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In healthcare debate, words matter, in their connotations and their number

By Tom Baxter

Recently, the indispensable Georgia Health News published six questions it submitted to the Stacey Abrams and Brian Kemp campaigns, and their full written responses. Abrams’ combined answers came to 885 words, Kemp’s to 297.

How much you say doesn’t matter as much as what you say, but in this case the word count speaks volumes about the way Georgia’s Democratic and Republican candidates for governor have positioned themselves on health care issues.

Abrams is one of several Democrats around the country who have made health care their top issue. Her answers, and the health care plan she released later, have a lot of details and take firm stands. Her answers never mention Kemp.

Kemp, on the other hand, spends several of the few words he has to say about health care criticizing Abrams’ “radical plan” which will “literally bankrupt our state while making it harder for hard-working Georgians to receive the care they need.” His answers are heavy on campaign boilerplate and light on details.

The Republican nominee is expected to release his health care plan in the next few days, and that should flesh out his positions somewhat. But he’s playing defense on this issue and likely will be throughout the fall campaign.

Last week the Kemp campaign moved a little on the question of state innovation waivers, which allow states to create their own health insurance programs so long as they provide the same protections as the Affordable Care Act. Kemp is open to something like the Wisconsin waiver program, which sets up a reinsurance program to cap insurance costs. Abrams has already proposed something similar, which is one of the benefits of saying three times as much on an issue as your opponent.

“The word waiver, what that means, whether it’s a waiver, flexibility, allowing the states to be an incubator – if somebody is talking about that on the federal level, I’m glad to talk to them,” Kemp told the AJC.

Yes, the word, such a critical part of every political discussion of health care in the United States. The state innovation waivers are a provision of the Affordable Care Act, which is also known as Obamacare, except the waivers have given state legislators the chance to say it’s something else and still receive federal funds.

This morning’s email brought a come-on from something called Trumpcare Medicare. I didn’t click the onscreen button to learn more about this scam, but the changing vocabulary of con artists is worth noting. Very slowly, an old word is losing its punch and a new one is being created, before what it is describing exactly exists.

Georgia has remained politically frozen over that word, Obamacare, for a decade, so that slight movement by the Kemp campaign signals a  significant shift. As Abrams likes to point out, the state has been losing $8 million a day in federal funds throughout that period, while Gov. Nathan Deal and now Kemp have argued that the program would bust the state budget in the long run.

This would, in fact, have been a lot of long run. In hindsight, after a decade in which rural hospitals have struggled to survive and demands on services for the old and poor have been strained to the breaking point, it’s hard to argue the state wouldn’t have been better off taking the money, up to now.

As for the future, the Trump administration remains committed to dismantling Obamacare and the Republican attorneys general of 20 states including Georgia have sued to have it declared unconstitutional. In the long run, to use the aforementioned words, these efforts may be successful.

But in the meantime the sky-high rates being offered in Georgia’s ACA insurance market actually went down a tad this year, even as the percentage of those without insurance has crept upward. We’ll be working within the framework of the existing law for at least the immediate future, and given the frustrations congressional Republicans have had in fashioning an alternative, that could turn into a long time. It’s really more a question of what words we’ll use to describe it.

Tom Baxter

Tom Baxter has written about politics and the South for more than four decades. He was national editor and chief political correspondent at the Atlanta Journal-Constitution, and later edited The Southern Political Report, an online publication, for four years. Tom was the consultant for the 2008 election night coverage sponsored jointly by Current TV, Digg and Twitter, and a 2011 fellow at the Robert J. Dole Institute of Politics at the University of Kansas. He has written about the impact of Georgia’s and Alabama's immigration laws in reports for the Center for American Progress. Tom and his wife, Lili, have three adult children and seven grandchildren.


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  1. George Wilson September 24, 2018 3:33 pm

    Georgia’s failure to extend Medicaid to everyone is one of the great failures of the Republican rule.It cost Georgia 60,000 jobs, kills hundreds of Georgians each year who lack health benefits, and puts medical care in rural areas at risk. We can afford it as many other states have over the years. This alone is enough to vote against every Republican.Report

  2. Chris Johnston September 24, 2018 10:17 pm

    @ George Wilson
    Please provide authoritative sources that verify the three assertions in your second sentence.Report

  3. George Wilson September 25, 2018 4:18 pm

    Expanding Medicaid expands employment in Georgia by 64,000

    A report by the White House Council of Economic Advisers, Missed Opportunities: The Consequences of State Decisions not to Expand Medicaid, outlines health and economic opportunities that residents in non-Medicaid expansion states are missing. Based on that data, residents of each of those states would benefit from gains in health, economic growth, and job creation if their state chose to expand Medicaid.
    Expanding Medicaid will mean that more state residents will have access to health care, get recommended preventive health services, and get the care they need when they are sick. Also, studies have shown a lower infant mortality rate. It is interesting that most of the states rejecting the expansion of Medicaid are in the south. Wonder why?Report

  4. George Wilson September 25, 2018 4:26 pm

    Expansion of Medicaid saves lives

    We draw on the scientific literature demonstrating that expanding health insurance reduces deaths. We specifically apply the results of a particularly robust study of the effects of health care reform in Massachusetts on mortality. Massachusetts’ health care reform — which expanded Medicaid, offered subsidized private insurance, and included an individual mandate — famously served as a model for the ACA. The Massachusetts study looked at county-level mortality data in 2001 to 2005 (pre-reform) and 2007 to 2010 (post-reform), and compared the changes to carefully selected control groups in other states that had not enacted health reform.
    For every 830 individuals insured, the authors found, one life was saved. In medical terms, 830 in this context is the “number needed to treat.” To put this into perspective, the colonoscopy number needed to treat is 1250; you need to conduct 1250 colonoscopy screenings to prevent one colorectal cancer death.
    Overall, in Massachusetts, insurance coverage expansion was associated with a 3 percent decline in mortality from all causes, and a 4.5 percent decrease in deaths from causes that are especially amenable to being prevented by health care — including heart disease, infection, diabetes, and cancer.
    Assuming that one death will occur for every 830 people who lose coverage is the same methodology used by the White House Council of Economic Advisers under the Obama administration to calculate reductions in mortality associated with the ACA.Report


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