The Takeaway: Gun Violence is a Public Health Issue. Time for Congress to Treat it Like One
Gun violence in the US seems to have reached epidemic proportions averaging at least one mass shooting per day in 2015. According to OECD data 87 percent of the children in the developed world who die from gun violence live in the US. House Democratic Leader Nancy Pelosi is pushing for an end to the ban on government-funded research on gun violence as part of a final budget agreement. The ban was put in place after the CDC found that having a gun at home led to a 300 percent increase in the chance of homicide or suicide.
While they are at it, Congress should consider an amendment to Rep. Pelosi’s effort, to fill a void in the tracking of violent deaths by creating a registry of law enforcement related deaths as recommended by researchers at the Harvard School of Public Health. Currently there is no central data source for such deaths, but the British newspaper The Guardian reports 886 law enforcement related fatalities so far in 2015, with black Americans being killed at roughly twice the proportionate level of their representation in the population.
Missed Opportunity on Enrollment?
In the absence of the ability to enact any legislative tweaks to the law, the Obama administration is limited in what it can do to smooth ACA implementation, but one has to wonder why it doesn’t at least do what it can. Case in point: people who miss open enrollment this year will not be eligible for a Special Enrollment Period (SEP). Given the oft-expressed desire to boost public perception of the law and to enhance enrollment, continuing this 2 for 1 win-win policy should be an easy decision. Without the SEP, at the same time that some people learn that they have to pay a penalty for this year, they will also be informed that they owe a penalty for next year and that it is too late to do anything about it. Maybe at some point the SEP will be unnecessary and it will make sense to suspend the option. But for now there are still a lot of people encountering the purchasing requirement for the first time–people aging off their parents’ plan, or who don’t have ESI for the first time in their lives or who for the first time earn enough money to owe a penalty. The SEP makes good sense and should be continued at least for the next few years.
Getting the ACA Jobs Story Wrong (Yet) Again
Some ACA-related misinformation seems as hard to kill as zombies. One perennial canard relates to the effect of the law on jobs. The CBO recently released an updated report on the ACA and labor force participation, which was predictably misrepresented as “the ACA causing job loss.”
What the CBO is really saying is that some people who had in the past been forced to work more hours than they wanted to in order to obtain health benefits, now will no longer have to. The truth is that not only has job growth has been pretty robust since ACA passage, but the health care sector will be one of the bright spots with respect to job growth in the future, largely courtesy of the ACA.
The Complicated Lessons of Kentucky
Although Governor Matt Bevin ran on a promise to rollback Kentucky’s successful Medicaid expansion, it appears that he won his election in spite of, not because of, his position. According to a recent Kaiser Family Foundation poll, a large majority of residents (72 percent), including a majority of Democrats, Independents and Republicans, favor leaving the expansion as is, rather than scaling it back. How should we understand this seeming contradiction especially in light of the fact that Gov. Bevin won a majority in a number of districts with the highest percentage of Medicaid enrollees?
First off, it is important to note that Kaiser polled residents, not voters. Many of the people who benefit from Medicaid coverage did not turn out to vote. Among Bevin voters, a majority favor scaling back Medicaid. The lesson for ACA supporters is that improving voter turnout, especially in non-presidential-election years, should be an urgent priority – right up alongside boosting enrollment and getting holdout states to expand Medicaid. The turnout in Kentucky was a dreadful 31 percent.
Second, elections are rarely about single issues. Each candidate is a complex mix of policy positions and perceived personal characteristics, including party identity. Voters will often support a candidate even if they disagree on some issues. But here is a lesson for officeholders. Too often, elected officials over-interpret their victory as a mandate to enact policies that the public does not actually support. Politicians who follow this course can soon find their public support evaporating. If Governor Bevin seeks to undermine Medicaid coverage in Kentucky, he should expect his current popularity to be short-lived.