Obamacare took a big step forward on Tuesday night, when the Michigan Senate approved an expansion of the state’s Medicaid program. The state House is likely to back the same measure, as early as next week. And while the program requires a special federal waiver, the Obama Administration is likely to grant it. Assuming all of that happens, Michigan will become the twenty-fifth state to expand Medicaid as part of the Affordable Care Act. As a result, a few hundred thousand residents are likely to get insurance—and the state will get a much-appreciated infusion of federal funds, while putting up a much smaller share of state money.
For the advocates of making health insurance available to all Americans, it’s a huge victory. But the victory did not come easy—or without some last-minute drama.
Tuesday’s vote was the product of a long, sustained campaign by Democrats, moderate Republicans, progressive organizers and business leaders. For months, they have made the case for expansion—citing the likely financial and health benefits for Michigan’s uninsured citizens, and the expected boost to Michigan’s economy. The federal government is picking up most of the expansion’s costs, they have argued, and hospitals need the revenue to make up for money they lost on charity care and declining reimbursement from other sources.
Among those assessing the statistical impact were Marianne Udow-Phillips, director at the Center for Healthcare Research and Transformation and a lecturer at the University of Michigan School of Public Health. As she told me on Wednesday,
if you look at all the facts—the fact that the majority of physicians in the state are ready to serve this population; the positive impact on the state budget, on the state’s economy at large, on hospitals, on businesses, on all those who are currently insured (by reducing cost shifting) – not to mention the half a million people who will directly benefit by getting health insurance coverage in a program that has the highest satisfaction of any insurance coverage type in the state – you have to draw the conclusion that the Medicaid expansion is the right thing to do for the state.
Governor Rick Snyder and the state Chamber of Commerce have been among the strongest proponents of expansion. The state’s health care industry, naturally, has lobbied furiously. But Tea Party Republicans and their allies have been dead set againt it, arguing that Medicaid is a wasteful, expensive program that subsidizes the indolent—and that the size of the federal subsidies masked the true impact on the state, which would actually be negative.
Writing this week in the Detroit Free Press, Joseph G. Lehman and Clifford W. Taylor from the Mackinac Center for Public Policy warned that
The state’s main incentive to expand Medicaid is a federal promise to transfer to Michigan $2 billion (increasing to $3 billion) annually for three years if we add 320,000 Michiganders earning up to 138 percent of the poverty level to Medicaid rolls.
After three years our federal subsidy would shrink by $300 million per year, meaning either Michigan taxes increase by that much or lawmakers kick 320,000 people off Medicaid, which seems unlikely.
Expansion supporters have responded that, even after the reduction, the federal government would still be picking up 90 percent of the new cost. They have also tried to accommodate concerns about Medicaid efficiency, by, among other things, proposing that some Medicaid recipients pay a portion of their own costs. The compromises changed a few votes, and in June the state House approved its version of the expansion. But the Senate in June surprised everybody, including the governor, by rejecting the measure. One likely reason: Tea Party groups, and their financial backers, were threatening to support primary challenges to Republicans who voted yes.
The expansion’s supporters spent the remainder of the summer making their case, rallying the public, and lobbying individual members. As of Tuesday morning, they were confident they had 19 senators willing to vote yes. That would produce a tie in the 38-member chamber, with the lieutenant governor prepared to vote yes and break the tie. But when the Senate first voted in early afternoon, only 18 said yes. The chamber quickly voted to reconsider and, after a feverish few hours of lobbying and meeting, tried one more time. This time, the bill passed 20 to 18.
Progressives aren’t thrilled about some of the compromises, particularly those asking Medicaid recipients to pay a larger share of their costs. (Sarah Kliff has more of the details if you want them.) And it’s not out of the question that the federal government will raise objections, because the federal Medicaid law limits the ability of states to change the program. But given political resistance to any expansion, supporters are mostly elated at Tuesday’s outcome. “It’s not perfect, but it’s going to help nearly half a million Michiganders,” Amy Lynn Smith wrote at Electablog, a progressive website based in Michigan.
Michigan’s decision is an important milestone in the effort to make Medicaid available to all low-income Americans—an endeavor that has proven far more difficult than most experts anticipated. Last summer, when the Supreme Court made it easier for states to reject Obamacare’s planned expansion of Medicaid, many of us assumed the vast majority of states would participate anyway. The need for coverage was too great, and the allure of federal money too tempting, for even most Republicans to reject. Quite obviously we were wrong. Conservatives serving either as governor or state legislators have successfully blocked expansion across a wide swath of the country, including the huge states of Florida and Texas, where a few million people would be eligible.
But the Medicaid expansion has gotten support from several other Republican governors, including Jan Brewer in Arizona (where the expansion is already going forward) as well as Rick Scott in Florida and John Kasich in Ohio. Florida looks hopeless, at least for the time being, given the grip extreme conservatives have over the legislature. Ohio is another story: The politics there look a lot like the politics in Michigan. The same goes for Pennsylvania, although that state’s Republican governor, Tom Corbett, doesn’t yet support expansion.
Obamacare’s Medicaid component, in other words, is moving ahead. But progress is taking place in fits and starts, with frequent setbacks, thanks mostly to political opposition that’s strongest in the most conservative parts of the country.
Yeah, you should get used to that pattern.
By: Jonathan Cohn, Sebior Editor, The New Republic,
Governor Rick Snyder (R-MI) was so desperate to make Detroit the largest American city to declare bankruptcy that his lawyers apparently used deception to make sure their filing was in before a judge could block it.
Ronald King, an attorney for Detroit’s General Retirement System and the Detroit Police and Fire Retirement System, said that he agreed to delay a hearing on an injunction that would have prevented the city from filing for bankruptcy for five minutes at the request of Snyder’s lawyers. In that five minutes, attorneys filed papers to put Detroit under bankruptcy protection, placing all legal action against the city in a temporary stay.
“It was my intention to grant your request,” Ingham County Judge Rosemarie Aquilina told the pensioners’ attorneys.
“There’s no denying this was a race to the courthouse this afternoon and yet another example of usurping the will of the people,” King said.
The Michigan Republican Party’s eager embrace of emergency manager powers has left about half of the state’s African-Americans without elected local representatives.
When voters repealed the emergency manager law in 2012 by 53 to 47 percent, the state’s Republican-dominated legislature quickly restored it, including a provision that made it impossible for votes to repeal the law again.
Part of the argument for these laws, which allow state officials to replace all elected city officials in municipalities deemed to be in “emergency” with an unelected bureaucrat, was that this process would prevent bankruptcy, which would be too disruptive.
When Snyder selected bankruptcy expert Kevin Orr to be Detroit’s emergency manager, however, it became clear what path the governor, who faces re-election in 2014, had in mind for the Motor City. Orr – who has already hinted at his intention to cut pensions – will manage the bankruptcy, carrying out the governor’s wishes.
Unions who have seen Snyder and a lame-duck legislature rush in a law designed to weaken unions along with tax increases on pensioners are not hopeful about the bankruptcy process.
“Every step of the way, the citizens of Detroit were told that they had to give up their right to democratic representation in order to avoid bankruptcy,” Metro Detroit AFL-CIO president Chris Michalakis and Michigan State AFL-CIO president Karla Swift said in a joint statement. “Now that this filing has come anyway, it is clear that either state control has failed or that Governor Snyder and his emergency manager appointee were not honest about their intentions in the first place.”
As the city’s debts are discharged, the question is who will be asked to pay: workers — who were promised a retirement and have already offered concessions — or investors — who knew they were taking a risk?
By: Jason Sattler, The National Memo, July 19, 2013
Mitt Romney’s financial and organization advantages in the 2012 Republican primaries were commanding, but conservatives who opposed him had faint cause for hope: Rick Santorum and Newt Gingrich combined for more support than Romney for most of the primary season. If one of them conceded, then the other could consolidate Romney’s conservative opposition.
These hopes were far-fetched. Polls showed that Romney would have maintained his lead if either Santorum or Gingrich departed the race, since Romney was actually the second choice of many of their voters. Still, the theory was nearly put to the test. On Friday, Business Week reported that Santorum and Gingrich apparently discussed an unprecedented “unity ticket” to block Romney from winning the nomination. A Santorum-Gingrich ticket could have won critical primaries and led the national polls, but it still probably wouldn’t have won the nomination—a fact that should alarm conservatives heading into 2016.
The plan failed, not surprisingly, because Gingrich and Santorum couldn’t agree which one of them should be on top of the ticket. But let’s assume that they had. A unity ticket would have presumably done better than either candidate would have on his own, since a Gingrich voter who preferred Romney to Santorum might still support the combination of Santorum and Gingrich. But even if the unity ticket didn’t immediately consolidate the Gingrich-Santorum vote, the formation of an unprecedented primary alliance would have received tremendous media attention, potentially generating momentum. Indeed, polls can’t really predict how candidate dropouts will affect a race: In 2008, polls said that Hillary Clinton would maintain a clear lead over Barack Obama if John Edwards dropped out. Yet Obama surged in late January, after his win in the South Carolina primary, Edwards’ departure, and a wave of high profile endorsements.
The combination of a unity ticket and a few big primary wins could have given Santorum-Gingrich the lead in national polls. According to the article, Gingrich and Santorum mulled a unity ticket before three critical primaries in Florida, Michigan, and Ohio. Realistically, a Gingrich-Santorum ticket would have struggled to win Florida, since Romney’s 46 percent of the vote actually exceeded Santorum and Gingrich’s combined 45 percent. But a unity ticket would have done better in Michigan or Ohio.
After sweeping Minnesota, Missouri, and Colorado, Santorum actually led the national polls until he lost the Michigan primary by a narrow 3 point margin. But Santorum held a lead in Michigan polls until just 5 days before the primary and Gingrich won 6.5 percent of the vote—the combination of Gingrich voters and momentum from a unity ticket announcement could have easily given Santorum a narrow win. Regardless of whether Santorum carried Michigan, a unity ticket probably would have won Ohio, where Romney won by just 1 point and Gingrich, who won nearly 15 percent of the vote, probably played the spoiler—especially since Gingrich excelled in the socially conservative southwestern part of the state. Either way, Santorum-Gingrich would have exited Super Tuesday with plenty of momentum and a lead in the national polls heading into a wave of favorable primaries and caucuses in Kansas, Alabama, and Mississippi.
Whether momentum would have allowed Santorum-Gingrich to breakthrough a Romney firewall like Illinois is hard to say. And it would have still struggled to actually win the nomination, even in the best case scenarios: The delegate math was stacked in favor of Romney. Romney would still have been favored to win a disproportionate share of the winner-take-all states, like Florida, Arizona, and New Jersey. The same was true for the big states using modified or conditional winner-take-all systems, like California and New York. In contrast, Santorum-Gingrich’s biggest wins would have been diluted by various methods of proportional delegate allocation in Texas, Georgia, North Carolina, and Tennessee (footnote: Tennessee is actually a conditional winner-take-all, but it’s condition is far more difficult than the other conditional winner-take-all states, since a candidate would need 66 percent of the popular vote). Neither Gingrich nor Santorum made the ballot in Virginia, giving all but 3 of Virginia’s 46 delegates to Romney. Unless Romney’s national support completely collapsed, Santorum-Gingrich would have been hard pressed to overcome the GOP primary system’s bias toward Romney’s coalition.
Conservatives should take note. The RNC’s Growth and Opportunity Project report’s proposal to end conservative caucuses for the purpose of allocating convention delegates has been panned as an attempt to help establishment candidates win the GOP nomination. But the RNC explicitly took “no position” on whether contests should be winner-take-all or proportionate, since “both methods can delay or speed up the likelihood of a nominee being chosen [depending] on who is winning and by what margins.” That’s technically true: A uniformly winner-take-all or proportionate system wouldn’t necessarily favor any type of candidate. But 2012’s mix of winner-take-all and proportionate states favored an establishment candidate. The same delegate allocation rules that would have doomed a hypothetical Santorum-Gingrich unity ticket could again doom a competitive conservative candidate.
By: Nate Cohn, The New Republic, March 25, 2013
Michigan’s Republican Party approved a resolution Saturday that would change the way the states award electoral votes from the winner-take-all system that has existed since the state’s admission to the Union.
A total of 14 votes would be awarded to the candidate with the most votes in each congressional district and two would go to the overall winner of the state’s popular vote.
Under this scheme, Mitt Romney would likely have won 10 of the state’s electoral votes to President Obama’s six — despite the fact that Obama carried the state by nearly 10 percent.
The resolution was introduced by Rep. Pete Lund (R), who offered electoral college reform legislation in 2011 that would have given Romney the state, but which state Republicans rejected because they assumed the GOP nominee, a Michigan native and son of a former governor, would win the state.
Lund will likely reintroduce the bill in 2013. Republicans have majorities in both state houses and Republican governor Rick Snyder is supportive of the plan, but questions its timing.
“The right way is to talk about it in a bipartisan way … just prior to a census,” Snyder said.
Snyder’s approval rating has declined rapidly since he signed anti-union legislation during last year’s lame-duck session. He’s since tried to move back to the center by saying he’d like the state to accept Medicaid expansion.
Michigan’s shift of 10 electoral votes to Romney would not have swung the 2012 election for Romney. However, if all the states that have suggested changing the way they award their electors — Michigan, Virginia, Ohio, Wisconsin and Pennsylvania — had done so, Romney would likely be in the White House now, which is why Republican National Committee Chairman Reince Priebus endorsed the scheme.
The idea has been rejected by a few top Republicans — like Paul Ryan (R-WI) and Virginia governor Bob McDonnell (R-VA) — and thus faded from the agendas in Virginia, Ohio and Wisconsin.
But in Pennsylvania — the state where voter ID was supposed to give the election to Romney — the effort continues.
A new bill that would rig the state’s electoral votes has been introduced by 13 Republican state senators. That support represents half the total votes the bill would need to pass the Senate. The bill could be on the desk of Governor Tom Corbett — who would sign it — this week.
Pennsylvania, like Michigan, has voted Democratic in every presidential election since 1992.
By: Jason Sattler, The National Memo, February 25, 2013
“When Republicans Were Problem-Solvers”: The Idea Of Politics As All-Ideology, All-The-Time Is A Relatively Recent GOP Invention
We interrupt this highly partisan and ideological moment with some contrarian news: President Obama is not the only politician who thinks that expanding access to pre-kindergarten is a good investment.
In Alabama, Republican Gov. Robert Bentley urged a 60 percent increase in preschool funding in his state, with the goal of having a universal preschool system in place within 10 years. “I truly believe by allowing greater access to a voluntary pre-K education,” Bentley declared this month in his State of the State message, “we will change the lives of children in Alabama.” The state Bentley leads is not a notoriously liberal place.
In Michigan, Republican Gov. Rick Snyder just proposed a large increase in preschool funding — from $109 million this fiscal year to $174 million in 2014 and $239 million in 2015.
Nobody should pretend that the president has found in pre-K education the key that will unlock bipartisanship. Right out of the box, Andrew J. Coulson of the libertarian Cato Institute’s Center for Educational Freedom told the New York Times that Obama’s plan “just doesn’t make any sense” while Rep. John Kline (R-Minn.), who chairs the House Education and Workforce Committee, sounded a skeptical note in saying the president “needs to explain how this program will be different.”
But by today’s partisan standards, Kline’s comment was remarkably restrained. So it’s worth pausing to wonder if we might be slowly opening an era when Republicans will be feeling a little less pressure to mouth tea-party attacks on government and more incentive to say that they, too, want to solve problems that concern the vast majority of Americans.
In pushing universal pre-K, Obama made a shrewd choice in both political and policy terms. There are enough studies to show that early childhood education programs make a real difference, which is why Republicans such as Snyder and Bentley embrace them. And Obama is structuring his initiative to work with the states to build on what many of them are already doing or would like to do.
This beachhead of cooperation might also serve as a reminder to Republicans that the idea of politics as all-ideology, all-the-time is a relatively recent invention. Education reform was a thoroughly bipartisan cause in the 1980s. Governors such as Democrats Bill Clinton in Arkansas and Richard Riley in South Carolina and Republican Lamar Alexander in Tennessee teamed up to push for higher standards. Alexander, who is now in the Senate, was willing to raise taxes to finance his education initiatives.
There is also the tale of Tommy Thompson, who as governor of Wisconsin in the 1990s tried to broaden health insurance coverage with his “BadgerCare” program. Early in the debate over Obama’s Affordable Care Act, Thompson called it “another important step” toward achieving reform.
Thompson had to eat those words when he sought the Republican nomination for the U.S. Senate last year in the face of tea party opposition. The rebuke of Thompson from Chris Chocola, president of the conservative Club for Growth, was representative. “The world has changed since he was elected to office,” said Chocola, who had endorsed one of Thompson’s primary opponents. “Now we’re talking about how much less we’ll spend rather than how much more we’ll spend.” That was right-wing ideology speaking.
Thompson survived the primary but was then defeated by Democrat Tammy Baldwin. While liberals cheered Baldwin’s victory, there was something poignant in Thompson’s losing, in part because he traded in his problem-solving past for a new anti-government disposition that didn’t really fit him.
Despite the abuse of the rules on Chuck Hagel’s confirmation, you sense that Republicans such as Thompson and Alexander (there are many others) are exasperated with the view that the only point of seeking public office is to shrink government. But it will take considerable courage for such Republicans to move their party back to a time when conservatives and progressives did not have to disagree on everything — when causes such as helping 4-year-olds to learn and thrive could encourage politicians to lay down their arms at least momentarily.
There are other issues that ought to be like this: training and education programs to restore mobility and ease inequalities; immigration reform; and at least parts of Obama’s agenda to curb gun violence. But progress will require conservatives to give up certain recent habits and remember when they, too, believed that government could successfully remedy some of the nation’s ills.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, February 17, 2013