“Ideology Over Sound Policy”: Republican Governors No Longer A Force For Moderation
Republican governors, who actually have to govern, used to be a moderating force on the most extreme aspects of Republican ideology. No longer. In major areas such as health care, taxes, and jobless benefits, ideology is trumping sound policy judgment in many gubernatorial mansions and state legislatures.
Healthcare
Antipathy toward “Obamacare,” not reasoned analysis, seems to be why many governors have expressed hesitation, if not outright opposition, to the Medicaid expansions under the Affordable Care Act, even though the federal government would pick up almost all of the costs. A similar antipathy (and probably a hope before the Supreme Court decision and 2012 election that the law would go away) led many governors to pass on the chance to use the flexibility that the it afforded them to design their own health insurance exchanges—new competitive marketplaces in which individuals and small businesses can choose among an array of affordable, comprehensive health insurance plans that the Affordable Care Act requires.
I’ve previously explained why Medicaid expansion is a good deal for the states. But as the map below from the Center on Budget and Policy Priorities’ report on the healthcare law’s Medicaid expansions shows, many states remain undecided or are leaning against expansion:
The Center’s report on the state health insurance exchange implementation shows that 26 states, including most of the states leaning against Medicaid expansion, have declined to either operate a state-based exchange or partner with the Department of Health and Human Services in designing their exchange. Under the law, that means they default to a “Federally facilitated exchange” that HHS will establish.
Taxes
In another disturbing development, numerous states are considering—or have already enacted—sweeping tax and budget proposals that follow recommendations of the American Legislative Exchange Council, also known as ALEC. As this CBPP report explains, ALEC’s recommendations for deep tax cuts and limits on revenues and spending reflect extreme “supply side” and antitax arguments that mainstream economic research discredited long ago.
CBPP’s most recent assessment finds that at least five states (Kansas, Louisiana, Nebraska, and both North and South Carolina) are considering eliminating income taxes. At least 11 others (Idaho, Indiana, Missouri, Montana, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Texas, and Wisconsin) are considering deep tax cuts. And at least three states (Arizona, Arkansas, and Kansas) are considering harsh revenue limits.
Unemployment Insurance
Unemployment Insurance is a joint federal-state program in which states have traditionally offered up to 26 weeks of benefits to qualified workers who lose their jobs through no fault of their own, and the federal government typically provides additional weeks of emergency unemployment compensation when national unemployment is high. In the current jobs slump, by far the worst since the 1930s, seven states have cut back on the maximum number of weeks of regular benefits they offer. Because the maximum number of weeks of federal emergency benefits is proportional to the maximum number of weeks of state benefits, that means jobless workers in those states have seen a significant reduction in support while they look for work in what remains a tough labor market.
Research shows that Unemployment Insurance is valuable not only to unemployed workers and their families but also for the additional spending that it injects into the economy. States that have cut back on it are hurting struggling families and their own economic recovery.
The North Carolina Trifecta
North Carolina is the poster child for these disturbing trends in state governments.
The Tar Heel State is one of the five considering eliminating its income tax. The new Republican governor supports legislation that would prevent the state from expanding Medicaid or establishing a health insurance exchange. And, in July, the state will become the eighth to have reduced the maximum number of weeks of Unemployment Insurance it offers. Moreover, North Carolina also cut the maximum level of benefits which, under the “maintenance of effort” requirement for receiving emergency federal benefits, requires the federal government to cut off all emergency Unemployment Insurance to North Carolina.
Republican governors used to fight for Medicaid and Unemployment Insurance because they recognized how much their states benefited. Now, many are leading the effort to cut valuable programs in order to finance tax cuts for high-income households and businesses, while letting the chips fall where they may for those of more modest means.
By: Chad Stone, U. S. News and World Report, February 22, 2013
“The GOP Crusade Against The UnInsured”: Republicans Are Doing Everything They Can To Sabotage Obamacare
When House Speaker John Boehner declared Obamacare the “law of the land” two days after his party took a drubbing in the election, the real reveal came in what happened next: he walked it back in record speed and re-affirmed his commitment to getting rid of it.
Having failed to repeal the Affordable Care Act at the national level, Republicans are now dedicating their efforts to botching its implementation at the state level. And having failed to invalidate the law at the Supreme Court, they’re now seeking alternate legal avenues to weaken its regulations.
Republican governors are turning down the law’s Medicaid expansion, a move made easier by the Supreme Court decision that made the expansion optional. Among them are Bobby Jindal of Louisiana, Phil Bryant of Mississippi and Nikki Haley of South Carolina. Given that the federal government pays the vast majority of the cost in the medium term, these states are, in effect, rejecting an extraordinarily generous financial incentive to insure their residents.
Implementing the expansion in full would insure about 17 million people. “If [many states] don’t accept the Medicaid expansion you’re going to have millions of low income Americans who will remain uninsured and without access to health care,” said Tim Jost, a health care expert at Washington and Lee University who supports the Affordable Care Act.
Some dozen Republican governors are refusing — and about a dozen more are considering refusing — to build state-based insurance exchanges, the law’s primary vehicle for expanding and improving coverage. These governors, which include John Kasich of Ohio, Rick Perry of Texas, Nathan Deal of Georgia and Mary Fallin of Oklahoma, are consequently empowering the federal government to build one for them.
The law does not set aside funds for the federal government to construct or operate exchanges, creating implementation headaches for the Obama administration. But it can be self-sustained through user fees, and Jost argues that state residents with governors who are uncommitted would be better served by a federal exchange that wants to cover them.
Conservative thinkers are also resurrecting their argument, championed by top Republicans, that federally-administered exchanges lack the legal authority to provide tax subsidies, which are critical to making them work. Although the language of the law is vague on this question, the IRS has said federal exchanges are permitted to provide the premium subsidies.
“I don’t believe they’re going to win on that one,” Jost said. “If they did win that would do serious damage to what Congress intended, which is to have a federal fallback exchange.”
Utah Gov. Gary Herbert (R) is flirting with continuing his state’s existing insurance exchange even though it does not comply with rules in the Affordable Care Act.
Meanwhile, conservative advocates are advancing a separate legal challenge to the law’s requirement that insurance plans cover contraception for women as part of a copay-free preventive services package. Cheered on by congressional Republicans, Catholic institutions such as the Archdiocese of Washington and University of Notre Dame are moving forward with lawsuits that could end up in the Supreme Court.
All in all, Republicans and conservatives are telegraphing that they’re not chastened by years of failed efforts to wipe away Obamacare. The crusade shows no signs of ending, and could still do serious damage to the law.
By: Sahil Kapur, Talking Points Memo, November 21, 2012
“Unexpanded Medicaid”: Millions Of Women Could Remain Uninsured If States “Opt Out”
It can seem like just a mirage created by the summer heat: only a few weeks ago the Supreme Court actually handed down a decision that progressives could celebrate. It held that the Affordable Care Act is constitutional, including the individual mandate, meaning that implementation can roll on full steam ahead. I was one of the first to celebrate, in particular for all the ways that the law will help women who need healthcare (which is all of us). As Katha Pollitt recently wrote here, women will benefit dramatically from the ACA. The law bars practices like charging women more just for being women, dropping women’s coverage if they become pregnant or sick, and denying coverage due to “pre-existing conditions” like having had breast cancer or being a victim of domestic violence. It adds new benefits like birth control coverage at no cost to the patient, expanded coverage of preventative services like prenatal care, mammograms, pap smears, and bone-density screenings through Medicare, and requiring insurance companies to cover maternity care.
But one aspect of the Supreme Court’s decision could have some very bad results for women: the ruling that states can opt out of the Medicaid expansion. While this could end up harming men and women, women in particular stand to suffer if states refuse to participate in the program.
The Medicaid expansion is a crucial component of the law’s overall goal of extending coverage to over 30 million uninsured Americans by 2019, covering almost half of the total number of people the bill promised to insure. Originally, the law included a provision that the federal government could take away all of a state’s Medicaid funding if it refused to go along with the expansion, which all but ensured participation. But the Court ruled that such a maneuver was unconstitutional. Just a few days after the decision was announced, seven Republican governors said they would flat out reject the money to expand Medicaid rolls, with at least eight more looking to follow suit. More have said no since then.
This could create a no-man’s land for those who earn less than 100 percent of the Federal Poverty Line, making them ineligible for tax subsidies to help them buy insurance, but don’t qualify for their state’s (unexpanded) Medicaid program. These Americans are surely struggling to get by, but not quite enough to get health coverage promised to those above and below them.
And women are likely to fall into this chasm. Remember that unexpanded Medicaid does not cover most childless adults. Currently, a woman must meet both categorical and income criteria to qualify for Medicaid: she must be pregnant, a mother of a child under age 18, a senior citizen, or have a disability, and each category has income criteria, which differ state by state. Given that women are more likely to be pregnant (duh) but also to fall into the other categories, they are already the majority of enrollees in the program. However, given that many women don’t meet categorical criteria, many don’t qualify no matter how poor they are. Over 17 million women lived in poverty last year, compared to 12.6 million men.
By 2016, 13.5 million women were expected to get coverage under the Medicaid expansion. That figure is now in danger. As the Kaiser Family Foundation reported before the Supreme Court decision, “Medicaid will be the foundation of health coverage expansions to very low-income women.” But not if some Republican governors get their way.
Many of the states already rejecting the expansion are home to the greatest number of women who would benefit. Texas and Florida top the list for the most uninsured women in their states: about 2.4 million and 1.5 million, respectively, and both states plan to refuse the expansion. (Some of these women were supposed to get coverage through the Medicaid expansion, but some will still qualify for the subsidies and be able to buy insurance in the state exchanges.)
Using Kaiser’s predictions, I calculate that there are over 4.2 million women who would be eligible for the Medicaid expansion by 2014 in the states either refusing or indicating they will refuse to participate. That’s a huge chunk of the 10 million women that were expected to be covered by that time through Medicaid.
Those are the immediate impacts on low-income, uninsured women. The ruling may have other far-reaching impacts on women’s lives, however. As Jessica Mason Pieklo writes at RH Reality Check, the idea that the federal government can’t withdraw all Medicaid funds from states that don’t follow federal requirements might have other consequences. The first may be states that are trying to prevent Medicaid from contracting with providers that also offer abortions (i.e., in many cases, Planned Parenthood). Such a case is going on in Indiana right now. As Pieklo writes,
Thanks to the majority in NFIB v. Sebelius, conservative states looking to enact state-wide funding bans may have the framing necessary to pin the federal government. That’s because the language of Roberts’ opinion as to the Medicaid expansion is vague enough to argue that the federal government can’t coerce a state into funding Planned Parenthood by threatening to withhold all of that state’s federal Medicaid money, especially, since conservative states argue, they believe cutting Medicaid funds is the only way to guarantee state dollars do not fund abortion services.
Planned Parenthood and its affiliate centers provide services to 3 million people annually, including 4 million tests for sexually transmitted infections, 770,000 Pap tests, and 750,000 breast exams. Banning Medicaid from contracting with Planned Parenthood will hurt the low-income women who need these services—but states may now have a legal leg to stand on if they try to do just that.
Perhaps the worst thing of all? The excuse that Republican governors are using to get out of the Medicaid expansion may not even hold up. They claim to be worried that even though the federal government will pick up the whole tab for the first few years, the portion they’ll have to pay after that (10 percent) is too burdensome on their budgets. Yet there is evidence that expanding Medicaid could actually help their finances. Rejecting the Medicaid expansion may not even make fiscal sense, but no matter what it doesn’t make moral sense. It could leave millions of women exposed, unable to afford health insurance but not able to participate in Medicaid.
By: Bryce Covert, The Nation, July 17, 2012
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