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.
Can someone explain why in slide #37 there are only 37% Gore voters from 2000 but 43% Bush voters?
Am I to understand that tons more people who voted for Gore in 2000 failed to come out than who voted for Bush? Why would that be?
There are moderate Democrats in the red states but they lose due to straight ticket voting – just look at the Senate elections this year, where moderate Dems got clobbered everywhere but Colorado.
Exit poll and other pre-election polling have a limited usefulness this time because they didn’t seem to correlate very well with the election itself. To use this data to try to understand why Kerry lost is probably not wise until we have a better understanding of why these polls didn’t match the outcome.
My personal theory is that there was an unusually large contingent of Bush backers who just weren’t willing to talk to pollsters– who they probably consider part of the “leftist media conspiracy”. In the same way that African-American candidates have often gotten fewer votes than polls indicated they would, I think voters who were anti-gay specifically or anti-tolerance more generally showed up to vote but not to talk to strangers. If that was the case– and it’s basically unprovable, probably– the exit polls would have to be adjusted.
Jay Bradfield, you’re exactly right.
They also beat us with discipline we lack. We’re always too busy making sure everyone gets to speak their mind. We wouldn’t want anyone to feel disenfranchised.
Organizing the left for Democratic theme issues is next to impossible, because complaining about THEIR issue always transcends winning the presidency or congress. As someone once said, it’s like moving frogs in a wheel barrow.
Conservatives love order, so they love a good, firm chain of command, where orders come down and are followed. Meanwhile, liberals are still arguing about which T-shirt makes the appropriate statement with this outfit.
Liberals are too busy crying about whatever it is that makes them unhappy at the moment to work on finding the middle. Not content to be minority status in all branches of federal and state government, they seek to turn the course further left.
I am a former conservative Republican red-stater turned progressive. The reason we don’t see fusion politicians in the red states is because of the effectiveness of the Inside the beltway conservative movement. I am sadly beginning to realize there is no equivalent progressive movement.
The conservative movement goes out of its way to get all of its candidates to tow the line on conservative issues. So you might have social conservative mid-westerners who is tempermentally opposed to free trade, as are his constituents but because of the working of the conservative network of think tanks, lobbyists, donors, and activists this guy will eventually change his tune on free trade. Maybe it’s because he is convinced by the rationales offered in a Heritage Backgrounder, maybe it’s because right-wing activists show how he can still win while be free trade, or maybe a wealthy conservative donor had a chat with him about his political future. Either way the conservative movement takes care of itself, its agenda, and its members. Progressive don’t. Progressives lose.
Dobson is a guru for the “family” devotees within the evangelics, but his role is no different in the Bush campaign than Limbaugh’s: He’s there to excite and motivate the base, and he does.
The people who listen to Dobson and Limbaugh and watch Fox News, are the same people. At least there is large overlap. Find someone who likes Dobson but doesn’t like Limbaugh.
Whatever his message, Kerry did a poor job of communicating it. Bush was just terrible in the campaign, and only because Kerry was hopelessly worse did Bush prevail.
alan abramovitz’s show claims that the the GOP have an effective lock on the senate and the house for the forseeable future, although he seems more optimistic about the dems regaining the presidency in 2008.
what puzzles me why the GOP has such a great advantage in the senate house, if “cultural issues” are so paramount. one would think that the senate and house candidates — from both parties — would more closely reflect the people that reside in their districts, which would effectively “level the playing field” with regard to cultural issues. why, then, aren’t there more democratic senators and representatives from the blue states? the only answer i have is that even for house and senate races, democratic candidates end up taking the views of the national party on issues such as gay rights and abortion, which puts them at odds with most of their consituents, even if they more closely “connect” with their voters on other, less crucial issues.
but this brings to mind another question: why do democratic candidates from red states persist in reflecting the the national party on cultural/wedge issues? why have we not seen the emergence of red state politicians (from either party) that would seek to more closely align themselves with red state voters by wedding cultural conservatism (opposition to gay rights, abortion) with economic liberalism (higher minimum wage, national health insurance)?
the fact that we’ve not seen “fusion politicians” such as these makes me wonder if there’s a flaw in thomas franks’ analysis in “what’s the matter with kansas?” maybe, contrary to what he says, the midwest picks the GOP as much for its economic program as its cultural program, although i’m hopelessly mystified as to why. or maybe there’s some coupling between the GOP’s cultural and economic programs that we blue staters simply can’t grasp.
Do not be distracted by continued verbal self-flgulation. The election was stolen and unless we ALL focus on the false result of this election, we are going to remin fractured and out of power. Evangelists are passionate but they are not stupid. They did not give Bush this election. Voter fraud did.
My understanding is that the Gay Marriage issue resonated with Dr. James Dobson whose radio show reaches a reputed 7,000,000 listeners. By “closing the deal” with Dobson and earning his endorsement, Bush probably picked up a fair number of his devotees who may or may not care much about gay marriage. My take is that the Republican Gay Marriage strategy was to influence those who can influence others. Then frighten the masses with wolves. It might be interesting to try to find out what portion of the population sought advice/were given advice from someone they trust and how this advice affected their vote.
So, the economy was a push, the morals issue was a wash, Kerry should have offered a clear opposing plan for Iraq, and for fighting terrorism. And he should never have switched his message from Iraq and foreign policy. Kerry kicked Bush’s butt in the first debate about foreign policy he had Bush rocked, but failed to knock him out. Joe Biden was right, hammer away on Iraq and offer a clear plan. The future doesn’t look too bright in the congress either.