Healthcare reform battlegrounds: where the uninsured are
Dante Chinni
Posted: 05.04.2009 / 7:43 AM PDT
Swine flu may seem like the only healthcare story in Washington right now, but a potentially much bigger story is coming to town.
Last week, the Obama administration got its wish as Congress passed the president’s budget plan and included language allowing for the use of “reconciliation” on this year’s healthcare reform bills in the Senate. Reconciliation allows bills to be brought for a vote with a simple majority, rather than 60 votes.
The meaning? The chances for healthcare reform in 2009 officially just jumped.
The debate in our 11 Patchwork Nation communities will not all be the same. In some places, the fight will be about expanding coverage. In others, it will center on maintaining benefits, while still others will probably be about immigration.
The issues in play on healthcare reform are vast – from legacy costs for automakers to stability for the new entrepreneurial economy – and they intersect with our community types in a variety of ways. A look at who is uninsured, or at least who was (these figures, the latest available, are from 2005), shows how multifaceted the issue is.
The intersection with the immigration debate
Community types with the largest numbers of uninsured are different in many ways – urban and exurban, liberal and conservative – but they share one common trait: They all have higher-than-average numbers of Hispanic residents.
The places with the highest percentage of uninsured by far, at about 23 percent, are our heavily Latino “Immigration Nation.” Many of the jobs in these places do not pay well or offer benefits such as healthcare. Illegal immigrants in these places, moreover, are extremely unlikely to have coverage.
Next on the list, our growing and diversifying “Boom Towns” have about 21 percent of their residents living without health insurance. These communities, while generally wealthier, had a lot of construction jobs as they grew during the housing boom, and many of those positions were filled by immigrant labor.
The same might be said for our socially conservative “Evangelical Epicenters.”
Meanwhile, the situation in our big-city “Industrial Metropolis” communities is slightly different. These areas are diverse, with many ethnicities and races but also with more working poor – people less likely to have insurance.
The reaction to broad healthcare reform will almost certainly vary greatly in these locales. There will likely be strong support in the “Industrial Metropolis,” where the issue will be tied to inequality and poverty. Meanwhile, in “Immigration Nation” it’s easy to imagine the issue becoming the latest front in the immigration wars. Those communities are already sharply divided on that front.
New issues
These figures on the uninsured are considered to be the best available on the topic, but they were taken from small samples, according to people at the Kaiser Family Foundation, which studies healthcare. Many experts believe they may understate the number of uninsured.
And considering the changes in the economy over the past few years, there is good reason to believe these numbers have changed appreciably, altering the calculus of reform.
For instance, it’s likely that the number of uninsured in our small-town “Service Worker Centers” has climbed as unemployment has risen. Those places have fairly low median household incomes and, even in two-income homes, often only one person will have insurance. When those jobs go, so does the health coverage. There may be strong support for reform in those communities.
Even the wealthy “Monied ‘Burbs,” which have a low percentage of uninsured and more people in good-paying jobs, may be more interested in supporting healthcare reform in 2009. There are certainly a large number of “gold-plated” plans in those places, but as white-collar jobs are threatened and disappear and low- or no-benefits jobs like self-employment and consulting grow, there will be countervailing forces.
Communication with our communities, however, reveals one community type that seems likely to be most resistant to any reform efforts: our aging “Emptying Nests.” They have the least amount of uninsured – only about 14 percent. Many people living in them have plans negotiated with employers long ago – some of these plans are those “legacy costs” the automakers complain about – and they aren’t eager to change.
“We’re talking about going into national health, I’m fearful of where we’re heading in that direction,” says Ray Goodgame, a city councilman in Clermont, Fla., our representative “Emptying Nest.” They are words we’ve heard from many there. “I don’t think the system we got now is perfect, but I had rather see us help those people that can’t afford it, rather then take the people who can afford it and put them on a government payroll for health.”
Those arguments are similar to the ones heard in the early 1990s, the time America last engaged in a serious healthcare reform debate. The question is how much the economic downturn and the larger changes in the global economy have altered the landscape on the issue.
May 4th, 2009 at 3:10 pm PDT
Dante - Lake County has the oldest age demographic in all of Central Florida, a total of 7 counties. I do believe we have a good number of retirees here who have employer sponsored health insurance as part of their retirement plan.
I also will bet that many here who are retired only have medicare and maybe a medicare supplement for healthcare and that overall, Medicare has a lot to do with why Emptying Nesters on average have the lowest rate of people without insurance in your survey.
I would also bet that if you look at working families and individuals here, that there is a much higher rate of uninsureds that is being hidden by the retiree demographics, reflecting moreso the high rate of uninsureds that is seen across the state.
May 5th, 2009 at 11:38 am PDT
Older Americans have good cause to fear “universal healthcare.” In Europe older native Europeans are being systematically denied medical care (that they paid for all of their lives) so that younger immigrants and their children can receive “free” medical care (which they largely didn’t pay for). A vote for “universal healthcare” is a vote for medical rationing for the elderly, as well as a vote for just another huge magnet for 110 million Mexicans and 50 million Central Americans to come to this country for their “better life” at the expense of native-born Americans. Let’s not kid ourselves: with our open borders and a government unwilling to enforce immigration laws, we’re not talking about universal healthcare for 300 million Americans, but for 450 million people and counting.
May 6th, 2009 at 8:36 pm PDT
MaryJ, I hardly believe that the government would allow the denial of health care for older americans. Yes, it can be said that the older demographic requires more health care, but what about the 19-35 year olds who rarely require any medical care, excluding child bearing women. Who is to say that an immigrant class would require any more medical attention than native Americans.?
May 7th, 2009 at 5:31 pm PDT
JohnF, if you don’t believe me, check out what is happening in Europe. In Sweden the wait for hip replacement surgery is five years. Meanwhile, Third World “immigrants” who showed up yesterday, and who paid little into the expensive universal heathcare system, get priority over elderly Europeans who paid for universal healthcare all their lives. We already see how much our “government” favors illegal immigrants over native-born Americans in many areas of policy — just think how this favoritism would play out in the healthcare arena. In addition, we really do not need another magnet for illegal immigration, period.