April 14, 2023


It’s a tale of two cities, East Palestine, Ohio, and Libby, Montana–small-town communities of modest means poisoned by the chemical and industrial pollutants of colossal corporations in pursuit of profit.

Libby was the victim of W. R. Grace, whose asbestos-laced vermiculite mine sickened and killed thousands in the surrounding area as the wastes from the mine were carried home, used in gardens, even spread on the running track at the local high school.  Not just the miners but their families and the entire community were unknowingly sickened.  The corporation knew the danger but hid it.  Heroic citizens battled to get to the bottom of the mysterious poisoning.  In the end, W. R. Grace, faced with legal and health liabilities, declared bankruptcy, leaving the community without help.

East Palestine, Ohio, is the site of a Norfolk Southern train wreck on February 3, 2023.  The vinyl chloride that poured from the broken railcars causes liver, brain, and lung cancers as well as lymphoma and leukemia.  The company increased the hazards by burning the waste.  “We basically nuked a town with chemicals so we could get a railroad open,” said the retired Youngstown Fire Chief, a hazardous materials expert.  “…(W)e’re going to be looking at this thing five, ten, fifteen, twenty years down the line and wondering, ‘Gee, cancer clusters could pop up, you know? Well water could go bad.”  The community is already reporting widespread rashes, coughing, nausea, and other illnesses as the company and the EPA assert all is well.

A little-known clause, Section 10323 in the Affordable Care Act (ACA), connects Libby and East Palestine.  In 2009-2010, Montana Democratic Senator, Max Baucus, Chair of the Senate Finance Committee, was writing the health care bill under the guidance of the insurance industry’s representative, Liz Fowler.  Fowler was a former Vice President of Wellpoint and currently presides over the Medicare Innovation Center, directing the privatization of Medicare.  Baucus slipped an earmark into the ACA that provides Medicare coverage for the poisoned people of Libby, even as he arrested the proponents of single payer health care who asked to be heard in the Finance Committee hearing.  Knowing that the provisions of the ACA would not come anywhere near solving the profound suffering of Libby, Baucus granted Medicare coverage to Libby and its surrounding area just as he slammed the door on a publicly-funded, improved Medicare for everyone.

The Baucus earmark in the ACA provides Medicare coverage for everyone in a certain Montana geographical area who is diagnosed with any of the conditions caused by exposure to asbestos.  The area is defined by an Emergency Environmental Public Health Order of 2009.

After the ACA was passed, Social Security officials were sent to Montana and descended on Libby, Whitefish, and Kalispell to sign the people up.  Unlike for the rest of Medicare beneficiaries around the country, age was of no concern.  People were eligible for Medicare regardless of age and without regard to having paid into the Medicare system.  This was a special instance, and coverage was immediate.  No one had to wait until two years beyond the substantiation of their disability.  Max Baucus used federal Medicare monies to pick up the debt of W. R. Grace to the people of Libby as he left the rest of the nation to deal with a failing health care system under the control of profit-making giants.

The health insurance industry went on to reap the benevolence of Baucus and Fowler with increased billions in profit in the following years.  In 2018, the Council of Economic Advisors reported:   “…(T)he ACA Medicaid coverage expansion and subsidies to insurers have resulted in a large increase in health insurer profits. Health insurers’ stock prices more than doubled the impressive gain in the S&P 500 since the law’s main provisions took effect on January 1, 2014.”

The corporate-oriented plan that Max Baucus gave the nation instead of the Improved Medicare for All advocated by those he arrested, improved coverage for some even as it brought escalating levels of underinsurance—a condition in which patients have health insurance yet still cannot afford care.

By 2022, health insurance companies were making record profits even as those newly insured under the ACA were dealing with costs of $12,000 annually before the benefits of insurance kicked in.

The Baucus clause for Libby in the ACA became Section 1881A of the Social Security Act.  It includes a possibility for future Medicare coverage for those who are the subject of a new Environmental Public Health Emergency Declaration.  Does that mean that the people of East Palestine will have Medicare coverage given the proper declaration of a public health emergency?

In a February 22, 2023, article, Newsweek’s Aleks Phillips asserts that the ACA defines hazardous substances and pollutants according to a list which includes vinyl chloride, one of the toxic chemicals spilled in East Palestine.  Newsweek has reached out to the White House and the Department of Health and Human Services with a request for comment on the issue of eligibility for Medicare for East Palestinians.

“At the very least, East Palestine residents deserve this universal coverage after being exposed to a known carcinogen,” tweeted Krystal Ball, a political commentator.

Our nation is now trying to recover from a pandemic that still claims lives at the rate of 95,000 a year.  Covid 19 exposed our broken health care system that failed every test as the United States came in last of industrialized countries, losing over one million people to the disease—a rate far above that of other nations.

In 2021, the United States suffered 900,000 excess deaths, only half of which could be attributed to the pandemic. Much of the rest of the suffering and dying—over 400,000 in that year—can be chalked up to this train wreck of a for-profit health care system.  The figure is astronomical–a little over 400,000 matches the number the United States lost in all of World War II.  Life expectancy in the US is dropping far below that in any other industrialized country.

An environmental, public health emergency declaration based on Section 1881A of the Social Security Act should have kicked us into a universal Medicare for All to begin to cope with the extent of the Covid disaster.  The enormity of that colossal tragedy was insufficient to break the chains that bind the political system to corporate insurance interests.  Will the United States ever enact a national, not-for-profit, single payer health care program, an Improved Medicare for All?  Only if the demand escalates beyond the pitiful calls for incremental change to a boldness and urgency commensurate with the depth of the crisis.


-This article first appeared in CounterPunch.

-Past articles by Kay Tillow.