Demonstrators hold up signs at an education and awareness event on the Affordable Care Act and protest against Tea Party officials they say are threatening an economic shutdown, in Santa Monica, California, October 10, 2013. (Reuters/Lucy Nicholson)

When the fate of the Affordable Care Act (ACA) was in question, independent Senator Bernie Sanders was no easy “yea” vote.

The single-payer, Medicare-for-All type of system that he favored was never on the table, and the final bill didn’t include a public option. He also felt the legislative process had catered too much to the interests of the healthcare industry, which had spent over $1.4 million per day lobbying to get the bill it wanted.

But Sanders knew Democrats desperately needed his vote. He used that leverage in a successful fight to increase funding for community health centers—comprehensive clinics in medically underserved areas that provide doctors, dentists, mental health counselors and prescription drugs on a sliding-scale fee so that nobody is turned away.

In the end, Sanders helped to pass the ACA—legislation that Republicans are now so desperate to repeal that they have shut down the government and put the full faith and credit of the US in jeopardy. Yesterday on Capitol Hill, Sanders held a forum to spell out exactly what the consequences would be if Republicans were to have their way and the ACA were nixed.

He noted that “we are [still] the only country in the industrialized world that doesn’t guarantee healthcare to people as a right.” As a result, there are 48 million Americans without health insurance. Under the ACA, 20 million currently uninsured people will finally receive coverage (more if GOP governors get out of the way) and thousands of lives will be saved every year as these individuals no longer delay or forgo healthcare.

Sanders pointed to a Harvard study that estimates 45,000 people are dying each year from illnesses that arise due to a lack of health insurance.

“Nobody can come up with an exact figure, but it is absolutely indisputable that if we deny the health insurance that 20 million Americans will get under the Affordable Care Act, at the very least thousands and thousands of our fellow Americans will die,” said Sanders. “For all of those folks saying we have to repeal the Affordable Care Act, what they are doing is passing a death sentence on many of our fellow Americans.”

Ron Pollack, executive director of Families USA, a nonprofit organization that advocates for affordable healthcare for all Americans, said that the US Census Bureau figure of 48 million uninsured is actually low because it is tallied at a specific point in time.

“Forty-eight million is a huge number,” said Pollack, “it’s more than the combined population of twenty-four states plus the District of Columbia. But it does not reflect how many people are uninsured over the course of a year, [which] is considerably larger.”

Families USA used a “conservative” methodology—designed by the nonpartisan Institute of Medicine—to determine how many people between the ages of 25 and 64 died in 2010 due to a lack of health insurance.

“We found that approximately 26,100 people between the ages of 25 and 64 died prematurely due to a lack of health coverage that year,” said Pollack.

He added that this breaks down to 2,175 people dying every month, 502 every week, and seventy-two every day.

“Every three hours a person passes away due to a lack of health insurance,” he said. He added that between 2005 and 2010, it added up to 134,000 preventable deaths.

That’s a number that resonates with Independent Senator Angus King of Maine, who shared his personal experience with health being determined by coverage.

When he was 29, married, and a father of two young children, King obtained health insurance that included a free annual physical. He decided to do it—his first physical in “ten or eleven years.”

The doctor noticed a mole on his back that turned out to be malignant melanoma.

“I thought it was a skin cancer, not a big deal, I learned subsequently that it’s a very deadly form of cancer,” said King.

He had successful surgery—the disease hadn’t spread so he didn’t have to have radiation or chemotherapy “and here I am thirty-nine years later.”

“Had I not had that coverage and the preventive care without the co-pay, I would not be here today,” said King. “Melanoma is one of the most dangerous forms of cancer, but it’s also one of the most treatable. You catch it in time and you live, you don’t catch it in time and you die.”

King tried to make clear the scope of preventable deaths that happen every day due to a lack of health insurance.

“These deaths occur invisibly,” he said. “They occur one at a time, all over the place, and it doesn’t say in the obituary ‘died because of no healthcare.’ If it happened all in one town, at one time, we would be moving heaven and earth to solve this problem, if we lost anywhere from 26,000 to 45,000 [people] a year. If we lost the town of Augusta in one year, and the next year it was someplace in Colorado, or Vermont, this society would have dealt with this many, many years ago.”

The senator noted that the United States is alone in allowing this problem to persist.

“In effect as a society we are watching people die in front of us and not doing anything,” said King. “And we’re the only industrialized country in the world that has basically said, ‘Yes, we are going to allow this to happen.’ ”

It is that isolation among advanced nations that makes Dr. Steven Woolf, director of the Virginia Commonwealth University Center on Society and Health, say that he is “mystified” when critics of the ACA assert that we are better off without the bill.

Woolf chaired a panel earlier this year—convened by the National Research Council and Institute of Medicine—that compared US health with that of sixteen other high-income countries.

“The title of our report says it all—‘Shorter Lives, Poorer Health,’ ” said Woolf. “Americans rank last in life expectancy. We die earlier, and we have higher rates of disease and injury.”

He said “the US health disadvantage” cuts across the whole population—men and women, young and old, all classes, “and across multiple areas of our health.”

Woolf said that flaws in our health care system are a key reason that “American progress in health is [falling] behind other countries’.” The peer countries offer universal healthcare, so Americans comparatively “find care inaccessible or too expensive.”

“A basic requirement is a healthcare system that, number one, works well and, number two, is available to everyone,” said Woolf. “We’ve failed on both counts under our old model, and we now have a chance to build a solid foundation…. Change is difficult, but in this case we will pay with our lives and so will our children if we don’t make a change.”

That need for change couldn’t be any clearer for Dr. Candice Chen, who works as a primary care pediatrician at a clinic five miles from the US Capitol.

“It’s in a part of DC that most people don’t ever go to,” she said.

Most of her patients receive preventive services through Medicaid. In contrast, Chen said, uninsured people first come to the clinic “after being in the emergency room or the hospital for something that was completely preventable like an asthma attack or a tooth abscess.”

She noted that the true costs of those hospitalizations are measured in missed work, school absences and expensive treatments. But these working families aren’t coming to the clinic—or don’t always fill the prescriptions written when they do come—because they don’t have insurance and are struggling to choose between paying for food, rent, and healthcare.

“I find hope in a 2012 New England Journal of Medicine Study by Ben Sommers [that shows] Medicaid expansion saved lives,” said Chen. “Up to [twenty] lives per 100,000 adults. What that shows is that health insurance saves lives and that the Affordable Care Act can and will save lives.”

Instead of bragging about how they are repealing, defunding or delaying Obamacare, maybe it’s time for the GOP to just tell the truth: they are denying tens of thousands of people the opportunity to live.

“Pilgrimage with the Poor”

Prominent faith leaders to join locked-out workers at the House GOP offices to pray and march for an end to the shutdownTuesday, October 15, 10:15 am, Cannon House Office Building rotunda.

Dozens of prominent religious leaders, locked-out workers and families suffering as a result of the shutdown will march to key Republican House offices—including leadership—and demand that members put the government back to work. At each office, the group will pray for the member to vote to immediately end the shutdown. They will also call attention to each representative’s stance on the government shutdown and debt ceiling. Simultaneously, faith leaders will deliver signed petitions to congressional district offices across the country.

Organizers say that politicians have put an “irresponsible agenda ahead of countless Americans.” Among those harmed: seniors who will see “Meals on Wheels” cut, preschoolers shut out of Head Start classrooms, pregnant women and infants whose vital nutrition support is at risk, workers who are locked out of their jobs without pay as the bills pile up and veterans who are facing benefit cuts and delays.

One organizer called it a “pilgrimage with the poor,” and emphasized that they will be marching and singing hymns with people who are being hit the hardest by the shutdown.

Some of the participants include: Sister Simone Campbell, NETWORK; Reverend Michael Livingston, Interfaith Worker Justice; Rabbi Arthur Waskow, the Shalom Center; Martin Shupack, Church World Service; Rev. Jennifer Butler, Faith in Public Life; Douglas Grace, Ecumenical Advocacy Days; Rev. Brian Adams, Mt. Rainier Christian Church; Rev. Ann Tiemeyer, National Council of Churches of Christ in the USA; and Rabbi David Shenyer, Am Kolel Judaic Resource Center.

Get involved

Wendy’s: Help End Slavery in Florida’s Tomato Fields

3 Things You Can Do About the Shutdown Right Now

Good Jobs Now

Tell Congress: There is Nothing Christian About Taking Food from the Poor

Tell nine House Democrats: We didn’t send you to Congress to vote with the Tea Party to shut down the federal government!

Share your story: How has the safety net helped you make ends meet?


The Institute for Policy Studies invites you to its 50th Anniversary Celebration and Reunion highlighting bold, progressive social movements over the last five decades. It will honor activists and activism, and envision a plan for a bold, progressive future. Today through Sunday, details here.

2013 Franklin D. Roosevelt Four Freedoms Awards (Wednesday, October 16, St. James’ Episcopal Church in New York City). These awards are presented annually to distinguished individuals or organizations that represent one of FDR’s famous “Four Freedoms.” This year’s laureates include my good friends from the Coalition of Immokalee Workers and Sister Simone Campbell; also Paul Krugman, Wendell Barry, and Ameena Matthews of Chicago’s Violence Interrupters. You can RSVP to the free public ceremony here.

Featured Article, from Economic Hardship Reporting Project

The GED Is About to Get Much Harder, and Much More Expensive,” Kavitha Cardoza

Clips and other resources

How the shutdown affects poor women and children,” Theresa Anderson and Erika Huber

No Progress Against Hunger,” Bread for the World

Care for the Homeless Graduates First Class of Certified Advocates,” Care for the Homeless

US Workers Lagging Behind on Basic Skills,” Marcie Foster and Janne Huang

Six Myths About Food Stamps,” Dave Johnson

Another View: Our heartless, ongoing war on poor people,” Jos Linn

Housing aid is maddeningly complex. It doesn’t have to be,” Dylan Matthews

12 ways government spending supports vulnerable people,” Zach McDade

Bill Moyers Essay: On the Sabotage of Democracy,” Moyers & Company

Displaced Minority Workers Suffered 29.6 Percent Drop in Wages from the Growing Trade Deficit with China,” Robert Scott

Why Isn’t Poverty Falling? Weakening of Unemployment Insurance Is a Pivotal Factor,” Arloc Sherman

Monthly Updates of the Number of ‘Missing Workers’ and What Unemployment Rate Would Be If They Were Looking for Work,” Heidi Shierholz

A Discussion on Racial Equity, Healing, and Poverty—Part 2,” Spotlight on Poverty

Millions of Poor Are Left Uncovered by Health Law,” Sabrina Tavernise and Robert Gebeloff

‘60 Minutes’ Gets Disability Insurance All Wrong,” George Zornick

Vital Statistics

US poverty (less than $23,492 for a family of four): 46.5 million people, 15 percent.

African-American poverty rate: 27.2 percent.

Hispanic poverty rate: 25.6 percent.

White poverty rate: 9.7 percent.

People with disabilities: 28 percent.

Poorest age group: children, 34.6 percent of all people in poverty are children.

Children in poverty: 16.1 million, 21.8 percent, including 38 percent of African-American children, 34 percent of Latino children, and 12 percent of white children.

Poverty rate among families with children headed by single mothers: 40.9 percent.

Gender gap: Women 31 percent more likely to be poor than men.

Deep poverty (less than $9,142 for a family of three): 20.4 million people, one in fifteen Americans, nearly 10 percent of all children, up from 12.6 million in 2000—an increase of 59 percent.

Twice the poverty level (less than $46,042 for a family of four): 106 million people, approximately one in three Americans.

Jobs in the US paying less than $34,000 a year: 50 percent.

Jobs in the US paying below the poverty line for a family of four, less than $23,000 annually: 25 percent.

Poverty-level wages, 2011: 28 percent of workers.

Federal minimum wage: $7.25 ($2.13 for tipped workers)

Federal minimum wage if indexed to inflation since 1968: $10.59.

Federal minimum wage if it kept pace with productivity gains: $18.72.

Hourly wage needed to lift a family of four above poverty line, 2011: $11.06

Families receiving cash assistance, 1996: 68 for every 100 families living in poverty.

Families receiving cash assistance, 2011: 27 for every 100 families living in poverty.

Impact of public policy, 2011: without government assistance, poverty would have been twice as high—nearly 30 percent of population.

Number of people 65 or older kept out of poverty by Social Security: 15.3 million

Quote of the Week

“When I got there I saw something that I never would have expected to see in this country. People I could have grown up with, who were in long, long, lines waiting to get care that was being provided by these doctors and nurses in barns, in animal stalls. And these people were standing in long lines, in the rain, and they were soaking wet. But they had no other options. And these were not the poorest among us. They were working folks. They were not enrolled in Medicaid or Medicare. They were just people who were victims of circumstance, and in many cases circumstances created by the [health insurance] industry I used to work for.”
   —Wendell Potter, describing visit to Remote Area Medical expedition in Kentucky, at Senator Sanders’ forum on Obamacare.

This Week in Poverty posts here on Friday mornings, and again at Moyers & Company. You can e-mail me at and follow me on Twitter.

Read what President Obama has to do to end the shutdown here.