Election Bodes Well for People in Poverty

The Shriver Center’s mission involves improving the quality of life and opportunities of people living in poverty. From that perspective, here are some initial thoughts on the presidential election.

Yes, as some have argued, it would be good to have a more forthright conversation about poverty in the presidential campaign, to name it as a priority to be addressed, and to hear the competing strategies. The principal framing of both sides on economic issues focused instead on the middle class. Much of that is unavoidable—the taking of advice from pollsters and experts about what messages will work during a particular passage of time to improve the chances of victory. That is a lesson all of us in the advocacy world have been struggling to learn for many years—the point is to win, to actually move the ball, not to deploy more personally satisfying rhetoric. 

A quick reminder about the time we are in helps to explain this middle-class framing. The Great Recession has dramatically blurred the lines between the middle class and people in poverty. Lost jobs, lost homes, lost health insurance, lost savings, lost credit, broken neighborhoods, and the very real threat of all those things for people who have managed to avoid them so far are all signs of the perilous nature of middle-class status. And yet the data tells us that everyone, rich or poor or in the middle, prefers to think of themselves as middle class. For most people in poverty, policies framed as advancing the middle class are policies aimed to help them.

So I’m OK with the framing. Particularly from the Obama side of things, it is hard to argue with success. Far more important than framing is the practical impact that the administration’s policies and economic plans will actually have on the prospects for people in poverty. What can we glean from the campaign and from last night? 

The acceptance speech was a resounding affirmation of the core attitude essential for a positive policy direction for people in poverty: “We are all in this together.” The election was yet another chapter in the major struggle of our times between competing narratives about national political life: “we are all in this together” versus “the primacy of the individual.”  People in poverty, and people in the middle class at risk of falling into poverty, will fare better when the general tide of the times favors the common good, mutual duty and responsibility, and the community as well as the individual.

The first level of translating this public narrative into practical outcomes that help people in poverty is the general attitude about the role of government. The campaign juxtaposed the Tea Party attitude that government is bad—because it is government—against the pragmatic notion that government is crucial to and capable of solving problems. As timely exhibited by the ongoing response to Hurricane Sandy, government can competently address emergencies without partisan rancor. The answer to government failure (Katrina) is not to jettison government but to do the job better (Sandy). What bigger emergency, what more compelling need for a smart pragmatic government role, than the thorny and massive-scale issues of poverty?

As a specific illustration of how winning these high-level arguments can produce pragmatic progress, we will now see the full implementation of health care reform. The Affordable Care Act is the single biggest blow against poverty since the 1960s—half a century, or the whole career of an anti-poverty advocate my age. It hasn’t been framed that way, but that’s what it is. It completes Medicaid, making health coverage available to everybody who is poor, which instantly makes them more employable and productive and opens the path to the middle class. It makes affordable commercial coverage available to the whole economic spectrum well up into the middle class, boosting upward mobility, and instantly eliminating the nightmare of lost coverage, bankruptcy, slow death from untreated conditions, blocked aspirations, and loss of middle-class status. The Affordable Care Act stands as a major rebuttal to those who say President Obama got nothing done, or did nothing to address poverty, in his first term.

The Affordable Care Act is a prime manifestation of “we’re in this together,” and of a pragmatic role for government in solving a major economic issue for people in poverty and the middle class. The leading critique against it took the opposite sides of these arguments—the mandate was “the biggest attack on freedom ever” (primacy of the individual) and the law was “too much government” —and failed.

From public narrative, to the role of government, to specific initiatives, the election can be understood as a promising direction for the prospects for people in poverty. It is not self-executing, however, and there are many obstacles, starting with a Congress probably not convinced that these core arguments are conclusively decided. Looming immediately ahead are the immense issues of the “fiscal cliff” that have profound implications for people in poverty. There is a compelling role for those of us committed to the improvement of the prospects of people living in poverty to help see to it that the promising direction of the election produces that improvement.        

Americans Want Health Care Reform to Go Forward

StethoscopeSome people are spinning hard about the outcome of the recent mid-term elections. They are trying to say that the changes in Congress were a “mandate” to repeal health care reform. As usual, most of those spinners have little to say about how to resolve health care issues--for them health care is an ideological or political issue, not an issue of importance in everyday lives. It is a tactical issue in the beltway game, a ploy in the never-ending struggle for power and for special interest money.

But out here, when the issue is reduced to kitchen-table reality, people don’t think ideologically or politically. They think about their own health care, their families’ health care, and their own financial circumstances. 

Here are some numbers about health coverage and the election. 

Even on the ideological level on which they choose to operate, the spinners are wrong. The election result was driven by concern about the economy and jobs, not health care. According to a CNN exit poll, only 19% of voters named health care reform as their top concern--a distant second to the 61% of voters most concerned with the economy.

On the big abstract ideological question about support for the health reform law, the voters split down the middle: 48% say they support repeal and 47% say they want the reform law to stay the same or be expanded. Some mandate. 

Polls consistently confirm that, when the public hears truthful facts (as opposed to the other kind of “facts”) about the health reform law, they want the benefits and support health reform. The specifics of health care reform already help people in ways that matter deeply to them. Undoing health care reform would mean:

  • People would continue to be denied coverage or charged more for it due to pre-existing conditions.
  • People diagnosed with the particular pre-existing condition of being female would continue to be discriminated against in the cost of their coverage. The spinners would continue that outrageous discrimination. 
  • People would continue to have coverage dropped when they get sick.
  • People would continue to have lifetime caps on their insurance coverage.
  • Small businesses would continue to have to pay higher rates for health insurance than big corporations.
  • There will be no smart investment in prevention as the focus of our healthcare system--clearly the way to get both lower cost and better patient outcomes.
  • People would lose the comfort of knowing that, no matter what happens to their job, their health, or their family, there will always be access to affordable, decent coverage.  
  • Entrepreneurs would continue to experience the drag on their creativity and chances for success caused by the health coverage problems. And health coverage issues would continue to prevent would-be entrepreneurs from even getting started, stuck in their current jobs in order to retain insurance.

The post-election spinners stay far away from these real problems. The new law leaves the private insurance sector in place (a single-payer system would have ended it), but imposes fair boundaries on it. The spinners, scrupulously avoiding anything specific about how to address health coverage issues, instead simply call the new law names: “takeover,” “socialism.” But calling something a name is not the same as talking about it honestly--indeed, it’s a time-honored way to stifle full discussion. The health reform law is in fact a very promising public-private effort to address a problem that plagues American households everywhere. The spinners are wrong about the importance to real people of health care reform. When the focus is on the actual health coverage problems that plague American households, most Americans want their federal and state officials to get on with implementation--and do a good job of it.