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Millions of Poor Are Left Uncovered by Health Law

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.

People shopping for insurance on the health exchanges are already discovering this bitter twist.

“How can somebody in poverty not be eligible for subsidies?” an unemployed health care worker in Virginia asked through tears. The woman, who identified herself only as Robin L. because she does not want potential employers to know she is down on her luck, thought she had run into a computer problem when she went online Tuesday and learned she would not qualify.

At 55, she has high blood pressure, and she had been waiting for the law to take effect so she could get coverage. Before she lost her job and her house and had to move in with her brother in Virginia, she lived in Maryland, a state that is expanding Medicaid. “Would I go back there?” she asked. “It might involve me living in my car. I don’t know. I might consider it.”

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion.

Every state in the Deep South, with the exception of Arkansas, has rejected the expansion. Opponents of the expansion say they are against it on exclusively economic grounds, and that the demographics of the South — with its large share of poor blacks — make it easy to say race is an issue when it is not.

In Mississippi, Republican leaders note that a large share of people in the state are on Medicaid already, and that, with an expansion, about a third of the state would have been insured through the program. Even supporters of the health law say that eventually covering 10 percent of that cost would have been onerous for a predominantly rural state with a modest tax base.

“Any additional cost in Medicaid is going to be too much,” said State Senator Chris McDaniel, a Republican, who opposes expansion.

The law was written to require all Americans to have health coverage. For lower and middle-income earners, there are subsidies on the new health exchanges to help them afford insurance. An expanded Medicaid program was intended to cover the poorest. In all, about 30 million uninsured Americans were to have become eligible for financial help.But the Supreme Court’s ruling on the health care law last year, while upholding it, allowed states to choose whether to expand Medicaid. Those that opted not to leave about eight million uninsured people who live in poverty ($19,530 for a family of three) without any assistance at all.Poor people excluded from the Medicaid expansion will not be subject to fines for lacking coverage. In all, about 14 million eligible Americans are uninsured and living in poverty, the Times analysis found.

The federal government provided the tally of how many states were not expanding Medicaid for the first time on Tuesday. It included states like New Hampshire, Ohio, Pennsylvania and Tennessee that might still decide to expand Medicaid before coverage takes effect in January. If those states go forward, the number would change, but the trends that emerged in the analysis would be similar.

Mississippi has the largest percentage of poor and uninsured people in the country — 13 percent. Willie Charles Carter, an unemployed 53-year-old whose most recent job was as a maintenance worker at a public school, has had problems with his leg since surgery last year.

His income is below Mississippi’s ceiling for Medicaid — which is about $3,000 a year — but he has no dependent children, so he does not qualify. And his income is too low to make him eligible for subsidies on the federal health exchange.

“You got to be almost dead before you can get Medicaid in Mississippi,” he said.

He does not know what he will do when the clinic where he goes for medical care, the Good Samaritan Health Center in Greenville, closes next month because of lack of funding.

“I’m scared all the time,” he said. “I just walk around here with faith in God to take care of me.”

The states that did not expand Medicaid have less generous safety nets: For adults with children, the median income limit for Medicaid is just under half of the federal poverty level — or about $5,600 a year for an individual — while in states that are expanding, it is above the poverty line, or about $12,200, according to the Kaiser Family Foundation. There is little or no coverage of childless adults in the states not expanding, Kaiser said.

The New York Times analysis excluded immigrants in the country illegally and those foreign-born residents who would not be eligible for benefits under Medicaid expansion. It included people who are uninsured even though they qualify for Medicaid in its current form.

Blacks are disproportionately affected, largely because more of them are poor and living in Southern states. In all, 6 out of 10 blacks live in the states not expanding Medicaid. In Mississippi, 56 percent of all poor and uninsured adults are black, though they account for just 38 percent of the population.

Dr. Aaron Shirley, a physician who has worked for better health care for blacks in Mississippi, said that the history of segregation and violence against blacks still informs the way people see one another, particularly in the South, making some whites reluctant to support programs that they believe benefit blacks.

That is compounded by the country’s rapidly changing demographics, Dr. Geiger said, in which minorities will eventually become a majority, a pattern that has produced a profound cultural unease, particularly when it has collided with economic insecurity.

Dr. Shirley said: “If you look at the history of Mississippi, politicians have used race to oppose minimum wage, Head Start, all these social programs. It’s a tactic that appeals to people who would rather suffer themselves than see a black person benefit.”

Opponents of the expansion bristled at the suggestion that race had anything to do with their position. State Senator Giles Ward of Mississippi, a Republican, called the idea that race was a factor “preposterous,” and said that with the demographics of the South — large shares of poor people and, in particular, poor blacks — “you can argue pretty much any way you want.”

The decision not to expand Medicaid will also hit the working poor. Claretha Briscoe earns just under $11,000 a year making fried chicken and other fast food at a convenience store in Hollandale, Miss., too much to qualify for Medicaid but not enough to get subsidies on the new health exchange. She had a heart attack in 2002 that a local hospital treated as part of its charity care program.

“I skip months on my blood pressure pills,” said Ms. Briscoe, 48, who visited the Good Samaritan Health Center last week because she was having chest pains. “I buy them when I can afford them.”

About half of poor and uninsured Hispanics live in states that are expanding Medicaid. But Texas, which has a large Hispanic population, rejected the expansion. Gladys Arbila, a housekeeper in Houston who earns $17,000 a year and supports two children, is under the poverty line and therefore not eligible for new subsidies. But she makes too much to qualify for Medicaid under the state’s rules. She recently spent 36 hours waiting in the emergency room for a searing pain in her back.

“We came to this country, and we are legal and we work really hard,” said Ms. Arbila, 45, who immigrated to the United States 12 years ago, and whose son is a soldier in Afghanistan. “Why we don’t have the same opportunities as the others?”

Chugging Along Behind

China and Japan have it. France has it, along with 11 other European countries. Come on, even Uzbekistan has it. The Obama administration really wanted it back in 2009. Sure, Amtrak sort of has it, with the Acela between Boston and Washington, D.C., but its average speed is a measly 78 mph. And Elon Musk dreams of a 760 mph Hyperloop, but right now that’s just a dream. So, why can’t the U.S. manage to get high-speed rail?

FIRST: JAPAN, 1964

Japan developed the world’s first high-speed rail network in 1964. In 2012 the busiest Shinkansen line moved 143 million passengers from Tokyo to Osaka in 2 hours and 25 minutes, at a top operating speed of 168 mph.

FASTEST: SHANGHAI MAGLEV, 311 MPH

The Shanghai Maglev (short for “magnetic levitation”) has been clocked at a top speed of 311 mph, though its top operating speed is 268 mph. The Maglev connects Pudong International Airport with the city’s metro system, making the 18-mile journey in about 8 minutes.

NEXT: CALIFORNIA, $68 BILLION

Phase 1 of the California high-speed rail system, which will take passengers from San Francisco to Los Angeles in under 3 hours (top speed: over 200 mph), is projected to cost $68 billion and to be complete by 2029. The first segment, Merced to Bakersfield, has an estimated price of $6 billion. 

Part of the answer is that high-speed rail systems come with high price tags. A Spanish study from 2007 found that the average cost of high-speed rail projects around the world was $34.5 million per mile, and rail infrastructure costs tend to be higher in the U.S. than in other countries. (This is partly because U.S. rail-safety regulations ban systems used successfully elsewhere – the Acela rail cars, for example, weigh twice as much as those of France’s TGV.) Amtrak’s proposed Northeast Corridor capital-investment program would cost an estimated $151 billion between 2012 and 2040. 

Read more: http://www.ozy.com/acumen/chugging-along-behind/1530.article#ixzz2gUdyrzsK 
Under Creative Commons License: Attribution Non-Commercial No Derivatives 
Follow us: @ozy on TwitterRail systems also require expensive maintenance. In June, Amtrak’s CEO told a congressional committee that Amtrak needed $782 million a year for the next 15 years to handle the maintenance costs of the Northeast Corridor alone. By comparison, the Congressional Budget Office reported that the Federal Highway Administration spent $2 billion for maintenance across the country in 2009.

Concerns about cost and overspending prompted Republican governors in Ohio, Wisconsin and Florida to reject substantial federal funds for high-speed rail projects in their states. Besides construction and maintenance costs, some worry that high-speed rail will not be profitable and will not create jobs. 

However, part of the American aversion to high-speed rail can be chalked up to culture: Americans love their cars, and some conservatives think train projects smell suspiciously like Euro envy and government attempts to deprive people of their sovereign choice to sit in traffic.

Are high-speed rail networks an instance of “If you build it, they will come”? Will travelers be wooed by comfy seats and more time to play on their smartphones? Perhaps. But without a much stronger political commitment from federal and local lawmakers (including Californians who didn’t like the idea of a train in their backyard), don’t count on seeing American bullet trains crisscrossing the country anytime soon.

Colorado teen Gracie Johnson says dad saved her from deadly rockslide

13-year-old Gracie Johnson is the only survivor of a deadly rock slide that killed five at Agnes Vallie Falls in Chaffee County, Colo.

A 13-year-old girl survived a deadly rockslide in Colorado when her dad used his body to shield her from tumbling boulders, authorities said.

Monday’s massive slide killed five hikers and trapped the teen, Gracie Johnson, among 100-ton boulders.

A Chaffee County, Colo., sheriff’s deputy discovered the girl.

Read more: http://www.nydailynews.com/news/national/hero-dad-shields-daughter-deadly-rockslide-article-1.1472407#ixzz2gUcpFMxd

An emergency helicopter searches for survivors following a rock slide at Agnes Vaille Falls on Monday.

“I heard a scream next to me,” Deputy Nick Tolsma told Good Morning America. “I saw a hand sticking out underneath the boulder.”

Tolsma freed the girl and learned the incredible story of her survival.

Read more: http://www.nydailynews.com/news/national/hero-dad-shields-daughter-deadly-rockslide-article-1.1472407#ixzz2gUcsm16j

Dwayne Johnson, right, used his body to shield his 13-year-old daughter from a deadly rockslide in Chaffee County, Colo.

“She said that her dad jumped on top of her to protect her right at the last moment when the rocks were coming down, so I really think that he saved her life,” Tolsma said.

Gracie was hiking the picturesque trail near Agnes Vaille Falls with her family, including dad Dwayne Johnson and mom Dawna Johnson, a track coach at Buena Vista High School, the Denver Post reported.

Witnesses heard a brief rumbling before giant boulders crashed down, carving a path the size of a football field in the mountainside.

Read more: http://www.nydailynews.com/news/national/hero-dad-shields-daughter-deadly-rockslide-article-1.1472407#ixzz2gUcuYEcE

A Flight for Life Helicopter rises above backed up traffic on Monday following a deadly rockslide in southern Colorado.

Rescuers dodged rolling rocks as they climbed up the crumbling slope.

The slide broke the girl’s leg and crushed the other five hikers in a shifting expanse of loose rubble, ABC News 7 reported.

Read more: http://www.nydailynews.com/news/national/hero-dad-shields-daughter-deadly-rockslide-article-1.1472407#ixzz2gUcx90HF

Chaffee County Sheriff's Deputy Kevin Everson, right, and other deputies on Monday walk out the Agnes Vaille Falls trail shortly after leaving the scene of a rock slide that killed five people.

Sheriff Pete Palmer said deputies found the bodies but had to wait to recover the bodies because the slope was too unstable.

“They are in bad shape,” Palmer said at a news conference. “They were rolled over by boulders as big as these cars.”

He said the coroner had no hope of finding any other survivors.

Read more: http://www.nydailynews.com/news/national/hero-dad-shields-daughter-deadly-rockslide-article-1.1472407#ixzz2gUczPOkf

Colorado State Patrol Trooper Brandon Wilkins tells a driver on Monday the road is closed to while rescuers deal with a rock slide at Agnes Vaille Falls.

“He’s seen the condition of the bodies,” Palmer said, according to the Post. “There is no one alive up there.”

The sheriff declined to name the dead.

Rescuers planned to return to the mountain on Tuesday to recover their bodies.

Read more: http://www.nydailynews.com/news/national/hero-dad-shields-daughter-deadly-rockslide-article-1.1472407#ixzz2gUd1KcSB

U.S. Reckons With Impact of Shutdown

WASHINGTON — The vast machinery of the federal government began grinding to a halt Tuesday morning just hours after weary lawmakers gave up hope of passing a budget in the face of Republican attacks on President Obama’s health care law.For the first time in 17 years, Congress failed Monday night to agree on a new budget and refused to extend the current one. Without the authority to spend money, the executive branch on Tuesday morning started the process of temporarily mothballing facilities and suspending the many services the government provides.

After a series of back-and-forth legislative maneuvers late Monday night and into Tuesday morning, the House and Senate did not reach a resolution, and the Senate halted business until later Tuesday while the House took steps to open talks.

On Tuesday morning, the Senate rejected the House proposal to begin conference committee negotiations, and the next legislative steps remained uncertain.

More than 800,000 federal workers across the country are bracing for an uncertain financial future in the days ahead as many government agencies prepared to close their doors, set up barricades and turn out the lights.Traveling in Seoul, South Korea, on Tuesday, Secretary of Defense Chuck Hagel called the shutdown “nonsensical” and said it would lead to the immediate furlough of about 400,000 civilian employees. (Mr. Obama signed legislation late Monday night ensuring that uniformed members of the military will get paid during the shutdown.)“It does cast a very significant pall over America’s credibility with our allies when this kind of thing happens,” Mr. Hagel said. “It’s nonsensical. It’s needless. It didn’t have to happen.”

At the Justice Department, Attorney General Eric H. Holder Jr. pledged to give back a portion of his salary in solidarity with his employees.

“As I’ve made clear to the people in this department, we are all in this together, and whatever pain they suffer, I will share with them,” Mr. Holder said as the shutdown approached.

Even as they contemplated a short-term future without pay, many federal employees in Washington headed into work Tuesday morning anyway, the result of a directive at some agencies requiring workers to show up briefly so they can help wrap up their work and shut down their facilities.

At the Federal Communications Commission, officials instructed their 1,716 employees to arrive at work Tuesday for no more than four hours. After that, the agency said, it would send all but about 38 of those employees home for the duration of the shutdown. Those “essential” employees will keep working on programs that address radio interference detection, treaty negotiations and other critical information technology issues, officials said.

The crowds were lighter than normal early Tuesday at L’Enfant Plaza in Washington, where there are a number of federal agencies. Phillip Davenport, a management analyst at the Federal Aviation Administration, who was deemed an essential employee, said he was expecting a heavier workload.

During the last shutdown 17 years ago, Mr. Davenport was on active duty in the military, based in Alaska, he said. “Back then, I don’t remember for sure, but we came to work regardless of whether we were paid or not,” he said.

On Monday afternoon, Mr. Obama described the potential closures in the case of a shutdown. He noted that “every one of the parks and monuments” would be immediately closed. That process began early Tuesday as park officials restricted access to some of the country’s most iconic locations and barricades went up to keep out tourists.

About 8 a.m., the steps of the Lincoln Memorial were being taped off by National Park police, metal barricades were erected and tourists were being turned away. Coincidentally, visitors to Google’s home page on Tuesday morning woke up to a doodle of park ranger patches honoring the 123rd anniversary of Yosemite National Park.

The National Zoo in Washington closed its gates to tourists. Zoo officials said they planned to flip off the two cameras that feed images to the popular “Giant Panda Cam” Web site for fans wanting to watch the rare new panda cub that was born last month. By 10 a.m., the panda cam said simply: “Error loading stream.”

A message on the zoo’s Web site said that “all vehicle, pedestrian, and bicycle paths into the zoo will be closed. None of our live animal cams will broadcast.” The Web site added that “all the animals will continue to be fed and cared for. “

People who do not work for the federal government will also quickly begin feeling the effect of the government shutdown.

After a general retreat on Monday, global investors reacted calmly on Tuesday in the hours after Congressional negotiations collapsed, as investors focused on the Oct. 17 deadline for raising the debt ceiling.

Stocks on Wall Street opened slightly higher, while European and Asian stocks were mixed. The bond and foreign exchange markets were quiet.

Those looking for financial data to assess the impact of a shutdown will have to do it without help from the Congressional Budget Office and the Census, both of which are closing. The Bureau of Labor Statistics, which is scheduled to issue its monthly jobs report this Friday, is also closing.

Across Washington — the site of the political paralysis — commercial establishments sought ways to try to minimize the impact of a shutdown that will hit harder here than anywhere else. Late Monday night, several bars and restaurants in the area started advertising “shutdown specials” for those who wandered in.

At Z-Burger, a popular hamburger restaurant in the Washington area, owners pledged to make good on their promise for a free burger for every furloughed federal worker. In a Twitter post, it said: “AlmostHere IF #GovernmentShutdown #FREE #Burgers."

One group of employees who appeared unaffected by the shutdown was those who write news releases on Capitol Hill. In the wee hours of Tuesday morning, statements began arriving from lawmakers’ offices.

“Closing down the government strikes at the heart of New Mexico’s economy and our middle-class families,” said Senator Martin Heinrich, Democrat of New Mexico. “And that was the decision Republicans made tonight.”

Senator Jerry Moran, Republican of Kansas, blamed the Democrats: “If we had a functioning Senate we would not be in this position,” he said, adding: “They would rather shut down the government than negotiate.”

As the shutdown approached on Monday, James R. Clapper, the director of national intelligence, sent a classified assessment of its impact to members of Congress on the intelligence committees. One congressional aide said the assessment was “very troubling” to many members because it showed a “very considerable reduction in force while the shutdown goes on.”

The aide, who declined to be named discussing a classified report, said Mr. Clapper declassified one sentence from the assessment: “Approximately 72 percent of the civilian workforce will be furloughed.”

Outside of government, the reaction was swift as well. Jenny Beth Martin, the co-founder of the Tea Party Patriots, a national conservative group, accused Democrats of burdening American families with Obamacare.

“Now the government has done even worse,” she said in a statement, adding: “The Senate Democrats delivered a triple whammy: shutting down government, bringing chaos and uncertainty to health care which affects American lives, and sticking American families with massive cost increases due to Obamacare — which most Americans don’t want.”

The daily schedule of the House, sent out by e-mail from the office of the majority leader, Eric Cantor, Republican of Virginia, took a hopeful tone: “Possible further consideration of H.J.Res. 59 — Continuing Appropriations Resolution, 2014,” it said, using the formal name of a bill that could be used to reopen the government. “Conference Reports may be brought up at any time.”

Reporting was contributed by Jennifer Steinhauer from Seoul, Charlie Savage, Emmarie Huetteman and Eric Schmitt from Washington, and Victoria Shannon from New York.

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