“Facing The Reality Of Politics”: Will Red State Governors Opt Out Of Medicaid Expansion?
While supporters of Obamacare are cheering the Supreme Court’s ruling upholding the constitutionality of the law, the celebration may
be short-lived as focus begins to shift to the one key aspect of the Affordable Care Act that was limited by the decision – the expansion of Medicaid to bring health insurance to approximately 17 million previously uninsured Americans.
As originally drafted and passed into law, states that failed to adopt the expansion and offer Medicaid coverage to anyone earning less than 133 percent of the Federal Poverty Level risked losing 100 percent of the money they receive from the federal government towards their state run Medicaid programs, even as currently offered.
In the ruling handed down on Thursday, the court held that such a penalty was unconstitutional and that the federal government is not permitted to punish the states in such a manner, leaving it to the states to decide if they want to stand pat with the Medicaid programs they currently operate or accept the expansion —and the federal largesse that comes with it.
Under the law, the federal government will pick up 100 percent of the cost of expansion for three years, 95 percent for the two years that follow and 90 percent of the costs thereafter. The expansion will allow the states to provide the benefit to many more low income Americans without taxing their state budgets at all for three years and then only slightly in the years that follow.
Currently, the federal government picks up the tab for about 55 percent of the costs of a state Medicaid program.
Those governors who are strong objectors to Obamacare will, no doubt, feel a strong ideological urge to reject the expansion and leave things as they are. But is that really going to fly? After all, conscientious objection to Obamacare is one thing but the reality of politics is something else entirely.
So far, there have only been angry ‘rumblings’ from Republican governors like Sam Brownback of Kansas and Bobby Jindal of Louisiana who say they will continue their objection to the ACA by refusing to begin organizing a healthcare exchange in their respective states and wait for the outcome of the November election. Other governors, such as Texas’ Rick Perry, who has refused federal money in the past, are staying a bit quiet on the subject, saying only that they will look into the matter and make a decision at a later time.
While it is to be expected that GOP governors—particularly those who refused to implement the requirements of Obamacare until they heard from the Supreme Court—would engage in a bit of sabre rattling, we can expect few, if any, to be foolish enough to pass up the opportunity to expand their Medicaid programs when Washington is offering such an exception deal for them to do so.
As National Journal’s Ron Brownstein points out, the 26 states that sued to block the Medicaid expansion contain over half of the nation’s unemployed and an even greater percentage of the nation’s uninsured population. Texas—one of the plaintiff states in the healthcare lawsuit—alone accounts for slightly over 6 million of the uninsured, 2 million of whom would gain coverage under the Medicaid expansion.
Additionally, because the federal government picks up virtually all of the costs attached to covering more people through expanded Medicaid, the program represents a massive transfer of money to those red states that tend to have less generous Medicaid programs already in existence. As a result, a state like Texas, with a rather sparse program, is going to get an enormous sum of federal cash where Massachusetts, which already has a generous program, will get very little in federal funding.
Are these red state governors really going to sit by and watch the taxes their citizens pay to the federal government flow to the benefit of their neighboring states as the recalcitrant governors allow their own residents to miss the benefit of that money?
I don’t think so. Ideological opposition is one thing—denying access to health care to voters who could certainly use it when, to do so, would cost the state a relatively tiny amount of money, is just dumb politics.
The pressure will not come only from the voters.
If there is one lobby that is highly supportive of the Medicaid expansion it is the nation’s hospitals. For them, covering millions of low income Americans means dramatically less free medical services being doled out to people who cannot pay. With more of those who have depended on free emergency room care as their sole means of getting health care now eligible to have Medicaid coverage, hospital balance sheets can be expected to look a lot better in the coming years.
Expect lots of huffing and puffing on this topic in the coming days.
Expect GOP governors to continue pressing the case that a Romney victory means saving their states from the further economic distress that these politicians will claim to be the fate of expanded Medicaid.
But remember that this Medicaid expansion is the bargain of the century for each and every state in the union that does not already offer generous Medicaid programs—especially the red states—and that beneath the inevitable bluster, there isn’t a Republican or Democratic governor in the country who doesn’t understand that passing up a sweet deal like this will bring unhappy political results.
My prediction?
Medicaid expansion, as written in the Affordable Care Act, will take place in every single state in the nation, without exception.
By: Rick Ungar, Contributor, Forbes, June 30. 2012
The “Amnesia Candidate”: Mitt Romney Lull’s The American People And The Media On The Economy
Just how stupid does Mitt Romney think we are? If you’ve been following his campaign from the beginning, that’s a question you have probably asked many times.
But the question was raised with particular force last week, when Mr. Romney tried to make a closed drywall factory in Ohio a symbol of the Obama administration’s economic failure. It was a symbol, all right — but not in the way he intended.
First of all, many reporters quickly noted a point that Mr. Romney somehow failed to mention: George W. Bush, not Barack Obama, was president when the factory in question was closed. Does the Romney campaign expect Americans to blame President Obama for his predecessor’s policy failure?
Yes, it does. Mr. Romney constantly talks about job losses under Mr. Obama. Yet all of the net job loss took place in the first few months of 2009, that is, before any of the new administration’s policies had time to take effect. So the Ohio speech was a perfect illustration of the way the Romney campaign is banking on amnesia, on the hope that voters don’t remember that Mr. Obama inherited an economy that was already in free fall.
How does the campaign deal with people who point out the awkward reality that all of the “Obama” job losses took place before any Obama policies had taken effect? The fallback argument — which was rolled out when reporters asked about the factory closure — is that even though Mr. Obama inherited a deeply troubled economy, he should have fixed it by now. That factory is still closed, said a Romney adviser, because of the failure of Obama policies “to really get this economy going again.”
Actually, that factory would probably still be closed even if the economy had done better — drywall is mainly used in new houses, and while the economy may be coming back, the Bush-era housing bubble isn’t.
But Mr. Romney’s poor choice of a factory for his photo-op aside, I guess accusing Mr. Obama of not doing enough to promote recovery is a better argument than blaming him for the effects of Bush policies. However, it’s not much better, since Mr. Romney is essentially advocating a return to those very same Bush policies. And he’s hoping that you don’t remember how badly those policies worked.
For the Bush era didn’t just end in catastrophe; it started off badly, too. Yes, Mr. Obama’s jobs record has been disappointing — but it has been unambiguously better than Mr. Bush’s over the comparable period of his administration.
This is especially true if you focus on private-sector jobs. Overall employment in the Obama years has been held back by mass layoffs of schoolteachers and other state and local government employees. But private-sector employment has recovered almost all the ground lost in the administration’s early months. That compares favorably with the Bush era: as of March 2004, private employment was still 2.4 million below its level when Mr. Bush took office.
Oh, and where have those mass layoffs of schoolteachers been taking place? Largely in states controlled by the G.O.P.: 70 percent of public job losses have been either in Texas or in states where Republicans recently took control.
Which brings me to another aspect of the amnesia campaign: Mr. Romney wants you to attribute all of the shortfalls in economic policy since 2009 (and some that happened in 2008) to the man in the White House, and forget both the role of Republican-controlled state governments and the fact that Mr. Obama has faced scorched-earth political opposition since his first day in office. Basically, the G.O.P. has blocked the administration’s efforts to the maximum extent possible, then turned around and blamed the administration for not doing enough.
So am I saying that Mr. Obama did everything he could, and that everything would have been fine if he hadn’t faced political opposition? By no means. Even given the political constraints, the administration did less than it could and should have in 2009, especially on housing. Furthermore, Mr. Obama was an active participant in Washington’s destructive “pivot” away from jobs to a focus on deficit reduction.
And the administration has suffered repeatedly from complacency — taking a few months of good news as an excuse to rest on its laurels rather than hammering home the need for more action. It did that in 2010, it did it in 2011, and to a certain extent it has been doing the same thing this year too. So there is a valid critique one can make of the administration’s handling of the economy.
But that’s not the critique Mr. Romney is making. Instead, he’s basically attacking Mr. Obama for not acting as if George Bush had been given a third term. Are the American people — and perhaps more to the point, the news media — forgetful enough for that attack to work? I guess we’ll find out.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 22, 2012
Changing Demographics: The GOP’s Census Problem
When the Census released its reapportionment totals in December, much of the focus was on the new seats in red states, and how it was a good thing for Republicans.
The data released by Census on Thursday, though, shows how those same population shifts are creating new challenges for the GOP.
While much of the shifting population is moving to red states, there is increasing evidence that it’s making those red states bluer, and most of the demographic trends are heading in Democrats’ direction.
Census Bureau director Robert Groves summed it up best Thursday: “We are increasingly metropolitan today, our country is becoming racially and ethnically more diverse over time … and geographically, there are a lot of areas of the country growing in number that have large minority populations.”
All three of those things suggest growing Demcoratic constituencies. Let’s look at each individually:
* The country is getting less rural: While 82.8 percent of the population in 2000 lived in metropolitan areas, that number is now 83.7 percent. A look at population changes county-by-county shows that many rural counties, especially in the solidly Republican middle of the country, actually experienced population loss over the last decade, while most of the big population growth was near big cities, where Democrats dominate.
* The country is getting more diverse: The minority population has increased dramatically to 36.3 percent and will only keep going down that path, as only a slight majority of U.S. children are white. And Republicans have major problems with minority populations. The black vote generally goes almost completely for Democrats, and even in the GOP wave in 2010, six in 10 Hispanics voted Democratic.
* The areas that are getting bigger are Democratic: A look at the states with the biggest growth over the past decade shows many of them have moved toward Democrats, including Nevada, North Carolina and Virginia (Obama was a surprise winner in all three, which had gone for President Bush in 2004). A look at the county-by-county growth in these states shows that the growth is focused in urban and Democratic areas — Las Vegas-based Clark County, Charlotte-based Mecklenburg County and the Research Triangle in North Carolina, and Northern Virginia all grew the fastest. That suggests that the growth is occuring in Democratic areas.
Now, just because Democratic-leaning demographics grow doesn’t necessarily mean Democratic voters will be created. For all we know, rural Republicans are moving into the city and making them redder.
But if Republicans want to compete in the decades to come, they need to be able to compete in metropolitan areas — likely by reasserting their dominance in the suburbs — and also be able to woo Hispanics, who now account for one in six people in the United States.
If they can’t, the demographics are just going to make it harder and harder.
By: Aaron Blake and Chris Cillizza, The Washington Post, March 25, 2011
State Crises Mean New Language Of Deceit
For most of history, we had undebatable definitions of words such as “bailout” and “bankruptcy.” We understood the former as an undeserved public grant, and the latter as an inability to pay existing bills. Whatever your particular beliefs about these concepts, their meanings were at least agreed upon.
Sadly, that’s not the case during a deficit crisis that is seeing language redefined on ideological terms.
“Bailout” was the first word thrown into the Orwellian fire. As some lawmakers recently proposed replenishing depleted state coffers with federal dollars, the American Conservative Union urged Congress to oppose states “seek(ing) a bailout” from the feds. Now, Rep. Paul Ryan, R-Wis., says, “Should taxpayers in Indiana who have paid their bills on time, who have done their job fiscally be bailing out Californians who haven’t? No.”
Ryan, mind you, voted for 2008’s TARP program — a bank bailout in the purest sense of the term. But one lawmaker’s rank hypocrisy is less significant than how the word “bailout” is being used — and abused. Suddenly, the term suggests that federal aid would force taxpayers in allegedly “fiscally responsible” Republican states to underwrite taxpayers in supposedly irresponsible Democratic ones.
Aside from stoking a detestable interstate enmity, this thesis ignores the fact that state-to-state wealth transfers are already happening. According to the Tax Foundation, most Republican-voting states receive more in federal funding than they pay in federal taxes, while most Democratic-voting states receive less federal money than they pay in federal taxes.
That means traditionally blue states like California are now perpetually subsidizing — or in Ryan’s parlance, “bailing out” — traditionally red states like Indiana. Thus, federal aid to states could actually reduce the state-to-state subsidies conservatives say they oppose.
Congressional Republicans will undoubtedly ignore these facts. Their proposed solution to the budget emergency could instead be a Newt Gingrich-backed initiative letting states default on outstanding obligations by declaring bankruptcy. Again, the word is fraught with new connotations.
Whereas sick or laid-off individuals occasionally claim a genuine inability to repay debts and thus a need for bankruptcy protections, states can never legitimately claim such a need because they are never actually “bankrupt.” Why? Because they always posses the power to raise revenue. The power is called taxation — and destroying that authority is what the new bankruptcy idea is really about. It would let states avoid tax increases on the wealthy, renege on contractual promises to public employees and destroy the country’s creditworthiness.
Blocking state “bailouts” and letting states declare “bankruptcy” are radical notions, especially in a bad economy. One would result in recession-exacerbating public layoffs; the other would institutionalize an anti-tax zealotry that destroys tomorrow’s middle class in order to protect today’s rich. That’s why advocates of these ideas have resorted to manipulating language. They know the only way to make such extremism a reality is to distort the vernacular — and if we aren’t cognizant of their scheme, they will succeed.
By: David Sirota, Syndicated Columnist, Sun Journal-published March 8, 2011
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