California led the nationwide charge in implementing the Affordable Care Act, including a provision in it that has helped a little more than 2 million more people sign up for the state’s low-income health insurance program known as Medi-Cal.But in spring, the Brown administration turned down a $6 million grant from the California Endowment (TCE) to keep those previously enrolled, as well as those newly enrolled poor people, on the insurance program. 

If these trends are more than a benign anomaly, they would not only ease pressure on the Medicare budget, but would moderate government health spending generally, a development that could vaporize concerns about the growing cost of entitlement programs.  As analysts of all political stripes have been saying, America’s government doesn’t have a spending problem; it has a health spending problem.  

The number of African Americans who lacked health insurance dropped dramatically in 2014's first quarter compared to 2013's fourth quarter thanks to the Patient Protection and Affordable Care Act, which Republicans threaten to repeal if they win control of both houses of Congress in November's national elections. The Gallup-Healthways Well-Being Index reported on Monday that the uninsured rate for African Americans fell from 20.9 percent in 2013's fourth quarter to 17.6 percent in 2014's first quarter, a drop of 3.3 percentage points.

Under the healthcare law, those who do not obtain coverage for 2014 face financial penalties of up to 1 percent of their yearly household income, or $95 a person, whichever amount is higher, although even before the deadline extension was announced, there was an array of exemptions for hardships and other reasons. While most Americans know that the law includes fines for those who do not buy coverage, Kaiser found that just 39 percent of the uninsured were aware of the Monday deadline. 

The logic of much lobbying is a two-step process.  It begins with the golf aphorism that every act leaves someone happy and someone sad.  Among the sad are potential clients.  Typically, there are two groups of sad people – one poor but sympathetic (perhaps people who’ve been denied a prescription drug they’re comfortable with because it has been found no more effective than cheaper options) and the other rich (perhaps the pharmaceutical firms making the expensive drugs) who are willing to spend to protect profits.

The first few months of a refugee’s life in the U.S. are filled with new experiences. And with doctor’s visits. All that initial care is covered by federal medical assistance. But when that coverage ends, refugees may still have outstanding health issues and no way to pay for them. Gov. Tom Corbett isn’t expanding Medicaid in Pennsylvania this year. It’s estimated that there are more than 600,000 people who could benefit from the Medicaid expansion, but for people like Tamang who face a disappointing reality, even the cheapest insurance plan would still cost him too much.

The relentless flow of good news about Obamacare may explain why a growing number of elected Republicans are walking away from the issue.  Two new bits of insurance news suggest progress that backers of reform find quite encouraging. The first explains how governments are competing in the insurance exchanges, simultaneously giving shoppers greater choice and potentially providing profit that can help fund services to indigent Medicaid recipients.  In essence this is the public option that liberals fought hard for, but failed to get into the legislation that was enacted.

The dream standard, which Obamacare does not aspire to meet, is a system that provides any care requested from any provider without worrisome costs.  Such care would include eyeglasses, hearing aids, dental work and unlimited physical and mental therapy, all conveniently available at sites where cost was never a barrier. There is no existing insurance plan in America that provides such a broad menu of services.  While these services may solve real problems, insurance typically limits or excludes them.

The center is holding.  Despite the enormous stresses of responding to a deep, painful recession while awkwardly implementing a long-sought national health insurance program, America’s politics are moving back toward the middle, fueling frustrated responses from fringe elements who see opportunities for fundamental change evaporating. The economy is coming back.  Threats of a government shutdown – or even default – seem to be receding. 

The government shutdown serves no discernible purpose beyond setting a very dangerous stage for competing political interests to try to advance their agendas and, of course, giving the news media and political commentators an urgent issue to cover and interpret. Yet it’s a fascinating time to be a student of political communication.  During these epic battles, we get to analyze rhetorical weapons while they’re still being fired.  We get to take a close look at who’s saying what and how what they’re saying is evolving.