Tag Archives: obamacare

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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Who are these people?

I’ve previously noted that the Republicans have so far seemed able to pull together their coalition in the House between (known) Freedom Caucus members and other Republicans. Yesterday’s successful election of Paul Ryan purely from within the Party underscores that. No one should be shocked by that, as the most recent hints at a possible split between the Republicans differed from earlier factional breaks in that there was basically no observable difference between the two groups’ congressional districts. In fact, the “true conservative” rival to Ryan’s Speakership was basically identical to the first establishment contender for the job, Kevin McCarthy. While he (and for several dissenting Republicans, Ryan as well) wasn’t conservative enough, someone almost indistinguishable on policy somehow fell in the same camp as them. In the end, this seems to have more to do with where different Republicans come down on the issue of how the caucus should run, and less about their ideological niche within the Party.

All that said, I don’t want to have overlooked anything. Since the ballots in the election of Ryan are secret, there’s no way of knowing which forty-three Republicans defected to Daniel Webster (FL-10). That said, the murmurs that helped derail Kevin McCarthy’s original candidacy for Speaker have continually come from a somewhat recognizable faction – the Freedom Caucus. While a large majority of that group’s members expressed support for Ryan holding the Speakership, they quite vocally avoided giving an official endorsement of him. Throughout this process, that caucus seems tied up within talk of splintering the Republican Party, at least within the House.

Earlier this week, I poured over the list of known Freedom Caucus members and compared it to two different letter-writing contingents within the Republican Party which challenged their leadership in the House. One was the “Suicide Caucus” who petitioned for the Republican leadership to demand the repeal of Obamacare or else let a debt-ceiling-induced default destroy the US credit rating in 2013. The other is a group very, very loosely affiliated with the Freedom Caucus that similarly petitioned for the Republican leadership to threaten to let us default on our debt by means of the debt ceiling if Planned Parenthood wasn’t stripped of federal funding.

Unsurprisingly, there’s a notable amount of overlap between the members of congress using what amounts to more or less the same tactic, and the Freedom Caucus itself. In the overlap of all these groups, there is a small cadre of seventeen Republicans who signed both of those public letters and are on the known member list for the Freedom Caucus.

usa house cd coreThe districts in red are held by the seventeen congressional members at the heart of these overlapping factions. They are alphabetically by last name Justin Amash (MI-03), Jim Bridenstine (OK-01), Jeff Duncan (SC-03), John Fleming (LA-04), Trent Franks (AZ-08), Tim Huelskamp (KS-01), Jim Jordan (OH-04), Raúl Labrador (ID-01), Mark Meadows (NC-11), Mick Mulvaney (SC-05), Steve Pearce (NM-02), Scott Perry (PA-04), Keith Rothfus (PA-12), Matt Salmon (AZ-05), David Schweikert (AZ-06), Randy Weber (TX-14), and Ted Yoho (FL-03).

Because of the secretive nature of the Freedom Caucus, those are only the confirmed set of congressional representatives who fall into all three of those groups. Another seven House members publicly have signed on to those two letters but have so far not been announced to be Freedom Caucus members themselves. For anyone attempting to uncover the presumably broader membership of that Caucus, those seven are more or less a researching ground zero.

usa house cd core plus seven hidingThe seven non-members of the Freedom Caucus but fellow signatories on the two letters have their districts in orange. They are John Duncan (TN-02), Blake Farenthold (TX-27), Louie Gohmert (TX-01), Richard Hudson (NC-08), Walter Jones (NC-03), Kenny Marchant (TX-24), and Thomas Massie (KY-04).

Similarly, there are another seven representatives who are confirmed members of the Freedom Caucus and publicly signed on to the most recent letter, but who couldn’t voice their support or criticism of the original “suicide caucus” because they were not elected until the 2014 midterm election, after that crisis had passed. The large number of freshman representatives is definitely a distinctive characteristic of this newest agitating group within the Republican House.

As Pew Research pointed out, that was arguably the motivating characteristic that prompted them to support Speaker candidates other than McCarthy and more generally have a combative relationship with Republican leadership. Their grievances were arguably less about getting a particular set of policies passed, and more about their perspectives being taken seriously by the Republican leadership in the House in spite of them lacking seniority.

usa house cd core plus seven hiding plus seven freshmenThe relevant freshmen representatives’ districts are in yellow. They are Brian Babin (TX-36), Dave Brat (VA-07), Ken Buck (CO-04), Curt Clawson (FL-19), Jody Hice (GA-10), Barry Loudermilk (GA-11), and Gary Palmer (AL-06).

With the differences dividing Republicans in the House increasingly being about dynamics between legislators and less about policy, the resulting boundary between Republican groups has been fuzzy and more difficult to characterize. The era in which the Far Right quasi-splintering bloc came from an especially distinctive part of the country is largely gone, and with it that these different groups will consistently represent the same faction. They have coalesced around the particular circumstance, usually with a changeable policy cause and fueled by a contest for seniority in the House and visibility in the Party. There’s nothing like a party platform which more or less unifies them. They’re just periodically emergent groups with a constantly shifting boundary with the broader Republican Party.

Out of the broader House, fifty Republicans joined the “suicide caucus” but appear to have eschewed the more recent letter and any overt affiliation with the Freedom Caucus (although admittedly twelve of them left the house before the formation of the Freedom Caucus or the recent letter campaign). Six Republicans have unambiguous membership in the Freedom Caucus but haven’t made public their support for either of the debt ceiling letter-writing campaigns. Another five have only joined the most recent abortion-focused letter. Together that makes up the majority of representatives with any involvement with these groups – people who were briefly, conditionally, or tangentially active.

Later today, I will have a post up exploring the ways in which these murkily distinctive groups of Republicans do and don’t differ from the broader Republican House and general congressional delegation. By and large, however, it seems that ideological disagreement has taken a backseat to (at times very contentious) disagreements how to go about legislating those shared ideas.

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This is a GOP shutdown

Between the Tea Party affiliated (and Sarah Palin and Ted Cruz inclusive) protest in front of the White House yesterday and the various online efforts to label this as “Obama’s shutdown”, it’s understandable that people may begin (or have already begun) to be somewhat confused about who precisely is causing the current shutdown. Let’s make it clear – it’s the Republicans. They created this shutdown. They urged this shutdown. They’re maintaining this shutdown.

(The barricades from the WWII Memorial, which protesters removed and then proceeded to throw at the fence surrounding the White House, from here.)

We could start that discussion with how it was a group of House Republicans in addition to Senator Ted Cruz who popularized in their political circles the idea of refusing to fund the government for the (then-coming, now-here) fiscal year, but that’s been known and that should be known. What’s less commonly recognized however, is that Republicans not only took that course of action, but in the process of that metaphorically locked the door behind them so that it’s near impossible for Democrats to resolve this issue by an up-or-down vote on the House floor. Instead, any such measure has to be brought forward by either House Majority Leader Eric Cantor or a designee of his choice, as per a rule resolution (specifically applied to this legislation, and some argue, in violation of House rules) passed right after the government shutdown.

That’s, unfortunately, a risky proposition since Cantor has in his nearly thirteen years in the Senate only sponsored 76 bills – just over five year. The last time he introduced a bill was April 9, 2013 – a date after which almost every other sitting member of the House has proposed at least one if not several prospective bills. Obviously, this renders the Democrats negotiations with comparatively moderate Republicans moot, since they could sway any number of representatives and fail to bring any bill to the floor without Cantor’s approval.

Ironically enough, the math suggests that several Republican House members voted in favor of giving away their ability to bring forward a modified budget before swinging in favor of Democratic proposals. The rule resolution passed with only nine Republicans voting against it and one failing to vote, meaning that at best ten Republicans now regret their vote (assuming that Nancy Pelosi’s claims of small but significant Republican support aren’t exaggerated).

Perhaps instead of throwing barricades at the White House in anger at President Obama, Republicans who want the WWII Memorial reopened should take up their quarrel with Eric Cantor, on whom this entire shutdown hinges?

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On healthcare and taxes

The Health Policy Institute of Ohio has an excellent set of brief online pamphlets about the impacts of the (until recently certain to be implemented) policy of expanding medicaid coverage to cover the “hole” between existing medicaid coverage and the Obamacare subsidies. In a nutshell, this primarily assists the working poor (as 58 percent of the households assisted by the expansion have at least one full-time working member), and a good chunk of the rest of the families assisted are elderly retired couples. Calling this economic redistribution seems like a distraction from the real issue: there’s an entire class of people in the United States who aren’t paid wages that allow them to actually buy necessities like healthcare.

(Ohio had one of the largest populations that would benefit from such an expansion, from here.)

Having states or the federal government enter the picture and actually cover those people’s healthcare in part or full is an obvious good in that it addresses their immediate needs, but also indirectly. It frees up those people caught in the “hole” to use the small amounts of money they currently have saved up for the rare co-pays they allow themselves on consumer items – indirectly stimulating the economy through whatever purchases they make.

But the funds for that coverage have to come from somewhere, even if the state of Ohio hopes to earn some of it back in sales tax and pass along the majority of the costs to the federal government (as medicaid primarily receives funding from there, with various new spending guarantees because of Obamacare, actually). How are we going to jump start the economy and raise living standards without the necessary funds which most companies are now pocketing as “profits”?

(An image being circulated about the approximately $400 billion lost to tax evasion annually in the US, from here and figures from here.)

Ultimately, the issue of how our tax policies are structured and how we prevent tax dodging is not just about “equity” or a vision of fairness, it’s also about how we as a society amass the funds to better ourselves.

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