“Obamascare Tactics In Red State Races”: Passing Laws That Prevent Any Future Governor From Accepting Medicaid Money
If I asked you to name two states where the incumbent Republican governors might lose reelection this fall, you would likely, I expect, say Florida and Pennsylvania. I doubt very much you’d offer up Georgia and Kansas.
But lo and behold—the contests in both of those states are right now a little closer than you’d expect. In Kansas, Sam Brownback is the governor. You remember Brownback—he was a senator for a spell, best remembered (by me anyway) for his prominent role in that hideous Republican appropriation of poor Terry Schiavo in their zealotry to “promote life.” In Georgia, the bossman is Nathan Deal, also a former Congressman, whose term is best remembered for the way he announced a departure date for his gubernatorial run. (He realized that the House would be voting on Obamacare shortly thereafter, and delayed his departure so he could vote against it.)
It ought to be easy-peasy-lemon-squeezy for right-wing Republicans to get reelected in those states, but recent polls have shown them dangling along the margin-of-error cliff. Deal leads Jason Carter (yep, Jimmy’s grandson) by just 3.4 percent in the realclearpolitics average, and Brownback actually trailed Democrat Paul Davis 42-40 in one February poll. Brownback’s approval rating is also deeply underwater. So it’s conceivable—that’s as far as we should prudently go—that both could lose.
Now, here’s the rub. Both, naturally, oppose the expansion of Obamacare into their states. They say no force on earth or in heaven will make them take that Medicaid money. It’s estimated that 600,000 Georgians and 78,000 Kansans would benefit. But they’re having none of it. And that’s their right. But what they’re doing now, in cahoots with friendly legislators, is a step beyond: In both states, they’re passing laws that would prevent any future governor from accepting the Medicaid money.
It works like this. Under the Affordable Care Act, the process by which states decide to accept the money is entirely up to them. Some states determined that legislative action should be required. You may have read about the Republicans in the Florida legislature rebuffing GOP Governor Rick Scott for the five minutes he was toying with taking the money. New Virginia Governor Terry McAuliffe wants the money badly, and his Democratic State Senate is with him, but they’re hamstrung by the GOP-controlled House of Delegates, which is against.
Initially, Georgia and Kansas were states where it was just the governor’s call. Which was fine as long as the Republicans looked like sure things. But the polls tightened up, and people started getting a little antsy. Hey, what if a Democratic governor got elected and said, ‘Okay, Barack, write me that check?’
And so Brownback signed his state’s law last Friday. His office just announced it this week. Why the delay? Shouldn’t one such as Sam Brownback be proud of signing this socialism-blocking law? Well, it turns out that it was originally a law about something else, requiring the state to provide quick payment to certain in-state Medicaid care providers. This provision was tacked on late. A Wichita Democrat, Jim Ward, said: “That bill is what I think is endemic with this legislative process under this governor and this speaker and Senate president. There was no hearing. There were no opportunities for people who have a stake in Medicaid expansion to come in and talk about it.”
In Georgia, it’s easier. The legislation was passed about a month ago. If Deal doesn’t veto it, it becomes law. And since he supports it—indeed, since his staff helped write this law that willingly hands gubernatorial power over to the legislature—it will. And into the bargain, the Georgia legislature also passed—on the next-to-last day of the session—a bill that blocks state employees from helping Georgians sign up for care under the ACA.
So stop and think about this. Kansas and Georgia have just taken what was a gubernatorial decision out of the hands of not only current but future governors. You can argue plausibly that the people’s representatives should have a say in such a decision, on principle. But principle wasn’t at work here. Political expediency was. Legislators in the two states know that Republicans are likely to have control as far as the eye can see. And they’ll never say yes. And they’re doing all this in the name of what? In the name of denying 678,000 people a chance at health-insurance coverage.
It gets worse. The ACA makes cuts to certain current Medicaid programs on the assumption that states would take this new Medicaid money. It cut funding for hospitals that serve the poor, cuts intended to be mitigated by the fact that a large number of poor would now be insured once the states they live in accepted the new money. But in states that did not, those people are suffering even more. Several rural hospitals in Georgia have closed. They could be saved if the state took the Medicaid money.
Carter vows he’s going to make this skeezy law, and the Medicaid question generally, an issue. The Georgia law has sparked large protests and arrests and might end up being the most important issue in the campaign. In Kansas, Davis supports Medicaid expansion—and according to a recent poll so do 55 percent of Kansans, against just 39 percent who oppose taking the money. So maybe there’s not as much the matter with Kansas as we thought. With the people, anyway. The governor and the legislators are another matter.
By: Michael Tomasky, The Daily Beast, April 23, 2014
“Stuck In The First Stage Of Grief”: GOP Reflexively Making Themselves Feel Better About A Reality That’s Causing Them Pain
At a press conference last week, President Obama announced a figure that was hard to even imagine a month ago: 8 million consumers signed up for private insurance through exchange marketplaces during the Affordable Care Act’s open-enrollment period. Obama also took a moment to chide Republicans for having been wrong about practically every aspect of the debate.
“I recognize that their party is going through the stages of grief,” he said, “and we’re not at acceptance yet.”
That sounds about right, though I’m not sure the GOP is “going through the stages of grief” so much as it’s stuck on the first one. If the process is believed to have five stages – denial, anger, bargaining, depression, and acceptance – we have quite a ways to go before “acceptance” is even on the horizon.
Rep. Tim Huelskamp (R-Kan.) said Monday he believes the uninsured rate in his state has increased since implementation of the 2010 health care reform law.
“It’s hard to get accurate numbers on anything,” Huelskamp told his constituents at a town hall in Salina, Kan., according to video posted by Eagle Community Television. “But the numbers we see today is that – as I understand them – we believe there are more people uninsured today in Kansas than there were before the president’s health care plan went into effect. And I thought the goal was to bring more people into insurance.”
There are a wide variety of counts when it comes to determining just how many uninsured Americans have been able to get coverage, but all of the reports have something important in common: they all show the rate of the uninsured going down, not up. We can discuss exactly how many, whether that’s in line with expectations, whether that’s enough to sustain the larger system, and why progress is happening faster in blue states than red states.
But to argue that the number of uninsured people is climbing is comparable to arguing that the federal budget deficit is getting larger; the planet is experiencing global cooling; and Obama has pushed use of executive orders to new heights.
Oh wait, conservative Republicans often believe all of those bogus claims, too.
Obviously, the problem isn’t limited to Huelskamp. On Friday, Sen. Dean Heller (R-Nev.) said he doesn’t believe the Obama administration’s enrollment totals, calling the figures “all smoke and mirrors.” On Thursday, House Majority Whip Kevin McCarthy (R-Calif.) suggested consumers receiving ACA subsidies to defray the costs of coverage may be engaged in “fraud.”
Much of the Republican establishment quickly embraced the “cooking the books” conspiracy theory, which was soon after followed by the Census Bureau conspiracy theory.
The right doesn’t bother with evidence to bolster any of this – evidence is irrelevant. Denial isn’t about rationality; it’s about reflexively making one feel better about a reality that’s causing them pain.
That said, GOP officials aren’t just embracing denial, they’re swimming in it in the most self-indulgent fashion possible. Republicans almost seem to be enjoying their distaste for health care reality, seemingly eager to one up their far-right colleagues.
Let’s also not brush past the “heads I win, tails you lose” problem – “Obamacare” critics believe the numbers are correct and reliable when they point to facts Republicans want to hear. Enrollment totals are low? This is proof that conservatives were right all along and that the ACA is a failure. Enrollment totals soared in March? This is proof that the White House is perpetrating a fraud – because conservatives were right all along and that the ACA is a failure.
It’s become effectively impossible under conditions like these for the two sides to even have a conversation about health policy. Paul Krugman’s take over the weekend rings true:
Not a day goes by without some prominent Republican politician or pundit insisting that the enrollment numbers are phony, that more people are losing insurance than gaining it, etc.. I know that’s what the base believes, because it’s what they hear from Rush and Fox. But you would think that important people would have someone around who has a clue, who knows that enrollment data and multiple surveys are all telling the same story of unexpected success. OK, maybe not – if famous senators don’t have anyone to clue them in about BLS data, they might really still be living in the bubble. But that’s really their choice.
And the point is that with enrollment more or less closed for 2014, there’s not much point in spinning. OK, maybe if you can keep up the pretense all the way to November, you can slightly sway base voters for the midterms. But even that’s doubtful – by the fall, we’re going to have a very clear picture of how things went; and the shape of that picture has already been determined.
I guess that what gets me is the – to use the technical term – wussiness of it all. Isn’t there any space on the right for people who sell themselves as tough-minded, who condemn Obamacare on principle but warn their followers that it’s not on the verge of collapse? Is the whole party so insecure, so unable to handle the truth, that it automatically shoots anyone bearing bad news?
I’m going to assume those are rhetorical questions, because the answer seems pretty obvious.
By: Steve Benen, The Maddow Blog, April 21, 2014
“She Surely Paid Her Dues”: Will Kathleen Sebelius Win In The End? Legacy Tied To Obamacare’s Outcome
Yes, there was utter failure, but there was also one hell of a recovery. As time goes on, she’ll get less blame for the former and more credit for the latter.
It was always going to be a tough job, Health and Human Services secretary under this president. Even so, I’d bet Kathleen Sebelius was plenty shocked at the whole business.
True, she was only a second-string nominee, after Tom Daschle had to bow out because of those tax problems. But Sebelius still should have had little to fear. After all, she’d been the Democratic governor of a ruby-red state, Kansas. In a state where Republicans outnumbered Democrats roughly two-to-one, she won reelection in 2006 with 57 percent of the vote. She got one of the state’s prominent Republicans to switch parties and run with her for lieutenant governor.
So yes, it must have shocked when only eight Republicans voted to confirm her, while 31 voted against. Four-to-one against?! What had she done that was so bad? The answer was: nothing. Oh, Republicans invoked her “ties” to a Wichita doctor who performed abortions. But really, it was what she was going to do. She was going to be a point person on health-care reform, and they needed to ding her.
Today, and in the near future, she will have to endure being associated with the massive fiasco that was the launch of healthcare.gov. And that’s deserved. It’s hard to imagine what she was doing last summer instead of spending every waking minute ensuring that the initiative for which this administration will be remembered, the one thing that will color and even determine its historical legacy, was going to launch well. But it happened.
I don’t know how many times she got dragged up to the Hill and asked the same questions by all those Republican solons, striving to win the “let’s use this guy!” competition for the cable nets and NPR and the nightly newscasts, but it seemed like she was up there almost every day for a spell. On the surface, it all looked disastrous.
But I will say this. Behind the scenes, they did get to work. I could tell just from the way people talked, the things they said were happening there, that it really was getting better. They were (and I guess still are) sitting on this battery of IT stats about response times and how long a person had to wait to be logged in and so on and so forth, and those were being cut quickly. So Sebelius and the rescue team really did do their jobs once they were up against the wall.
Think of it this way. Did you think, last fall, that they’d actually hit the 7 million? Did you think they’d even come close? In a year-end column I wrote with my 2014 predictions, I said they’d make 5.8 million. And I thought that would be respectable. The latest report is that they’re approaching 7.5 million. So yes, there was utter failure. But there was one hell of a nice recovery. As time goes on, I think Sebelius will start getting less blame for the former, and more credit for the latter.
But her fate will be forever tied to Obamacare. If it succeeds, she’ll share the credit as the secretary who helped bring it to life. If it fails, she’ll share the blame. It’s about that simple. And I think it’ll probably succeed.
Meanwhile, there’s the question of getting a new HHS secretary installed. Obama’s nominee is Sylvia Mathews Burwell, who heads the Office of Management and Budget. Chief of staff Denis McDonough told The New York Times that “the president wants to make sure we have a proven manager and relentless implementer in the job over there,” which is both praise of Burwell and a little slap at Sebelius.
But will the Republicans let her through? Actually, forget the Republicans: Six Democratic senators are seeking reelection in red states. Are they going to vote for a new Obamacare point person during an election season? It never ends. Except it is now for Sebelius, who’s surely paid her dues.
By: Michael Tomasky, The Daily Beast, April 10, 2014
“LePage Vetoes Medicaid Expansion For All The Wrong Reasons”: Maine’s Paul LePage Is One Uninformed And Paranoid Governor
Maine’s Democratic state House Speaker, Mark Eves, noted the circumstances this week surrounding Medicaid expansion. “We have a bipartisan plan for life-saving health care for tens of thousands of Mainers,” he said. “It creates jobs, it save lives, it saves money.”
All of this happens to be true. Every state north of Virginia has either embraced Medicaid expansion or is working towards doing so – except Maine, where Gov. Paul LePage (R) refuses to cooperate. More than 60,000 low-income Mainers would benefit from the policy, on top of the economic and fiscal benefits, but the Republican governor nevertheless vetoed Medicaid expansion yesterday.
The measure also would have established a managed care system for all 320,000 beneficiaries, an effort to control costs in the $2.5 billion program, which is Maine’s version of the Medicaid health insurance program.
Under the Affordable Care Act, also known as Obamacare, the federal government offered to reimburse states for 100 percent of the cost of expansion for at least three years, then gradually reduce reimbursements rates to about 90 percent.
But in his veto message to the Legislature, LePage wrote that Maine could neither afford expansion nor trust the federal government to deliver on its promises.
The rejection didn’t come as a surprise, and Democratic state lawmakers will try to override LePage’s veto. By all accounts, however, they face an uphill climb – some GOP state lawmakers are on board with the policy, but probably not enough to generate a two-thirds majority.
But what was somewhat surprising was just how awful LePage’s defense was. The governor, struggling in his re-election bid this year, had plenty of time to come up with a credible rationale for blocking Medicaid expansion, but he didn’t come up with much.
“It is shortsighted to think federal funds will always be available, especially after watching the federal deficit climb and witnessing continual delays and changes from Washington,” he said in a statement.
I realize that Paul LePage sometimes struggles with policy details, but there are some rudimentary facts he should probably understand before telling 60,000 people they can’t have health insurance.
For example, if LePage is “watching the federal deficit climb,” he’s not watching closely enough. The federal deficit isn’t climbing; it’s shrinking. In fact, in recent years, we’ve seen the fastest deficit reduction than at any point since World War II. Does LePage not know that? Maybe he should have looked it up before issuing his statement?
What’s more, LePage is convinced federal funds may not “always be available” to finance Medicaid expansion. In other words, he’ll refuse the funds now because maybe, someday, far off in the future, Washington won’t offer the funds they’re promising to provide.
Sorry, 60,000 struggling Mainers. You can’t have access to affordable medical care because your governor is paranoid about a fiscal situation that may or may not materialize at some point.
These are the best arguments the governor’s office could come up with after having months to prepare?
By: Steve Benen, The Maddow Blog, April 10, 2014
“Health Care Nightmares”: There’s An Extraordinary Ugliness Of Spirit Abroad In Today’s GOP America
When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.
Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare”; on the same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.” Some nightmare. And the overall gain, including children and those who signed up during the late-March enrollment surge, must be considerably larger.
But while Obamacare is looking like anything but a nightmare, there are indeed some nightmarish things happening on the health care front. For it turns out that there’s a startling ugliness of spirit abroad in modern America — and health reform has brought that ugliness out into the open.
Let’s start with the good news about reform, which keeps coming in. First, there was the amazing come-from-behind surge in enrollments. Then there were a series of surveys — from Gallup, the Urban Institute, and RAND — all suggesting large gains in coverage. Taken individually, any one of these indicators might be dismissed as an outlier, but taken together they paint an unmistakable picture of major progress.
But wait: What about all the people who lost their policies thanks to Obamacare? The answer is that this looks more than ever like a relatively small issue hyped by right-wing propaganda. RAND finds that fewer than a million people who previously had individual insurance became uninsured — and many of those transitions, one guesses, had nothing to do with Obamacare. It’s worth noting that, so far, not one of the supposed horror stories touted in Koch-backed anti-reform advertisements has stood up to scrutiny, suggesting that real horror stories are rare.
It will be months before we have a full picture, but it’s clear that the number of uninsured Americans has already dropped significantly — not least in Mr. McConnell’s home state. It appears that around 40 percent of Kentucky’s uninsured population has already gained coverage, and we can expect a lot more people to sign up next year.
Republicans clearly have no idea how to respond to these developments. They can’t offer any real alternative to Obamacare, because you can’t achieve the good stuff in the Affordable Care Act, like coverage for people with pre-existing medical conditions, without also including the stuff they hate, the requirement that everyone buy insurance and the subsidies that make that requirement possible. Their political strategy has been to talk vaguely about replacing reform while waiting for its inevitable collapse. And what if reform doesn’t collapse? They have no idea what to do.
At the state level, however, Republican governors and legislators are still in a position to block the act’s expansion of Medicaid, denying health care to millions of vulnerable Americans. And they have seized that opportunity with gusto: Most Republican-controlled states, totaling half the nation, have rejected Medicaid expansion. And it shows. The number of uninsured Americans is dropping much faster in states accepting Medicaid expansion than in states rejecting it.
What’s amazing about this wave of rejection is that it appears to be motivated by pure spite. The federal government is prepared to pay for Medicaid expansion, so it would cost the states nothing, and would, in fact, provide an inflow of dollars. The health economist Jonathan Gruber, one of the principal architects of health reform — and normally a very mild-mannered guy — recently summed it up: The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.
And while supposed Obamacare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.
But nobody expects to see a lot of prominent Republicans declaring that rejecting Medicaid expansion is wrong, that caring for Americans in need is more important than scoring political points against the Obama administration. As I said, there’s an extraordinary ugliness of spirit abroad in today’s America, which health reform has brought out into the open.
And that revelation, not reform itself — which is going pretty well — is the real Obamacare nightmare.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April, 11, 2014
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