A huge step forward for Obamacare: Pennsylvania's Republican governor embraces Medicaid expansion

By Michael J.W. Stickings

Greg Sargent reports:

In another sign that the politics of Obamacare continue to shift, the Medicaid expansion is now all but certain to come to another big state whose Republican governor had previously resisted it: Pennsylvania.

The federal government has approved Pennsylvania Governor Tom Corbett's application for the state's own version of the Medicaid expansion, without a handful of the conditions Corbett had hoped to impose, Dem sources tell me.

Corbett just announced that he will accept the expansion that has been offered, perhaps with some last-minute changes — expanding coverage and subsidies to as many as half a million people.

As a Republican, Corbett either opposed Obamacare on principle (however ignorant) or had to pretend to oppose it, or at least thought he did. So even though Pennsylvania is mostly a blue state, it's an extremely positive sign that he has come around.

Yes, the politics of Obamacare continue to shift, as it entrenches itself as the law of the land and proves to be a success. Democrats demand its implementation and overall the electorate is either embracing it or softening, and clearly Corbett realized that he could no longer oppose Medicaid expansion. It's shameless political calculation, no doubt, but it's telling that the calculation is that the pro-Obamacare position is the more desirable one. Don't expect this to happen in hardened red states, at least not anytime soon, but slowly and surely Obamacare is succeeding.

And just take a look at that figure. We're talking about health care coverage expansion to hundreds of thousands of people. That alone is significant, as these are people who need Medicaid and obviously cannot pay for health care otherwise. But what's also significant, let us not forget, is that we're talking not just about Medicaid recipients, but about citizens, about voters, which is what most of them are. And voters will have their voices heard, and those who were against them -- namely, Republicans -- will ultimately face their electoral wrath.

Republicans still denying health care to millions of Americans

By Michael J.W. Stickings

From the Times:

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states. 

If you're poor, the Republicans basically don't give a shit about you -- unless they think they can somehow manipulate you into voting for them, and even then they don't.

They truly are a cruel and vindictive bunch of class warmongering thugs.

Inside Obama's budget

By Frank Moraes 

In his "Happy Hour Roundup" at The Plum Line the other night, Jonathan Bernstein provided links to three articles that argue in different ways that there is much to like in Obama's new budget. I've never argued otherwise, but I have been too focused on the entitlement cuts. Let's be clear though: Obama's offer of these cuts is very bad. Even if nothing happens in the next four years, Republicans will go on to accuse Democrats of intransigence: "Even that socialist Obama thought we needed to cut entitlements!"

Annie Lowrey over at the Economix blog argues that Obama's entire focus, not just his budgets, have been about reducing income inequality. She rightly notes that the ACA (Obamacare) will help the issue. Just on the face, giving people healthcare who didn't have it before makes them richer; it doesn't matter that you aren't giving them cash. But perhaps as important, it will make medical bankruptcies far less common. (Remember the big push by the feds to make bankruptcy harder because all of these spendthrifts were abusing the poor bankers? It was mostly bankruptcies because of our broken health-care system.)

She goes on to mention a number of good things that are in the new budget. It includes a rise in the minimum wage, universal preschool, and of course, slightly higher taxes for rich people. One thing that is in there really surprised me: the earned income tax credit (EITC). The budget would make it permanent. I thought it already was, especially since traditionally, that is one form of welfare conservatives agree with. Well, it is only in effect until 2017. That's a big deal. The idea that President Paul Ryan would end the program is very troubling.

In the great Wonkblog fashion, Brad Plumer presents the "Winners and Losers in the White House Budget." The winners (at least in terms of programs) are primarily the poor. As Lowrey points out, there is the EITC and the minimum wage. But in addition, although Medicare is cut, Medicaid is not. To some extent, this defines Obama's economic policies. I can see that he truly does care about the poor. It is when you move up the income ladder to the middle class, that he thinks things are fine. But they aren't fine. And helping the middle class thrive is really important to all of the classes.

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Holding freedom hostage

By Mustang Bobby 

Paul Krugman writes that the Republicans have dusted off an old argument from years ago to block the agenda of President Obama and the Democrats. Instead of arguing the merits of, say, expanding Medicaid to people who need it, they now say that giving people a guarantee that they will have health insurance is an assault on freedom:

Conservatives love, for example, to quote from a stirring speech Reagan gave in 1961, in which he warned of a grim future unless patriots took a stand. (Liz Cheney used it in a Wall Street Journal op-ed article just a few days ago.) "If you and I don't do this," Reagan declared, "then you and I may well spend our sunset years telling our children and our children's children what it once was like in America when men were free." What you might not guess from the lofty language is that "this" — the heroic act Reagan was calling on his listeners to perform — was a concerted effort to block the enactment of Medicare.

These days, conservatives make very similar arguments against Obamacare. For example, Senator Ron Johnson of Wisconsin has called it the "greatest assault on freedom in our lifetime." And this kind of rhetoric matters, because when it comes to the main obstacle now remaining to more or less universal health coverage — the reluctance of Republican governors to allow the Medicaid expansion that is a key part of reform — it's pretty much all the right has.

They trot out this pony for lots of other things, too. Universal background checks and liability insurance for gun owners shreds the Second Amendment. Giving free or reduced lunches to impoverished children takes away the parents' rights to feed their children the way they see fit. Banning interracial marriage is an assault on the rights of states to protect their own traditions, and of course the one we've been hearing a lot of recently, permitting marriage equality is a blatant attempt to muzzle the freedom of the "religious" to bully and harass the LGBT community.

David Brooks' column last week where he said that granting gays more freedom actually meant less was a caricature of the argument, and this is how we know that they're getting down to the fumes. When they have to tell you that more is actually less and up is actually down; that more choice for more people is tyranny and that finding a way to stop a madman from sweeping a kindergarten with 154 bullets in less than five minutes is the last step before Stalinism, it makes you wonder at what point will it dawn on them how utterly contemptuous of freedom they really are.

(Cross-posted at Bark Bark Woof Woof.)

Republicans fight to kill Medicare

By Frank Moraes 

Do you remember the Independent Payment Advisory Board (IPAB)? It is what Sarah Palin famously called "death panels." It is necessary for not only making more affordable Medicare and Medicaid, but all health care in the United States. Of course, conservatives hate it. They wouldn't have hated it had McCain been crowned president and the Affordable Care Act been a Republican law. But it wasn't and so the reason they claim to hate it is that it limits care. In fact, it does not. What's more, these people who are oh so concerned that we won't spend millions of dollars keeping brainless babies alive are not at all concerned about the 50 million Americans without health insurance.

The IPAB has come up recently because the House said it is going to stop the current law that states that the IPAB should be fast-tracked. (Strangely, the vote was supposed to take place on Thursday, but I haven't been able to find any information indicating that the vote took place.) What this means is that the Republicans are trying to kill healthcare cost containment. They claim that this is in the name of of providing "Freedom!" But of course it is the opposite.

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Behind the Ad: Romney's record on Medicaid

By Richard K. Barry

(Another installment in our extensive "Behind the Ad" series.) 

Who: The Obama-Biden campaign.

Where: New Hampshire, Virginia, North Carolina, Florida, Ohio, Iowa, Colorado, and Nevada.

What's going on: The Obama campaign has a new ad out called "Only Choice." This is how they explain the piece:

One of the hardest decisions a family can make is moving a relative into a nursing home, and for many middle-class Americans, Medicaid is the only way to afford the care. But as Obama for America's new television ad highlights, Mitt Romney raised nursing home fees eight times as governor. And as a presidential candidate, his proposed budget cuts Medicaid by one-third and threatens the well-being of families burdened by nursing home costs. President Obama won't let that happen.

The point here is that Mitt Romney may be able to lie his way to convincing people he cares about them, but his "smaller government" pitch means many will suffer. He and his friends won't, but a lot of people will.


(Cross-posted at Lippmann's Ghost.)

States? Right.

By Carl 

In the victory on the Affordable Care Act last week came a few disappointments. This is one of them, and one of the most important:

But what happens if states choose not to expand Medicaid to meet the new guidelines? That's where the conservative majority, joined by liberals Stephen Breyer and Elana Kagan, surprised a lot of people. As the law was originally written, the entire Medicaid package became an all-or-nothing deal: States that didn't want to meet the new, more expansive guidelines were free to do so. But choosing that option meant forgoing all federal Medicaid money. The Court on Thursday ruled that choice was "coercive." Roberts, echoing the arguments of the law's challengers, likened it to holding a gun to the states' heads.

The remedy was not as extreme as it might have been: The justices didn't strike down the Medicaid expansion altogether. But they insisted that states choosing not to expand coverage give up only the money that would have gone to covering the new populations. Those states would remain eligible for the funds that they already get, to cover people who already qualify for Medicaid under the old guidelines. 

And yet, it's extreme enough: People who do not have health insurance and cannot afford it under traditional private insurance plans will not have as much opportunity to get it.

My suspicion is, as with stimulus funds, over the longer term states will give up and give in. Governors across the nation at first were foursquare against accepting those funds, but quietly, even the last holdouts like Chris Christie have reneged on those vows. Same thing will likely happen here.

But here's the thing: This isn't just about Medicaid. For example, did you know that if your state doesn't set its speed limit at 55 (or require seat belt use, for that matter), it is ineligible for federal highway funds? In the future, the federal government will have a hard time instituting sane regulation in exchange for dangling road repair in the faces of governors like a cherry for a sundae. The courts are effectively saying "You can only refuse to give more money than the status quo."

So... this is a pretty effective demolishment of much social engineering that the federal government could impose (and includes such right-wing plums as defense contracts and even a potential military draft) while at the same time putting social engineering through tax impositions into jeopardy.

Even though the courts were pretty adamant that the individual mandate was a tax, it does not mean every tax will be allowable. And it won't surprise me if another lawsuit is forthcoming on that point with respect to ACA, anyway.

(Cross-posted to Simply Left Behind.)

Friday night political randomness: Palin, Weiner, and Perry

By Michael J.W. Stickings

Sorry, I've been so busy all evening wading through Palin's e-mails. Such a glorious treasure of wonderment. (No, not really. There are people who can be bothered to read through, or even to skim through, the 24,000 pages. I'm not one of them.)

**********

So Weiner had online contact with a 17-year-old girl. Not good -- not good at all. A spokesman says that the contact was "neither explicit nor indecent," but I'm not sure it matters. Well, sure, it does, but his reputation, rightly or wrongly, has already been destroyed, and he's pretty much on his own now, with little to no support from his own party.

Perhaps it was only a matter of time before it came out that he had contact with a minor. He acted like an idiot and did idiotic things, especially for a public figure. There isn't necessarily anything wrong with having contact of an innocent nature with a near-adult, but given that he was using the Internet to chase women, the fact that his contacts included a minor only makes it all seem so much worse. Even if he wasn't sexual with this girl, the speculation that he might have been with some other minor is unavoidable.

I don't see how he escapes this. Pressure is mounting on him to resign. He says he won't, and his constituents apparently want him to stay, but he can't take much more. His thread is unravelling.

**********

The train wreck that is the Gingrich campaign (and that is The Newt himself) leaves an opening for Perry to jump into the Republican presidential race, as some of those ex-Gingrich staffers are close to the Texas governor. And it looks like Perry is very likely to run.

Given the weakness of the field, Perry could very well emerge as one of the frontrunners, perhaps even the favourite if he manages to bridge the divide between the establishment and the far right. Pawlenty looks to be that bridge right now, but Perry could easily surpass him. Republicans, after all, are looking for a savior. Why not Perry? Pawlenty hasn't been able to get much traction, others on the right, like Bachmann (and Palin), are far too crazy/extreme, and the Tea Party and the social conservative base will never approve someone like Romney or Giuliani.

Just keep in mind that Perry isn't exactly a sensible, moderate, old-school Republican, or even the sort of conservative with broad-based appeal. Check out ThinkProgress's "Top 10 Things Texas Gov. Rick Perry Doesn’t Want You To Know About Him."

**********

Oh, there was some good news today: The Obama Administration has extended Medicaid protections for same-sex couples.

That's some change we can believe in.

Fighting an election on the Paul Ryan budget plan? Good idea (for Democrats)

By: R.K. Barry

Steve Benen at the Washington Monthly recently discussed a poll by a major Democratic pollster, Greenberg, Quinlan, Rosner, which suggested that Republicans might have some difficulty selling the Paul Ryan budget plan to the American people.

On the day the plan passed in the House, the pollster wrote:

Congressman Paul Ryan's budget proposal, to be embraced by the House Republican majority today, faces serious obstacles in winning public support. The Republican plan provides Democrats with a strong argument that Republicans have the wrong priorities for America and will break a long-standing agreement the country has with seniors. The budget opens up a fundamental debate about values that could end up defining the Republicans in the public mind and allowing Democrats to draw sharp differences and regain their standing on the economy and spending priorities and advocacy for the middle class. The decision to end Medicare and shift costs to seniors in continuing tough times may be the Republicans' undoing.

The Republican deficit plan does not even win majority support, but when voters learn almost anything about it, they turn sharply and intensely against it. They have particularly grave concerns about the plan to end Medicare and slash Medicaid spending, pushing seniors into the private insurance market and costing them thousands of dollars in out-of-pocket expenses.

The bottom line is that when people are asked in general terms if they like the Republican plan, 48% support the idea, while 33% were against it. Not bad for the Republicans.

But when people are told exactly what is in the plan, there is a shift.

As Benen writes:

But then respondents were given an accurate description of the same plan, noting, among other things, that the GOP proposal makes small cuts in defense spending, repeals health care reform, cuts taxes on corporations and the wealthy and makes major cuts to Medicaid and Medicare.

Upon hearing this, support drops from 48% to 36% and opposition rises from 33% to 56%.

As Nate Silver points out, "clearly there is a political upside for Dems in attacking the Ryan plan, however, they also have a lot of work to do to inform voters about it."

But that would seem to be the point and opportunity. This is what some people call a ballot question: the top of mind issue that people are thinking about when they enter a voting booth. Understanding that Democrats have a lot of work to do to ensure that people "get it," the Republican approach provides a coherent point of attack for Democrats. Campaigners are always grateful when these sorts of things fall out of the sky. Perhaps we should all send a gift to Mr. Ryan to show our gratitude.

Speaking of the Congressman, when he first started flogging his plan, he was all over the press expressing his hope that Democrats would not politicize his proposal. Here we have perhaps the single most important political decision that can be made in Washington, articulation of the financial architecture of the country for years to come, and Ryan thinks it would be a shame if political hay were made out of it by Democrats.

Not to school Paul Ryan in any way, but there was a very important book written by leading American political scientist Harold Lasswell in 1935 called Politics: Who Gets What, When, and How. I don't think things have changed that much since then. This budget battle is a contest to determine just this. It is the most political of exercises for everyone involved. Republican have a clear idea of who they want to help, as do Democrats.

So far it seems that the more the American people learn about the GOP's plan for America, the more likely they will be to understand that Democrats advocate for a much larger portion of the population and Republicans for a more select few. It's about time something made that picture clearer.

No wonder President Obama is getting fired up lately.

(Cross-posted to Lippmann's Ghost)