July 2012 Volume 19 Number 3
Population, Education, Health
The American Community Survey and the economic census are under attack in Congress; the House approved a bill in May 2012 to eliminate funding for both. The ACS, which surveys about 3.5 million households a year, collects the personal data previously obtained from the "long form" of the decennial census. The economic census collects information from five million businesses every five years.
The Bureau of the Census, which conducts both surveys, says that 97 percent of those asked to participate do so. The Census can (but says it does not) levy a $5,000 fine for failure to complete the surveys.
Population. There were four million births in 2010-11, and over half were to minority mothers, Hispanics (26 percent of US births), Blacks (15 percent), Asians (four percent) and those of mixed race. The so-called birth "tipping point" highlights the fact that the US is becoming a "globalized multiethnic country." Non-Hispanic whites are a minority of residents in 10 percent of the 3,100 US counties, in four states, and in many cities, including New York and Las Vegas.
Whites, whose median age is 32, are a majority of US residents over 50. The median age of Hispanics, by contrast, is 27. In Yuma County, Arizona, almost three-fourths of residents over 65 are white, compared with less than 20 percent of residents under 20. Whites are far better educated than Blacks and Hispanics. Almost a third of whites have a college degree, compared with an eighth of Hispanics and a fifth of Blacks.
The US has 18 million Asian-Americans (compared to 50 million Hispanics), including eight million who arrived since 1980 and three million who came after 2000. Almost 75 percent of Asian Americans in the US were born abroad. A third of Asian Americans live in California. Chinese Americans are the largest Asian immigrant group, with more than four million Chinese, followed by Filipinos, Indians, Vietnamese, Korean and Japanese.
Since 2008, there have been more Asian than Hispanic arrivals. In 2010, about 36 percent of new arrivals (legal and illegal) were Asian Americans, while 31 percent were Hispanic.
Asian Americans are often considered the model minority. Their median household income is $66,000, compared to $50,000 for all Americans. Many Asian Americans marry non-Asians: 29 percent married non-Asians between 2008 and 2010, compared with 26 percent of Hispanics who married non-Hispanics and 17 percent of Blacks who married non-Blacks.
In polls, 70 percent of Asian-Americans, compared with 60 percent of other Americans, believe that the best way to get ahead in America is with hard work. A sixth of Asian American babies are born out of wedlock, compared with 40 percent of babies born to other Americans. Over 80 percent of Asian-American children live with two parents, compared with 60 percent of other American children.
Health. The US Supreme Court ruled 5-4 in June 2012 that the individual mandate in the 2,700-page Patient Protection and Affordable Care Act (PPACA) was a constitutional tax. The Court held that the government can require individuals to buy health insurance or pay a penalty, which the Court deemed a tax. The court rejected the argument that the federal government has the power to require Americans to buy health insurance under the Commerce Clause in Article 1, Section 8, Clause 3 of the Constitution.
The PPACA changes the way insurance is sold by requiring insurers to offer coverage to all who apply, expanding the Medicaid program that requires states to offer health insurance to poor residents, and requiring employers to offer health insurance to their employees or pay a tax. Most Americans will continue to get health insurance based on employment, income and age.
The Court held 5-4 that the federal government may not require individuals to buy particular goods and services. During arguments on the constitutionality of the PPACA, Justice Scalia asked whether the government can require people to buy healthy food such as broccoli. In an 1824 decision, the US Supreme Court held that Congressional power to regulate commerce "may be exercised to its utmost extent." When President Clinton proposed health reform early in his first term that would require all Americans to buy health insurance, opponents argued that the individual mandate violated the commerce clause because it would force people to purchase a particular good.
Opponents of PPACA sought to highlight their belief that requiring Americans to buy a particular good was unconstitutional by focusing on whether Congress could use the commerce clause to order Americans to buy a healthy food such as broccoli or pay a fine. Supporters argued that health care is a unique product and, while the government cannot generally compel Americans to buy a particular product, it can require them to buy health insurance.
Some 3.2 million small businesses that employ over 19 million workers were eligible for tax credits worth more than $15 billion for the 2011 tax year if they offered health insurance to their employees. However, several studies concluded that fewer than 360,000 small businesses are expected to claim the tax credit. PPACA offered businesses with fewer than 25 full-time workers a temporary tax credit of up to 35 percent of the cost of the health insurance if the businesses cover at least 50 percent of premiums, up to $800 per employee for workers earning less than $50,000 a year.
In 2011, 71 percent of small businesses with 10 to 24 workers offered health coverage, compared with 48 percent of businesses with fewer than 10 workers.
In 2014, businesses with 50 or more full-time employees that do not offer health insurance must pay $2,000 multiplied by the number of employees (after deducting the first 30 employees), or $3,000 for each employee who qualifies for coverage under state health exchanges.
Oregon in 2008 allowed almost 90,000 working-age poor residents to join Medicaid. The winners were selected in a lottery, prompting studies of how health insurance would affect medical costs. Those with Medicaid had health care costs about 25 percent higher than otherwise similar adults without health insurance, suggesting that the preventive medicine available with insurance will not save on health care costs. However, obtaining health insurance made people healthier, happier and more financially stable.
The PPACA requires states in 2014 to extend Medicaid eligibility to all adults whose incomes are less than 133 percent of the poverty line, which is $11,170 for a household of one and $23,050 for a household of four in 2012. However, the US Supreme Court said that the federal government cannot compel states to expand Medicaid by threatening the loss of all the federal government's Medicaid spending. Under PPACA, people under 65 will generally qualify for Medicaid if their income is less than 133 percent of the federal poverty level, $25,390 for a family of three.
The Congressional Budget Office estimates that 17 million uninsured people will gain coverage through Medicaid under PPACA at a cost to the federal government of $930 billion from 2014 to 2022. The federal government pays an average of 57 percent of the cost of Medicaid.
Most observers say that universal health coverage is likely to be President Obama's legacy, explaining why he fought so hard for comprehensive health care reform despite Republican opposition.