Tag Archives: affordable care act

Sanders’ lost opportunity in appealing to California

As Hillary Clinton’s delegate count creeps towards a hard fought win, Bernie Sanders’ campaign has increasingly hung their hopes on one state alone – California. It might seem like a curious choice. Racially diverse and a part of the Democrats “blue wall,” California seems more comparable to Illinois, New York, or Pennsylvania – all states Hillary Clinton won. Sanders’ support has largely come from more predominantly White states, both within and outside of typical “blue states” with his wins admittedly coming from places as socially different as Oregon and West Virginia.

In spite of breaking the pattern so far, there’s a certain logic to it, particularly if Sanders returned to the rhetoric he used when first launching his campaign. California was initially touted by many as a success story for the implementation of Obamacare, but the longer term frustrations with putting it in place have created an untapped political market in the state that could be decisive if addressed well.

Like all states, California’s experience with Obama-era health care reform boils down to effectively three big picture changes:

  • Health care providers and health insurance companies face greater obligations to their patients and customers, but in exchange those customers are required to have coverage.
  • In order to help people who would have trouble paying for that coverage, medicaid and other assistance programs are given greater resources and more people are deemed to qualify for their assistance.
  • In order to make accessing and assessing insurance plans easier for everyone who can pay for that coverage, those plans will be helpfully listed on online-accessible exchanges.

That seems simple enough, right? At first, California avoided most of the pitfalls and hangups that other states experienced with putting together those initiatives – the state didn’t drag its feet to expand Medi-Cal or leave it to the federal government to build the online exchange’s website. The system worked. The public health care available was enough of a carrot and the threat of a tax penalty for lacking coverage was enough of a stick, and so in 2014’s open enrollment alone 1.9 million people applied for coverage through Medi-Cal and 1.3 million people purchased insurance through the exchanges.

Hopefully you noticed the discrepancy there. People too poor to afford insurance asked the state to provide it for them, and waited a decision. People with enough wealth to buy it bought and had it, end of story. This wasn’t an abstract demonstration of class inequality. This was about access to health insurance, at times to cover chronic or vital health problems. People died from lack of care while the wait list ballooned into the thousands.

Worse yet, the exchanges and Medi-Cal application system – although tied together into one system – would permit people to apply for Medi-Cal, and only that program, if they met the income standards to do so (see answer 9). Lower income people were literally obligated to wait, and denied access to expensive care in the name of protecting them from the cost. Meanwhile, the question of whether they would be liable under the tax penalties for lacking coverage while waiting for an answer from the state remained hanging in the air.

For all its horrifying flaws, with court rulings and administrative decisions this privatized public health insurance model has seen some improvement. Many Californians do, at the end of the day, want to retain the Covered California system, but there is a sizable chunk of the electorate that could stand to hear some talk about how to shake up the system for the better. Looking at the numbers of applicants and enrolled, as a raw number it’s probably a bigger one that is open to criticism of it, even while wanting the system to exist in some form. That’s a tricky place to articulate, where we need this public system but with different ideas underpinning it, but whoever describes it first could become surprisingly popular in California.

Bernie Sanders seemed prepared to be that candidate and speak in that way towards the beginning of the primary campaign. His messages on how he envisions health care policy still speak to many of the fundamental problems a “success story” like California has seen under Obamacare. Health care, under the PPACA, has not become an essential human right that the state must guarantee, but only a public good it will guarantee you if you demonstrate adequate need. The practical application of that – that by the thousands people have to wait for that assessment to occur – is a nightmarish reversal of any talk about inalienable rights, which the Sanders campaign continues to use. In short, the implication in some of Sanders’ statements, that he would reduce or even dismantle the application process for publically-provided health care, taps into the precise flaws and frustrations with the system as is in a place like California.

But, as of now, those have stayed just implications. To be frank, it’s unclear how much any president can or would be able to shape a redesigned ACA that would address that problem. Sanders might actually have a greater ability to champion that within the legislature, and to the extent that he has, could rely on replaying clips of that in a last minute ad blitz in California. He has less than a fortnight for that now. Can he pivot back to that discussion and articulate this nuanced point about a flaw within a means-tested public health care system? It might already be too little and too late.

The featured image for this article is of the California State Senate Chamber in Sacramento, California.

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This year’s presidential campaigns are stuck between a rock and a hard place

TW: misogynistic policies and rhetoric, institutional racism, deportation, gun violence

Last week, I quoted Brian Williams lamenting that there’s currently little in the way of grand appeals to moderate, centrist, and undecided voters from either the Obama or Romney campaign. Williams faulted the campaigns themselves, implying that they are unconcerned with the quality of political discourse in the country, but I think there’s other factors explaining why both major parties’ tickets are playing cautiously. Looking back over Nate Silver’s record of the presidential polls so far this year, there have been two really interesting political shifts over the summer. As his methodology behind the his poll numbers is rather well thought out and has a good track record of predicting results, I think there may be something important to the appearance a subtle shift in favor of Obama in late June and a sudden erosion of that support at the tail end of July.

(This is a capture of Nate Silver’s “Now-Cast” for the popular vote in the presidential election.)

As shown above, for the most part Obama has hovered approximately 1 to 1.5 percentage points above Romney, excepting the brief period mostly in July when the gap reached as much as 2 points. Interestingly, both the background lead of Obama as well as his July boost seem linked to a wide variety of shifting factors. Unlike the 2004 and 2008 presidential elections, which were to a large extent referendums on George Bush’s prior term or terms, there’s a great deal of muddling about what issues this election will focus on.

I’d argue that two major forces were creating Obama’s smaller but sustained lead prior to the last week of June, through his July surge, and even now – the blowback from the War on Women and increasing restrictions on voting. Especially in the past few weeks, misogyny that simultaneously denies women their reproductive freedoms, denies basic scientific knowledge of female reproductive biology, and denies that women are valid witnesses to their bodily experiences, has been exposed as a component to the Republican presidential ticket and the Republican Party’s platform.

Likewise, while new voter restrictions have disenfranchised millions of Americans, their effect on the polls is probably quite negative for the Republican Party, as they can easily be interpreted as fixing elections. Whether criticism of the party for attempts to purge voters in Florida and Colorado as well as instituting new restrictions in numerous other states will actually counterbalance the mass disenfranchisement in the coming elections remains to be seen, but currently both presidential campaigns seem to anticipate even the most stringent barriers to voting to have minimal impact.

Against the electoral background created by those two issues, late June saw a bit of a perfect storm, if a smaller one, for the Obama campaign. The President’s executive order to halt deportations of undocumented individuals who would have been able to apply for citizenship under the DREAM Act on June 15, was an action the Romney campaign couldn’t respond to without either alienating vital Latino support or nativist segments of the Republican base. He spent the following weeks in June seeming weak and indecisive if not two-faced on the issue, which allowed Obama to regain levels of Latino support reminiscent of his 2008 landslide.

Meanwhile, in proceeding weeks the Obama campaign had been producing some hard-hitting ads about Romney’s record of disaster capitalism at Bain, but I remember an ad originally aired on June 23 affecting people more than earlier ones. Something about the poetic cruelty of being forced to build the stage on which an executive announced your downsizing convinced people more effectively than earlier ads, which many pundits had declared to be a tactical mistake by the Obama campaign. In any case, this and later ads seemed to shore up Obama’s support in Democrat-leaning areas of the rustbelt and give him a small but clear lead in more conservative states in the same formerly union-rich region.

Of course, not all of the major events at the end of June were ones that necessarily favored Obama. The most impacting of them – the Roberts ruling on the constitutionality of the Affordable Care Act (ACA) – was contained in its damage, however, as it mainly rallied the conservative base to push for a full repeal and the liberal base for a reinstatement or similar fix. The only demographic that it seems to have caused to shift were independents who agreed with Obama’s progressive social policies and comparatively moderate international approach but differed with him on economic issues. Concentrated in rural New England, the worst damage was in New Hampshire, where Obama’s lead shrank significantly but didn’t disappear.

While there are obviously other issues that have reared their heads at various points in this election, these seem to be among the major players, which the Republican National Convention is in part trying to respond to, both to prevent another rush like the July surge and to address the fact that their party is systemically behind. That’s why we’ve seen so many prominently featured female speakers of color – Mia Love, Nikki Haley, Lucé Vela, Condoleezza Rice, and Susana Martinez. That’s partly an attempt to inoculate their party from criticism for supporting nativist, racist, and misogynistic policies. This is also why they’ve worked to reframe the “You didn’t build that”/“We built it” debate around immigrants who started family-run businesses (like the Tangs referenced by Rand Paul), pulling the quote out of its context as a criticism of the supposed captains of industry. That’s an effort to reframe the previous discussion of class and inequality in a way more favorable to their party. That’s also why Attorneys General Pam Bondi and Sam Olens (of Florida and Georgia, respectively) framed voter restrictions as a reasonable precaution and a national health care mandate as tyranny – to defend the Republican stance on those issues. It seems likely that at least a few of those themes will be touched on throughout the remaining speeches tonight.

Intriguingly enough though, the issue of violence in American culture and potential policies of gun control, which seem linked to Obama’s falling numbers in later July, is a topic that can only be faintly implied, as in New Mexico Governor Susana Martinez’s speech. It’s worth noting that in the later weeks of July, originally after the Aurora shooting but as similar incidents continued to rock the nation, calls for gun control seriously perturbed firearm advocates, and tapped into a long-standing anti-Obama message. With a wide range of firearm-related deaths in recent memory, it’s understandable that this point is too politically risky for Republicans to directly address. It’s likewise the case that Obama, as described by Ta-Nehisi Coates, has to remain absolutely non-threatening as a Black man and can’t even obliquely reference these issues without eliciting blowback.

So the political campaigns have taken a huge twist in the past few months. Obama is capable of making key choices to heighten his lead but vulnerable to events outside of his control limiting his ability to discuss pressing issues in any capacity. Romney likewise can’t directly reference the issues most toxic to Obama because they’re potentially dangerous for him to be seen as politicizing, and he can’t counter Obama’s current strengths without some duplicity (namely, implying one thing to White supporters and implying another to Latinos and other people of color). This race is practically guaranteed from here on out to be an interesting series of rhetorical gymnastics. Obama can speak plainly but only as long as certain issues are out of the picture and Romney has to speak around issues to lead different groups to mutually exclusive conclusions about what his policies would be. To the extent that Brian Williams is right that neither campaign is directly addressing many of the important political issues, he’s ignoring the complex reasons behind their strategic choices.

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The first sign we shouldn’t trust a word from Romney about Ryan

Potentially you’ve already seen the political advertisements, or read the CNN article on the leaked memos, or in one of any number of other ways found out the secret: Obama’s already cut Medicare by as much as the Ryan plan! And this isn’t the Heritage Foundation or another right wing think tank claiming this, but the Congressional Budget Office (CBO) – the non-partisan, government-run body that everyone trusts to explain fiscal details. Cat’s out of the bag everyone:

Unless of course you actually bother to fiddle around on the Congressional Budge Office’s website looking for whatever article it is they wrote in late July that credited Obama with cutting $716 billion from Medicare. The first obstacle to this, as near as I can tell, is that CBO has since updated the number to correct for some mistake or other, so you better not search based on that specific dollar amount alone. (This seems to have happened as the article in question still comes up when searching for the $716 billion figure but has been corrected in the article itself). Interestingly enough, this promo was uploaded to Romney’s account on Tuesday, so either he’s been sitting on this for some time and not bothered to double check his sources or the CBO only just recalculated this. Given Romney’s history with financial figures, I’m leaning towards him being the incompetent one here.

In any case, the actual number cited by the CBO is $711 billion – so the Romney campaign’s not pulling this entirely out of thin air! At least that’s what you’ll think until you realize that the CBO article is actually a public letter to John Boehner explaining what the fiscal impact would be a legislative attempt to repeal the Affordable Care Act (or ACA, also colloquially known as “obamacare”). The letter explains that taking such a course of action would in fact increase rather than decrease the federal deficit for many reasons including that-

The ACA also includes a number of other provisions related to health care that are estimated to reduce net federal outlays (primarily for Medicare). By repealing those provisions, H.R. 6079 [the bill repealing the ACA] would increase other direct spending in the next decade by an estimated $711 billion.

In other words, the ACA makes cuts in Medicare in the context of a massive investment in preventative care – which should ultimately make up for the lower expenditure on Medicare, but until then are explicitly to be made up by a structural overhaul of inefficiencies. The figure of $711 billion (or however many) is the amount of funds needed to cover Medicare recipients effectively, assuming that the necessary reforms packaged into the ACA are repealed. In contrast, Ryan’s plan would retain those cuts but without the systemic reorganization designed to make those cuts socially and economically feasible. Or rather, it relies on an unrealistic surge of economic growth as a result of its restructuring of tax policy to make its cuts reasonable. As one detailed analysis of Ryan’s budget and candidacy noted,

the most confusing aspect of the Ryan budget is that assumes these new tax policies will raise revenue above the 30-year moving average of 18.2% of GDP, from roughly 15% where it presently sits. […] the plan presupposes massive economic growth causing more taxable income from the populous.

Any one with a cursory knowledge of the past decades has seen precisely the same claims and how they’ve fallen disastrously short. As previously noted, Romney’s campaign narrative is built on falsities that are practically routine at this point, and Ryan doesn’t change the overall mood of the ticket but instead parrots it. Now they’ve even gone so far as the claim that the costs which would be needed to be made up during a hypothetical repeal of the ACA by John Boehner are integral to Obama’s health care plan, misquoted the dollar amount, and are ignoring that the ACA is constructed to manage without those funds while theirs assumes a historically unprecedented event to justify the lowered spending on Medicare. In spite of all of the problems raised by this, one of the most recent polls has these candidates leading nationally.

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