I’ve just returned tonight from a quick weekend trip to Prince Edward Island, a delightfully remote corner of Canada, but all the talk while I was there was of the USA.Like Americans, Canadians have been riveted by the incredible destructive power of Hurricane Katrina, and particularly the predictions that New Orleans might finally be wiped out by catastrophic flooding. (Since New Orleans is my favorite place, I was frantic yesterday and today to get the news, and only after sitting through a long CNN feature about the impact on oil refinery capacity at the Charlottetown airport did it become apparent that massive loss of human life did not occur in the Crescent City, though Biloxi was less fortunate).But the news item that competed with Katrina across much of Canada involved America in a far less sympathetic story. Canadians are absolutely livid about a cavalier rejection by the Bush administration of a NAFTA-sponsored arbitration decision declaring U.S. duties on Canadian softwood lumber illegal under the agreement. In fact, under heavy public pressure, Prime Minister Paul Martin is reportedly thinking about calling a special session of Parliament to take retaliatory measures against U.S. exports.This hasn’t exactly been big news in the States, but Canada is America’s biggest trading partner, and the longstanding U.S.-Canada partnership on trade policy is the linchpin not only of NAFTA, but of hemispheric free trade efforts generally. And the long-simmering dispute over Canadian lumber is now leading a variety of voices north of the border to call for a reconsideration of that partnership, and of NAFTA itself.It didn’t help that Bush’s ambassador in Ottawa, David Wilkins, responded to outrage over the U.S. decision to ignore the lumber ruling by lecturing Canadians to eschew “emotional tirades.” Bush himself, of course, is vastly less popular in Canada than his predecessor, and Wilkins’ comments reinforced every available perception about the administration’s general disdain for the opinions of long-time allies.This incident also shines a bright light on the Bush administration’s generally bumbling and inconsistent stewardship of trade policy, which follows few clear principles other than solicitude for domestic business interests with political clout.In any event, it was fascinating to spend a few days among our neighbors whose love-hate relationship with the U.S. was illustrated by their worries over a hot wind from the south roaring into the Gulf Coast, and their willingness to launch a cold wind from the north towards Washington.
TDS Strategy Memos
Latest Research from:
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.