“We’ll Never Stop Arguing About It”: Obamacare Is Helping A Lot Of People. Not Everyone Thinks That’s Good News
In politics there are some issues where liberals and conservatives share the same goal, but disagree about how to achieve it — we all want to have as little crime as possible, for instance, but there are different ideas about how to accomplish that. Then there are issues where the two groups have different goals — liberals want to preserve women’s reproductive rights, and conservatives don’t. And sometimes, there are issues we think fall in the first category, but actually belong in the second.
Health care may just be that kind of issue, where we talk as though we all have the same fundamental goals, but we actually don’t. There’s an interesting article in the New York Times today on a major success of the Affordable Care Act that demonstrates why we’ll never stop arguing about it. Here’s how it begins:
The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates.
Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. Low-wage workers, who did not have enough clout in the labor market to demand insurance, saw sharp increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and cashiers. Minorities, who disproportionately worked in low-wage jobs, had large gains.
Before we go farther, we should remember that the ACA is a complex piece of legislation that affects every area of American health care, but for now we’re going to talk just about insurance coverage. When liberals see a report like this one, they say, that’s terrific — some of the most vulnerable people in America, and those who had the hardest time getting covered before, now have health insurance. They offer this as practical evidence of the law’s success.
But conservatives (not all conservatives, but many of them) don’t see that as a success at all. If the government is helping an immigrant who washes dishes for a living get health coverage, then to them that means that government is redistributing tax money from deserving people to undeserving people. The two groups look at the same practical effect, and interpret it in opposite ways.
That isn’t to say that the ACA didn’t give benefits to everyone, because it did. Millions of middle-class and even upper-class people were hurt by the fact that insurance companies used to be able to deny you coverage if you had a pre-existing condition, but the ACA outlawed that. And if the payment reforms in the law bring down overall health spending, we all benefit. But the most visible and dramatic parts of the law relate to the tens of millions of Americans who used to be without health coverage but now have it.
This is why Republicans continue to call the ACA a “disaster” and a “catastrophe” despite the good it has done. Liberals hoped that once the law was implemented and its practical effects became clear, the law would become hugely popular. Instead, views of the law divide closely on ideology and partisanship, and that hasn’t changed and won’t change.
That’s because there’s a fundamental clash of values at work, which means that liberals and conservatives will always judge it according to different standards. Because the law did a large amount to bring coverage to those who couldn’t afford it (through both the expansion of Medicaid and subsidies), and because it included a raft of new regulations meant to solve a variety of problems within the health care system, conservatives will always oppose it, whether it succeeds on its own terms or not. To doctrinaire conservatives, a government regulation that accomplishes what it sets out to isn’t a success at all; it’s a moral failure by definition. That’s why liberals will never convince them to support the ACA by pointing to its practical successes.
That isn’t to say that conservatives don’t make practical arguments against the ACA, because they do. But they’re mostly window dressing placed atop their moral objections to government involvement in health care. So yes, they predicted that Obamacare would destroy the economy, and cost millions of jobs, and lead to fewer people with health coverage, and balloon health care spending, and make premiums skyrocket. When they turned out to be wrong about all these things, conservatives didn’t say, “Well gee, I guess this law was a pretty good idea after all.” Because the fundamental moral objection remains, whatever the practical impact.
You can see it in the decision to accept or reject the law’s expansion of Medicaid. The federal government offered states a huge pot of free money to provide coverage to their poor citizens, and though some conservative governors tried to argue that it would be too expensive, those arguments were laughably weak. As one independent analysis after another has shown — from groups like the Rand Corporation, not exactly a bunch of lefties — taking the expansion leads to healthier state finances and better economic growth, on top of helping your state’s constituents. But for many governors, insuring poor people isn’t a moral good at all; just the opposite, in fact. So they were even willing to incur economic damage in order to avoid it (and to give Barack Obama the finger, of course).
Where this all leaves us is that the ACA will never become something we agree on, no matter what it does or doesn’t do in the real world. But even that’s not the whole story, because there are political factors at work. Smart Republicans understand that with each passing year, the law becomes more and more entrenched and harder to unwind, no matter how much they hate it. It’s one thing to keep people from getting insurance, but it’s something quite different, and far more politically dangerous, to take away insurance people already have — and if they really repealed the law, that’s what they would be doing, not just to a few people but to 20 million or so.
That’s why Republicans have so much trouble coming up with their “repeal and replace” plan. It’s not because there aren’t conservative health care wonks who could give them an outline. It’s because any real repeal would be so spectacularly disruptive to the system that it would a political nightmare. Just today there’s an article in The Hill on the efforts of the Republican task force charged with producing the new repeal-and-replace legislation, under the title, “GOP group promises ObamaCare replacement plan — soon.” If you’ve been following this issue, you know that title is a joke. As the piece says:
Coming up with a plan to replace ObamaCare has been an aim for the Republican Party for so long that it’s become a laugh line even in conservative circles. Despite voting more than 50 times in the House to repeal the law, the GOP has not once voted on legislation to take its place.
But every couple of months, they say that they’ll be releasing their plan any day now.
If Republicans actually took the White House and held Congress, my guess is that they’d pass something they called “repeal and replace” but which would leave the ACA largely intact. Just as they propose to privatize Medicare but rush to tell seniors who love it that their own coverage wouldn’t be affected, it would be some kind of time-delayed change that would avoid kicking people who now have insurance off their coverage. And if Hillary Clinton gets elected in the fall, it’ll be another four or eight years before they could even try this. No matter what happens between now and then, conservatives won’t ever decide that the ACA has worked out well, whether it actually did what it was designed to do or not. As far as they’re concerned, the design itself was the problem. But they may decide, as they did with Medicare, that doing away with it isn’t worth the bother — at least not worth bothering to to try all that hard.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, April 18, 2016
“They’re Not An Interesting Story Line”: Hillary’s Army Of Women Conquers New York, Occupies The Democratic Party
We talk endlessly about the youth vote in the Democratic primaries, as Bernie Sanders wins young voters four- and five-to-one. But young voters are typically around one-fifth of electorate; under 30s were 17 percent in New York, according to the exit polls.
But we talk less about the women’s vote, which made up an eye-popping 59 percent of the Democratic vote. That’s three out of five voters, with Clinton winning more than three out of five of those votes (63-37). But hey, they’re not an interesting story line.
Actually that 59 percent number isn’t eye-popping if you’ve done any homework. Women were 58 percent of the Democratic primary vote in New York in 2008, when Clinton beat Barack Obama by one point more than the 16 she topped Sanders by yesterday. And it tracks with other results this year. Women were 58 percent in Florida, 56 percent in Ohio, and 55 percent even in Michigan, which Clinton lost (although she carried women by 51-44 percent). There’s hardly a state where women weren’t at least 55 percent of the vote (in primaries; caucuses don’t have gender breakdowns), and there aren’t many states where Clinton didn’t win among women by double digits.
So what? True, it’s not surprising. But just because something isn’t surprising doesn’t mean it isn’t interesting or that it doesn’t have ramifications. This is, and does.
What’s interesting about it is this: Sanders’s campaign surely knew the 2008 exit-poll data. Don’t you think a candidate might try to craft a message that would appeal more directly to three-fifths of the electorate he’s trying to woo?
Assuming Sanders does lose this nomination, his supporters will complain about the corrupt bosses and the system being rigged and all that. But those who decide to take a slightly more introspective approach to their Monday-morning quarterbacking might ask why their candidate didn’t bother to make any effort to speak more directly to the particular concerns of the groups that are the Democratic Party.
I know, I know—Citizens United affects everybody, health care affects everybody, the big banks affect everybody. You don’t have to tell me. I’m a universalist critic of excessive identity politics going back to the 1990s. At the same time, some measure of identity politics is necessary and good! Different groups of people have actual distinct concerns in life, and politicians are supposed to address them.
When Sanders talks about the Supreme Court, it’s always about Citizens United, and only occasionally about Roe v. Wade. When Clinton went on that riff at the Brooklyn debate about how in all the debates they’d never been asked a single question about Roe, I bet a lot of light bulbs went off over a lot of heads. Sanders didn’t actively alienate women as he did African Americans and their conservative, reality-distorting votes, but he didn’t go out of his way for them either.
As for ramifications, the results tell us a little something about how a general election might play out against Donald Trump or Ted Cruz. It should be pointed out that Trump crushed it among women in New York on the Republican side, since after all as we know he cherishes women and will be the best president for women in history, forget about it. He got 57 percent to John Kasich’s 28 percent and Cruz’s 15 percent. But there, women were only 44 percent of the vote. And in terms of raw vote totals, Clinton hauled in almost exactly twice the number of votes Trump did—1.037 million to 518,000. That means about 665,000 women voted for Clinton, while just 215,000 voted for Trump.
The story has been similar in most contests. In Florida, Trump’s best big state outside of New York, Clinton got 675,000 votes from women, and Trump 464,000. It adds up. Of course Trump is going to dominate her among men overall (she’ll beat him, one assumes, among black and Latino men, just because they’re so overwhelmingly Democratic and, in the case of Latinos, she doesn’t want to throw them out of the country).
The big secret questions of whether Clinton can make it to the White House are these: How much sexism is out there in 2016, in terms of men just not wanting a woman president; and how many women will say “I don’t like that Hillary” a hundred times up until Election Day but then get in the voting booth and think, “Well, woman president…” and pull her lever.
We’re not going to know these things until the morning of Nov. 9. We do know that we’re headed toward a real battle of the sexes this fall.
By: Michael Tomasky, The Daily Beast, April 20, 2016
“Chinese Expansionism”: Donald Trump Will Make China Great Again!
New York Republicans aren’t the only ones convinced by Donald Trump’s “America first” foreign policy — they’re just the only ones who can vote on it. Chinese state media has continued to support the racist businessman’s ascent to his party’s nomination.
Rather than seeing a threat in Trump’s promises to wage a trade war against China, state media have viewed such commitments as both negotiable and indicative of imperial decline.
“The United States has no obligation to allies or the international community to provide more public services in the area of trade,” said the nationalist Global Times, laying out the characteristics of what it called the Trump Doctrine. “He must keenly smell the isolationist sentiment in American society, and has dared to put forward such a bold foreign policy.”
Returning to an isolationist conception of foreign policy, to which Americans stayed roughly committed until the start of World War II, would ease China’s attempts to project its own power further beyond its shores. The power disparity in the South China Sea between China and its neighbors would be far more acute today if President Barack Obama had not carried out his pivot to Asia, essentially a containment policy aimed at maintaining the postwar status quo in the Pacific.
“Why isn’t China worried about Mr. Trump’s threat of high tariffs on their exports to the US? Because he’s also said he’s a deal-maker. They think they can make a deal to preserve what they have in the US-China relationship while a Trump administration retreats from world economic leadership,” said Derek Scissors, a resident scholar at the libertarian American Enterprise Institute, to The Daily Beast.
A Trump presidency would most likely relinquish the Pacific region from American military and economic dominance, given Trump’s demands that Japan and South Korea cover the cost of housing American troops in their countries, an unprecedented break in the postwar world order. And Trump would be seen as more pliable than previous American presidents, due to his obsession with approaching international problems as opportunities to peacock his negotiating prowess.
“Between Trump and Hillary Clinton, Trump may be the better choice,” said Caixin, another Chinese media organization. “Trump is an advocate of negotiating.” Hillary Clinton, who represented the country most recently as Secretary of State under Obama, would take a much harder line against any attempts at Chinese expansionism.
In a 2011 piece published in Foreign Policy, Clinton laid out her vision of American involvement in the Pacific, and calling out China’s behavior in the region in all but name. “Strategically, maintaining peace and security across the Asia-Pacific is increasingly crucial to global progress, whether through defending freedom of navigation in the South China Sea, countering the proliferation efforts of North Korea, or ensuring transparency in the military activities of the region’s key players,” she wrote.
Key to maintaining balance, Clinton said, was the projection of American power across the region, which may grow deeper as China continues to increase its economic and military strength. Trump has made no similar commitment, despite his obsession with strength and power.
By openly suggesting that he would make American allies in the Pacific pay the cost of American protection, despite free trade benefitting the U.S. far more than cash payments, Trump has revealed an opening the Chinese government hopes to exploit.
By: Saif Alnuweiri, The National Memo, April 20, 2016
“Cleaning Up Another Republican Mess”: Louisiana Ready To Make Big Gains Through Medicaid Expansion
Few states need Medicaid expansion more than Louisiana, which made it all the more difficult to justify former Gov. Bobby Jindal’s (R) refusal to consider the policy. By all appearances, the Republican made a plainly political decision without regard for the state’s needs: Jindal wanted to be president (yes, of the United States), so he took a firm stand against “Obamacare.”
Louisiana’s current governor, Democrat John Bel Edwards, ran on a platform of Medicaid expansion through the Affordable Care Act, won his election fairly easily, and immediately adopted the policy. The Times-Picayune in New Orleans reported yesterday that the governor went directly to the legislature to explain why this was the smart move for Louisiana.
Medicaid expansion is estimated to save Louisiana $677 million over the next five years and more than $1 billion over the next decade, Department of Health and Hospitals officials told Senate Health and Welfare Committee members Monday (April 18).
The cost estimates came after Gov. John Bel Edwards testified before the committee about his decision to expand Medicaid eligibility to about 375,000 people between July 1 and June 30, 2017. DHH officials will make an effort in the coming weeks to educate legislators about the benefits of Medicaid expansion and what they said was misinformation given to the Legislature to justify not expanding Medicaid under former Gov. Bobby Jindal.
“I believe the folks in the prior administration who said we couldn’t afford Medicaid expansion, they took the worst case scenario on every variable,” Edwards told lawmakers in the GOP-led legislature. “If you look at what we’re doing in light of experience in other states … we know we’re going to save money.”
And he knows this because it’s true.
I can appreciate why this may seem a little counter-intuitive. Ordinarily, when state policymakers recommend expanding benefits to struggling families, critics will respond, “We’d like to help, but we can’t afford it and we’re not willing to raise taxes.”
But Medicaid expansion is one of those policies in which states get to do both: participating states receive federal funds to implement the program, while expanding coverage for low-income families who would otherwise go uninsured. At the same time, hospitals’ finances are strengthened as medical facilities see fewer patients who can’t pay their bills.
Since implementation of the Affordable Care Act began, how many states have found Medicaid expansion hurt state budgets? None. Republicans will be quick to argue that someday, maybe, in the future, the fiscal challenges will become more acute, but given pre-ACA reimbursement rates, there’s no reason to believe they’re correct.
It’s exactly why every governor with access to a calculator – including plenty of red-state Republicans – have found the arithmetic undeniable.
As for Louisiana in particular, as we talked about last week, the state really is having an “elections have consequences” moment right now. Gov. Edwards, the region’s only Democratic governor, hasn’t been in office long, but he’s already making strides to clean up the Republican mess he inherited.
By: Steve Benen, The Maddow Blog, April 19, 2016
“A Brutal General Election”: Bernie Sanders’ Supporters Are Convinced He Could Win A General Election. They’re Wrong
Bernie Sanders’ rather unconventional personal style and characteristics are part of his appeal. Not some blow-dried politician who could fill in doing the weather on your local newscast, Sanders looks different from other candidates. A 74-year-old socialist with wild hair, frumpy suits, and an old-timey Brooklyn accent thicker than a pastrami sandwich, Sanders seems like the last guy who’d be able to assemble a national majority. But if that’s what you think, his supporters will tell you, you’ve got it all wrong. In fact, they say, Bernie is the only Democrat who can win in the fall. It’s only if the party screws up and nominates Hillary Clinton that Democrats are doomed.
It may be getting late in the process for arguments about electability, particularly when Clinton will almost have the nomination in hand if she wins in New York. But since Sanders supporters are so insistent on this point, it’s worth exploring.
Before we begin, we should acknowledge that all judgments about electability are imperfect, to say the least. That’s partly because politics is inherently unpredictable, and you never know what issues will emerge, what events will occur, what the other side will do, and how your candidate might screw up. It’s also because all of us have a hard time putting ourselves in the mindset of people who think differently than we do. In particular, people who care a great deal about politics and have clearly thought-out and ideologically coherent beliefs often find undecided voters positively baffling. How on earth can a person look at two candidates representing parties with profoundly different agendas and values, and say, “Gee, I just don’t know who to pick”?
But they do, and as we’ve seen before, the voting public’s judgments about candidates they don’t know much about beforehand can be radically altered by what happens in the fall campaign.
Sanders supporters, however, say not to worry. Their primary evidence for the superior electability of their candidate comes from “trial heats,” polls that ask voters whom they would choose in the general election between each Republican and each Democrat. And it’s true that in those polls, Sanders usually does better than Clinton. Trial heats show her beating Donald Trump, roughly tied with Ted Cruz, and behind John Kasich, while Sanders beats all three.
But is that much of an indication of what would happen in the general election? Clinton and Sanders come to this race with very different profiles. He was a completely novel character to most Americans, while she has been one of the country’s central political figures for over two decades. So in the eyes of most Americans — who are paying only intermittent attention to the primary campaign — Bernie Sanders seems like a kindly if eccentric uncle. He doesn’t sound like a typical politician (always a bonus), he speaks some uncomfortable truths, and he has an air of purity about him.
But what hasn’t happened yet is anyone really attacking Sanders. Clinton’s criticisms have been mild, and have largely come from the left, on those few issues like guns where she could position herself there. But you can barely get a Republican to utter an unkind word about Sanders, and that’s precisely because they know how they’d be able to go to town on him if he became the nominee.
So let’s consider the kinds of attacks Sanders would face from Republicans. They wouldn’t just call him a socialist — in fact, that’d be about the nicest thing they’d say about him. They’d say he’s coming to raise your taxes to fund big-government schemes. They’d say he wants to cripple the military. They’d say he’s advocated eliminating our intelligence capabilities. They’d say he was part of a Trotskyite party that expressed “solidarity” with the theocratic government of Iran while it was holding Americans hostage. They’d say he wants government to seize the means of production. They’d say he hates America. They’d say he’s the author of smutty rape fantasies.
These attacks would be unfair, exaggerated, distorted, dishonest — and when Sanders protests, the Republicans would laugh and keep making them. By the time they’re done with him, most Americans would think Sanders is so radical and dangerous that they wouldn’t want him running their local food co-op, let alone the United States government.
Sanders supporters tend to wave away the possibility that these attacks would hurt him in much the same way the candidate himself dispenses with questions of practicality, by saying that his revolution will be so extraordinary that it will sweep all opposition away. Millions of heretofore absent voters will turn up at the polls, Americans will see the wisdom of his ideas, this election will be different than any that came before! But there’s little reason to believe that will happen, particularly when even within the Democratic Party, Sanders hasn’t been persuasive enough to overcome Hillary Clinton, who is supposed to be so weak.
And there’s no doubt that Clinton does indeed have plenty of weaknesses as a candidate. Twenty-five years of attacks from the right have taken their toll on her public image, and she’s made plenty of her own mistakes along the way. But there’s nothing new that the GOP is going to throw at her — we know what Republicans will say, and we have a good idea of how the public will react.
On the other hand, the Democrats haven’t nominated a candidate as far to the left as Bernie Sanders since George McGovern in 1972 (and maybe not even then). I’d love to think that a candidate with his ideological profile could get through a brutal general election and still assemble a national majority. But it’s an awfully hard thing to believe.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Week, April 19, 2016
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