As pundits and media continue to dissect the arguments surrounding King v. Burwell—just another in a series of attempts to chip away at the Affordable Care Act (ACA)—it’s easy to lose sight of the forest while staring at the trees. That is, while our country is poised to hear the Supreme Court’s ruling over what two sentences in a 2,500-page law mean, it is missing what initiatives like the ACA achieve for real, human populations.
So let’s take time to highlight some of the people who benefit from government-subsidised health care.
As of this past December, one-in-three children in the country—that’s 29.1 million—were covered under Medicaid and the Children’s Health Insurance Program (CHIP). While Medicaid shoulders the bulk of this cohort, about 8.1 million children are covered by CHIP or CHIP-funded Medicaid expansions. CHIP helps ensure that children whose parents earn too much to be eligible for Medicaid are covered, which has garnered support from both sides.
However, CHIP is only funded under the ACA until September, and it may face some major changes, even if it is extended. Recently, Senator Orrin Hatch (R-UT) and Congressman Fred Upton (R-MI) published a discussion draft that would reduce federal funding for CHIP and allow states to cut back children’s eligibility in the program. The bipartisan Boehner-Pelosi deal currently in the works would only extend the program for two years, shortchanging our children compared with the four years preferred by the president, Senate Democrats, and child health experts.
Since CHIP was started in 1997, the number of uninsured children has been cut in half, to 7 percent in 2012. For low-income children, the share of uninsured dropped from 25 percent to 13 percent, and for low-income Latino children, the drop is even more drastic—from 34 percent to 17 percent. If separate CHIP coverage was eliminated, states were allowed to scale back eligibility levels of Medicaid for children, and the King v. Burwell tax credits were discontinued, 3.3 million children could lose their health insurance. It would be an unnecessary step back in the progress we’ve made.
2. Crime Victims
As my colleague Harold Pollack notes in his article, alcohol is by far the deadliest drug in the United States. Of those incarcerated for committing a violent crime, 40 percent had been drinking prior to their offense, with an average blood alcohol level of more than three times the legal limit. And, surprisingly, data from the Illinois Violent Death Reporting System showed that 40 percent of homicide victims had alcohol in their systems when they were killed.
Correlation does not equal causation, but as Pollack states, “alcohol misuse is a core part of our violence problem.” Alcohol lowers inhibitions and can foster aggressive behavior. It also impairs your judgment, making you more vulnerable in dangerous situations.
So where does the Affordable Care Act come in? As Pollack notes, it actually contains the greatest expansion of treatment for alcohol abuse in the history of our country. By treating substance abuse, the ACA helps reduce the likelihood of people committing crimes, or even that of being the victim of crime. As Marie Gottschalk, author of recently released book on incarceration, Caught, points out, if red states were genuinely trying to reduce prison rates, they would expand Medicaid, which helps treat some of the people most likely to end up in prison—those suffering from substance abuse and mental health disorders.
3. People With Good Jobs
Although we may not all receive subsidies from the ACA, as this article in the Washington Post deftly notes, the 158 million Americans who receive employer-sponsored insurance still get government subsidies because their health care benefits are tax exempt. This tax break costs the federal government almost $250 billion every year.
In a telling YouGov/Economist survey, 85 percent of people who were asked if they personally receive a government subsidy to help pay for health insurance said no. Even more, 93 percent of seniors said they don’t receive subsidies, even though most are enrolled in Medicare.
This lack of public awareness of who is receiving government support has been dubbed by my fellow TCF colleague Suzanne Mettler as the submerged state. Mettler argues that the invisible design of certain government policies, such as exclusion of health insurance costs from workers’ taxable income, results in, “Americans often fail[ing] to recognize government’s role in society, even if they have experienced it in their own lives.”
Additionally, if ACA subsidies were cut, premiums likely would rise, even for those who don’t receive such subsidies. This is because healthier people who lost their subsidies could be priced out of purchasing insurance by higher costs and declining coverage, thus leaving behind a smaller pool of sicker insured individuals, which would force insurance companies to hike up prices.
So, while many are cheering for cutting down ACA subsidies, they are simultaneously pocketing their own government benefits. In truth, government supports health care at all levels of society, and the nation is greater for it.
And amidst the numerous attacks on the ACA—and the continued aversion toward government-supported health care in general—it’s easy to forget that everyone benefits and that lives that are saved by government health care expansion.