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.
I agree that this is unacceptable, yet it is not surprising. The old Democratic establishment does not want to reform its party “from the grassroots down” because they would loose power. The people would be in control, not the McAuliffes.
More here: http://www.politicalthought.net
With his habit of hurling epithets like “Republican lite,” Howard Dean is the best prime example of somebody who (in Nick’s words) “is deeply invested in restarting the DLC/liberal food fights” and would therefore be part of what Nick calls “the rump establishment.”
Dean has done much at the grassroots level and has much to contribute to the party, but he is far too polarizing a figure to be a plausible candidate for DNC chair.
It’s not a left-right thing really … what does that mean anyway? There are probably some “right” things that I could get behind. From where I am, a blue area in what once was a blue state, the party needs to remember its real roots — the people. Those inside the Beltway haven’t a clue, and because of that all they manage to do is try to emulate Republicans. Well, I’m not a Republican. And if someone doesn’t take this party away, far away, from that, I’d say it’s time for a true third party. Read Adam Werbach’s Nov. 3rd Theses (http://www.3nov.com/images/Nov3Theses_letter.pdf) for an idea about that. And forget about any nudges to the center. The party has gone too far in that direction already. And you know what it says to voters when one party keeps trying to look like the other party? That the other party’s right. And it’s not.
To me it’s completely about wresting the party away from the corporate/beltway leadership and building a grassroots party. That’s why I think Dean, Ickes and Rosenberg are the only acceptable candidates.
But really, I don’t think that there is any question that it should be Dean.
Except for being prematurely right about Iraq and bold about his criticisms of the Bush administration, Dean is not particularly liberal. He was part of the DLC at one point. It was however, his strong criticisms of Bush that got the Dems back in the race.
In this last election most of the volunteers on the Kerry campaign started in the Dean campaign. When his candicacy tanked, Dean started DFA, the organization raised $5 million contributed to over 700 candidates up and down the ballot and made a difference in some long shot and pivotal races.
What did Leo Hindery do in ’04? What did Wellington Webb do?
Moving left or right could pull in some swing voters is the classic political theory. But it’s wrong, most people are just not ideological. More important to the vast majority of people is: Does this party or candidate really stand for something? And that’s what Bush succeeded on making the election about: And more people thought they knew where Bush was coming from.
What the Democrats failed to do is to position the central question as simply: Does this guy have any clue about what he’s doing?
Those are the simple things that most people vote about, not ideological tests. And focusing too much on ideological tests detracts from the clear message on other items.
So definitely the most important thing is to stand up for something. That to me is the core problem right now – can one point at anything which the Democrats have stood their ground on in the past 4 years?
First , Kerry did not lose…the election was stolen through frudulent manipulation of the electronic voting system.
That said, Howard Dean is the only possible person to lead the Democratic Party.
We do not need to move ANYMORE to the center. The Democratic Party is already Republican lite!!!
It has to be Howard Dean…there is no one else articulate, passionate or honest enough. All this pontificating is diplomatic and appeasing but too corporate!
I agree with Nick Confessore that this is more a battle between an entrenched establishment and reform forces, with both sides having their fair share of both liberals, moderates and even a few conservatives.
Where I disagree with Confessore’s opinion is his suggestion that it is the OUTSIDERS, the REFORMERS who want to make this a battle about ideology. That may have been true a few years back, but my experience in the Dean campaign has taught me that the #1 reason people got involved in that effort was because they were sick and tired of Democrats rolling over every time the Republicans or the establishment media barked.
It had nothing to do with ideology and everything to do with testicular fortitude.
On the other hand, we have people like Al From and Peter Beinert who continue to frame the debate as one about ideology, as if they are the great defenders of the Democratic big tent against the crowd of pitchfork wielding radical lefties.
I suspect this may have something to do with where both Confessore and I are coming from. He is closer to the insiders than I am, so he can’t see what is so painfully obvious to us out here in the “heartland”.
“Pretty much anyone who is deeply invested in restarting the DLC/liberal food fights is by definition part of this rump establishment, since the distinction of vision between Democratic centrists and liberals pale next to the differences between the Democratic average and the Bush-era conservatives.”
I disagree. There a fundamental differences between DLC and progressive Democrats over, for want of a better term, economic populism that goes to the core of the party’s beliefs. While I would not dispute the need to shake up the party’s beltway establishment, that pales in the face of resolving what the party stands for.
I also thought the TAP piece presented a caricature of progressive Democrats, then and now. Gee, I remember when TAP wasn’t trying to emulate TNR’s rush rightward. Now with such items as this Tapped piece and the presence of people like Matthew Yglesias, I’m beginning to wonder.
Lead, follow, or get out of the way. From where I was working (for the first time ever, in a very red Florida county) all of the leadership and most of the effort came from DFA and MoveOn. I am shocked and infuriated that Kerry lost, that the entire national slate was beaten so badly, with a few brilliant exceptions. When someone suggests Joe Lockhart for chair, I want to scream.
. Top-Down or Bottom-Up .
I think that in addition to the Liberal/Dino conflict and the Washington/Heartland struggles there is the Top/Bottom struggle.
In the past the parties have been lead by the people on top, but with the Dean/Trippi group there was the start of a leadership from the Bottom. Many of us in the Virtual community are starting to suggest that it is possible to have a party that interacts with us rather than just uses the WEB as a way to gather money and foot soldiers.
It may be that this time the struggle for the DLC leadership is between those who want a classical party structure and those who whould like to explore if the party can really be organized as a Bottom-Up representative group.
If the Bottom-up’ers are represented then perhals we can develop the tools, community, etc. so that we can really separate the CORE democratic/progressive/populist… issues from those that are desirable or wedge issues, and then ofcourse proceed to properly frame/communicate these to the people who also believe in them.
It is hard not to come across as a sychophant, great post Ruy, I wish this could be fed into an amplifying circut.
I can’t say I agree. Since we live in an age where just a slight nudge to the center on a few key issues (partial-birth abortion? terrorism? gay marriage?) could mean the difference between getting a Democrat elected–both as President and to Congress–those small policy differences between Democratic centrists and liberals become very much personified, though they pale materially in comparison to the average Democratic views the Bush-era conservatives. Love the site and the book. thanks.