VIDEO: People in Denmark Are a Lot Happier Than People in the United States. Here’s Why.

The Nation

VIDEO: People in Denmark Are a Lot Happier Than People in the United States. Here’s Why.

When governments provide benefits and services that allow its citizens to thrive, everyone wins.

By The Nation Twitter    July 17, 2017

Text by Joshua Holland. Graphics and animation by Rob Pybus. This work was supported by the Economic Hardship Reporting Project and its Puffin Story Innovation Fund.

Last week, in Denmark, Malthe and Lærke Knudson had a baby girl they named Emma. That same day, the Robinsons—Dale and Beth—had a little baby in the United States. They called her Rachel.

Right now, they’re just two little babies keeping their parents awake at night. But Emma and Rachel were born in countries that have very different priorities, and that’s going to lead to pretty different futures.

It all boils down to this: Though Danes pay a lot more than Americans in taxes and government fees, they get a whole lot more back in social services.

As a result, Americans end up spending twice as much out-of-pocket for those social goods and services. Let’s see how that plays out over their two lives.

Early Childhood Education

In six months, Emma will probably enroll in preschool. By law, every 6-month-old Danish baby is guaranteed high-quality preschool, and parents can’t be charged more than a quarter of the cost of those services. Parents who can’t afford it? They don’t have to pay.

In the United States, kids from low-income families are often eligible for full-time Head Start programs. Even then, the program only has enough funding for a half-million slots nationwide. But the Robinsons make too much to qualify, so they’ll either have to park little Rachel with Dale’s mom, or one of them will have to get a second job to help cover the cost of daycare. That little luxury could set the Robinsons back as much as $22,000 a year.

Danes receive a child benefit which starts with $225 a month at birth, and goes to $140 a month from age 7 to 17. That’s not a benefit just for poor people, everyone gets it!

Child Benefit

It costs a lot to raise kids these days no matter where you live, but the Knudsons will enjoy a child benefit which starts at $225 a month. When Emma hits age seven, they’ll get $140 a month until she’s 17. That’s not a benefit just for poor people; everyone gets it!

Rachel, on the other hand, will have to start learning some cool tricks ASAP in order to get into a decent elementary school and prepare herself for a high school that will help her get into a good college.

Public Schools

Some American schools are world class, but others, often serving students from low-income families, can rank down there with those in developing countries.

That means the Robinsons may soon be shopping for a house in another school district—a notion that would never even occur to the Knudsons, because all of the public schools in Denmark are really good.

Free College

Emma and Rachel are both good students, and they’ll both go to college when they get older. In Denmark, almost every college student attends public colleges and universities, which don’t charge tuition.

Rachel will navigate a very different educational system. She’ll probably end up with a good deal of debt—in the US, 71 percent of the class of 2015 graduated with student-loan debt averaging around $35,000.

Many Danes get about seven weeks of paid vacation every year.

Vacation

Fresh out of school, the young women enter the workforce. And again, they’ll have very different experiences.

If Rachel is lucky, she’ll get two weeks a year of paid vacation, but maybe not—the US is the only industrialized nation that does not require any amount of paid vacation. Emma, like most full-time workers in Denmark, is guaranteed five weeks of paid vacation time a year.

That doesn’t include the nine public holidays, which most employees get. And many Danes enjoy a sixth week of paid vacation during the holidays. And that’s how you relax like a Viking!

Leisure Time

Danes and Americans have similar incomes, but Americans work a whopping 24 percent more hours per year. That means that Danes get to spend about an hour and a half more each day on leisure activities than Americans.

Unemployment Benefits

When Rachel loses her job she’ll qualify for unemployment benefits that cover about half of her income, usually up to half a year.

Emma will face a similar situation—hey, it happens to the best of us—but she’ll get up to 90 percent of what she was making, and she can collect that for up to two years and sometimes more!

Employment

Now, some people say those generous benefits create a culture of dependency and discourage people from looking for a job, but 73 percent of working-age Danes have a paid job, compared with 60 percent of Americans.

Health Care

And Emma will always have access to an excellent public health-care system. In Denmark, everyone’s covered. Americans, on the other hand, spend two and a half times as much per person on health care as the Danes, but around one in eight are still uninsured.

With our lack of paid parental leave, the US has a gender pay gap around three times as large as Denmark’s.

Parental Leave and Gender Pay Disparity

Some day, Emma and Rachel will meet the right partner and have babies themselves. Emma won’t pay anything for delivering her baby, but Rachel will pay around $5,000 out-of-pocket for a normal delivery.

Rachel also lives in the only advanced economy that doesn’t mandate paid family leave. She can take some unpaid time, but for most women, there’s no guarantee that her job will be waiting for her.

One in four American women quit or are laid off when they have a baby, so they lose seniority and end up with an uneven work history. According to one study, each child lowers an American woman’s earnings by 6-8 percent.

Emma and her partner, on the other hand, will be able to divide a full year of paid parental leave between them. Many Danes work under union contracts that give them up to 100 percent of their salaries during that time, but if they don’t, the government will give them $630 per week while they’re on leave.

This is one reason why the gender pay gap is around three times bigger in the United States than it is in Denmark.

Retirement

Emma and Rachel will watch their kids grow up, and then they’ll look to enjoy their golden years.

According to the World Happiness Report, Denmark is the 2nd happiest country in the world. The US is 15th.

As an average American, Rachel will work two years longer than Emma. Emma’s pension will cover two-thirds of her pre-retirement income, while Rachel’s Social Security benefits will cover less than half of what she had earned.

The Result?

Emma will have lived her life under the crushing burden of democratic socialism. That combination of state-funded education, health care, parental leave, and plenty of other benefits has made the citizens of Denmark the second happiest in the world. And Americans? Number 15.

Watch the full video here.

Sen. Al Franken on why he’s a Democrat

Al Franken Gets Emotional Explaining Why He's a Democrat

Al Franken’s beautiful explanation for why he’s a Democrat will move you to tears

Posted by NowThis Politics on Tuesday, July 18, 2017

4.5 GPA Valedictorian’s Earth Shattering Secret

4.5 GPA Valedictorian Reveals Secret

Larissa Martinez, a Texas high school valedictorian, reveals that she is an undocumented immigrant in her valedictorian speech.Summary: https://goo.gl/HC19XeCredit: ABC News

Posted by Illumeably on Sunday, July 16, 2017

What is wrong with Donald Trump?

Chicago Tribune

What is wrong with Donald Trump?

Leonard Pitts Jr., Miami Herald    July 16, 2017

So here we are, six months later. How time has trudged.

But the calendar does not lie. On Thursday, we will be half a year through the Trump Era. And, contrary to his signature promise, America seems less great by the day. Nor are his other promises faring particularly well.

There is no sign of progress on that border wall, much less any idea how he is going to make Mexico pay for the thing. His promise to preserve Medicaid and provide health care for everyone has dissolved into a GOP bill that would gut Medicaid and rob millions of their access to health care.

Meantime, the guy who once said he would be working so hard he would seldom leave the White House spends more time on golf courses than a groundskeeper.

But for all that Trump has not achieved, there is, I think, one thing he indisputably has. He has taught us to live in a state of perpetual chaos and continuous crisis. Six months later, the White House commands the same horrified attention as a car wreck or a house fire.

In that sense, the recent revelation that the Trump campaign, in the person of Donald Trump Jr., did in fact collude with a hostile foreign power to influence the 2016 election was just another Tuesday. Sure, it might have been shocking from the Bush or Obama campaigns. But under Trump, we live in a state of routine calamity.

Besides which, a few days from now, there will be something else. With Trump, there inevitably is. Things can always get worse — and usually do.

And when they do, we can count on the GOP, that inexhaustible fount of righteous outrage, to stand tall and courageously look the other way. For almost 20 years, the party has never seen a minor episode (Travelgate), a sheer nothing (Whitewater) or even an international tragedy (Benghazi) it could not turn into Watergate II. Yet, as credible accusations of treason, obstruction, collusion and corruption swirl about this White House, the GOP has been conspicuous in its acquiescent silence. It seems the elephant has laryngitis.

But the rest of us can’t stop talking.

Indeed, from the studios of CNN to the bar stools of your neighborhood watering hole, amateur psychoanalysis has become America’s favorite pastime in the past six months. Dozens of theories have been floated, all aimed at answering one question:

What is wrong with him?

But I have come to believe that question misses the point. Sixty-three million people voted for this. And make no mistake, they knew what they were getting. It was always obvious that Trump was a not-ready-for-prime-time candidate, but they chose him anyway. And the rest of us need to finally come to grips with the reason why.

It wasn’t economic anxiety. As a study co-sponsored by the Public Religion Research Institute and The Atlantic magazine reported in May, people who were worried for their jobs voted for Hillary Clinton. But people who dislike Mexicans and Muslims, people who oppose same-sex marriage, people mortally offended at a White House occupied by a black guy with a funny name, they voted for Trump.

That’s the reality, and it’s time we quit dancing around it.

This has been said a million times: Donald Trump is a lying, narcissistic, manifestly incompetent child man who is as dumb as a sack of mackerel. But he is the president of the United States because 63 million people preferred that to facing inevitable cultural change. So I am done asking — or caring — what’s wrong with him. Six months in, it’s time we grappled with a far more important question.

What in the world is wrong with us?

Tribune Content Agency. Leonard Pitts is a columnist for the Miami Herald.

Dark Money Review: Nazi oil, the Koch brothers and a rightwing revolution

The Guardian

Dark Money Review: Nazi oil, the Koch brothers and a right-wing revolution

New Yorker writer Jane Mayer examines the origins, rise and dominance of a billionaire class to whom money is no object when it comes to buying power

David Koch listens to speakers at the Defending the American Dream Summit, in Washington DC in November 2011. Photograph: Chip Somodevilla/Getty Images

Charles Kaiser     July 14, 2017

Lots of American industrialists have skeletons in the family closet. Charles and David Koch, however, are in a league of their own.

The father of these famous rightwing billionaires was Fred Koch, who started his fortune with $500,000 received from Stalin for his assistance constructing 15 oil refineries in the Soviet Union in the 1930s. A couple of years later, his company, Winkler-Koch, helped the Nazis complete their third-largest oil refinery. The facility produced hundreds of thousands of gallons of high-octane fuel for the Luftwaffe, until it was destroyed by Allied bombs in 1944.

In 1938, the patriarch wrote that “the only sound countries in the world are Germany, Italy and Japan”. To make sure his children got the right ideas, he hired a German nanny. The nanny was such a fervent Nazi that when France fell in 1940, she resigned and returned to Germany. After that, Fred became the main disciplinarian, whipping his children with belts and tree branches.

These are just a handful of the many bombshells exploded in the pages of Dark Money, Jane Mayer’s indispensable new history “of the billionaires behind the rise of the radical right” in the US.

A veteran investigative reporter and a staff writer for the New Yorker, Mayer has combined her own research with the work of scores of other investigators, to describe how the Kochs and fellow billionaires like Richard Scaife have spent hundreds of millions to “move their political ideas from the fringe to the center of American political life”.

Twenty years after collaborating with the Nazis, Fred Koch had lost none of his taste for extremism. In 1958, he was one of the 11 original members of the John Birch Society, an organization which accused scores of prominent Americans, including President Dwight Eisenhower, of communist sympathies.

In 1960, Koch wrote: “The colored man looms large in the Communist plan to take over America.” He strongly supported the movement to impeach chief justice Earl Warren, after the supreme court voted to desegregate public schools in Brown v Board of Education. His sons became Birchers too, although Charles was more enamored of “antigovernment economic writers” than communist conspiracies.

After their father died, Charles and David bought out their brothers’ shares in the family company, then built it into the second largest privately held corporation in America.

“As their fortunes grew, Charles and David Koch became the primary underwriters of hard-line libertarian politics in America,” Mayer writes. Charles’s goal was to “tear the government out ‘at the root’.”

Another man who studied Charles thought “he was driven by some deeper urge to smash the one thing left in the world that could discipline him: the government”.

Much of what the American right has accomplished can be seen as a reaction to the upheavals of the 1960s, when big corporations like Dow Chemical (which manufactured napalm for the Vietnam War) reached the nadir of their popularity.

In 1971, corporate lawyer (and future supreme court justice) Lewis Powell wrote a 5,000-word memo that was a blueprint for a broad attack on the liberal establishment. The real enemies, Powell wrote, “were the college campus, the pulpit, the media, the intellectual and literary journals, the arts and sciences”, and “politicians”.

He argued that conservatives should control the political debate at its source by demanding “balance” in textbooks, television shows and news coverage – themes that were echoed in inflammatory speeches by Richard Nixon’s vice-president, Spiro Agnew.

The war on liberals was so effective that practically everyone reacted to it: from the New York Times, which hired ex-Nixon speechwriter Bill Safire to “balance” its op-ed page, to the Ford Foundation, which gave $300,000 to the American Enterprise Institute (AEI) in 1972. The impact was cumulative: almost four decades later, Barack Obama was astonished by one of the first questions asked to him, by a New York Times reporter, after he became president: “Are you a socialist?”

The AEI was one of dozens of the new think-tanks bankrolled by hundreds of millions from the Kochs and their allies. Sold to the public as quasi-scholarly organizations, their real function was to legitimize the right to pollute for oil, gas and coal companies, and to argue for ever more tax cuts for the people who created them. Richard Scaife, an heir to the Mellon fortune, gave $23m over 23 years to the Heritage Foundation, after having been the largest single donor to AEI.

Next, the right turned its sights on American campuses. John M Olin founded the Olin Foundation, and spent nearly $200m promoting “free-market ideology and other conservative ideas on the country’s campuses”. It bankrolled a whole new approach to jurisprudence called “law and economics”, Mayer writes, giving $10m to Harvard, $7m to Yale and Chicago, and over $2m to Columbia, Cornell, Georgetown and the University of Virginia.

The amount of spent money has been staggering. Between 2005 and 2008, the Kochs alone spent nearly $25m on organizations fighting climate reform. One study by a Drexel University professor found 140 conservative foundations had spent $558m over seven years for the same purpose.

The next step for the radical right was to support the creation of the Tea Party movement, through organizations like Americans for Prosperity, which was funded by the Kochs.

“The Heritage Foundation, the Cato Institute and Americans for Prosperity provided speakers, talking points, press releases, transportation, and other logistical support,” Mayer writes. As the writer Thomas Frank has pointed out, the genius of this strategy was to “turn corporate self-interest into a movement among people on the streets”.

The last element of this multi-pronged campaign saw the direct investment of hundreds of millions of dollars in political campaigns at every level, from president to city councilor. In 1996, a last-minute $3m campaign of attack ads against Democrats in 29 races, a campaign which may have been financed by the Kochs, was considered outrageous and extravagant. But after the disappearance of virtually all restrictions on campaign contributions – another result of rightwing lobbying and the supreme court’s Citizens United decision – $3m is now a tiny number.

In the 2016 elections, the goal of the Koch network of contributors is to spend $889m, more than twice what they spent in 2012.

Four years ago, because Obama had the most sophisticated vote-pulling operation in the history of American politics, and a rather lackluster opponent, a Democratic president was able to withstand such a gigantic financial onslaught. This time around, it’s not clear that any Democrat will be so fortunate.

  • Charles Kaiser is a writer based in New York. He is the author of 1968 in America, The Gay Metropolis and The Cost of Courage.
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The new Senate health bill is terrible for anyone who is sick, has been sick, or will be sick

Vox

The new Senate health bill is terrible for anyone who is sick, has been sick, or will be sick

The revised Senate bill turns Obamacare into a high-risk pool.

by Ezra Klein       July 13, 2017

The revised Better Care Reconciliation Act was released today, and here’s the bottom line: It returns individual insurance markets to the bad old days when insurers competed on insuring the healthy and finding ways to avoid covering the sick.

There are a host of changes in the new BCRA, most of which leave the fundamental thrust of the legislation intact. But there’s one addition that genuinely changes everything.

Included in the new bill is a version of Ted Cruz’s amendment allowing insurers to offer plans that don’t comply with Obamacare’s insurance regulations so long as they also offer plans that do comply with Obamacare’s insurance regulations.

So imagine you’re an insurer. As long as you offer some Obamacare compliant plans, you can also offer plans that deny people coverage for preexisting conditions, that don’t cover mental health benefits or pregnancy.

What will happen here is clear: The plans that have to offer decent coverage to anyone who wants it, no matter their health care history, will become a magnet for the old and the sick or the soon-to-be-sick, as they can’t afford, or perhaps can’t even buy, the other plans. That will drive premiums in those plans up, pulling younger, healthier people into the non-compliant plans.

The Senate bill thinks it has a fix: a roughly $200 billion fund to offset the costs of sick enrollees. So, in short, what the GOP bill attempts to do is to rebrand high-risk pools as Obamacare plans and make them subsidized dumping grounds for the sick and the old, while everyone else buys insurance in a basically unregulated market.

This is a very bad idea for anyone who is sick, has been sick, or is likely to get sick. It attacks the core changes Obamacare made to build insurance markets that serve the sick, the well, and, crucially, everyone in between.

Prior to the Affordable Care Act, insurers in the individual market worked to sign up healthier people and avoid sicker people. They did this in ways that were crude, like simply refusing to insure people with preexisting conditions, and ways that were subtler, like designing plans that made sense for the healthy but didn’t cover key services needed by the sick.

The Affordable Care Act ended all that. It standardized the benefits insurers had to offer, so they couldn’t design plans that didn’t work for the sick, and barred them from turning the sick away, or charging them more.

The BCRA reverts individual health insurance markets to their pre-Obamacare days. Under this legislation, an insurer who had some Obamacare-compliant plans could also craft plans that were, say, great for 30-year-olds with a low risk of cardiovascular disease, but terrible for 53-year-olds with high blood pressure and cholesterol, or that simply denied coverage to anyone over age 60 with a history of health problems.

The GOP’s answer to this problem is to try to quarantine sicker people off to the side in subsidized plans. But sickness is not a binary state. Yes, the sickest people, the ones who need health insurance most, will do whatever is necessary to get insurance, and the high-risk plans might work for them. But what about young women who insurers consider demographically likely to be pregnant in a few years? They’re not sick enough to be willing to pay the exorbitant premiums of the high-risk plans, but they’re also going to be up-charged by insurers scared of their future costs.

Or how about the 42-year-olds who aren’t sick now, but had health scares in the past? To insurers, they might be basically uninsurable outside a high-risk pool. But to the healthy-feeling 42-year-old, the cost of the high-risk pool may be exorbitant. And so they go uninsured, and then disaster hits.

Nor is there any detail in the bill of how these high-risk pools will work. There are funds states can use to subsidize them, but will they use them? And how will they use them? And will the subsidies make the insurance worthwhile for people who are hard to insure but not yet truly ill?

And what kinds of insurance will actually be subsidized? Will people with serious illnesses and low enough incomes to qualify for Medicaid now be looking at plans with $5,000 deductibles?

Back in May, President Donald Trump said protections for “preexisting conditions are in the bill. And I mandate it. I said, ‘Has to be.’”

Well, now the protections for preexisting conditions are gone. The GOP vision is of health markets where the very sick can buy unaffordable Obamacare-compliant plans that are, maybe, made affordable by subsidies, but most people are back in an insurance market where past allergies or future pregnancy or a history of knee problems will leave you basically uninsurable.

The new Senate health care bill — and the return of preexisting conditions — explained

Vox

The new Senate health care bill — and the return of preexisting conditions — explained

by Sarah Kliff       July 13, 2017

Senate Republicans introduced a revised version of their bill to repeal and replace the Affordable Care Act on Thursday, one that would allow insurers to once again deny coverage based on preexisting conditions, and to charge higher rates to sick people.

The bill would keep most of the Affordable Care Act’s tax increases but repeal one aimed specifically at medical device manufacturers. It would deeply cut the Medicaid program, making few changes to the bill’s first draft.

Even with these new changes, the general structure of the bill stays the same from its original draft, which was itself largely similar to the bill that passed the House in the spring.

Healthier and higher-income Americans would benefit from the changes in the new Republican plan, while low-income and sick Americans would be disadvantaged. It would create a two-track system for health coverage on the individual market. One would offer cheaper, deregulated health plans, which healthy people would likely flock to. The other would include comprehensive plans governed by Obamacare’s regulations, which would cost more and mostly be used by less healthy people and those with preexisting conditions — a system experts expect would function like a poorly funded high-risk pool.

Deductibles would almost certainly rise under the Republican plan, as would overall costs for low- and middle-income Americans. Individual market participants would have more options to purchase catastrophic coverage, an option likely to appeal to those with few health care costs.

Experts expect the changes will do little to change the Congressional Budget Office’s estimates that 22 million Americans would lose coverage under the proposal.

You can see a full explainer on the Senate bill here, which will be updated shortly with the latest information. This post focuses on the changes made in the July 13 revision.

Health insurers could bring back preexisting conditions, offer skimpy health plans

Perhaps the biggest policy change in this revision is an amendment to allow health insurers to deny coverage based on preexisting conditions and cover few benefits, so long as they offer a comprehensive plan that covers the Affordable Care Act’s mandated benefits.

These deregulated health plans would be allowed to charge sick people higher premiums or simply deny them coverage. They would not have to pay by the rules of the preexisting condition ban that the Affordable Care Act sets up (Phil Klein at the Washington Examiner has a summary of the rules they’d be exempted from here). Instead, they would operate much like health plans in the pre-Affordable Care Act market, offering cheap rates to consumers they believe would have low medical bills.

Health policy experts know exactly how this would play out: Healthy people would pick the skimpier plan, while the comprehensive plan would essentially become a high-risk pool for sicker Americans.

Individual market enrollees would likely game the system too. A couple expecting a baby, for example, would be expected to upgrade to the plan that covers maternity care for one year before returning to the cheaper plan they had before.

“Someone with chronic illness, they’re going to end up wanting to buy the more comprehensive coverage,” says Joe Antos, a health policy expert with the conservative American Enterprise Institute. “This means that people with those kinds of illnesses will end up paying more. Even if they receive a federal subsidy, they will likely see higher cost sharing.”

As Antos notes, individuals who want to buy the comprehensive plan would receive federal tax credits to do so. They could not use the tax credits for the deregulated plans.

But even after that financial help, these people would still face significant out-of-pocket costs, including high deductibles and premiums. The Congressional Budget Office estimates, for example, that a 64-year-old individual earning $11,500 and receiving tax credits would still need to pay $4,800 to purchase that plan.

The updated Senate bill also allows individuals to use tax credits to purchase catastrophic coverage

There is a quieter way the Senate bill lets people buy skimpier plans: by using their tax credits to purchase catastrophic plans.

This is a practice the Affordable Care Act barred, as the law’s drafters wanted to encourage enrollment in more generous options. But the Senate bill would allow the tax credits to be used for these high-deductible plans. These plans would only include three primary care visits before individuals hit their deductibles and have to pay their medical bills out of pocket. The plans could cover a wide array of health benefits, including maternity and mental health, but, again, coverage would only kick in after paying a large deductible.

The updated bill would let individuals use pre-tax dollars to pay for their premiums

An estimated 29 percent of American workers are enrolled in tax-advantaged health savings accounts (HSA), that allow them to use pre-tax dollars to cover things like co-payments and coinsurance.

The Senate bill would allow HSA dollars to go toward premiums as well, meaning someone in the individual market could use pre-tax dollars to pay their monthly bill. This practice was not allowed under the Affordable Care Act.

Liberals have typically opposed this provision, which they argue would mainly benefit wealthy Americans who have the money to contribute to an HSA in the first place. This provision would have fewer benefits for low-income Americans, who rely on tax credits to finance the lion’s share of their premium.

The Senate bill gets rid of most Obamacare tax cuts — but keeps two on high earners in place

 

The Senate’s revised health care bill still includes an estimated $657 billion in tax cuts by eliminating the health law’s taxes on the medical industry and its individual mandate penalty for not carrying coverage, among other changes.

It does continue two taxes aimed at wealthy Americans: a 0.9 percent investment tax and a 3.8 percent Medicare payroll surtax. Keeping these two taxes in place would net the government an estimated $231 billion in revenue over the next decade, and eliminate some of the benefits high-income Americans would have received under the first draft.

These new taxes, however, do not seem to be fully spent on enhancing the law’s benefits. The new bill includes a $45 billion program to combat opioid abuse as well as $70 billion to offset the costs of expensive patients (this is in addition to the $112 billion already appropriated for that purpose in the first version of the bill). The inclusion of these taxes does not appear to lead to any additional funding of the Medicaid program or offset any of the cuts to the tax credits in the individual market.

The Senate bill still makes very deep cuts to Medicaid

The Senate bill is notable in what it doesn’t change: namely, significant cuts to the Medicaid program. While moderate senators have protested these cuts (particularly those who represent Medicaid expansion states), these provisions of the Senate bill remain largely intact.

One of the main ways Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Prior to the health law, the entitlement was restricted to specific groups of low-income Americans (pregnant women, for example, and the blind and disabled).

Obamacare opened up the program to anyone below 138 percent of the poverty line (about $15,000 for an individual) in the 31 states (plus the District of Columbia) that opted to participate.

The Medicaid expansion gave states generous funding to cover this particular population. Typically, the federal government picks up about half the cost of the Medicaid program and states cover the rest.

For Medicaid expansion, however, the federal government currently pays 95 percent of the costs — an especially good deal for states meant to assuage their budget concerns during the original Obamacare debate.

The Senate bill would begin ratcheting down that Medicaid expansion funding in 2021. By 2024, states would get that same match rate they typically get to cover other populations. In 2021, for example, the match rate would fall to 90 percent, then decline in steps to 75 percent by 2023.

The Congressional Budget Office has projected in a separate analysis that this policy change would mean no additional states expand Medicaid — and that some current expansion states would drop out of the program, resulting in millions losing coverage.

“CBO anticipates some states that have already expanded their Medicaid programs would no longer offer that coverage,” the agency wrote in its analysis of the House bill, which makes a similar change.

The Senate bill would cut the rest of the Medicaid program too

There are significant changes to Medicaid in the Senate bill outside of the expansion too. This bill would convert Medicaid to a “per capita cap” system, where states would get a lump sum from the federal government for each enrollee. Or states would have the opportunity of a block grant — a sum of money untethered from the number of people involved.

This is very different from current Medicaid funding. Right now the federal government has an open-ended commitment to paying all of a Medicaid enrollee’s bills, regardless of how high they go.

The Senate bill would set different amounts for different groups of people. It envisions, for example, higher payments to cover Medicaid enrollees who are disabled (and tend to have higher costs) than for Medicaid enrollees who are kids (generally healthy with lower costs).

The rate at which these payments grow is also important. The Senate bill would have the funding growth tethered to the Medical Consumer Price Index plus 1 percentage point through 2025, and then switch to the urban Consumer Price Index. Analysis of this type of proposal suggests this change would amount to funding cuts for Medicaid, as the program’s spending typically goes up faster than these growth rates.

Home care workers have our lives in their hands. They’re paid only $10 an hour

the guardian

Inequality…Inequality and Opportunity in America

This series is supported by The Rockefeller Foundation

Home care workers have our lives in their hands. They’re paid only $10 an hour

Home care is expected to add more jobs than any other field in the coming years. Caregivers will look after us in old age – but do we care enough about them?

By Sarah Jaffe     July 13, 2017

June Barrett’s day as a home care worker starts at 5pm and lasts for 16 hours, overnight. All night long, she checks on her elderly clients, a married couple both in their 90s. They sleep in different parts of their Miami home, and much of Barrett’s job is spent trekking through the corridors, back and forth, to make sure husband nor wife has suddenly taken a turn for the worse. “I’m constantly on my feet,” she says.

Two million workers across the US do the kind of home care that Barrett does – the workforce has doubled in size over the past 10 years, and the Bureau of Labor Statistics predicts the field will add more jobs than any other occupation by 2024.

Barrett, a tall woman with short dark hair with a bright red streak and a Jamaican accent, started in the field in 2003, and has worked for her current clients for nearly four years. They require round-the-clock care and so she gets to her clients’ home when the day-shift carer is still there, ready for the handover. She then prepares dinner, helps them eat, and makes sure they get their medication. The wife, Barrett says, doesn’t like to take her pills, so this part of her day requires some finesse.

The husband is able to walk by himself, but the wife needs Barrett to bring her to the bathroom, to wash her and brush her teeth, and to bring her to bed. While her clients sleep, Barrett cleans the kitchen, prepares supplies for the next day, and checks to make sure they have everything they need.

When one of them is ill, the process gets more complicated. “When you do this work, you are responsible for people’s lives,” she says. “One mistake can cost your client his or her life.” Balancing two clients is challenging: when she has to help one bathe, she is worrying about the other’s safety. When things are difficult right now – the wife has slight dementia – she reminds herself that her client was a strong advocate for schools and students when she was younger. “I look at her, I see a warrior woman,” Barrett says.

All things considered, Barrett’s current situation is good. But in the past, she has worked with violent children, people in advanced stages of dementia, and clients who abused her verbally and sexually harassed her.

“Remember now, you and I, we are not sure what is going to happen to us when we become ill,” she says. “We don’t know. So with this work I do, I do it from a place of empathy and from a place of love. I am 53 now. I am giving that care the way that I, June Barrett, would like to get that care when I am old.”

Barrett first came to the US via New York in 2001 and then moved to Miami to join her sister, going straight to her first job interview from a 20-hour Greyhound bus ride. Stepping in to greet her new client, she was met with a racial slur. “I worked my magic and I ended up staying with her for about four months,” she says.

Shortly thereafter, she settled into a live-in job with another elderly couple. At first, she moved her things into the only spare bedroom in the house. But when her client asked where she was sleeping, and Barrett told her, “she said: ‘You must be out of your cotton-picking mind.’ That was the first time I was hearing those words, ‘cotton-picking’. She took everything out from that room. And for five and a half years, I spent those nights sleeping in the study – and I am a tall girl – on a sofa with my feet hanging over.”

She’s also faced sexual harassment on the job – one client demanded she come to bed, groped her and kissed her. “The humiliating part about it was that I wasn’t able to leave right away,” she says. She’d been out of work for a while, and could not afford to leave the job immediately.

Modern home care has its roots in the New Deal era as a way to give work to poor women, explains Eileen Boris, distinguished professor in the department of feminist studies at the University of California, Santa Barbara, and co-author of Caring for America: Home Health Workers in the Shadow of the Welfare State.

Home care exploded in the 1970s, she says, with the birth of the independent living movement among disability rights activists, combined with older people’s desire to avoid nursing homes, which were seen as underfunded warehouses.

“What had been a way to relieve the crisis of public hospitals and to give employment to poor women on public assistance became an integral part of the limited healthcare rights that Americans developed with the Great Society,” Boris says.

The Obama administration was a high point for the rights of home care workers, many of whom were still locked out of basic labor protections. In 2013, the labor department extended federal minimum wage and overtime protections to them. Elly Kugler, who leads federal policy work at the National Domestic Workers Alliance, says it was meaningful because it recognized them as workers, and afforded them additional pay. Wages for home care have been largely stagnant, hovering just above $10 an hour on average.

Low wages had often driven people out of the field who otherwise found the work meaningful, Kugler notes. “Though many of our members care deeply for the work they do … they had to go and work in other kinds of jobs. Meaning fast food, other sectors, making a little bit more money.”

I am giving that care the way that I, June Barrett, would like to get that care when I am old

“I think one of the interesting things about home care is that it forces all these different worlds to connect,” Kugler adds. “The world of state funded home care and and healthcare and also worker rights and disability rights and senior rights and racial justice – all these different worlds are connected in home care.”

Nowhere is that more clear than in the Affordable Care Act (ACA), also known as Obamacare, now under fire from the Trump administration and a Republican Congress.

The expansion of Medicaid, which took effect in 2014, meant more funding for home care and more jobs for care workers. The bill also expanded healthcare for the workers themselves – Barrett had never had chicken pox as a child, and when she contracted it as an adult from a client with shingles, it aggravated her asthma.

The Inequality Project: the Guardian’s in-depth look at our unequal world

“Before the Affordable Care Act passed, one in three home care workers was uninsured,” says Josephine Kalipeni, director of policy and partnerships at Caring Across Generations. After its passage, that rate dropped by 26%.

Because of the general forward trajectory, Kugler says, the Obama years had meant that the movement for care workers had gained more public traction with bigger issues, such as immigrants’ rights (many home care workers are immigrants like Barrett), racial justice, and the value of women’s work. Home care workers had joined the Fight for $15, initiated in part by the Service Employees International Union, which represents tens of thousands of home care workers around the country.

Workers who liked their care jobs, like Barrett, could begin to think about their work as a career.

And then came Trump.

“When I think about how work is being talked about right now and by Trump [when he was] on the campaign trail, it is almost like he colors some jobs pink and some jobs blue, even though there are women in the manufacturing sector and men in the care sector,” Kugler says.

Despite the fact that home health care is one of the fastest-growing jobs in the country, “it has colored the tenor of the debate ever since. We still have this very pink and blue tenor to the debate and only the blue ‘boy’ jobs are really getting talked about.”

It would be bad enough if the Trump administration was merely ignoring the efforts of Barrett and others like her. But the administration’s policies seem designed, Kalipeni says, to uphold a “myth around creating jobs” that returns to the values that created entrenched inequality between rich and poor, black and white, men and women.

Discussions about infrastructure tend to focus on bridges and roads – which are important, certainly, but ignore the equally necessary infrastructure of care that allows a workforce to exist in the first place.

Those priorities are clearly demonstrated in the Republican plan to “repeal and replace” the ACA, currently moving through the Senate. Estimates compiled by the National Domestic Workers Alliance range from 1.8 to 3 million jobs lost in just a few years if “Trumpcare” passes; between 305,000 and 713,000 of those will be home care workers.

The latest version of the bill to be scored by the Congressional Budget Office predicts that 22 million people would lose their health insurance by 2026 if the bill were passed as is. Premiums would spike for elderly people like Barrett’s clients, as Medicaid spending would be slashed by $772 billion over 10 years. Changes to Medicaid could include a “per capita cap,” or a limit to how much the federal government pays states per enrollee in the program.

“It is basically saying, ‘Your state can only get so sick. You can only have so much of a disability and then you are just going to have to pay,’” Kugler says. These cuts, Kalipeni notes, will fall squarely on the shoulders of women – the women of color and immigrant women who do the paid home care work, the women who still do most of the unpaid care work that will pick up the slack when the budgets for paid care are cut.

Until such cuts directly affect people’s lives, she says, people often don’t realize the importance of these systems – and by then it is frequently too late.

When Ana Ramirez came to the US from the Dominican Republic, she got a job at the airport, but the work was grueling and the schedule made it difficult for her to take care of her child. She decided to go through training to become a home care worker.

That was 10 years ago. “I am very good at taking care of people,” she says through a translator. “You get very close to them. When I go and take care of people, they want me to come back. There are people who don’t have a family, and the home care attendant becomes their family.”

Ramirez – a warm, motherly woman with reddish-black hair in a ponytail, who greets me with a hug and a kiss on the cheek – works through an agency in Queens that sends her to different clients. She works 10-hour shifts four days a week, but there have been plenty of times when her hours run beyond that.

Sometimes, her clients’ family members demand things that are not in her job description. “There are people whose family believes that the home attendant is their own domestic worker,” she says.

Some of her clients are bedridden, meaning she must bathe and change them, as well as bring food and water. But she says that the thing that many of them value the most is when she sits with them and listens to them talk about their lives. For Ramirez, it is meaningful work.

Still, the low wages (she is paid $11 an hour) and the sometimes harsh conditions led her to the National Domestic Workers Alliance. Her listening skills from years of care work have made her a natural organizer, a role in which she listens to the complaints of other home care workers and brings them into the organization.

One of those complaints in New York, she says, is that many home care workers moved into the field from other low-wage service work, hoping that it would be an improvement. But then Andrew Cuomo, the state governor, increased the minimum wage specifically for fast-food workers, pushing some care workers to consider returning to fast food.

Barrett first heard about domestic worker organizing when the New York Domestic Workers Bill of Rights passed, in 2010. Then, a year ago, she got a phone call from the Miami Workers Center, and they told her that they were organizing workers like her. When she went to the first assembly, she saw women wearing T-shirts that read “National Domestic Workers Alliance”.

“I can’t explain to you the joy that came to me,” she says of that first meeting. “I’ve always been involved with activism, but I didn’t want it to get involved with work, so I’ve kept my politics, including my queerness, quiet.”

But after the assembly, she says, “I was on fire”. She called her current clients’ daughter, technically her boss, and asked to meet her and her father. In that meeting, she says, she told them that she was going to be a part of the domestic workers’ movement. “I said, ‘I’m sorry, but if this movement needs me then I’m going to be there. If you want, you can fire me, but please give me two weeks’ notice so I can get another job.”

To her surprise, they not only did not fire her, but they gave her a check to donate to the National Domestic Workers Alliance. They have supported her membership in the organization, and have even given her paid time off to travel to speak – she has just returned from a trip to Nicaragua. They said they didn’t want Barrett to fight the fight without taking part themselves. They’ve also given her and the other care workers in the household paid sick days and paid vacation time.

Other clients weren’t so supportive. “They didn’t see me as a human being,” Barrett says. Organizing, she says, is the way to change those conditions. “My self-esteem was stripped from me, horrible stuff was said to me,” she says. “Some women just do [home care] because there’s a check at the end of the month. But if they can regain their own self-worth, their own dignity, they can do this work with pride.”

Three weeks ago, Barrett was one of the speakers at a press conference at Senator Marco Rubio’s office, testifying to the positive changes the Affordable Care Act brought to her life. She is angry, as many of her colleagues are, that once again she has to fight for her work to be seen, to be recognized, for her efforts to be counted as real work and not just a budget line to be slashed.

“People look down on you when you do this work,” she says. “They have to remember that they too are going to get old and this work will continue until the end of the world. There is always going to be somebody needing care.”

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(N.Y.Times) David Brooks has a point – upper class kids have invisible cultural advantages

Washington Post   Monkey Cage

(N.Y.Times) David Brooks has a point – upper class kids have invisible cultural advantages

By Henry Farrell       July 11, 2017

David Brooks is getting a lot of ridicule for an op-ed today, where he uses the example of ordering sandwiches to argue that upper and upper middle class kids have a lot of hidden cultural advantages. Despite the skepticism, many social scientists agree with Brooks’ emphasis on the hidden ways in which culture reinforces inequality, even if they might not all agree with Brooks’ suggestion that these cultural factors outweigh economic and political ones. In 2015, I interviewed Lauren Rivera, an associate professor of management and organizations at Northwestern University’s Kellogg School of management. Her book, “Pedigree: How Elite Students Get Elite Jobs,” examines how inequality is produced by subtle social patterns of education and informal skills as well as big political and economic forces.

When social scientists think about economic inequality and the ways in which elites are able to hand down advantages to their kids, they usually argue that it’s driven by obvious material differences, such as access to good schools. Your book argues that elite privilege can involve subtle benefits that help some students – and not others – get jobs at top ranked law firms, banks and management consultancies. What are these benefits?

LR – Whether intentionally or not, elite parents expose their children to different experiences and styles of interacting that are useful for getting ahead in society. Many of these are taken for granted in upper and upper-middle class circles, such as how to prepare a college application (and having cultivated the right types of accomplishments to impress admissions officers), how to network in a business setting in a way that seems natural, and how to develop rapport with teachers, interviewers, and other gatekeepers to get things you want from those in power. Basically, if we think of economic inequality as a sporting competition, elite parents give their kids a leg up, not only by being able to afford the equipment necessary to play but also by teaching them the rules of the game and giving them insider tips on how to win.

One of your most counter-intuitive arguments is that students from working class and lower-middle class backgrounds are less likely to get elite jobs, because they concentrate on studying rather than their social life at college. That’s the opposite of what the conventional wisdom would suggest. How does these students’ devotion to academic seriousness hurt their job prospects?

LR – Working and lower-middle-class children are less likely to participate in structured extracurricular activities than their more privileged peers while growing up (and when they do, they tend to participate in fewer of them). This hurts their job prospects in two ways. First, it affects the types of schools students attend. Elite universities weigh extracurricular activities heavily in admissions decisions. Given that these employers—which offer some of the highest-paying entry-level jobs in the country—recruit almost exclusively at top schools, many students who focus purely on their studies will be out of the game long before they ever apply to firms. Second, employers also use extracurricular activities, especially those that are driven by “passion” rather than academic or professional interest and require large investments of time and money over many years, to screen résumés. But participation in these activities while in college or graduate school is not a luxury that all can afford, especially if someone needs to work long hours to pay the bills or take care of family members. Essentially, extra-curriculars end up being a double filter on social class that disadvantages job applicants from more modest means both in entering the recruiting pipeline and succeeding within it.

Your book finds an enormous difference in how many recruiters at elite firms treat graduates from a tiny number of prestigious colleges, and how they treat everyone else. Candidates who “chose” to go to a lower ranked school are seen by some recruiters as having demonstrated moral failure. What drives this culture of selectivity and perpetuates it?

LR – Quite simply, we like people who are similar to ourselves. Ask anyone what constitutes a good driver, leader, or parent, and chances are they will describe someone like themselves. The same is true for how people think of merit in the working world. Most employees in these firms are graduates of highly elite undergraduate or graduate programs and believe that’s where talent really resides. In addition, given how segregated our society has become socioeconomically, people who grow up in upper-middle or upper-class communities where college attendance is the norm may not realize structural factors that influence educational pathways and erroneously view university prestige as a reflection of ability alone. Finally, national rankings matter. Rankings provide an easily quantifiable, presumably “scientific” way of making sense of the myriad of educational institutions out there. They both reinforce beliefs that school prestige equals student quality (even though things having nothing to do with students’ abilities factor into a university’s rank) and serve as a convenient justification for limiting recruitment to a small number of elite schools with strong alumni ties to firms.

One of the ways in which your book has been received is as a way for people to figure out how to improve their chances of getting a job at an elite firm. One prominent review treated your book as more or less a “how to” guide for joining the 1 percent. This, presumably, wasn’t your motivation for writing the book. What’s your reaction to readers who are reading the book in ways that may potentially reinforce the problematic system that it is describing?

LR – The purpose of the book was to reveal how taken-for-granted ideas about what merit is and how best to measure it contribute to class inequalities at the top of the U.S. economic ladder. I certainly did not intend for the book to be interpreted as a how-to manual. However, given rising levels of anxiety about class position among the relatively advantaged and the high stakes of getting jobs in these firms, I’m not entirely surprised that some people are using it as a tool to try to game the system. I have mixed feelings about this. On one hand, it can help groups currently disadvantaged in the hiring process, such as working class students and racial minorities, break into these jobs. On the other hand, it can benefit the already advantaged and reinforce the types of inequalities documented in the book. My hope, however, is that the research will open employees’ eyes about inequities and inefficiencies in the way hiring is currently done in these firms and motivate change in a positive direction.

New York Times    Opinion Pages

How We Are Ruining America

David Brooks, Op-ed Columnist      July 11, 2017

Over the past generation, members of the college-educated class have become amazingly good at making sure their children retain their privileged status. They have also become devastatingly good at making sure the children of other classes have limited chances to join their ranks.

How they’ve managed to do the first task — giving their own children a leg up — is pretty obvious. It’s the pediacracy, stupid. Over the past few decades, upper-middle-class Americans have embraced behavior codes that put cultivating successful children at the center of life. As soon as they get money, they turn it into investments in their kids.

Upper-middle-class moms have the means and the maternity leaves to breast-feed their babies at much higher rates than high school-educated moms, and for much longer periods.

Upper-middle-class parents have the means to spend two to three times more time with their preschool children than less affluent parents. Since 1996, education expenditures among the affluent have increased by almost 300 percent, while education spending among every other group is basically flat.

As life has gotten worse for the rest in the middle class, upper-middle-class parents have become fanatical about making sure their children never sink back to those levels, and of course there’s nothing wrong in devoting yourself to your own progeny.

It’s when we turn to the next task — excluding other people’s children from the same opportunities — that things become morally dicey. Richard Reeves of the Brookings Institution recently published a book called “Dream Hoarders” detailing some of the structural ways the well educated rig the system.

The most important is residential zoning restrictions. Well-educated people tend to live in places like Portland, New York and San Francisco that have housing and construction rules that keep the poor and less educated away from places with good schools and good job opportunities.

These rules have a devastating effect on economic growth nationwide. Research by economists Chang-Tai Hsieh and Enrico Moretti suggests that zoning restrictions in the nation’s 220 top metro areas lowered aggregate U.S. growth by more than 50 percent from 1964 to 2009. The restrictions also have a crucial role in widening inequality. An analysis by Jonathan Rothwell finds that if the most restrictive cities became like the least restrictive, the inequality between different neighborhoods would be cut in half.

Reeves’s second structural barrier is the college admissions game. Educated parents live in neighborhoods with the best teachers, they top off their local public school budgets and they benefit from legacy admissions rules, from admissions criteria that reward kids who grow up with lots of enriching travel and from unpaid internships that lead to jobs.

It’s no wonder that 70 percent of the students in the nation’s 200 most competitive schools come from the top quarter of the income distribution. With their admissions criteria, America’s elite colleges sit atop gigantic mountains of privilege, and then with their scholarship policies they salve their consciences by offering teeny step ladders for everybody else.

I was braced by Reeves’s book, but after speaking with him a few times about it, I’ve come to think the structural barriers he emphasizes are less important than the informal social barriers that segregate the lower 80 percent.

Recently I took a friend with only a high school degree to lunch. Insensitively, I led her into a gourmet sandwich shop. Suddenly I saw her face freeze up as she was confronted with sandwiches named “Padrino” and “Pomodoro” and ingredients like soppressata, capicollo and a striata baguette. I quickly asked her if she wanted to go somewhere else and she anxiously nodded yes and we ate Mexican.

American upper-middle-class culture (where the opportunities are) is now laced with cultural signifiers that are completely illegible unless you happen to have grown up in this class. They play on the normal human fear of humiliation and exclusion. Their chief message is, “You are not welcome here.”

In her thorough book “The Sum of Small Things,” Elizabeth Currid-Halkett argues that the educated class establishes class barriers not through material consumption and wealth display but by establishing practices that can be accessed only by those who possess rarefied information.

To feel at home in opportunity-rich areas, you’ve got to understand the right barre techniques, sport the right baby carrier, have the right podcast, food truck, tea, wine and Pilates tastes, not to mention possess the right attitudes about David Foster Wallace, child-rearing, gender norms and intersectionality.

The educated class has built an ever more intricate net to cradle us in and ease everyone else out. It’s not really the prices that ensure 80 percent of your co-shoppers at Whole Foods are, comfortingly, also college grads; it’s the cultural codes.

Status rules are partly about collusion, about attracting educated people to your circle, tightening the bonds between you and erecting shields against everybody else. We in the educated class have created barriers to mobility that are more devastating for being invisible. The rest of America can’t name them, can’t understand them. They just know they’re there.

Single-payer healthcare gains traction with Democrats

The Hill

Single-payer healthcare gains traction with Democrats

By Lisa Hagen and Rachel Roubein      July 9, 2017

Democrats are increasingly committing to support single-payer healthcare, amid Republican attacks on ObamaCare and pressure from their party’s left-wing base.

What was once considered only a progressive talking point has gained traction as more Democratic candidates have been willing to embrace government-funded healthcare on the campaign trail and more House members have been signing onto the idea.

Single-payer isn’t just being discussed in liberal enclaves of the country like California, where a single-payer measure recently fell short in the state Assembly. It’s a hot topic in Speaker Paul Ryan’s (R-Wis.) Republican-leaning district, where all the Democratic candidates running in the primary have supported it.

The idea hasn’t won universal appeal in the party, but the spotlight has been shone on the concept of a government-run healthcare system as concerns mount over the Senate GOP’s plan to repeal and replace ObamaCare, which would lead to 22 million more Americans without insurance.

Sen. Bernie Sanders (I-Vt.) championed the idea of universal healthcare during his insurgent presidential campaign, and he’ll introduce his single-payer plan once the debate over ObamaCare ends.

Other senators — such as Elizabeth Warren (D-Mass.) and Kirsten Gillibrand (D-N.Y.), two potential 2020 contenders — are getting on board with a Medicare for All proposal. Sen. Tammy Baldwin (D-Wis.), who faces a tough reelection in a state won by President Trump, said she’s a “maybe” on Sanders’s plan but “anticipates” supporting it, according to The Capital Times.

In the House, Rep. John Conyers Jr.’s (D-Mich.) Medicare for All bill has already netted 113 co-sponsors — nearly double the number of co-sponsors the legislation garnered last congressional session.

Key names are noticeably absent from the list, including House Minority Leader Nancy Pelosi (D-Calif.) and Minority Whip Steny Hoyer (D-Md.). But other members of leadership, including Democratic Caucus Chairman Joseph Crowley (D-N.Y.) and Assistant Democratic Leader James Clyburn (D-S.C.), are co-sponsors of the bill.

“It’s nice to see many senators … and a variety of people in the House publicly stating for the first time on record that a single-payer system is the way of the future that we need to be working toward,” Shannon Jackson, the executive director of the Sanders-aligned group Our Revolution, told The Hill.

Warren has publicly encouraged Democratic candidates to campaign on the idea in 2018 and 2020. But even though the Democrats in Ryan’s likely safe GOP district are supporting it, other Democratic candidates in red states and districts have been more cautious about endorsing single-payer. Rob Quist, the Montana Democrat endorsed by Sanders, was the only candidate in this year’s House special elections to run on that platform.

“I think that the politicians who choose to run on a campaign that states and embodies that pillar of our platform will be successful and they will be able to connect with the people,” Jackson said.

A Kaiser Family Foundation poll shows a modest increase in Americans’ support for the concept, with 53 percent of the public supporting all Americans getting their coverage through a single government plan.

That’s up from 2008 and 2009, when about 46 percent of the public held this position. A majority of the uptick in support has come from independents, Kaiser noted.

But in practice, Democrats haven’t been able to muster enough votes to pass a single-payer plan. In California’s state Assembly, moderate and progressive Democrats couldn’t agree on the proposal. While it passed the state Senate, California Assembly Speaker Anthony Rendon (D) ultimately tabled the proposal in his chamber.

“It’ll tend to be an issue that more left-leaning Democrats are willing to embrace,” said Dan Mendelson, president of consulting firm Avalere Health.

“In order to embrace that concept, you’ll have to be willing to defend the efficiency and effectiveness of a fully run government system, and there are many Democrats who are not going to do that and there are some who are.”

For Democrats, the increased talk about single-payer offers an alternative message to oppose the Senate GOP’s bill to repeal and replace ObamaCare, he said.

Under a single-payer system, all Americans would have health coverage, whereas the nonpartisan Congressional Budget Office estimates 22 million people would become uninsured under the Senate GOP’s healthcare plan.

“I think what you see is the Democrats on the Hill are searching for a single unifying message to unite in opposition to what is happening presently in the Congress,” Mendelson said. “And that’s really what they’re looking for.”

Republicans have taken note, seizing on Warren’s request for Democrats to campaign on single-payer in an attempt to play offense in the healthcare debate as Republicans struggle with their unpopular plan.

But Republicans are seeing an advantage in Democrats’ embrace of single-payer, too. The National Republican Senatorial Committee (NRSC) is running auto-play Facebook ads that seek to tie the 10 Democratic senators up for reelection in states Trump won to Warren and government-run healthcare.

The Senate GOP’s campaign arm and the Republican National Committee have pointed to studies that say Medicare for All could cost as much as $32 trillion over a decade.

“I think that the idea that this is becoming our central focus is mistaken and one that our opponents are trying to put forward so they don’t have to talk about their age tax,” said a Democratic strategist with ties to Senate races. “What unites Senate Democrats is opposition to this disaster of a Republican bill.”

Some Republicans don’t see single-payer becoming a toxic issue for Democrats, arguing that those kinds of attacks are more of a “deflection tool” from the GOP’s own healthcare bill.

“It almost seems like it’s too wonky and not enough red meat to really make something catch fire,” a Republican operative in Washington told The Hill. “It’s hard to attack Democrats over single-payer healthcare when we can’t get our act together on repealing ObamaCare.”

Despite increasing talk of single-payer, Democrats haven’t agreed yet on a healthcare message for the 2018 midterms, in part because that will depend on whether Republicans manage to repeal ObamaCare.

“The [GOP] Senate bill is almost designed to make healthcare top-tier issue in the next elections,” said Larry Levitt, a Kaiser Family Foundation senior vice president.

“If the repeal and the replace bill is enacted and signed into law, Democrats will face a challenge as to what their healthcare message will be in 2018 and 2020,” Levitt said, adding that “it’s very likely that many Democrats would turn to single-payer as the next step.”