I’ve worried in the recent past that Democrats will fail to pick their fights carefully on Bush administration appointments, and just submerge their principled objections in a white noise of white-hot rage. But Bush sure seems inclined to pick our fights for us, as evidenced by the, shall we say, rather provocative choice of John Bolton for U.N. ambassador. Is there a single constructive impulse in administration foreign policy that Bolton hasn’t mocked or rejected in the past? Hard to think of one. U.N. reform? Bolton seems to think the organization is inherently an affront to U.S. power. Collective action to stop genocide? Bolton has opposed any U.N. role in “civil conflicts,” up to and including genocide, and as the country’s best-known critic of U.S. cooperation with the International Criminal Court, he’s certainly not in a good position to propose any immediate effort to bring the Darfur murderers to justice. Engagement with China to bring that country more fully into the community of rules-observing nations? As a former hired hand of the Taiwanese government, and an outspoken proponent of formal Taiwanese independence, Bolton isn’t likely to get onto drinking-buddy terms with Beijing’s representatives at the U.N. And then there’s the really big issue on which Bolton has had formal responsibility in his current gig at the State Department: trafficking in nuclear materials. It’s no big secret that the administration until recently treated this rather urgent threat to our lives and limbs as a second- or third-order problem, on the bizarre theory that terrorists are too frightened of George W. Bush to consider setting off a nuke in one of our cities. The current Proliferation Security Initiative that Bolton has directed is a lot better than nothing, but typically, Bolton has pushed it in the direction of ad hoc, U.S.-led action to interdict and inspect suspect cargo, rather than the full-fledged, top-priority international effort to prevent “leakage” of nuclear materials that we need. Aside from his foreign policy views, Bolton is also a stone partisan warrior. I did a couple of radio shows with him back during the madness of the 2000 election cycle, and found him to be genial and cerebral until the mikes went live; at that point, he was indistinguishable from Tom DeLay. I’ll never forget turning on the tube during one of those Florida court hearings on the presidential vote and seeing Bolton sitting there in the front row of the phalanx of GOP lawyers, hour after hour. Since I don’t think the Bush legal team was in need of foreign policy advice, it was clearly an act of hyper-partisan solidarity. (According to this morning’s Post, Bolton even got into the chad-counting act at one of the county-level election boards). Soon we will begin to hear suggestions that Bolton’s appointment may be one of those Nixon-to-China things: you know, let’s go out and find the most abrasive unilateralist in the administration to patch up our relations with the rest of the world. This only makes sense if the Bushies are afraid a more constructive attitude towards the U.N. and the world in general will make them vulnerable to criticism from the almightly Conservative Base. But if this is what’s really going on, then Bolton better make it pretty damn clear during his confirmation hearings. He’s sort of the Robert Bork of foreign policy nominees: a guy with enough material in his public record to script two or three days of tough Democratic questioning. If he expects any Democratic votes at all, he’d better start wolfing down a lot of crow. Otherwise, this is just another in-yer-face appointment that begs for a fight.
TDS Strategy Memos
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By Ed Kilgore
March 24: The Republican Case Against Medicaid Expansion Continues to Crumble
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.