The Affordable Care Act Helps The Middle Class

The Affordable Care Act is not charity for the destitute: it is critical assistance for American WORKERS. And the Democrats must not forget it.

Like Steve Benen, I think it’s great that French President Nicolas Sarkozy is a fan of the Affordable Care Act.  But Sarkozy — and Americans — should understand better what the ACA is about:

“Welcome to the club of states who don’t turn their back on the sick and the poor,” Sarkozy said, referring to the U.S. health care overhaul signed by President Barack Obama last week.

From the European perspective, he said, “when we look at the American debate on reforming health care, it’s difficult to believe.”

“The very fact that there should have been such a violent debate simply on the fact that the poorest of Americans should not be left out in the streets without a cent to look after them … is something astonishing to us.”

Thanks for the compliment, Nick, but get a better briefer.

The ACA really is not about the “poorest of the poor.”  That population is helped predominantly by Medicaid.  To be sure, there are lots of gaps in Medicaid — and there will be more until and unless Congress funds it better.  Single low-income people do not get it in most states.  But it is the program for the destitute.

The ACA, on the other hand, is basically about the real middle class in this country — people making 150% of the poverty level, up to about 350%.  In other words, it insures families of four making between roughly $33,000 and $77,000 a year.  Individuals on the exchange, or in the interim high-risk pool, are working people, small business owners, prospective small business owners, etc.

I don’t begrudge Sarkozy for making this mistake; he’s got enough on his hands, after all.  But Democrats must avoid it.  Otherwise, the Right will smear this thing as yet another handout to “those people” (and we know what color they are and/or what countries they come from) who are lazy and shiftless, etc.

We should be helping the “poorest of the poor” to a much greater degree than we do.  But let’s not confuse the way that the biggest piece of social legislation since the Great Society actually works.

Author: Jonathan Zasloff

Jonathan Zasloff teaches Torts, Land Use, Environmental Law, Comparative Urban Planning Law, Legal History, and Public Policy Clinic - Land Use, the Environment and Local Government. He grew up and still lives in the San Fernando Valley, about which he remains immensely proud (to the mystification of his friends and colleagues). After graduating from Yale Law School, and while clerking for a federal appeals court judge in Boston, he decided to return to Los Angeles shortly after the January 1994 Northridge earthquake, reasoning that he would gladly risk tremors in order to avoid the average New England wind chill temperature of negative 55 degrees. Professor Zasloff has a keen interest in world politics; he holds a PhD in the history of American foreign policy from Harvard and an M.Phil. in International Relations from Cambridge University. Much of his recent work concerns the influence of lawyers and legalism in US external relations, and has published articles on these subjects in the New York University Law Review and the Yale Law Journal. More generally, his recent interests focus on the response of public institutions to social problems, and the role of ideology in framing policy responses. Professor Zasloff has long been active in state and local politics and policy. He recently co-authored an article discussing the relationship of Proposition 13 (California's landmark tax limitation initiative) and school finance reform, and served for several years as a senior policy advisor to the Speaker of California Assembly. His practice background reflects these interests: for two years, he represented welfare recipients attempting to obtain child care benefits and microbusinesses in low income areas. He then practiced for two more years at one of Los Angeles' leading public interest environmental and land use firms, challenging poorly planned development and working to expand the network of the city's urban park system. He currently serves as a member of the boards of the Santa Monica Mountains Conservancy (a state agency charged with purchasing and protecting open space), the Los Angeles Center for Law and Justice (the leading legal service firm for low-income clients in east Los Angeles), and Friends of Israel's Environment. Professor Zasloff's other major activity consists in explaining the Triangle Offense to his very patient wife, Kathy.

5 thoughts on “The Affordable Care Act Helps The Middle Class”

  1. In all these income level benefits, what is the income being indicated? AGI? MAGI? Taxable? Gross (I hope not)?

  2. Perhaps the single most important thing that Congerss and the Administration can do about Medicaid is to make it a national program funded and run by the federal government. It is now a state-run and partially state-funded program, with wildly different operations in different states. Some states, such as Indiana, are planning to (or have already) cut back on Medicaid funding because of their budget situations (which are, true, quite difficult). As long as this continues, the treatment of the very poor in the US will be left to governments with neither the resources nor, frankly, the will to deal with it.

  3. According to "The biggest government expansion in the bill would be in Medicaid. All individuals earning less than 133 percent of FPL would get free insurance through Medicaid. The CBO has estimated that this expansion will cover 16 million American by 2019."

  4. As Alonzo notes, the federalization of Medicaid is underway, and that actually comprises roughly half the spending and half the coverage expansion under the ACA. Moreover, while Medicaid will still have a means-test, it will now be a nationally uniform income test, rather than the hodgepodge of super-restrictive income and assets tests that currently prevail in many states. And this expansion is 90% paid for by the federal gov't after (I think) 2019, and 100% paid for by the federal gov't prior to that. A really good measure for a future reconciliation bill would be moving up the date of the Medicaid expansion to ASAP.

  5. How on earth is a family of four which earns $33,000 middle class? That wouldn't pay my mortgage if it were tax free and I could eat air.

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