About the ACA

acaMost of today’s Affordable Care Act coverage is driving me nuts. Some basics:

Obamacare is not a thing. It’s a nickname for the Affordable Care Act (ACA) – a comprehensive law passed in 2010 that did a lot of good things, including making it illegal for insurance companies to deny coverage based on pre-exisiting conditions they themselves defined. That’s important. Before this law, if you were a freelancer or contract worker or lost your job or didn’t have a job that offered health insurance, you had to try to buy a plan on your own as an individual. Unless you were a 21-yr-old male who never had seen a doctor for any reason ever, it was almost impossible to find coverage. Not just affordable coverage. ANY coverage. You see, insurance companies can offer affordable insurance to companies because grouping people together mitigates risk. But one lone person… not so much. So insurance companies would decide most normal people weren’t worth the risk and refuse to sell them a plan. I know because this happened to me and a lot of arguably very healthy people I know. Then if you were lucky enough to find an affordable plan, it likely had an obscene deductible. Or even better. If you tried to use the coverage for anything substantive, the insurance company would fight tooth and nail to avoid paying. No excuse was too ridiculous for the insurer to use to attempt to weasel out of giving you the coverage you’d paid for. Thanks to the ACA, this no longer happens with regularity.

Did I mention Obamacare is not a thing? Because it’s also not a health insurance plan. The ACA required the states to set up marketplaces (or exchanges) where people can comparison shop for private health insurance plans. Did you catch that? Private insurance plans. Not government-run health care. Private companies selling private plans. 14 states have their own marketplaces. 36 states use Healthcare.gov because Republican governors and legislators refused to work with the Obama Administration and do their part to set up something on their own. The ACA accounted for this possibility by saying if you don’t do it, the federal government will. So no matter whether you go to a state site like CoveredCalifornia.com or bewellnm.com or Healthcare.gov, you now can comparison shop for an individual plan – a private health insurance plan – which is something you couldn’t do before the law passed.

“But it’s so expensive!” Is it? Well, for me, it’s not cheap because my income fluctuates year to year, and I cannot claim I make under 400% of the poverty level so I have to pay full price. BUT… if you make less than 400% of the poverty level, you can get help paying for your health insurance. Obamacarefacts.com explains this well:

Americans making under 400% of the Federal Poverty Level (FPL) may qualify for cost assistance through the marketplace.  Cost assistance includes: reduced premiums via tax credits for those making between 100% – 400% FPL, out-of-pocket cost assistance (on Silver plans only) for those making between 100% – 250% FPL, and Medicaid for those making under 138% FPL (if their State has implemented Medicaid expansion).

“Costs keep going up!” Yes, yes they do. But they always have, and they actually are going up at a slower rate now than before we passed the ACA. Cost control is a big part of why we needed national health care reform so badly. Unfortunately, getting reform through Congress was tough (I know because I was there), and one of the great mechanisms for cost control – the public option – died in the process. Having a government-run health insurance plan as one choice in the marketplace (think Medicare) would have forced the private insurance companies to offer competitive prices and reasonable networks. Instead, they continue to operate mostly unchecked, and they set the prices as high as they think they can go. Access to health care is not like a regular consumer good. If you get sick, you have to see a doctor or get medical care. Insurance companies are the gatekeepers to care in this country. They know this and take advantage by charging whatever the market will bear. So where the ACA fell short was in not including the cost control mechanism we needed most.

HOWEVER… this does not mean you scrap the law that has a lot of other great parts to it and start from scratch. You get in there and make it better. You build on the good parts and improve on the ones that need fixing.

“But, Jacki,” you’re thinking, “I’m still really mad about my costs going up. I’m angry. And it’s called Obamacare so I blame Obama.”

Congratulations. You’ve been manipulated by the insurance industry… twice. They control costs. No one else. There is no government-run health insurance plan. If anything, the government doesn’t have the muscle to go far enough and stop the insurance industry from taking advantage of you. Oh, and insurers LOVE that it’s now called Obamacare because they want you to blame the President. It lets them off the hook.

Health care policy isn’t easy to understand and plenty of stakeholders are glad you won’t have the time to dig into it. But if you do, you will learn that the ACA was a good first step in the right direction, and the key now is to harness that frustration and use it to continue to fight the injustice.

Just make sure you’re aiming in the right direction.


Over The Edge

trump town hallThat’s it. I’ve had it. I cannot listen to one more political analyst, pundit, or reporter pretend Donald Trump is anything but in over his head and out of his league. He’s not “not conservative enough.” He’s uninformed. He’s not revolutionary or unpredictable. He’s ignorant. He’s not strategic. He’s stubborn.

During Tuesday night’s town hall, Trump – when asked the top three functions of the federal government – answered “Security, security, and security.” Not because it’s that important to him but because he didn’t know what else to say. You know how I know? Because when Anderson Cooper pushed him, he defaulted to health care and education. Really? So he thinks the federal government should be in charge of health care and education? The man who – every day in every speech – rails against government-run Obamacare and Common Core (neither of which actually is a government-run program, by the way) announced two of the top three functions of the federal government are health care and education. And it’s not because he’s not a true conservative. It’s because he has absolutely no clue what he’s talking about. Period.

Trump can’t tell you what he should or shouldn’t be for or against beyond the rhetoric he’s memorized and regurgitates on the regular because he doesn’t stand for anything but himself. He has absolutely no idea what’s progressive or conservative. He has no deep-seated convictions. He’s not moored to any longstanding idealogical port. He just knows what gets a crowd riled up. He’s willing to say whatever whenever, and he doesn’t worry about having to walk something back because – strangely – absolutely nothing sticks.

Speaking of sticking, every time Trump got stuck on a question Tuesday night, he defaulted back to excerpts of his stump speech. There didn’t even have to be a connection between the two. He just launched into whatever came to mind because there is no original innovative thought happening in that brain when it comes to government, policy, or public service. He doesn’t know anything about international relations or political history or social justice or anything that truly matters for someone who wants to be President of the United States.

And what sucks so terribly is that no one I’m watching or hearing on cable news on a regular basis is flat out saying any of this because everyone’s trying so hard to pretend there’s a “there” there. Don’t tell me these longtime politicos don’t know Trump is a farce. A joke. They absolutely do. Why is everyone so afraid?

Trump may win this nomination because the GOP is that screwed up. But any rational, thinking human being – especially one labeled an expert on television – has a responsibility to stop playing make-believe and start saying what’s true. Stop participating in his game. Stop letting him and his surrogates manipulate every interaction and interview. Call them all out. Relentlessly. Now. Because trying to find some shred of decency in what this man’s selling is destroying what little dignity we have left. And frankly, once you put this fraud up against a real candidate like Clinton or Sanders, it’s not going to get better or easier. He’s completely prepared to take this charade all the way, no matter what damage it may do or what carnage it may leave in its wake.

Donald Trump isn’t about this country. He’s about Trump. Always has been. Always will be. In fact, that’s the one and only constant you can bank on.

I wanted to be a broadcast journalist since I was teenager because I wanted to dig up and tell the truth. Watching coverage of this campaign, I don’t think that profession even exists anymore. It’s been disappearing for years, and that used to make me sad, but today, I hit my breaking point. Listening to CNN on the radio in the car on my way home, I realized I’m not sad anymore.

Sadly, now I’m angry.

Risky Business

trump handI like to think I’m a bit of a risk-taker. Not in a jump off bridges and out of airplanes adrenaline junkie kind of way. Turns out my body’s afraid of heights. But I do take risks in pursuing work and love and friendship and have both my fair share of cool stories and broken hearts to show for it.

I mention this because at a small dinner party Friday night, conversation turned to politics and, of course, Donald Trump. No one in the room was a fan, but a couple of guests brought up an interesting perspective. They said (and I paraphrase), “Many of his supporters don’t think he’s actually going to deport 12 million people or build a giant wall. They know he’s exaggerating, but they like the points he makes. They like where he’s going.”

Let’s say – for the sake of argument and keeping an open mind – that this theory is possible. Let’s assume the thousands attending his rallies and cheering his repetitive speeches selling less compassion, more torture, heavy-handed diplomacy, nebulous policy, and casual threats think he’s not really totally serious. What does that say about who we are?

There is a way to speak to the disenfranchised and advocate for those feeling like they are struggling just to make ends meet. There is a way to galvanize a movement to fight back against special interests and say enough is enough to the corporate lobbyists and billionaires who’ve bought and now control our political system. No matter how you feel about Bernie Sanders or his chances of winning the Democratic nomination, you have to admit he’s figured out a way to tap into the energy that wants to see change. Obama did it too in 2008. The difference boils down to tone, temperament, and maturity.

Trump’s antics definitely are entertaining. His over-the-top declarations, his childish insults, and his embarrassing taunts from the podium succeed in amusing and riling up his audience. They – and the media – can’t get enough. What will he say, do, or tweet next? Just when you think he can’t cross any more lines, he draws new ones and hurdles them effortlessly.

But at the same time, I am baffled by how many people are willing to condone and encourage the methods to his madness. I don’t want to believe so many people carry so much anger and hate in their hearts. Trump doesn’t come from a place of goodness. He operates and thrives in the darkness that breeds greed, contempt, intolerance, and superficiality.

Circling back to the picture my dinner companions were trying to paint, their proposition also could make some sense if you watch the dance his surrogates do daily on his behalf. After Trump spews something inflammatory or just downright false, his unofficial spokespeople hop on cable news and say things like the following:

Katrina Pierson: “I think where he feels a little slighted is the question [Megyn Kelly] had asked him about his comments had nothing to do with Donald Trump the man. It had everything to do with Donald Trump the television character.

Scottie Nell Hughes: “It’s not riots as in a negative thing.”

Chris Christie: “I don’t think he meant literal riots.”

Jeffrey Lord: “I assure you that I mean, if there were a pool there that he could draw from, that he felt he could draw from of qualified people for all Americans, he probably would do so.” (note: there were and he didn’t)

Now before you say, “Yeah, Jacki, but surrogates defend their candidates on TV all the time,” please understand I’m not talking about simple reinforcement. Trump surrogates do something completely different. They interpret his language how they want to hear it. They take his crude and detrimental remarks and recreate a best case scenario even if that scenario is categorically impossible.

This paragraph from David Brooks’ op-ed on Friday perfectly sums up why – words aside – Trump belongs nowhere near the White House:

Donald Trump is epically unprepared to be president. He has no realistic policies, no advisers, no capacity to learn. His vast narcissism makes him a closed fortress. He doesn’t know what he doesn’t know and he’s uninterested in finding out. He insults the office Abraham Lincoln once occupied by running for it with less preparation than most of us would undertake to buy a sofa.

I, too, wholeheartedly believe Trump’s substituting provocative and exaggerated rhetoric for real policy because he has nothing of substance to say and is completely out of his league. I think he’s playing a very dangerous, manipulative game that could – and likely will – have severe consequences. And I’m comfortable sharing my opinion that far too often, the media has been complicit in giving Trump a benefit of the doubt he’s definitely proven he doesn’t deserve.

Even if Donald Trump doesn’t really mean what he says, the fact that he’s mean enough to vocalize it makes him unqualified to lead.

Maya Angelou said, “When someone shows you who they are believe them; the first time.” Donald Trump’s spent decades showing us exactly who he is.

His supporters may assume or want to believe he’s exaggerating, but what if he’s not? What if when he reads the lyrics of Al Wilson’s “The Snake” at rallies now, he’s not referring to Syrian refugees? What if he’s flat out telling us he’s the snake?

Once again, I’m not against risk, but I don’t think Donald Trump is a risk this country should be willing to take.

Laugh Riot

hughesThose of you following along at home already may have seen the clip of Trump supporter Scottie Nell Hughes telling Wolf Blitzer that riots aren’t necessarily a bad thing. Mediaite has a good summary plus video of what went down Wednesday on CNN:

Trump warned of riots if the GOP brokers away his nomination, and Hughes told Wolf Blitzer this afternoon that people would of course be angry. She argued, “Riots aren’t necessarily a bad thing if it means it’s because it’s sitting there and fighting the fact that our establishment Republican party has gone corrupt and decided to ignore the voice of the people.”

Blitzer asked her if she seriously would want riots. Hughes responded, “It’s not riots as in a negative thing.”

I was watching the segment live, and after they came back from break, Wolf did a strange thing. He encouraged Hughes to change her rhetoric. And as she did, she came up with a different definition for the word “riot.” It’s clear she’s reading off something as she cites this “technical” variation. Fast forward to 6:55 and watch until about 8:15:

Hughes found her new definition of “riot” from Oxford Dictionaries. It’s not tough to Google. However, when Trump said there will be riots, Hughes’ convenient second definition definitely is not what he meant.  In fact, it doesn’t even make sense as a possibility. Just look at the sample sentences:


I couldn’t decide what bugged me more about the whole charade: that Wolf editorialized in an effort to help Hughes sound less insane or the fact that he let her even dumber explanation slide.

I know it’s very likely Trump is going to be the Republican nominee, and I know the media then is going to be compelled to pretend he’s not a complete maniac. But he is. And the ridiculous twisted explanations that come out of his surrogates and spokespeople have to be challenged.

Journalists are supposed to research and report facts, and when someone says something incorrect, it’s more than okay to refute it. It’s mandatory. It’s the job.

Or at least it used to be.

Why I Refuse to Ignore Trump

trumpI’ve been watching a lot of Donald Trump rallies lately. Unfiltered. Unedited. In their entirety. There are a couple of networks and websites that carry all of them in real time, and while I’m glad they do, I won’t post names or links here because I have no interest in driving traffic to either. Suffice it to say, they’re not tough to find.

Day in and day out – sometimes two or three times a day – Trump gets up at a podium and gives the same tired, empty speech. Came down the escalator. Record crowds. Don’t have to do this. Self-funding. Lyin’ Ted Cruz. Little Marco. Get rid of Common Core. Repeal and replace Obamacare. We’re building a wall. Who’s paying for it? (Mexico!). Press are the most dishonest. Terrible people. We don’t win anymore. Vets treated horribly. Military depleted. Make America Great Again. Swear you’ll vote for me.

But peppered throughout the rhetoric, without fail, are the extra words of anger, hate, and violence. When a protestor stands up and speaks out – something happening about once every five minutes these days – Trump yells in the microphone variations of the following:

“Get him out of here”

“Go home to mommy”

“Go home and get a job”

He then says they’re  “just singles” and that they’re weak and that they cave quickly.

He ridicules. He makes faces. He launches insults. And then it gets even worse.

He laments the fact that he and his people can’t get physical with phrases like, “It would be so nice. It would be so nice, folks. I refuse to say what’s on my mind.”

“That’s the kind of stuff that’s taking us down. There has to be some law and order. We’re going to do things. Can’t be like this.”

“These people are so bad for our country. You have no idea. They contribute nothing.”

“They help us realize how important we are and how important it is what we’re doing. They add nothing.”

“Troublemakers. Just troublemakers. Get ’em out, police. Come on. Let’s go”

“They all look like spoiled kids.”

“Who are these people? Where do they come from?”

Saturday morning in Ohio, Trump – having learned nothing – called Friday night’s Chicago protest a planned attack by professionally-staged wise guys (not true). Says he dealt with law enforcement at every level (not true) and that they told him not to go (not true). Says his supporters caused no problems (not true).

When protestors showed up Saturday morning and he had a chance to use softer rhetoric, instead he chose to go with “If there’s a group out there, just throw them the hell out,” adding, “The media is the most dishonest group of people I’ve ever met. The worst.”

Then a little later: “We have one protestor. He’s a whack job”

“It’s easy over there. They can just put him out on the runway.”

None of this is new information, but it’s important to put Chicago into accurate perspective. After weeks of taunting people who are speaking out against his bigotry, sexism, ignorance, and all around animosity, thousands turned out in Chicago to say stop. And what did Trump do? He assessed the situation, and against the recommendation of law enforcement, he turned and ran. He left thousands of riled-up people alone to sort it out amongst themselves.

There is such a thing as nonviolent protest. When I was working on health care reform in DC, we learned strategically how to protest insurance industry events. Yes, you can get arrested for just sitting down and refusing to leave, but at no point was any form of violence ever in any plan. And I fully believe the intention Friday night in Chicago was for people to turn out in numbers and show Trump that he’s not as wildly beloved as he likes to think he is.

The truth is that the protestors were not violent. They outnumbered Trump and his supporters. But they were not violent. Things only got out of control once Trump decided not to show up – against law enforcement advice. I knew at the time Trump was lying about consulting with law enforcement because it didn’t make any sense. If police knew Trump was going to cancel, they would have had officers in place to shuttle people out of the hall supervised and in an orderly fashion. Instead, he pulled the plug without warning, and police had to rush to the scene once the fire had been lit. It was dangerous and irresponsible and downright selfish.

Trump wasn’t worried about the people or law enforcement. He was worried about himself. For the first time, he was faced with reality, and he handled it like a high school bully who’s been taunting underclassmen for weeks and finally is confronted by the kids’ older siblings and their friends. Trump is all talk when one or two people show up and speak out, but when real crowds take a stand and say, “Enough!” he bolts.

This is why we have to stay on him. It’s why – as sick as it makes me to listen to him vomit the same tired buzzwords and unbridled venom over and over again – I will keep watching and sharing what I hear and see. Because while Trump has proven he can manipulate a crowd predisposed to gulp his poison in a controlled environment, he’s got nothing but bluster in the light of day. And frankly, I still believe this country has more light than darkness and more love than hate, and the real majority can be mobilized not to let one narcissistic sociopath hijack something as important as our presidency to fuel whatever deranged ego trip he’s on.

Don’t get me wrong. I’m scared. But I still have faith.


Why I’m Not All That Concerned About Clinton’s and Sanders’ Health Care Plans

sanders clintonI haven’t been tweeting or commenting much about either (all if we count O’Malley) of the Democratic candidates’ proposed health care plans. You may think that’s odd for someone who spent two years fighting for national health care reform and who devours health care policy information for fun. But truth is I believe – as someone who fought for health care reform  – that either candidate’s stance will be just fine. Here’s why:

I know both Clinton and Sanders will protect the best of the Affordable Care Act, but neither will be able to get much done to improve upon it without full control of both the House and Senate.

When I started heading up communications for Health Care for America Now (HCAN), we fielded a lot of frustration and a decent amount of full-on anger from staunch single payer advocates. They didn’t understand why a giant progressive coalition wouldn’t start the fight for change from the farthest left stance possible. What I learned and had to explain time and time again was that there is so much deeply engrained fear of change when it comes to health care in this country that proposing something like single payer to the general public would have been a nonstarter in 2008. Add to that the stranglehold the massively influential medical industrial complex has on 17.5% of our nation’s GDP, and we would have been facing sudden death. There wouldn’t have been a negotiating table at all.

You may not remember (oh, but I do) that candidate Obama spent 80% of his advertising budget in October 2008 on ads featuring his health care plans, and those plans emphasized the middle ground between single payer and the private insurance-dominated status quo. That middle ground included setting up a marketplace where people could comparison shop for health insurance plans, including a public option that would serve to control costs and keep private insurance companies honest (ish).

The public option fell by the wayside in December 2009, an ugly casualty of the reality of how laws make their way through Congress. In other words, I’ve seen how the health care reform sausage is made, and it’s not appetizing.

So while I have come to appreciate the benefits of a single payer system and wish we could get there, I know it’s not a realistic outcome in the short term. I get what Sanders is going for, and I’m down for his optimism. I can respect his desire to get the message across that the system we have now is abusive highway robbery at best and deadly at worst, and we can do better. And I also adore his emphasis on the truth that without campaign finance reform, we’ll never get out from under the shackles of big money buying elections and elected officials. I even can vote for it.

But just like President Obama had to change course once he faced the reality of Congressional pushback so would Sanders. All the Presidential will in the world can’t move a stubborn, bought-and-paid-for Congress.

As for Clinton, she’s intimately familiar with the challenges of making any national health reform improvements, and she’s attempting to convey that on the campaign trail. Personally, I wouldn’t mind hearing her be a little less practical and a little more aspirational, but I get it. She knows the game, and she’s aiming to keep expectations low.

Health care reform was a heavy lift, and I don’t expect it to be as high a priority for the next Administration as it was for this one. I think it will be considered a second tier issue compared to the plethora of other economic and national security concerns we have facing our nation at the moment. As much as I love it, and would gobble up every ounce of coverage, I’m not counting on it taking center stage.

Elect a Republican, however, and you can kiss all that is working for patients (eliminated pre-existing condition exclusions, expanded parental coverage for young adults, women not being charged more than men, Medicaid expansions, mandatory essential services) goodbye. There is no viable GOP health care plan. Never was. Never will be. Repeal and replace is a farce. It’s just repeal and move along.

And that’s why I am not going to spend too much time digging into the details of either Clinton’s or Sanders’ health care proposals. They won’t really matter. The one thing that will is protecting the work we’ve done up until now and keeping it intact so we can make incremental adjustments and improvements until this country finally hits the tipping point and is ready for wholesale change.

I’m excited for that day, but we’re just not there yet. The key now is voting for your preference in the primary and then supporting whoever wins the Democratic nomination in the general. And voting for down-ballot Democrats too.

President Obama didn’t have the luxury of enough members of Congress willing to fight for what he promised and what we truly needed in national health care reform. Politics killed the details of good policy. This time around, back whomever you prefer in the primary, but then vow to give the Democratic nominee both your vote and a Congress to work with.

Because no matter the plans presented on the campaign trail, with that kind of support, he or she just may surprise you.


Girl on Film

Jacki on Rubin Report

Jacki on The Rubin Report

A few weeks ago, I shot an episode of The Rubin Report with Dave Rubin and Jimmy Dore. Here’s the show broken out into 7 snack-sized nuggets:

Something New

2014-20152015, huh? I know I know. It’s been a bit since I’ve posted anything here, but that doesn’t mean I haven’t been active and active online. I do some of my best work on Twitter so it’s always a good bet you can find something substantive and/or fun there, like the time I got retweeted by @Cheezit. And if you know my affection for those salty little squares, you will appreciate just how amusing that moment happened to be.

Anyway, on the more serious side, I am working on developing a vehicle by which to address the daily inquiries I get about health care reform, insurance companies, the ACA, and our health care system overall. I think we need an outlet to have conversations about what’s happening away from DC, away from the political posturing, and away from the cloud of partisanship. I’ve argued all along that health care shouldn’t be political. I want to build a forum to talk about – and push to the forefront – policy that works, and that means engaging everyone with some expertise who is willing to participate.

I’m fairly certain I know what this project looks like, and the trick now is finding it the proper home. As the pieces continue to fall into place, I’ll keep you posted. In the meantime, happy new year. I think it’s going to be a good one.

Health Care Quickie: Yes on Prop 45

Where It All Began

CarsonDaly Tweet