In a hard-hitting New York Times op-ed on Friday, senior New York Democratic Rep. Steve Israel put all of Washington on notice. He is fed up with campaign fundraising. He joins Sen. Barbara Mikulski, D-Md., this year and Sen. Tim Johnson, D-S.D., last year in retiring from Congress. They’ve had enough of shaking down America’s superrich. Corporate lobbyists and wealthy activists dictate much of American politics today. In the 2012 presidential race, 0.01 percent of Americans contributed almost 30 percent of the money spent in that entire election cycle. Corporations spend billions of dollars annually on lobbying. America’s big spenders exert tremendous influence over elected leaders and have dramatically different priorities from everyday citizens’. Nowhere is that clearer than in the political battle over the Affordable Care Act’s Medicaid expansion , which exemplifies how very wealthy political donors impair access to health care. The law raised the income threshold for low-income Americans to qualify for Medicaid. Households with income up to 138 percent of the federal poverty line are eligible. However, the Supreme Court ruled this provision optional for states. For states that expand Medicaid, the federal government picks up all costs to cover additional Medicaid populations until 2017. States pick up 5 and then 10 percent of the tab thereafter. Twenty states have failed to expand Medicaid, leaving 3.1 million Americans uninsured. With a new executive order in Louisiana, the number will fall to 19 states, and an additional 200,000 Americans will eventually become insured. Medicaid expansion is vital. If it were expanded in every state, it could have prevented 7,115 to 17,104 unnecessary deaths and 240,700 racked-up catastrophic medical bills each year. Expansion also saves money. With it, states could spend far less on uncompensated emergency care. If Pennsylvania alone expanded Medicaid coverage, Rand Corp. economist Carter Price found that it could add $3 billion to the state’s GDP and create 35,000 jobs. Yet expansion is being held up because of politics. New research shows that Charles Koch and David Koch’s advocacy group Americans for Prosperity is having great success blocking state Medicaid expansion. The organization’s 34 state chapters currently spend large sums to build its grass-roots advocacy and place political ads. It’s paying off in Florida, where Gov. Rick Scott has all but retreated on his openness to expand Medicaid to cover 567,000 low-income Floridians. This trend is unfortunate, because there’s fertile ground for Medicaid expansion nationwide. New research suggests if public health activists could better mobilize, they could pressure lawmakers to expand Medicaid. Citizen advocates can trump the austerity-first agendas of billionaire-financed interest groups. They simply have to organize better. The priorities of rich donors are out of line with voters. Brian Schaffner’s analysis from the 2014 cooperative congressional election study shows a large gap in opinion about Medicaid expansion between the average GOP supporters and the richest among them. Sixty-two percent of nondonor Republicans surveyed said they would refuse the Medicaid expansion, compared with 77 percent of donors who gave much more than $1,000.

Opposition to Medicaid expansion Source: Brian Schaffner, Cooperative Congressional Election Study 2014

Medicaid expansion aside, the political influence of the extremely rich undercuts American health care. A study of wealthy Americans by political scientists Benjamin Page, Larry Bartels and Jason Seawright finds that while average Americans favor national health insurance, which would be publicly financed on the basis of one’s ability to pay, only 32 percent of the wealthy surveyed said they support the policy, compared with 61 percent of all Americans. When asked if average Americans were willing to “pay more taxes in order to provide health coverage for everyone,” 41 percent of the rich said yes, compared with 59 percent of the general public.

Views on health care Source: Page, Bartels and Seawright, 2013

Donations from the wealthy and corporate contributions for lobbyists have also resulted in attacks on Medicare, the half-century-old national health insurance program for seniors and people with special needs. Raising Medicare’s eligibility age from 65 to 67 is a frequency cited idea among the current crop of Republican presidential candidates, even though it would dramatically curb health access for seniors. It’s not crazy to expect House Speaker Paul Ryan to sneak it into this year’s budget. President Barack Obama even offered it as part of a large budget deal in 2011. This policy would force people off their health coverage, particularly in states that have not expanded Medicaid. An estimated 435,000 seniors would lose coverage by 2021 if the eligibility age were raised. If the eligibility age had been raised in 2014, seniors would have had to pay $3.7 billion more in out-of-pocket costs that year, preventing many of them from obtaining necessary treatments. Most troubling is that this proposal would increase overall health care spending. Medicare is much better at controlling costs than private insurance, and it has lower administrative costs. Individuals kicked off Medicare likely would get private coverage, and their health care bills would add to overall U.S. health care spending. Thus any Medicare savings achieved by increasing the eligibility age would be canceled out. The Center for American Progress found that raising Medicare’s eligibility age would cost individuals, businesses and states twice as much as the federal savings suggested by the reform.

The very rich’s austerity agendas are literally killing people. It’s imperative we take the required steps to restore confidence in our democracy.