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.
Try this site also. Good, intelligent reading.
http://gadflyer.com/
Dare I cite “nattering nabobs of negativism”?
To echo something RT said earlier, Dems’ pessimism and self-defeating psychology can be their own worst political enemy.
I live in liberal Seattle, and I’m amazed here how many people in one breath champion Kucinich / Nader / Sharpton, but then sigh that Bush will win anyway so they won’t even vote. They think that the GOP machine is unstoppable and grant it near-supernatural powers.
I often direct these people to DR to give them some positive signs and motivation!
Please give it some space, Space! Accentuate the positive, eliminate the negative.
Kerry = positive, Bush = negative.
Focus, focus, focus. Don’t fall into their false numbers game. The polls are useless in telling the real story. Polls are designed to brainwash the masses and are easily manipulated to do just that. The votes will rule. Think positive and talk positive about a future with President Kerry, show everyone the right way.
Save the negative for the liars cowboy club clan. oops.
Donkey Rising is engaging in nothing less than willfull ignorance. The CBS poll contains far more bad news than good. Among the disturbing numbers:
1. Kerry TRAILS Bush in battleground states.
2. Nearly twice as many people think Bush says what he believes than think Kerry does despite the fact that Bush has been lying to them for 3 years.
3. More people still think Bush will protect the U.S. from a terrorist attack.
4. More people think Kerry has been running a mostly negative campaign.
Yes, the numbers are trending away from Bush. But still, they should be much more favorable to Kerry.
How’s this for a play on their own words. Yes they are secretive evil doers who lie and try to hide what they are up to.
Someone said the other day that Nixon would be a tremendous improvement over this president. How sad of a state of affairs America has dropped to because of the Supreme Court’s installation of this person to run our country. Fortunately real American’s will have the last word come November. You know I used to think I hated Nixon and Reagan, just goes to show you how a new reality can alter what you think you knew ( I still hate them but now I have been shown that hatred has multiple levels).
Sorry just venting.
More good news in California where the latest poll has Bush at 38% approval rate to Kerry at about 50%. Bush never had a chance in California anyway, but the numbers have shown a tremendous downward slide for Bush in the last week or two.
Maxcat, They are a bunch of liars, but if I had to choose one word to describe this administration it would be “secretive”. They put Nixon to shame. John Dean’s book makes that clear.
Hey let’s start using the “L” word applied to this administration. All of them and their kind are always so fond of throwing that at the progressives like it means something dirty and bad. Well now it does but only when applied to them. That’s right, the “L” word as in LIARS.
Goodbye Mr. Bush.
Good News today. In addition to the Pew Report poll indicating the overall approval trend continues downward — now 43% down 5 points from March, Minnesota apparently went Kerry nuts over the last month. The previous poll had a 2 point spread, but today’s Star-Tribune poll puts Bush at 38 and Kerry at 50. A mite of progress. I was hoping Ruy was back, I am looking forward to his take on the Pew.
Prediction: Israel has the green light to assassinate Arafat. If there’s a suicied bombing in Israel that kills more than a few people, Arafat is gone.
My fear is that the Administration is rapidly reaching a point where they are willing to take a gamble on sheer global chaos to win.
Am I paranoid??
John Kerry will win in November by a considerable margin. Bush has betrayed his own parties agenda, betrayed democracy, and betrayed all good Americans. No amount of semantics will erase what Bush has led this country into. Nothing will wash the blood of our soldiers from his coat tails. All of America will speak and Bush will be silenced.
Joe, Kerry comes across to me as someone who–like Bill Clinton, and when he has the time to do so–prefers to be able to collect factual information and differing views and mull it over before making especially important decisions. To that I say “Hurray!! I miss that.” I agree with that part of what you said.
He does not come across to me as someone who makes decisions with a lack of self assurance, though. I think that’s what the Republicans want the public to believe. But I don’t have that perception of him at all. He comes across to me as generally quite sure-footed, in fact.
What really has to be done is a bit more organizing on the ground. Someone put up a dairy-entry on Kos about the lack of an organization in Ohio. There’s the same weakness here in Illinois.
This has got to change — rapidamente
Grush, it’s very tough to disengage your own feelings, your fear, your hope, from what is really going on out there in 50 different media markets – especially when you’re in one of the markets that is not in a target state.
Plus, the media saturation of NY leads people to buy into the “who’s up, who’s down’ mentality. If one candidate gets more press one week, it feels like they had a better week. Well, if that happens 6 weeks in a row, there’s a shift. But 1, 2, or even 3 weeks are too small of a time frame, unless we’re in October.
Sara: I too live in a swing state but in a very Republican area, West Michigan. Consequently, Kerry isn’t making any cable buys here to speak of. I suspect that the ad buys are heavier in the Detroit metro region.
I also suspect Kerry is in the process of developing a more centrist message and firming up campaign strategy. It will be a slow process for Kerry in that he doesn’t appear to be a person who makes decisions quickly or with a great deal of self assurance.
I hope he speaks out soon though on the need to finance our Iraq operations with a tax cut roll back for those higher income people. It would (1) help explain his vote on the $87 billion, (2) remind voters that we went there for no good reasons and(3) spread the sarifices of the war more equitably, something voters can identify with.
Sara,
That’s great, and encouraging. I live in New York, so the general din of life drowns out such things. Maybe Warren Buffet does have it right investing from Omaha.
Plus, I make it a point to listen to and read the enemy: Hannity, New York post, etc (plus, Page Six beats anything the Times has). So I have trouble separating signal from noise.
Still, after the Clarke testimony, Rice’s ridiculous waverings and the increasingly anarchy in Iraq, Bush should be down by 20 points.
It is simply not in Kerry’s interests to engage in the kind of tit for tat advertising war Bush undertook when he went up with his ads a few weeks ago.
Kerry needed the rest, and his primary centered staff needed to be re-organized, built out, and re-focused on tasks for the long haul. It is to Kerry’s advantage to be off the hot trail while this is done. Moreover, some other matters, such as the 911 commission were scheduled, and the better part of valor was to get out of the way and let them happen on their own., Kerry needed to raise big time money, and he is doing so effectively.
From where I sit in a battleground state, I see lots of advertising — Kerry’s stuff plus a number of good 527 efforts. I see lots of party planning meetings being announced, I see campaign staff being recruited and appointed to camapign jobs, I see announcements that surrogates are visiting town and making appearances. I would much prefer to see good organization and the finances to sustain it through to November than I would witness a hot altercation now about an issue that could easily be moot come November.
Not a very scientific or quantifiable observation here, but does anyone else sense the momentum slipping away from the Dems?
I feel as though Kerry is invisible… and that the major media is covering the candidates in proportion to their advertising spend.
Images of Bush crosscut with Iraq carnage, I’m afraid, will help him. “The world is a terrifying mess, don’t take any chances right now.” (Of course, the world is aflame because Bush decided to throw gasoline on the fire after 9/11).
One key dynamic is that Kerry really CAN’T affirmatively define himself. Bush’s deficit makes any spending on social programs impossible, cultural issues are a minefield, and there is general ‘consensus’ among the ‘elites’ on current foreign ‘policy.’
I’m concerned.