Single-moms will be next. The Center on Budget and Policy Priorities, described by Vice President Joe BidenJoseph (Joe) Robinette BidenThe Hill's 12:30 Report Biden to decide on White House run at end of year Stormy Daniels’s 'View' is incorrect MORE as “invaluable” and  “the go-to resource for consistently reliable analysis on matters of budgets and fiscal policy at every level of government,” note that the law contains provisions “significant disincentives to hire or retain” low and moderate income families.  By penalizing companies if even a single employee meets the qualifications for a subsidy, employers will be forced to look to hire families with two wage earners, or those without children, so that the likelihood of meeting the subsidy threshold is diminished.

Reeling state budgets mean higher taxes on everything, and fewer services.  The ‘maintenance of effort’ requirement in the law says eligibility for all Medicaid and SCHIP programs cannot be diminished or all federal matching funds for these programs will be forfeited.  The trickle down effect in Arizona, for example, is a new 2% food tax in Phoenix and the prospect of an 18% increase in the state sales tax.  Education and public safety funding across the country are being cut.  Who are the biggest losers?  Low income and minority communities, who are now being asked to give more out of their communities, for benefits that may or may not materialize over the next decade.

Jobs will be harder to come by as well.  With many of the biggest corporations being forced to write down hundreds of millions in new tax liabilities for their retirees, with young entrepreneurs at risk of being taxed an extra 2.5% of their income and investors in companies looking at a new 3.8% tax on any returns, where the jobs are expected to come from remains a mystery.  And a new tax provision on businesses to create IRS documentation for any purchase of $600 over the course of an entire year from any vendor means huge new costs just to comply.

Once on the bursting Medicaid rolls, having insurance will mean little in the new ‘health care deserts’ that the law creates in inner cities and poor areas around America.  The law fails to provide any relief for such inadequate payment for services that Walgreens in Washington state has already stopped filling Medicaid prescriptions.  Medicaid payments average 30% less than even Medicare, and in many states are far less.  The law cuts $42 billion in home health care and penalizes hospitals for readmissions.  Low income patients are the most likely to have inadequate social support systems to handle after-discharge care without help.  It all adds up to a recipe for no providers, hospitals that need to move away from these areas to survive, and leaving residents with only one option: government-run community health clinics.

Even if low income and minority Americans manage to find a doctor to see them, their care will be inferior—by design.  When the mammogram issue exploded last November, and millions of American women age 40-49 were suddenly at risk of losing access to mammograms, Senator Mikulski wrote an amendment that ended up being incorporated into the law on page 13. 

She and her fellow Democrats, and the President, did not bother to include those who get insurance through Medicaid.  California, to cut costs, in response to the new government recommendations, eliminated mammograms for Medicaid women age 40-50.  Minority women have lower rates of screening already, and African-American women have a lower incidence of breast cancer, but it is more deadly.  And a provision in section 2713 banning out of pocket spending for some preventive care could easily be interpreted to prevent these women to seek mammograms with their own money.

The President and Democrats in Congress who voted for this assault on low-income and minority access to quality health care now have the gall to beg for their votes and enthusiasm. Every member and leader of these communities should demand a full and open accounting from those who voted ‘yes’, and not accept the usual brush off of “we’ll fix it later.”