Experts had predicted a last-minute surge in enrollment. The figure could give a boost to Democrats, who have suffered from the criticism of the law, ahead of November congressional elections.

Obama's party is seeking to hold on to its control of the U.S. Senate and minimize losses in the Republican-controlled House, but the problems with Obamacare have complicated congressional races and handed Republicans a key talking point for skeptical constituents.

Republicans on Tuesday were quick to highlight outstanding questions including how many of the enrollees had seen their plans canceled because of the new law; how many people saw their premiums go down, and how many people who selected plans actually completed the process and paid their premiums.

“We don't know of course, exactly what they have signed up for, we don't know how many have paid,” Senate Minority Leader Mitch McConnell told reporters on Capitol Hill, referring to the enrollees in the program.

“What we do know is that all across the country our constituents are having an unpleasant interaction with Obamacare. Whether they can sign up for a policy or not, they are discovering, of course, higher premiums, a higher deductible.”

STRONG SURGE

White House officials dismissed the Republicans' criticism. Speaking to reporters ahead of Obama's announcement, one official noted that Democrats seeking to get voters from the coalition that elected Obama to support them would not be able to do so without embracing the law.

House Democratic leader Nancy Pelosi told reporters her members were not running away from the issue.

“Our members are out there on the offensive on this issue because of what we did, and we're proud of it, and we're proud of what it means in the lives of Americans,” Pelosi said after a meeting with Obama.

Monday's deadline for initial enrollment in the program came after a surge in registrations despite the return of technical problems, including a longer-than-expected maintenance session, although nothing as serious as the issues that beset the website's launch in October.

The site on Tuesday announced that open enrollment for Obamacare had closed, but people whose applications were thwarted by technical problems would be given a chance to finish their registration.

By last week, more than 6 million people had signed up for private health coverage through the new Obamacare insurance markets, surpassing a target set after the disastrous rollout called the enrollment process into question.

Industry analysts echoed Republicans' calls for more information about those who had signed up.

“We still have a lot to learn about what underlies those numbers in terms of who signed up and how many were newly insured people versus switching from other coverage,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

“We have more to see … about how many of them actually completed enrollment and how much coverage expansion was accomplished.”

The healthcare law, one of Obama's key promises as a presidential candidate in 2008, was intended to expand access to healthcare coverage for millions of uninsured Americans, so having enrollment figures that reflect newly insured people is critical to the program's success.

Having a robust percentage of healthy young people to offset older enrollees is also important. White House spokesman Jay Carney said such details were yet available, but he said the demographic mix would be sufficient to ensure that the health market places that form the cornerstone of the law would function smoothly. (Additional reporting by David Morgan, Thomas Ferraro and Larry Downing; editing by G Crosse)

Reporting by Jeff Mason and David Storey; Editing by Sandra Maler

Obamacare: At 29, covered and faithless

The disappointment, like so many others, began with a promise. “If you like the plan you have,” President Barack Obama told the nation on June 6, 2009 at the nadir of the economic downturn, “You can keep it.  If you like the doctor you have, you can keep your doctor, too. The only changes you’ll see are falling costs as our reforms take hold.”  

It was a promise that provided relief to Americans, many of whom feared the side effects of Obama’s new Affordable Care Act, and were, at best, cautious about its adoption. It assured them that things would continue as usual, that while things around them changed, they could stay the same.  

The only problem was, the promise was a lie.

I’m 29. I voted for Obama, twice. I believe that national health care is important, and I would have strongly supported a single-payer system in the mold of Canada or the United Kingdom. This is to say, I am not part of the crowd that believes the Affordable Care Act was evil, or that adopting a single-payer system would inevitably turn us into godless communists. But as the March 31 deadline for signing up for Obamacare approaches, I am, however, deeply disappointed with the gap between what was promised and what’s being delivered.

I’ve always been among the more responsible of my peers when it came to having health insurance. While many of my friends went uninsured through their early- and mid-20s, I always kept at least a catastrophic plan. When I moved to California, I purchased a plan from Aetna.  It wasn’t the world’s greatest plan —  there was a significant deductible, but it had the doctors I wanted in its network, and it wasn’t expensive.  

When the Affordable Care Act’s first wave of requirements came into effect, I watched as my formerly inexpensive plan more than doubled in price. This was, I reasoned, a fair trade for obtaining godsends such as the banning of lifetime benefit caps, the elimination of pre-existing conditions as reasons for denying coverage, and mandating coverage for maternity care for women. If I was suddenly paying more than $250 per month for a plan that had once been $120, I reasoned that progress has a price. 

But in the spring of 2013, Aetna sent me a letter announcing that they would be canceling my plan, as they no longer wanted to sell insurance in California. How could this be? Obama had promised that if you liked your plan, you wouldn’t lose it.  I liked my plan, and I lost it.

I decided to give the state’s Web-based exchange, Covered California, a shot, figuring that maybe I’d at least save some money. But the site was a counterintuitive den of poor Web design and confusing language. Everything from the half-dozen required security questions to the bizarre way you had to report your income was cumbersome — and that was when the site was actually working, which it often wasn’t. Like many young people, my income varies from month to month as I don’t have a yearly salary; but Covered California didn’t provide me with an option to report my total yearly income, only my monthly income, making it nearly impossible to report what I earned.

Once I’d signed up for a plan, my work wasn’t done. I’d signed up well in advance of the deadline, but my card didn’t arrive on time. I tried calling, but I was greeted by a message saying call volumes were so heavy that they weren’t taking calls that day. Even though Covered California anticipated more than 1 million people signing up for new plans, it only hired 500 workers for its call centers, according to the Los Angeles Times, meaning one worker for every 2,000-plus customers.

My experience is hardly the worst I’ve heard about. I finally received a card in the third week of January, but my brother went uninsured until March 22, despite having signed up on time. He played by the rules, followed the government’s instructions, and yet still had to pay for medical care and antibiotics out of pocket during the first months of the year. And friends told me similar stories of impossibly long wait times on the phone, the loss of primary care physicians, cards that arrived late or not at all and, most galling, the loss of access to Cedars-Sinai Medical Center, which can only be accessed through Covered California via one “bronze-level” plan with an extremely high deductible.

I do not, like my cousin George Will, believe that the Affordable Care Act is a disaster, nor do I wish for its repeal. But I do believe I was lied to by the president and his spokespeople, who claimed on no less than 37 different occasions, according to the Tampa Bay Times’ Pulitzer Prize-winning politifact.com, that no American would lose access to their plan or to their doctor. 

I lost access, my friends have lost access, and we certainly haven’t seen falling costs. Yet I still believe health care reform is worth it. The false promises, however, made even small victories seem like defeats. The ill-timed, ill-planned, and just plain ill rollout of the health exchange system has left many young Californians wondering if aggravation, confusion and delays are all we have to look forward to. The president sold us change we could believe in, but delivered us changes that have left us faithless.


Jonathan Maseng is a frequent arts contributor for the Journal.

This is how you’ll feel when the GOP wins the Senate

It’s the morning after.

You stayed up late watching election results on TV.  By the time you went to bed, the Republicans had won five of the “>20 percent of registered voters voted for them.  This, in a country where “>older and whiter than the country.  And that the combined population of states where Republican senators ousted Democrats was less than the population of California. And that some victory margins were under a “>“clobbered” in the midterm elections. On Sunday, “>declaration by Oklahoma Republican Jim (“The Greatest Hoax: How the Global Warming Conspiracy Threatens Your Future”) Inhofe that he’ll be in charge of the Senate environment committee if they win; or the thought of Chuck (““>Marty Kaplan is the “>USC Annenberg School for Communication and Journalism.  Reach him at martyk@jewishjournal.com

Henry Waxman: Not quite the last of the just, but close

I don't fault Rep. Henry Waxman (D-Calif.) for leaving Congress. The House of Representatives is a terrible place these days, with the Senate only marginally better. The overwhelming majority of members from both parties have only one goal: it is to be re-elected. Henry Waxman's goal was to improve lives. Reelection took care of itself; his district is as progressive as he is.

Take a look at some of the laws Waxman was instrumental in enacting.

The 1990 Clean Air Act Amendments, which established new programs to reduce urban smog, hazardous air pollution, and acid rain and prevent the depletion of the stratospheric ozone layer.Safe Drinking Water Act Amendments, which strengthened the standards for drinking water and established funding mechanisms for drinking water infrastructure improvements.Laws Reducing Childhood Lead Exposure, including laws removing lead from plumbing supplies, water coolers, and children’s toys, requiring disclosure of lead hazards during real estate transactions, and setting standards for safe renovations. The Formaldehyde Standards Act, which set minimum standards for formaldehyde levels from plywood, fiberboard, and particleboard.Laws Reducing Greenhouse Gas Emissions, including provisions requiring greater efficiency in federal buildings and procurement of clean vehicles. The Affordable Care Act, which gives all Americans access to affordable health insurance, strengthens Medicare and Medicaid, and reduces the deficit. Medicaid and CHIP Expansions, which extended the coverage and benefits available to millions of needy and working families. Nursing Home Reforms, which stopped the industry’s worst abuses and protected the rights of vulnerable residents. The Waxman-Hatch Generic Drug Act, which gave rise to the generic drug industry, saving consumers over $1 trillion in the last decade alone.The Orphan Drug Act, which gave drug companies incentives to develop treatments for rare diseases they had previously ignored.The Ryan White CARE Act, which provides medical care and other services to Americans living with HIV/AIDS. Women’s Health Initiatives,including the laws establishing standards for mammography, requiring the inclusion of women in clinical trials, and creating the Office of Research on Women’s Health at NIH. The National Childhood Vaccine Injury Act, which strengthened FDA oversight of vaccine manufacturers and created a no-fault compensation system for vaccine-related injuries. The Nutrition Labeling Act, which mandated the ubiquitous and popular nutrition labels that consumers rely upon to compare packaged foods. The Food Quality Protection Act, which established a strong health-based standard for pesticide residues in food. The Food Safety Modernization Act, which sets science-based standards for the safe production and harvesting of raw agricultural commodities and requires new preventative controls for companies that process or package foods. Cigarette and Smokeless Tobacco Health Warning Laws, which required rotating Surgeon General warnings on cigarette packages and advertisements and the first health warnings on smokeless tobacco packages and advertisements. The Family Smoking Prevention and Tobacco Control Act, which restricted the marketing of cigarettes and smokeless tobacco to children and gave FDA jurisdiction over tobacco products. The Safe Medical Devices Act, which enhanced public protection from dangerous medical devices by requiring mandatory reporting of adverse events and surveillance and tracking of implantable devices. The Drug Quality and Security Act, which strengthens FDA’s authority over compounded drugs and creates a uniform system for tracking drugs to prevent counterfeits. 

No legislator in our time (except, perhaps the late Senator Edward Kennedy) comes close to matching this record, a record that essentially adds up to the saving of millions of American lives. Waxman's successful war on tobacco alone reduced the lung cancer death rate by millions.  Add Clean Air and Clean Water to that and you come up with an incredible number of saved lives.

Waxman is a remnant of the good old days. Think back to the Progressive Era of Teddy Roosevelt, FDR's New Deal, and LBJ's Great Society when Congress fought the special interests on behalf of the American people and often won. Not always. But enough so that life in America is still far from the unregulated hell envisioned by, among many others,  the Koch Brothers, Paul Ryan, Ted Cruz  and Rand Paul.  America only remains a decent country because of the work and lives of men and women like Henry Waxman who not only resisted those two-bit Ayn Rands but beat them, over and over again.

Naturally, I will note the Jewish angle. 

Henry Waxman is utterly devoted to Israel (in fact, he is pretty conservative on Israel). He is also an observant Jew, one of the few in Congress. 

And yet his work in Congress rarely touched on Israel.  He left that to his Los Angeles colleague, Howard Berman.  Waxman focused on the needs of the American people. Like Carl Levin of Michigan, he did what he had to do on Israel, but as a legislator, he worked for America. (His opposite is Chuck Schumer who has devoted his career to supporting Wall Street, the Banking Industry and AIPAC, all cash cows). 

Waxman  comes out of the old socialist Jewish tradition which we now call liberalism or progressivism. Prophets not profits. And always, the people first.

I wish Waxman would run for something else. His governor, Jerry Brown, is a year older than Henry and he is running for re-election. But I doubt that will happen.

Of course, Waxman has accomplished enough for one political life (or 100 these days).

As was once said of Christopher Wren, the man who built St. Paul's Cathedral in London. “If you want to see his monument, look around you.”

As a Jew and as an American, Henry Waxman makes me proud. I think I'll tell my grandkids stories about him. They love hearing about the good guys who win.

Obamacare: Glitches or death spiral?

It’s not easy to wrap your mind around a program as complex as Obamacare, which features 381,517 words in its actual bill and 11,588,500 more words in added regulations.

Thankfully and mercifully, in trying to understand this migraine-inducing puzzle, I found some relief in one simple idea: The system won’t work unless it entices enough young and healthy people to sign up.  

Right now, the big news is that the launch of the HealthCare.gov Web site has been a flop, with countless horror stories of people who haven’t been able to enroll because they were lost in a digital and bureaucratic maze.

Many liberal supporters see this initial failure (wishfully, perhaps) as a case of annoying but fixable “glitches” on the way to a more humane universal health care system.

Many conservative critics see it (wishfully, perhaps) as the kind of “disaster” that happens when Big Government bites off more than it can chew. 

As of now, the critics are on a roll. 

“With the GOP’s antics now over,” Kimberley Strassel of The Wall Street Journal writes, “the only story now is the unrivaled disaster that is the president’s health care law. Hundreds of thousands of health insurance policies cancelled. Companies dumping coverage and cutting employees’ hours. Premiums skyrocketing. And a Web site that reprises the experience of a Commodore 64.”

Even a liberal, fair-minded policy wonk like Ezra Klein of the Washington Post admits that, so far, Obamacare “is not working well at all.”

Conservative wonk Yuval Levin of National Review Online goes as far as seeing a potential “death spiral,” which he describes as follows: “The fact that it is so difficult to sign up for exchange coverage may mean that only highly motivated consumers do sign up, and those are likely to be people with high expected health costs.

“If the exchanges end up containing too many people in poor health and not enough people in good health, insurers could take massive losses in 2014 and be forced to dramatically raise premiums for 2015 plans. … Those higher premiums would cause even more healthy people to avoid getting coverage … and the cycle would continue.”

The importance of getting young, healthy people to enroll is echoed by Klein, who, after interviewing White House officials and asking “repeatedly” how they defined success, reported that “everyone in the White House shared a singular definition: Success meant setting up the exchanges and attracting enough young people [so] that premiums stayed low.”

Let’s face it — no matter where you sit, this is a scary thought: The success of Obamacare depends on getting millions of young people with short attention spans to spend hours in front of an exasperating government Web site with zero entertainment value — and trying to enroll in something they’re not sure they want.

But enroll they must, if they want to save the president’s plan. As Klein reports, the administration figured that if they got 7 million people to sign up for the exchanges in the first year, about 2.7 million needed to be young.

That’s 5.4 million jaded eyeballs to entice. 

You’d think that with the $600 million they budgeted for this Web site, the government could have splurged for a few creative types in Hollywood whose business is to keep people entertained. Put them together with the tech geniuses who built Amazon and you’d have at least the possibility of wooing these jaded eyeballs with something other than a threatened fine. 

But the user-unfriendly Web site, as bad as it is, is only a symptom of deeper issues. As Klein explains, what’s causing “deep problems” for the health care law is the mess in the infrastructure of the program, which he describes metaphorically: 

“In brick-and-mortar terms, it’s the road that leads to the store, the store itself, the payment systems between the store and the government and the manufacturers, the computer system the manufacturers use to fill the orders, the trucks that carry the product back to the store, the loading dock where the customers pick up the products, and so on.”

For the program to run smoothly, that whole infrastructure needs repair. The question is: Can the bureaucracy which created the mess do that repair work?

Many conservative critics believe that it can't, and that the program will fall under its own weight. Klein believes there’s still time to right the ship, but not much. He quotes health care experts who suggest that the Web site needs to be running smoothly by “Thanksgiving at the latest.” 

It shouldn’t shock anyone that Obamacare has been at the center of one of the nastiest partisan battles in recent memory. When a government tries to take over one sixth of the U.S. economy as it pushes through a controversial and gargantuan entitlement program on a strictly partisan vote, it can’t expect smooth sailing.

In any event, as Klein notes, the president’s program “isn't a political abstraction any longer. Its success doesn't depend on spin or solidarity. What matters for the law — and for the people who are depending on it — is how well it actually works.”

There’s something refreshing about that. After years of fighting, spinning and promising, we’re down to results.

Even a well-meaning and eloquent president has to face this reality: Ultimately, government comes down to how effectively you can solve people's problems. Either you do or you don’t.

President Obama fought tooth and nail for his 12-million-word health care legacy. Now, he needs the government he believes in and the young people who voted for him to help him deliver on that legacy. It’s far from clear that this will happen.


David Suissa is president of TRIBE Media Corp./Jewish Journal and can be reached at davids@jewishjournal.com.

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).

Ted Cruz, as in lose

What's playing out in Washington this week is a classic example of that old political shibboleth, “that may be what I said but that's not what I meant.” Republicans are piously assuring us they have no desire to shut down the government only to go marching off toward the cliff.  Then they have the chutzpah to claim it is all Barack Obama's fault because he refuses to pay the ransom they're demanding on the hostage their holding, namely the operating budget for the federal government, and the ransom is his agreement to defund the Affordable Care Act, the signature legislation of his presidency..

Along the way a civil war has broken out on multiple fronts among Congressional Republicans.  It's House vs. Senate and establishment Republicans vs. tea party zealots.

The battle, reflecting the rise of a GOP faction even more extreme than the evangelical right, is one more reason Republican claims to a bigger share of the Jewish vote are pure myth.  It's wackos like Cruz who will keep Jewish voters firmly in the Democratic fold for many elections to come.

To a large extent this internecine warfare pits veterans against more extreme recent arrivals on Capitol Hill who are convinced they were sent to Washington on a holy crusade to reshape government and that compromise is tantamount to treason.  This is as much if not more responsible for the gridlock gripping Washington as the rivalry between Republicans and Democrats.

More than anyone else, Sen. Ted Cruz (R-Tex.) is the driving force behind the standoff that has tied defunding of Obamacare to passing a budget to keep the government operating when the new fiscal year begins October 1.  A majority of Republicans in both chambers say they don't want to shut the government down, so why are so many marching to the cliff like lemmings?

They don't want to get “Cruzed,” to be attacked from their right by even more conservative primary challengers accusing them of insufficient ideological purity as happened over the past two election cycles.  In some instances, like Texas (Cruz), Utah (Mike Lee) and Kentucky (Rand Paul), the tea party favorite made it to the Senate, but in several others, like Delaware, Nevada, Missouri and Indiana, some loonies won the primaries but lost elections the GOP could have won.

Cruz has been the driving force in this confrontation, goading House Republican leaders to go along with a vocal but strident minority in their caucus to tie ACA funding to keeping the government open.  The House passed that bill, largely along partisan lines, and sent it to the Senate, where Cruz had promised to do everything in his power to pass it.

But as soon as it arrived he ran up the white flag, saying he didn't have the votes and urged a filibuster, but said killing ACA was really up to the House.  The hot air was taken out of that wind bag when the top Senate GOP leadership, Mitch McConnell (KY) and John Cornyn (TX) announced Monday they'd vote for cloture to shut down Cruz's threatened filibuster.

Both leaders are worried about being Cruzed in their own primaries next year, but they also are cncerned about the damage a government shutdown would do to the GOP.

When colleagues said they didn't want another government shutdown, Cruz kept telling them Obama might blink and back down, abandoning his signature achievement. Besides, he said, the last time Republicans shut down the government, in 1995-96, it was successful.  I don't know what Cruz has been smoking but had he been around 20 years ago instead of just the past nine months he'd know his party can't afford more victories like that.  Just ask ex-Speaker Newt Gingrich what it did for his political career and for House Republicans.

Cruz, whose idea of party unity is everyone should fall in step behind him, had earlier said any vote for cloture “is a vote for Obamacare” and Republicans who support passage of a bill to fund the government and not to defund ACA are cowards.

That brought a swift reply from angry House Republicans, already seething at Cruz for starting a fight he walked away from.

Cruz is the “real coward,” said Rep. Michael Grimm (R-NY); Rep. Peter King (R-NY) called him a fraud. Rep. Sean Duffy (R-WI) called him a bully who “refused to fight” but instead “wave(d) the white flag… Thank God he wasn't there fighting at the Alamo.”

King said the best thing Cruz could do is shut up, and the best outcome of this episode would be an end to Cruz's influence and his ability to set the Republican agenda.

The damage Cruz has done to his relations with his Republican colleagues won't go away soon.  Chris Wallace of Fox News said that when Cruz had been booked for his Sunday talk show Republican lawmakers and staffers called to urge him to “hammer” Cruz. 

Republican critics say Cruz's loyalty is to Cruz, not the party, and his actions may advance the Cruz brand but they damage the GOP brand. He has been in the Senate since January but his focus has been on the other end of Pennsylvania Avenue. 

Tilting at extremist windmills doesn't produce legislative accomplishment but it can increase his name recognition, solidify his base, raise big bucks and give him scapegoats to blame for his failures.  Cruz is not a “follow me” leader but a “go get 'em” guy shouting from the rear.

Once the short-term funding bill (CR) passes, House tea partiers will begin focusing on their 42d vain vote to kill, cripple or maim Obamacare next month on legislation to raise the $16.7 trillion debt ceiling. After that it will be linked to renewing the CR that expires on December 15.  Those and successive attempts  to kill ACA will also fail so long as a Democrat is in the White House.

So why bother?  Because it plays well with diehard conservatives and the big money boys on the far right.  And isn't that what it's all about?

Opinion: A good deed for health care in a weary world

The U.S. Supreme Court ruling upholding the Affordable Care Act is far more than a narrow legal decision. It is a decisive affirmation of what is right. Health care surely is right—and a right.

This issue is highly personal, hitting home for me much as it did for tens of millions of Americans lacking adequate health care.

My beloved dad, Roy, endured the challenges of many immigrants carving out a new life. He worked hard and is a devoted American. He rarely displays emotion. Imagine my shock at age 10, sitting at our Long Island kitchen table, as my dad told my mom that we’d lost our health insurance. He had just been laid off from his job as a mechanical engineer.

Few things are scarier for a family man or woman—for anyone—than having nowhere to go when you get sick. The recent Supreme Court ruling means that millions of people will never again have to endure such fear. As such, it represents a crucial win for Americans—and for America. Millions of middle-class families now will have the security of affordable health coverage, even with pre-existing medical conditions.

President Obama, House Minority Leader Nancy Pelosi and Supreme Court Chief Justice John Roberts have earned this country’s appreciation for their leadership in attaining justice for all Americans. The president and Congress spoke out clearly on the need for the Affordable Care Act, then passed and signed the landmark legislation. Roberts led the high court in affirming the law’s constitutionality.

Jewish law and tradition have much to say about taking an active role in guarding one’s health—and the health of our fellow man. Health and life are bedrock Jewish values, to the extent that saving someone (“pikuach nefesh”) supersedes even the sanctity of the Sabbath. The Shulchan Aruch (Code of Jewish Law) notes, “If one has medicine that a sick person needs, it is forbidden to charge more than the appropriate price.” This statement of Jewish law now becomes the spirit of America’s national health policy, and I could not be more proud.

The Jewish community has long supported a national health-care policy that includes everyone, and traditionally has viewed health care as a communal responsibility. This central Jewish tenet is consistent with a society’s prioritizing of health and safety of everyone in its midst and is demonstrated by the commitment that American Jews have made to supporting hospitals and health services through our communal institutions.

Unfortunately, some of these same institutions, many of them the traditional political voices in American Jewish organizational life, became somewhat muted as health-care legislation was debated nationally. Whether it was due to decisions to focus only on narrowly defined “Jewish interests” or, as we so often hear is the case, because of the political interests of a small group of very wealthy and very conservative donors, it is not possible to say conclusively. What is clear and conclusive is that at a time when the Jewish community needed to speak out in support of the kind of health-care policy that our tradition demands, far too many of us failed to do so.

We at Bend the Arc are proud to stand with the millions of American Jews who did help shepherd this law through and who want their voices to be raised in its support. We believe that moving forward, the law’s affirmation in the Supreme Court should herald a renewed American Jewish commitment to the basic right of health care for all.

Contrarily, what this country surely does not need now is refighting the old fight. Congressional leaders priming to pursue the law’s repeal should reconsider. The House and Senate could better heal this country by working collaboratively across party lines to continue righting the economy and creating jobs.

A favorite film scene relates appropriately to the vote’s denouement. In “Willie Wonka and the Chocolate Factory,” the child protagonist, Charlie, is rewarded for returning the “everlasting gobstopper.” Gene Wilder’s elated Wonka exclaims, “So shines a good deed in a weary world.”

The Supreme Court ruling was the good deed—the final good deed, I pray—in the extended-play drama that has characterized this country’s health-care debate. My hope is for this ultimate judicial decision to herald a new era. Let us all in the American Jewish community rededicate ourselves to attaining a far more secure future for everyone’s family so that, at long last, society becomes far removed from yesterday’s weary world.

Alan van Capelle is CEO of Bend the Arc: A Jewish Partnership for Justice.

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.