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.
The New York Times latest poll numbers are excellent news for Kerry. While the article says nothing has changed in the race for the Presidency, with Kerry leading by only 2 points. The fact remains that Kerry was down by 3 points in the last Times Poll and is now up by 2. This is a 5 point swing! That is excellent news! A 5 point swing toward Bush would have the press saying it was a significant development.
For those who will not be getting to Richard Clarke’s book (which I highly recommend) there is an excellent review of it in the New York Review of Books:
http://www.nybooks.com/articles/17092
A public opinion poll around the time of his 9/11 Commission testimony found that only about 25% of the public saw him as a dedicated public servant. Sheesh. Not saying I would have wanted to get crosswise with him in the federal bureaucracy but I think history will be kind to him. And I mean to be kind to him now.
I had the feeling while reading his book that someone was turning the lights on inside the federal government so just us citizens could get some idea not only what has been going on but how it might be done better.
There’s one way to interpret these numbers so that the Iraq was is still working in Bush’s favor.
It’s probably fair to say that it is indeed Bush’s base who embrace the notion that the fight against terror is the most important issue. Yet those who believe this probably also buy into Bush idea that the war in Iraq is simply a part of the larger, more important issue of terrorism.
Put together the numbers for the voters who put Iraq number one in importance with those who likewise place terrorism number one, and Iraq turns out to be a MUCH more favorable issue for Bush than the Iraq numbers alone would suggest.
Please pardo my previous typo… (rpress)… Once again passion overtakes accuracy. 🙂
Forget waiting for the rpess to cover this stuff. We shoudl encourage MoveOn and all the others to organize demonstrations which literally SURROUND the New York Times, the WashPost, LA Times, all the major outlets. ABC, CBS – God knows they never have anyone else outside on the plaza for their morning gig!
Seriously. We need to take this fight for information directly to those responsible for the job. They aren’t doing it. Nothing else will get their attention.
The economy is important, but I think, despite this poll, Bush is vulnerable on terrorism, too. A strong case can be made by Kerry that the war on Iraq has made us weaker on the war on terrorism. It has distracted us, first and foremost, from looming security issues here at home: tankers, air freight, train transport – no safer than we were before 9/11. Second, the war on Iraq has handed to Bin Ladin a great recruiting tool. Third, there’s solid evidence that the war on Iraq diverted attention from the search for Bin Ladin, and the deTalibanization of Afghanistan.
Kerry needs to point out that there never was a link between the war on terror and Saddam Hussein. This delusional link in the public mind has to be erased. There never was a link between Al Queda and Saddam, and yet many Americans still believe otherwise.
Bush is SO vulnerable on his handling of the war on terror that I can’t understand why this point isn’t being made over and over, not only by Kerry, but by the media. It seems so obvious that I must be missing something here.
I certainly admire Ruy’s panglossian optimism — no cloud without a silver lining for Kerry — and I hope he’s right.
But, as I stated in yesterday’s comment to the previous post, Kerry would be better positioned to benefit from the increased opposition to the war in Iraq if Kerry were opposed to the war in Iraq.
I noted with interest today’s New York Times article reporting that Bush’s numbers on his handling of the war are plummetting, but Kerry is not benefitting.
http://www.nytimes.com/2004/04/29/politics/29POLL.html?hp
That article states in part:
“The diminished public support for the war did not translate into any significant advantage for Mr. Bush’s Democratic challenger, Senator John Kerry of Massachusetts. ”
Too bad, but not all that surprising. As I stated yesterday, if Kerry had from the start adopted Sen. Bob Graham’s stance on the war on terror, these erosion of support for Bush on the war would be helping Kerry much more.
–LB
aRuss- In 1956, Adlai turned the VP nomination to the convention. Estes Kefauver beat out the original JFK for the VP nomination. Stevenson-Kefauver lost. I’m not certain this is the best idea. for one thing, there would be no real vetting of the VP candidate.
Re the finding that among the 28 percent of respondents saying terrorism would be the most important issue affecting their vote Bush wins 83-14, I find that an amazing result.
MDtoMN may be right–these may be Bush’s hard core supporters. But if a significant portion of them are persuadables, another way of looking at that number is that it presents a fat target to come way down.
Other polling data suggesting that, for example, more respondents now see the Iraq war as making us more vulnerable to terrorist attacks rather than less suggest that–again, only among those who have not already made up their minds for Bush– Kerry may have some daylight on this issue to get those numbers way down.
I’d like to clarify that in earlier posts I did not mean to suggest that Kerry *should* select national security as his primary issue thrust to try to win the election. What I was trying to say is that, especially if there is strong Q3 job growth, we are going to need to know how we’re going to win making the national security issue work for us. I may be at one pole among those who frequent this site in believing that is actually possible!
In any case I am unable to see how establishing that as our goal is likely to hurt us. The way Kerry will make the issue work for him will be by coming off as commanding, as knowing what he’s doing and what he’s talking about. And if that perception of him takes it will help him generically. That may be part of why the Republicans are working so hard to portray him as exactly the opposite–as the opportunistic flip flopper who has no core principles or larger vision of where he wants to lead the country.
Most of the commentary has until recently assumed the economy and health care will favor Kerry and that his strategy to win should stress these issues. That may yet turn out to be the way to go. And I’m not suggesting this is an either/or matter where he talks mostly about the economy or mostly about national security.
What I’m suggesting is that it would be a disastrous mistake not to have a plan B. The point is that with both the economy and foreign policy in a high degree of flux right now we don’t know now which issues will work best for us in the fall.
Others here have written, and this makes sense to me, that it takes the public time to digest developments that cut against their earlier perceptions. I would add that may be especially true in issues of foreign policy, which have a large knowledge component to them, than the economy, which is something voters have some concrete experience with as well as an intuitive feel for.
Laying the groundwork for the national security argument now, during a period when the public is being presented with many developments unfavorable to Bush in his area of strength, seems like a common sense precursor for a plan B to win. I’m looking forward to the Westminster speech tomorrow.
I believe the 28 percent who picked terrorism are in fact the Republican Base. I don’t think this is really the issue, I think that it’s ideologues who need something to cling to. They are responding to Bush’s constant talk about terror, and they are embracing it because it cannot be examined empirically (is he actually good at terror?) by our present media. So, I think that 28% is our lower bound, and nothing can be done to ever make them waver.
I think the Republican Party also recognizes the need for such an issue (an unexamined issue that the media will let them take credit for). That’s why they talk it up, and their ranks respond.
As a result, I’m not sure Kerry could sway these people whatever he does.
It’s an inescapable fact that a presidential nominee has to have a vice presidential nominee, though many would have been happy to do without. But there is no reason Kerry has to use the traditional selection method, which is only slightly more democratic than the British monarchy.
Win or lose, he could contribute to a lasting improvement in our political system by devising a better way.
Fourteen vice presidents have gone on to the presidency, including nine who ascended when a president died or resigned. As John Adams, the first person in the job, noticed, “In this I am nothing, but I may be everything.”
We could wake up tomorrow to find President Dick Cheney taking the oath of office.
But the Constitution doesn’t say we have to leave the choice entirely to the nominee. Kerry could offer a list of candidates he considers suitable and let the Democratic convention delegates take it from there. Or he could let the delegates nominate three or four possibilities and then make his choice from that list. Or he could announce that he’ll turn it over to the convention and invite aspiring veeps to campaign for the job.
Any of these would give the voting public a vastly greater role than it normally has. It would also have some advantages for Kerry himself, such as attracting favorable attention–after all, who could possibly object? It would also allow him to contrast his open, inclusive approach with the secretive, Machiavellian style of the incumbent vice president. It could win strong public approval.
IT WOULD BE GREAT TO HAVE TWO CANDIDATES RUNNING
THAT PEOPLE REALLY WANT!
Adapted from Steve Chapman’s article in the Chicago Tribune April 25, 2004
The problem with the economy as an issue is the media. It seems to me, and correct me if I have some misperceptions, that every time I turn on the news in any medium in any media outlet I’m seeing good news about the economy. Don’t get me wrong, I’m not wishing away prosperity simply to see W lose his job, but the problem with the economy as an issue will be one of public perception. If the media keep saying the economy is fine or at least on its way there I think a large part of the public (especially his staunch supporters but more importantly the undecideds who don’t share the Dems disdain for W) will give him the benefit of the doubt on the economy.
If everytime you turn on CNN, NPR, etc, etc you see “the markets are up a little bit” and “we added a few jobs last month” and reports that are basically saying “things aren’t great, but they could be worse” the economy at the very least won’t be useful for Kerry. At the worse W and his media troops will be able to keep saying “if it weren’t for those perfectly timed tax cuts we’d be in a lot of trouble right now.”
Either way, at the end of the day I’m afraid that it doesn’t matter what the polls say. People are probably going to say the economy isn’t terrible but the war is, I think we should keep Bush there because he’ll do a better job protecting us even if he did create the problem.
What we need for the economy is some tangible issue that people can really understand. There has to be something more concrete for people to wrap their heads around. If there is a news report saying that we added jobs in the previous month (whether it’s 300 or 3 million) it doesn’t matter that Bush has a net loss of jobs on his watch. All that matters is that people will see the words “added” and “jobs” and the GOP media attack will begin with the line that “tax cuts are the solution to everything from job loss to bear attacks.”
Long story short (too late) it’s a problem of perception and the media
The latest poll seems to reflect Bush’s weakness in the numbers.
A couple of points occur to me: Is it possible that people are really beginning to listen to W now? I used to think of this sort of thing as a kind of a test: His manner of expression is so inchoate, so vague that any listener can, in the immortal words of Harry Nilsson, “see what he wants to see and hear what he wants to hear.” Oddly soft-focus talk — warm, kinda friendly — rich in baco-bits. Is it possible now that people are not so willing to fill in the blanks: Another phrase that must roll through the White House typing polls — cost of Iraq, cost of Medicare prescription, cost of steel tarrifs, cost of… We’ll fill in the blanks later.
The degree of mismanagement is such that all W has begun to bet on is the economy. All eyes are on the economy, was the word. Pocketbook isssssssues. When inflation tags interest rates, I’m not sure mortgage refinancing will continue to work as the nation’s economic engine. Imagine the water cooler conversation: Yeah, I had 4.5%, but wow! I’m in solid at 7.5%
Thoughts?
Everybody take a look at this new CBS/NY Times poll:
http://www.cbsnews.com/stories/2004/04/28/opinion/polls/main614605.shtml