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“Politicians Protecting Themselves”: Ideology And Polarization Are Trumping All Of The Old Rules Of Politics

If you need convincing that 2015 wasn’t just an “outlier” of a year in American politics, where all of the old rules seemed to fly out the window, please read Mark Schmitt’s fascinating piece in the New York Times earlier this week that examines the rapid decline of some of the bedrock principles of political behavior we all used to take for granted. You cannot, he concludes, blame any of this weirdness on Donald Trump; it’s preceded his rise for a good while.

He may be changing the rules of the presidential primary race, but in the halls of Congress and in governors’ mansions across the country, politicians have already acted in ways that would have been unimaginable a decade ago. By testing and breaking the rules, they have been reshaping the practice of politics since long before Mr. Trump emerged.

Members of Congress, Schmitt observes, are showing unprecedented independence from their own constituents, and so, too, are state elected officials. In both cases they are beginning to refuse to “bring home the bacon” if they dislike the ideological provenance of the cook:

[S]everal members even announced in 2013 that they would not assist constituents with problems involving the Affordable Care Act. The idea of not just neglecting but actively refusing constituent services, for reasons of ideology, would be unimaginable to the constituent-focused members of Congress of both parties elected beginning in the 1970s.

Governors, too, rejected everything from infrastructure spending to federal funding for Medicaid expansion. Even when they saw their approval ratings drop into the 30s, they survived. In 2011, Rick Scott of Florida rejected $2.4 billion in federal funds for a commuter rail project and yet got reelected.

The widespread expectation that red states would accept the Medicaid expansion once the Supreme Court made it voluntary, as a deal too good to refuse, is an example of the old conventional wisdom.  In nearly half the states, ideology trumped helping constituents access available funds and services.

Schmitt believes that predictable partisan voting patterns and special-interest pressure have combined with ideology to all but kill the once-reigning assumption of American politics: the “median voter theorem,” which held that politicians of both parties would inevitably cater to the interests of swing voters in the middle of the ideological spectrum in the pursuit of a majority. It’s the basis of the still-common belief that in competitive contests candidates have to “shift to the center” to win general elections no matter how much time they spend “pandering to the base” in primaries. If, however, an ever-higher percentage of voters simply and reflexively pull the lever for the party with which they identify, then keeping them motivated enough to vote — perhaps by negative attacks on the hated partisan foe — becomes far more important than appealing to an ever-shrinking number of “swing voters.” Eventually, as Schmitt suggests, the whole idea of accountability to voters begins to fade, as pols try to figure out how to protect themselves via gerrymandering and oceans of special-interest money.

[B]y recasting politics as a winner-take-all conflict between wholly incompatible ideologies and identities — as most of the presidential candidates have done — they help to closely align party and ideology, so that those who identify as Republican will always vote Republican and vice versa. When politicians know more or less who will vote and how, they can ignore most voters — including their own loyalists.

Schmitt attributes a lot of these trends to the conquest of the GOP by conservative ideologues, but also notes that the declining competition for median voters has liberated Democrats — themselves less constrained by a conservative minority that barely exists anymore — to think bigger and bolder thoughts about the role of government than they have at any time since the Great Society era. So judging the new rules of politics as a good or a bad thing will most definitely depend on one’s own ideological perspective.

If Donald Trump didn’t cause the fading of the old political order, is he nonetheless benefiting from it? Quite probably so, in that he is the living symbol of spitting defiance to the belief of Republican elites that the median voter theorem required a less viscerally angry and culturally reactionary GOP. Indeed, political observers view Trump as strange and scary precisely because the old rules that would have consigned him to the dustbin of history don’t seem to be in operation anymore. We’d better all lower our resistance to the unexpected.

 

By: Ed Kilgore, Daily Intelligencer, New York Magazine, January 6, 2015

January 7, 2016 Posted by | Donald Trump, GOP Primaries, Ideology | , , , , , , , | Leave a comment

“A Familiar Premise Of Free-Market Conservatism”: Iowa’s Radical Privatization Of Medicaid Is Already Struggling

On Jan. 1, 31 days before Iowa caucus-goers cast the first votes of the 2016 presidential race, the state will gain another national distinction, but of a dubious variety: It plans to launch the most sweeping and radical privatization of Medicaid ever attempted.

In an extraordinary social policy experiment, Iowa’s Gov. Terry Branstad (R) is kicking about 560,000 of the state’s poorest residents out of the traditional Medicaid health-care program for the poor and forcing virtually all of them to sign up with private insurers. The trend toward managed care for Medicaid has been underway for decades and some 39 states do it to some extent. But experts inside and outside government say no state has tried to make such a wholesale change so quickly — in Iowa’s case, launching the program fewer than 90 days after signing contracts with private health-care companies.

Iowa is conducting an extreme test of a familiar premise of free-market conservatism: that the private sector is more efficient at management and service delivery than government. But the results so far should give pause to those who automatically make such assumptions. The transition of Iowa’s $4.2 billion Medicaid program has made the rollout of HealthCare.gov look orderly.

An Iowa administrative law judge late last month recommended that Iowa throw out the contract it awarded to WellCare, one of the four companies hired to manage the new program, noting that the company failed to disclose details of its “integrity agreement” with the federal government after the 2014 convictions of three former executives involving the misuse of Medicaid money. In addition, WellCare had paid $138 million to resolve claims that it overbilled Medicare and Medicaid, and the firm had also hired two former Iowa legislators, who improperly communicated with the Branstad administration during the bidding process.

The Des Moines Register has reported that the four companies selected to operate the Iowa program have had more than 1,500 regulatory sanctions combined and have paid $10.2 million in fines over the past five years. These involved canceled appointments, privacy breaches, untimely processing and failure to obtain informed consent.

The Iowa rollout has been hampered by delays, and some beneficiaries of the program are only now getting their enrollment packets, though the deadline for signing up is Dec. 17. Health-care providers complain that they are being forced to sign incomplete contracts or face a penalty, and they complain that some contracts don’t cover services that had been covered under the existing Medicaid program.

Branstad’s administration has answered critics by saying the new program will save $51 million in its first six months. But he has been unable to come up with documentation to justify the cost savings for Iowa, which already has a low-cost Medicaid system.

Branstad had the authority to implement the new program without input from the state legislature. But officials with the Centers for Medicare and Medicaid Services (CMS) were in Iowa this week and will make a ruling next week on whether the plan can proceed.

“The rollout has been an absolute unmitigated disaster,” said Democratic Sen. Joe Bolkcom, the Iowa chamber’s majority whip. “CMS and the Obama administration need to protect vulnerable Iowans from this train wreck.”

Branstad has implicitly acknowledged some difficulty. This week he extended until April the “safe harbor” in which Medicaid providers will receive 100 percent reimbursement regardless of managed-care network.

In response to my inquiry, Branstad’s office sent me to the state’s Department of Human Services, where a spokeswoman, Amy Lorentzen McCoy, said all is well. The state, which now has 12 percent of Medicaid recipients in managed care, would have gone this way anyway, she said, but the urgency increased with the recent Medicaid expansion. (Branstad was one of the few Republican governors to accept the Obamacare expansion of the program.)

Now, as the nation’s attention turns to the Iowa caucuses, Iowans will likely be witnessing either a fight between Branstad and President Obama (if the federal government forces a delay in the Iowa program) or chaos (if the program is allowed to proceed). Other states, such as Kansas and Kentucky, have tried similar experiments, but they either moved more deliberately or didn’t extend the private program to vulnerable populations such as the disabled.

“A lot of issues have been raised with the pace of the rollout” in Iowa, said Julia Paradise, a Medicaid expert with the Kaiser Family Foundation. “The provider networks for the plans have not yet been established. There’s a lot of confusion among beneficiaries.”

Branstad could recognize this, and slow things down. In failing to do so, he’s relying more on dogma — faith that the private sector always does things better — than reality.

 

By: Dana Milbank, Opinion Writer, The Washington Post, December 11, 2015

December 14, 2015 Posted by | Free Markets, Medicaid Privatization, Terry Branstad | , , , , , , , , | Leave a comment

“The Diaper Dandy is Done”: I’m Just Glad To See David Vitter Go; I Never Liked That Man

Louisiana state Rep. John Bel Edwards soundly defeated David Vitter in yesterday’s gubernatorial election. Not only that, but in his concession speech, Vitter announced that he won’t seek reelection to the U.S. Senate next year. In other words, David Vitter is finished as a consequential politician, done in mainly by an eight year old prostitution scandal, but also by the immense unpopularity of the sitting Republican governor Bobby Jindal.

The Democratic Party is encouraged to see a flicker of life in the Deep South, although progressives need to keep things in perspective.

From the start of his run, Edwards knew any chance of victory hinged on distinguishing himself from the prevailing image of Democrats among voters. In meetings with small groups in rural parishes, he touted his opposition to abortion and strong support for gun ownership.

The devil is in the details when it comes to opposing abortion and supporting gun ownership. What kinds of bills would be radical enough that Edwards would veto them? Is there a different line than there would be for a Republican governor?

In some ways, it’s already a defeat if Democratic candidates feel that they need to concede the Republican position on these two very important issues in order to get a hearing on other policies. And there’s a price they have to pay when their party is more divided on issues than the Republicans. It waters down the message.

On the other hand, more than anything else, it was the Democrats’ ability to unite around one candidate while the Republicans were slugging it out in a nasty primary that brought them success. “Edwards” is a big name in Louisiana politics, but John Bel Edwards’s clan is not related to former Governor Edwin Edwards. In a pre-election analysis, The Daily Beast‘s Jason Berry did a comprehensive examination of the new Edwards family power in the Bayou State. Here’s part of that:

It also helps Edwards, 49, that his brother, Daniel, 47, is Tangipahoa Parish sheriff—a fourth-generation sheriff in a sprawling family of lawyers, politicians, and law enforcement officials with deep Louisiana roots.

Tangipahoa is a heavily rural civil parish whose seat, the town of Amite (population 4,141) is 82 miles north of New Orleans. Edwards’s law firm is in Amite; he lives in nearby Roseland (population 1,165). For much of the last century, the parish, which is 30 percent African-American, was known as “Bloody Tangipahoa,” with a history of lawlessness that included a gruesome chapter involving the Ku Klux Klan. That stigma changed under Sheriff Frank Edwards, John Bel’s father.

“Frank Edwards was one of the first sheriffs that hired blacks,” says Donald Bell, the African-American pastor of New Life Outreach Ministries in the town of Hammond.

“Frank was balanced. Everybody loved him. John Bel had good training from his daddy. I was close to Frank. He lived and died politics. If Frank told you, ‘Jerry can’t beat John,’ you could bet that Jerry wasn’t gonna beat John. And Frank would give you two, three reasons why. He was a good Catholic guy. They were committed, just like John Bel—he doesn’t miss Mass. John Bel is a people person, down to earth, what you see is what you get.”

According to Pastor Bell, Edwards has always gotten along well with the local NAACP, and he actually won a state House seat that had been drawn up to be held by a black politician. This ability to bridge the racial divide helps explain how he managed to avoid any Democratic challengers in the primary. And, of course, it was his father who paved the way.

With the endorsement of state law enforcement organizations, his strong record at West Point and as an Airborne Ranger, his family’s good reputation for piety and positive race relations, and an opponent who was best known for paying prostitutes to dress him in a diaper, it would probably be a mistake to see this election result as some kind of bellwether for anything.

The Democrats simply had a much better candidate.

They also didn’t have Bobby Jindal hanging around their neck like an anvil. Like all Louisiana Republicans these days, Vitter tried to destroy his opponent by tying him to President Obama, but this tactic was neutralized by Edwards’ efforts to tie Vitter to Jindal. This left Vitter dependent on social issues, like guns and abortion, but there weren’t any meaningful distinctions between the two candidates on those issues, and there wasn’t much question which candidate had the better record for being a good family man.

And, so, we got a result that is surprising but really was foreseeable if you drilled down into the specifics of the race.

As for what happens now, the The Times-Picayune believes that Gov.-Elect Edwards will bring Medicaid expansion to the state and that teachers unions will have more influence. Edwards will try to deliver on a campaign promise to double funding for higher education, but Jindal has left the state’s finances a mess, and he’ll need to work with a legislature dominated by Republicans.

The Democrat has promised to govern from the middle and is expected to appoint Democrats and Republicans alike to cabinet positions. For example, [Republican Lt. Governor Jay] Dardenne is likely on a short list to fill a high-profile position in the Edwards administration.

Edwards may have to govern in a bipartisan manner, not just by choice. The governor-elect has a serious budget crisis on his hands, and will need a two-thirds vote of the GOP-controlled Legislature for many of his proposals to fix Louisiana’s finances.

“I think that the Legislature and executive branch should cooperate fully,” said Senate President John Alario, R-Westwego, who is likely to remain atop the state senate in 2016.

But not everyone is excited to see Edwards head up the executive office. The Democrat makes many of the state’s leading business groups nervous. Edwards has not been supportive of the school choice movement, including charter schools and the state voucher program. Business leaders also believe he is more inclined to roll back their tax credits and incentive programs to fix the state’s budget problems than a Republican would be.

Edwards will have to find an enormous amount of money somewhere to shore up the state’s finances. Louisiana is wrestling with a $500 million shortfall in its current budget cycle and a projected $1 billion budget gap in the next fiscal year.

I’m no expert on Louisiana’s legislature, so I don’t know whether Medicaid expansion will get done or not. I do know that Edwards will have four years to rebuild the Democratic Party and that a lot of people will get experience working in his administration.

Above all, I’m just glad to see David Vitter go. I never liked that man.

 

By: Martin Longman, Web Editor for the Washington Monthly; Ten Miles Square, November 22, 2015

November 29, 2015 Posted by | Bobby Jindal, David Vitter, John Bel Edwards, Louisiana | , , , , , , , | Leave a comment

“ACA Plays ‘Remarkable’ Role In Cancer Detection”: A Striking Picture Of Increased Early-Stage Diagnoses Among Young Women

As the Affordable Care Act has taken root, there’s been quite a bit of anecdotal evidence pointing to people whose lives were saved – quite literally – by the law’s existence. But at this point, we’re also able to measure the ACA’s efficacy beyond just the anecdotes.

The New York Times reported on a substantial increase in the number of young women who’ve been diagnosed with early-stage cervical cancer, and there doesn’t seem to be much of a mystery to explain the trend. Because “Obamacare” covers young adults before their 26th birthday, the percentage of uninsured 19- to 25-year-olds has plummeted.

You can probably guess what that means: more young women are able to see a doctor, more doctors are able to do cancer screenings, and more exams are detecting cancer at early stages. From the Times’ report:

Researchers from the American Cancer Society wanted to examine whether the expansion of health insurance among young American women was leading to more early-stage diagnoses. Early diagnosis improves the prospects for survival because treatment is more effective and the chance of remission is higher. It also bolsters women’s chances for preserving their fertility during treatment. And women with health insurance are far more likely to get a screening that can identify cancer early.

Researchers used the National Cancer Data Base, a hospital-based registry of about 70 percent of all cancer cases in the United States. They compared diagnoses for women ages 21 to 25 who had cervical cancer with those for women ages 26 to 34, before and after the health law provision began in 2010.

The results painted a striking picture of increased early-stage diagnoses among the younger group, with no meaningful change in the older group.

One of the researchers, Dr. Ahmedin Jemal, said the effect of the Affordable Care Act is hard to miss, leading to results he described as “very remarkable.”

For the ACA’s proponents, it’s additional evidence to suggest the law is literally a life-saver, and for the ACA’s opponents, it’s another challenge in explaining why the law must be destroyed in its entirety, regardless of the consequences.

 

By: Steve Benen, The Maddow Blog, November 25, 2015

November 28, 2015 Posted by | Affordable Care Act, Cancer Screenings, Obamacare, Women's Health | , , , , | Leave a comment

“Health Reform Lives!”: The Reality Is That Obamacare Is An Imperfect System, But It’s Workable — And It’s Working

To the right’s dismay, scare tactics — remember death panels? — and spurious legal challenges failed to protect the nation from the scourge of guaranteed health coverage. Still, Obamacare’s opponents insisted that it would implode in a “death spiral” of low enrollment and rising costs.

I mention all of this to give you some perspective on recent developments that mark a break in the string of positive surprises. Yes, Obamacare has hit a few rough patches lately. But they’re much less significant than a lot of the reporting, let alone the right-wing reaction, would have you believe. Health reform is still a huge success story.

Obamacare seeks to cover the uninsured through two channels. Lower-income Americans are covered via a federally-funded expansion of Medicaid, which was supposed to be nationwide but has been rejected in many Republican-controlled states. Everyone else has access to policies sold by private insurers who cannot discriminate based on medical history; these policies are supposed to be made affordable by subsidies that depend on your income.

Nobody ever expected Obamacare to cover all the uninsured. In fact, Congressional Budget Office projections made in 2013 suggested that about 10 percent of nonelderly U.S. residents would remain uncovered: some because they are undocumented immigrants, some because of the gap created by red-state Medicaid rejection and some because they would fall through the cracks of a complicated system. But the law was nonetheless projected to produce a sharp reduction in the number of Americans without insurance, and it has, especially in states like California that have tried to make it work.

Meanwhile, both insurance premiums and the cost of subsidies designed to make them affordable came in far below expectations in both 2014 and 2015.

Sooner or later, of course, there were bound to be some negative surprises. And we’re now, finally, getting a bit of bad, or at least not-great, news about health reform.

First, premiums are going up for next year, because insurers are finding that their risk pool is somewhat sicker and hence more expensive than they expected. There’s a lot of variation across states, but the average increase will be around 11 percent. That’s a slight disappointment, but it’s not shocking, given both the good news of the previous two years and the long-term tendency of insurance premiums to rise 5-10 percent a year.

Second, some Americans who bought low-cost insurance plans have been unpleasantly surprised by high deductibles. This is a real issue, but it shouldn’t be exaggerated. All allowed plans cover preventive services without a deductible, and many plans cover other health services as well. Furthermore, additional financial aid is available to lower-income families to help cover such gaps. Some people may not know about these mitigating factors — that’s the problem with a fairly complex system — but awareness should improve over time.

Finally, UnitedHealth Group made a splash by announcing that it is losing money on the policies it sells on the Obamacare exchanges, and is considering withdrawing from the market after next year. There were some puzzling things about the announcement, leading to speculation about ulterior motives, but the main thing to realize is that UnitedHealth, while a huge provider of employment-based insurance, is actually a fairly small player in this market, and that other players are sounding much more positive.

Oh, and official projections now say that fewer people will enroll in those exchanges than previously predicted. But the main reason is that surprisingly few employers are dropping coverage; overall projections for the number of uninsured Americans still look pretty good.

So where does that leave us? Without question, the run of unexpectedly good news for Obamacare has come to an end, as all such runs must. And look, we’re talking about a brand-new system in which everyone is still learning how to function. There were bound to be some bobbles along the way.

But are we looking at the beginnings of a death spiral? Some people are indeed saying that, but as far as I can tell, they’re all people who have been predicting disaster every step of the way, and will still be predicting imminent collapse a decade from now.

The reality is that Obamacare is an imperfect system, but it’s workable — and it’s working.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, November 23, 2015

November 24, 2015 Posted by | Affordable Care Act, Health Reform, Obamacare | , , , , , , | 1 Comment

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