There’s another turn in a story we’ve all been following for over a decade, so I wrote it up at New York:
The Affordable Care Act was signed into law 13 years ago, and the Medicaid expansion that was central to the law still hasn’t been implemented in all 50 states. But we are seeing steady, if extremely slow, progress in the effort to give people who can’t afford private insurance but don’t qualify for traditional Medicaid access to crucial health services. The U.S. Supreme Court case that upheld the ACA also made Medicaid expansion optional for states. Twenty-four states accepted the expansion when it became fully available at the beginning of 2014, and that number has steadily expanded, with the most recent burst of forward momentum coming from ballot initiatives in red states like Missouri, Nebraska, Oklahoma, South Dakota, and Utah. Now a 40th state is in the process of climbing on board: North Carolina. As the Associated Press reports, legislation is finally headed toward the desk of Governor Roy Cooper:
“A Medicaid expansion deal in North Carolina received final legislative approval on Thursday, capping a decade of debate over whether the closely politically divided state should accept the federal government’s coverage for hundreds of thousands of low-income adults. …
“When Democratic Gov. Roy Cooper, a longtime expansion advocate, signs the bill, it should leave 10 states in the U.S. that haven’t adopted expansion. North Carolina has 2.9 million enrollees in traditional Medicaid coverage. Advocates have estimated that expansion could help 600,000 adults.”
So what changed? Basically, over time the fiscal arguments North Carolina Republicans used to oppose the expansion began sounding increasingly ridiculous, AP suggests:
“GOP legislators passed a law in 2013 specifically preventing a governor’s administration from seeking expansion without express approval by the General Assembly. But interest in expansion grew over the past year as lawmakers concluded that Congress was neither likely to repeal the law nor raise the low 10% state match that coverage requires.
“A financial sweetener contained in a COVID-19 recovery law means North Carolina also would get an estimated extra $1.75 billion in cash over two years if it expands Medicaid. Legislators hope to use much of that money on mental health services.”
In other words, the GOP Cassandras warning that the wily Democrats would cut funding for the expansion in Congress once states were hooked turned out to be absolutely wrong. Indeed, the very sweet deal offered in the original legislation got even sweeter thanks to the above-mentioned COVID legislation. States like North Carolina appeared to be leaving very good money on the table for no apparent reason other than partisanship, seasoned with some conservative hostility toward potential beneficiaries. In this case, GOP legislators finally reversed course without much excuse-making. The AP reports:
“A turning point came last May when Senate leader Phil Berger, a longtime expansion opponent, publicly explained his reversal, which was based largely on fiscal terms.
“In a news conference, Berger also described the situation faced by a single mother who didn’t make enough money to cover insurance for both her and her children, which he said meant that she would either end up in the emergency room or not get care. Expansion covers people who make too much money for conventional Medicaid but not enough to benefit from heavily subsidized private insurance.
“’We need coverage in North Carolina for the working poor,’ Berger said at the time.”
That, of course, has been true all along. Final legislative approval of the expansion was delayed for a while due to an unrelated dispute over health-facility regulations. And the expansion cannot proceed until a state budget is passed. But it’s finally looking good for Medicaid expansion in a place where Democrats and Republicans are bitterly at odds on a wide range of issues.
There remain ten states that have not yet expanded Medicaid; eight are Republican “trifecta” states (Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee, Texas, and Wyoming) and two others have Republican-controlled legislatures (Kansas and Wisconsin). Perhaps the peculiar mix of stupidity and malice that keeps state lawmakers from using the money made available to them by Washington to help their own people will abate elsewhere soon.
Regarding Bush (and Gov. Romney, and other socially backward types of their ilk) on gay marriage: It is not clear to me that they will not be able to use it as a wedge issue. But I believe it should be possible for our candidate to argue forcefully that it is un-American to decry judges for doing the terrificly important job that the Founders gave them: defending the rights of a minority of citizens, especially when those citizens are widely disliked. When Bush and his allies lament that the “will of the people” has been usurped by activist judges, they really are talking about the mob mentality of the bullying majority, which Madison & Co. most reasonably feared.
“And as we’ve seen in the last few weeks, people don’t really start thinking about an election until very late. He could tank, as his father did when people started thinking seriously about whether they wanted to see him on TV for another 4 years.”
Ron Thompson, I certainly hope you’re right. The continuously mounting evidence of this administration’s utter dishonesty and incompetence makes it rather discouraging that Bush’s approval rating is still anywhere near 50%.
I am of the belief that Karl Rove still has cards to play.
But in order to keep Rove off his game, Dems have to keep Bush playing defense. Talk lost tax revenue as well as defecit. Index cuts to popular and essential programs in terms of dollars gained by people who make over $2 million per year. Ask the big question, “Should a president deceive you in order to do something you agree with? Graphically demonstrate (not simply pie charts, etc) how long it would take to make up the the slack between the jobs Bush promised and the jobs he’s created. There’s more, but I have to get back to work….
The problem with Kerry is the same as it was for Gore, he seems completely ungenuine (ingenuine?). I believe that he, like Gore, is a very well qualified and principled individual, and I would vote for him in a heartbeat, but he is going to turn off my mother-in-law just like Gore. He just can’t win because Bush seems genuine (ironies of ironies).
I’m still for Clark. The question “Who can beat Bush?” is the right question. I don’t think the answer is Kerry because Kerry says he won’t make an issue of the war. Of course he might be rethinking that if the polls show that it’s safe to speak up, but assuming he sticks to his original agenda, he won’t talk about the war. and that is not only cowardly but also stupid.
Bush will make an issue of the war. He has to. He has no othe issue. That means like it or not the Democrats have to run against the war. Humphrey tried to ignore the biggest moral issue of his day when he ran aginst Nixon in 1968. He concentrated on domestic issues because the Democratic party leaders then, as now, lacked the balls to take a moral stand or provide leadership in opposition to a war. Humphrey lost.
Dean understands that leaders create issues. /they speak out over and over until they are heard. They don’t check the polls to find out what they think. The problem is that Dean isn’t the right messenger to tell the American people that Bush led them into an unnecessary war and killed over 500 citizens for a megalomaniacal fantasy. Kerry is in a better position to attack but he lacks the nerve. He won’t publicize Bush’s lies until the polls tell him it’s safe. That leaves Clark.
Clark is the person who has the courage to take an stand and the stature and experience to back it up. He is the one that can tell Americans that they got conned and misled. His candidacy is that best thing that has happened to the Democrats in years.
He’s also the best choice for another reason. He’s a Southerner and he has the Southerner’s ability to talk about values, religion, family etc. and sound sincere(because he is sincere). Those issues and that sincere demeanor matter to Independent voters. It may be that Ruy is right and we don’t need the Southern states to win. However we do need the Independent voters and they are more likey to vote for a Southerner regardless of where they reside. Look at the track record. Southern Democrats have won far more often than Northerners. It’s a matter of style. They have a broader appeal in marginal states.
To bad he won’t get the nomination.
A similar thing happened in the President’s last big speech, on September 7th. He did a Sunday night address to the nation on Iraq, hurriedly announced on Friday afternoon, and the percentage of approval for his handling of Iraq after the speech was worse than before. So that’s twice in a row he’s left his audience unimpressed.
The country willed itself to think well of him after 9/11. And as we’ve seen in the last few weeks, people don’t really start thinking about an election until very late. He could tank, as his father did when people started thinking seriously about whether they wanted to see him on TV for another 4 years.
i think it’s great that Bush’s SOTU address was properly interpreted, and it HURT him accordingly. after all, he focused more on steroids than health care.