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.
Don’t expect the polls to carry the day.
Bush is a lot smarter than most Democrats, and realizes that polls mean only present support. Once he’s gotten out there and beat the drum for a while, the polls will change.
Unless Democrats respond in kind, with Kristoff’s advice… reject it sight unseen and declare there is no Crisis.
Cranky, Allen and others.
There are big political and mechanical differences between Iraq and pushing Social Security Privatization through. Once the decision is made to go to war the nation is on a speeding train with no way to control the engineer. And all kinds of wells are tapped: general patriotism “we are at war”, “support the troops”. And once you are engaged in combat it is in many ways too late, there is no easy way to extract yourself.
Social Security is different. No one enlisted in the War on Social Security. It may be true that this president has the iron grip over his party and the media that you suggest, and that he will be able to ram some plan through even in the face of productivity numbers that suggest no crisis at all. I don’t agree with the premises, but those are issues for another time.
The problem Bush and the Republicans face is time. Whatever plan is adopted, it will require months to actually put individual accounts into place and then to allow individuals to exercise whatever limited choices in investment vehicles they have. As the actual details of the plan start coming out, mainly the fact that future benefits even with returns on the private accounts will be much less than promised under the current plan, people will begin to murmer.
Now if they were able to maintain the sense of “crisis” they might sell this as being “better than nothing”. But the only way to do this is to stop reporting economic productivity numbers altogether. 4.0% economic growth for 2004, already in the bag, simply blows the doors off the productivity models of the Social Security Trustees, not just the Intermediate Cost (which called for 2.7% in 2004 and 1.8% in 2005) that produces the 2018 and 2042 dates used by all, but all the Low Cost one that shows no long term shortfall at all (2.8% and 2.1%).
By June it will be clear that doing nothing would have been a better deal than doing something, particularly this something. And Republicans will be staring up a hill at 2006. They will be faced with having broken something that never needed a fix, lurching ever closer to that Third Rail of American politics.
The beauty is that there is no downside to cut and run here. There is no way that accounts will be set up by June and the US will have invested probably a few million dollars in staff time. The Republican Congress will have two choices: repeal it, or ride it into the Valley of Death that will be the 2006 midterms.
Bush may not care, he is not running for reelection, but the firmer he grasps that veto plan, the better for Dems in 2006.
And? Not to be rude, but it appears to me that the general public is not going to be given a chance to express its opinion. Transfer of Social Security wealth to Wall Street is already scheduled to happen, and there will be a big “burst” of support at just the right minute to satisfy the media.
Cranky
OK, but since when does this administration need informed public support to achieve its goals? And the goal here of course is not to improve investment opportunities or retirement benefits for retired Americans – it is to destroy a successful and essential government program as part of an ideological crusade to deligitimize all government programs that do not redstribute wealth upwards. They will lie and distort and dissemble to whatever degree necessary unless Democrats stand up and call this for what it is, and contesting the issue on this terrain – what the American people really want – is not what the fight is about.
That is, of course, until they start the lying.
Actually, check out Talking Points Memo – Josh points out that the Post wrote up the poll quite badly and that the numbers look better for the Democrats.
LATEST NEWS IN THE WASHINGTON STATE GUBERNATORIAL RACE
Democratic candidate Christine Gregoire put together a string of victories Wednesday against Republican Dino Rossi. The race, which still isn’t over, has been extremely close.
Permanent Defense: King County reported +59 votes for Gregoire, giving Gregoire the overall lead in the statewide manual recount by 10 votes. This does not count the 725 ballots the Supreme Court said can be counted.
The especially good news about all of this is it shows Democrats are willing to stand and fight. We won’t be intimidated by the GOP….No more stolen elections! Christine Gregoire has held on for almost two months now – and we believe she will emerge from this as our state’s Governor.
He’s hoping to scare the public into supporting his plans, a la Iraq. The advantage he had that time was that a lot of Americans wanted to lash out at Arabs–any Arabs–in the wake of 911, so they were open to persuasion. The advantage he has this time is that the relentless talk of “Social Security crisis” has eroded the public’s support to some extent, since many are skeptical that they’ll ever get benefits. It’s not as strong a card to play as the post-911 anger was, so there’s hope. Given the Democrats’ disarray, however, I’d say he has a decent chance of prevailing. The real test is whether the Dems can wake up and finally start acting like an opposition party, and not get caught up in giving the Republicans fig leafs.