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Political Strategy for a Permanent Democratic Majority

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New Johns Hopkins Study Probes Social Class and Shifting Political Identity

Jill Rosen previews a Journal of Sociological Science report, which presents the results of a study of 30,000 eligible voters, exploring “how social class affected political identity in the run up to the 2016 presidential election.” According to Rosen’s article, “Shift away from party loyalty among working-class voters set stage for Trump’s victory” in Johns Hopkins University Magazine:

On the cusp of last year’s presidential election, many working-class voters who were once staunch Democrats had gone independent, opening the door for a non-traditional Republican candidate…”A substantial proportion of eligible voters within the working class turned away from solid identification with either the Democratic Party or the Republican Party during the Obama presidency,” wrote lead author Stephen L. Morgan, a Johns Hopkins Bloomberg Distinguished Professor of Sociology and Education. “Even before the 2016 election cycle commenced, conditions were uncharacteristically propitious for a Republican candidate who could appeal to prospective voters in the working class, especially those who had not voted in recent presidential elections but could be mobilized to vote.”

Morgan and graduate student Jiwon Lee studied data from the 1994 through 2016 editions of the General Social Survey, to model how party identification has evolved over the past 24 years…They focused on more than 30,000 eligible voters. The survey asks respondents which political party they identify with, as well as questions about their occupation and education, which allowed the researchers to determine how working-class voters aligned themselves politically over time.

“We found substantial change in party identification across the presidencies of Bill Clinton, George Bush and Barack Obama, particularly during Obama’s tenure,” Morgan said. “Many eligible working-class voters were becoming less attached to the Democratic Party, but their loyalties weren’t shifting to the Republican Party.”

Many of these voters—lower-paid, lower-skilled workers often in blue-collar jobs—had begun to consider themselves independent, Morgan found.

Graphic charting affiliations of working class voters as independent (black line), Democrats (blue line), and Republicans (red line)

Image caption:A graphic of working-class party identification from 1994-2016 shows that most identify as independents.

The report likely won’t suprise political observers who have been studying white working-class party identification. But the large size of the study adds some weight to its conclusions. As for the reasons behind the trend, Rosen writes,

The survey didn’t explore why voters who changed party affiliation did so, but Morgan suspects a number of causes: a slow economic recovery after the recession, a failure by those in office to prosecute the individuals responsible for the collapse of financial institutions, and the continuing erosion of real wages for semi-skilled and unskilled workers…Rejection of the civil rights agenda, however defined, appears fashionable again..Morgan estimates that between 6 and 10 percent of working-class voters shifted allegiances, not enough for the Democratic Party to entirely lose its overall working-class advantage.

Whatever advantage Democrats still have with the working-class surely rests on the political preferences of African-American working-class voters, who remain the Dems’ most reliable supporters. Increasing Black voter turnout is still a critical chalenge for Democrats, regardless of white working-class voting trends.

Rosen notes “A silver lining for Democrats, Morgan said, is that some of these lost working-class voters didn’t support a traditional Republican, but someone who appealed to their economic interests.” Democratic candidates who figure out how to project themselves as serving working-class economic interests will find themselves in a good position to win in 2018.


Don’t Forget to Thank Democrats, But War Against ACA Will Go On

It’s well and good that Sens. McCain, Collins and Murkowski are receiving widespread tributes for their pivotal opposition to ‘skinny repeal’ of the Affordable Care Act. But let’s also thank the Senate Democrats, whose unanimous rejection of the measure lead the way. David Leonhardt does a good job of it in his New York Times column, “The Americans Who Saved Health Insurance“:

I know it’s unfashionable to praise a political party, and I have plenty of complaints about the Democrats. But the fact is, many Americans would soon lack health insurance were it not for the unity of elected Democrats.

Not a single one wavered in recent months. On the left, Bernie Sanders, who’s technically an independent, worked to poke procedural holes in the bills. Every red-state Democrat stood firm, too. Why? They thought their Senate leader, Chuck Schumer, was listening to them and their concerns. They had also held their own town halls, and they knew the bills were deeply unpopular.

The unity was a fitting echo of 2010, when Barack Obama, Joe Biden, Nancy Pelosi and Harry Reid kept their party together to pass the most important social policy in decades. Today, it remains the law of the land.

Democrats can be rightly proud of their leadership in protecting the Affordable Care Act. But let’s also affirm the pivotal leadership of citizens and human rights organizations who supported Democrats in winning this battle. In his HuffPo post, “Thanks to the millions who fought to save our health care,” Mike Lux points out that citizen activism was the key to defeating ‘skinny repeal’:

It should not be forgotten that it was all those actions by regular people fighting their hearts out for this cause that won this fight. The people demonstrating, the town hall meetings, the letters, the petitions, the phone calls, the social media postings. Everything all of you did made the difference. You not only terrified the Republicans, but you bolstered and fired up the Democrats to fight back— and fight back they did, to their enormous credit…We have so many battles yet to fight. You activists have shown you can pull off miracles and we are going to need some more of them in the years to come. But last night gives me faith we can do it— again and again and again.

Leonhardt also acknowledges the critical role of “thousands of citizens who took time to attend meetings, visit congressional offices and call those offices, often repeatedly. This sustained action worked better than any poll to show Congress how unpopular the bills were. It was a reminder of how democracy can work.”

It’s important, however, to see the defeat of ‘skinny repeal,’ not as a war that has been won, but a battle victory, or really just one of many skirmishes in the decades of struggle for health security for all Americans.  As Leonhardt cautions, “No one should think the fight is over. Murphy, the Connecticut senator, says he wakes up every day fearful of a new repeal effort. Even without one, Obamacare needs to be improved, and defended from Trump’s sabotage. There’s much more work to do.”

For now, however, let’s give the Democrats in congress due credit for their unified defense of health security for all Americans. Too often, the public takes Democratic support for needed reforms for granted. But the impressive unity Democrats demonstrated in this battle should not be shrugged off. It took courage and vision to hold the line against relentless opposition that controlled the rules and agenda. Countless lives have been saved and million more will get needed health care because of Democratic unity in this most central of struggles for a decent society.


Political Strategy Notes

After giving Sen. John McCain due credit for his vote that helped kill “skinny repeal,” his comments accompanying the vote that Obamacare received no Republican votes in the Senate gloss over the reality that Democrats, unlike their Republican colleagues last week, made an honest effort to give their adversaries a chance to help shape the legislation. It’s not like Obama didn’t bend over backwards to try and create  bipartisan support for the bill. Further, the Affordable Care Act passed the Senate with 60 votes, an overwhelming majority, even if they were all Democrats. In stark contrast, the Republicans are gunning to repeal and/or replace the law by just 51 percent.

Hats off to Senate Minority Leader Chuck Schumer for doing a good job of keeping Democrats unified against all versions of Trumpcare/Obamacare repeal. As Jennifer Steinhauer explains in her article, “How Schumer Held Democrats Together Through a Health Care Maelstrom” in The New York Times, “Democrats give Mr. Schumer — song-belting, frequently badgering, endlessly frenzied — credit for his tireless attention to senators from every faction, and for quiet outreach to Republicans who he thinks could be partners down the line…He has worked carefully — far more than Mr. Reid, many Democrats agreed — to be almost relentlessly inclusive, talking with them at all hours of the day, over every manner of Chinese noodle, on even tiny subjects, to make them feel included in strategy…”

And while we’re thanking everyone for blocking ‘skinny repeal,’ let’s not forget Democratic Sen. Mazie Hirono, who made sure she got to the senate and voted against the GOP bill — despite having just completed surgery for kidney cancer. “I am fighting kidney cancer,” said Hirono, “and I’m just so grateful that I had health insurance so that I could concentrate on the care that I needed rather than how the heck I was going to afford the care that would probably save my life…Where is your compassion? Where is the care that you showed me when I was diagnosed with my illness?” Hirono asked before the Senate narrowly voted down the measure. “I find it hard to believe that we can sit here and vote on a bill that is going to hurt millions and millions of people in our country. We are better than that.” — from Rebecca Shapiro’s HuffPo article, “Sen. Mazie Hirono Holds Back Tears During Impassioned Health Care Plea.”

For an indication of how popular single-payer health care reform has become with Democratsin congress, read David Weigel’s “In GOP’s repeal failure, Democrats find a potential game plan,” in which he notes, “On Thursday, as the repeal effort headed for the cliff, Sen. Steve Daines (R-Mont.) needled Democratic senators — 10 of whom face reelection next year in states Trump won — by introducing the text of a single-payer bill sponsored by Rep. John Conyers Jr. (D-Mich.). For the first time, most House Democrats have co-sponsored Conyers’s bill; 43 members of the Senate minority, including Sen. Bernie Sanders (I-Vt.), voted “present,” while five voted “no” on the Daines amendment.”


Not With a Bang But A Whimper

After watching CSPAN2 into the wee hours of last night, tuning out only when a bitter Mitch McConnell abruptly ajourned the Senate, I offered this immediate take for New York:

The drama on the Senate floor was palpable as the vote on Mitch McConnell’s “skinny repeal” substitute amendment neared. A previous vote was held open for more than an hour as rumors circulated among the journalists watching nearby and following on Twitter and C-Span. Was Vice-President Mike Pence in the chamber to cast the deciding vote? Was John McCain yucking it up with Democrats? Might Lisa Murkowski succumb to pressure or bribes and rejoin Team Mitch?

When the ayes and nays finally started on the “skinny repeal,” some observers figured McConnell must have gotten the 50 senators he needed; otherwise why was he forcing a vote? But in the end, Collins and Murkowski held fast against the bill, and John McCain put it down with a loud “No!” and a visible thumbs down, provoking a shocked roar among his colleagues…..

[T]he high drama of this vote provided a sharp contrast to the low comedy that led Republicans to this breaking point after so many weeks and months of efforts to enact health-care legislation. In January, they abandoned the “repeal and delay” strategy for dealing with Obamacare. In May, after a false start, they finally got a partial-repeal-and-replace bill out of the House on a wave of shady deals, and with the promise of Senate improvements. In unprecedented secrecy, Mitch McConnell tried to fine-tune the scheme of tax and Medicaid cuts and insurance deregulation known as Trumpcare. But its unpopularity steadily grew, its baleful effects were serially exposed by the Congressional Budget Office, and deal after deal lost as many senators as could be gained. Just this week, the Senate voted down both Trumpcare and a revised repeal-and-delay scheme, leaving Republicans with no real proposal to enact.

That is what brought the Senate to the “skinny repeal” idea, McConnell’s phantom legislation that was at best a deceptive means of kicking the can down the road to a House-Senate conference that might revive Trumpcare, and at worst (if, as McCain and others feared, the House simply rubber-stamped it) a nasty piece of work that would boost insurance premiums and deny 16 million Americans health coverage. For all the drama of the vote that killed “skinny repeal,” it was really a moment when the Republican drive to do something — anything — to claim a victory over Obamacare finally lost momentum and ground to a halt. To borrow a phrase from T.S. Eliot, the GOP health-care crusade ended “not with a bang but a whimper.”

In the shocked Senate chamber after the crucial vote, McConnell seemed near tears, furious at the three apostates who frustrated his Republicans-only process, and completely out of ideas. He instantly canceled the scheduled “vote-a-rama” series of amendments scheduled for the wee hours, and dispensed with any “final passage” vote; with the failure of “skinny repeal,” the only thing on the floor to pass was the House-passed American Health Care Act, the bill Donald Trump himself called “mean.” Even as he bitterly taunted Democrats to come forward with their own ideas, McConnell seemed to take one immediately critical bipartisan idea — funding Cost-Sharing Reduction subsidies to keep individual insurance markets functioning — off the table.

Moving from a failed effort to enact transparently phony legislation to the sabotaging of anything else would indeed be a logical next step for McConnell, and likely would put him in tune with the vengeful, destructive mood we can expect from Donald Trump the next time he approaches his Twitter account. But Republicans earned this defeat a long time ago, when they chose to pretend they could improve health care while denying universal coverage and restoring discrimination against the sick and the poor. They have also earned a long and bitter series of internal recriminations over their failure to bring down the Great White Whale of Obamacare. If the GOP chooses to blame it all on three senators who refused to vote for a bill no one actually wanted to see enacted, their road back to relevance on health-care policy will be very long.


Despite’s Trump’s Pandering in Youngstown, Obamacare Repeal Threatens Working Class Communities

The following article by labor experts John Russo* and Sherry Linkon* is cross-posted from The American Prospect:

During the 2016 presidential campaign, Donald Trump visited the Youngstown area three times. On Tuesday, President Trump returned. Officially sponsored by his 2020 campaign, the rally at Youngstown’s Covelli Center provided him an opportunity to be buoyed by the cheers of 7,000 fans.

While many of those attending Tuesday’s rally came from outside of the city and the region, Trump has significant support here, rooted in the politics of resentment. Distrust of government—and especially of politicians—developed in the aftermath of plant closings and downsizings that began in the late 1970s, as tens of thousands of workers in Youngstown and the surrounding Mahoning Valley lost jobs in steel mills, auto plants, and related industries. Many blamed environmental regulations, trade agreements, and corporate pursuit of cheap foreign labor, and they vowed to make those who negotiated NAFTA pay a price. Political resentment grew as candidate after candidate used crumbling steel mills as backdrops for speeches promising to rebuild the local economy—and then failed to take real action to create change. Resentment deepened over the last decade, as many working- and middle-class people lost their homes and jobs in the foreclosure crisis, even as wages declined and work became more precarious.

That’s why Trump’s focus on illegal immigration, trade, government regulations, and betrayal by elites resonated with local residents in this historically Democratic region. In the Republican primary, thousands of previously unregistered voters turned out to support him, and a number of long-time Democrats crossed party lines. During his Tuesday visit, Trump claimed to have won Mahoning County in the general election. In reality, he lost it narrowly to Clinton, though he did win in Trumbull County next door. But he wasn’t wrong that he had shaken up local political patterns. In both counties, Republicans had their strongest showing since 1972.


GOP Burying Its Past Health Care Initiatives

As the madness surrounding the U.S. Senate’s consideration of health care legislation continued, it occurred to me Republicans are burying their own past, as explained at New York:

Amid the confusion and procedural obscurity surrounding Senate consideration of the FY 2017 budget reconciliation bill this week, something remarkable is happening that should not be missed: The Republican-controlled chamber is in the process of repudiating two solid years of GOP health-care policy.

[T]he latest version of the Better Care Reconciliation Act went down to defeat on a procedural vote with no less than nine Republican senators voting to kill it. Lest we forget, the BCRA is really just a variation of the House-passed American Health Care Act. It represents the closest thing Republicans have to a consensus repeal-and-replace plan for Obamacare.

Before the GOP made the fateful decision to develop an Obamacare “replacement,” its big plan was known as “repeal and delay,” based on the legislation Congress passed late in 2015 to simply repeal key elements of the Affordable Care Act with effective dates delayed long enough to allow for future “replacement” legislation. A replica of that 2015 legislation, now known as the Obamacare Repeal Reconciliation Act, is up for a vote in the Senate today. It is universally expected to fail [it actually lost on a 45-55 vote], and in fact is probably only on the floor because Senator Rand Paul and other hard-core conservatives wanted to register a vote for it badly enough to make that a condition for their support of yesterday’s must-pass motion to proceed.

So in less than 24 hours, the 2015–16 and 2017 GOP plans for dealing with Obamacare will be tossed into the dustbin of history. Yes, it is possible that yet another version of BCRA/AHCA — also known as Trumpcare — will emerge from the ashes for another Senate vote or, more likely, will be adopted by a House-Senate conference if the Senate can pass anything. That’s what is behind the talk of a “skinny repeal” bill that simply kicks the can down the road and into a conference where the real decisions will be made.

It’s instructive, though, that all this misdirection and deception are necessary. For seven years Republicans behaved as though getting rid of Obamacare was a fait accompli once they won both Congress and the White House. Now the two main strategies they devised for achieving this no-brainer are going down to defeat in “their” Washington, and can only be revivified, if at all, by stealth. It’s a sign of both intellectual bankruptcy and political fecklessness that does not bode well for the rest of the GOP agenda.


Poltiical Strategy Notes

Jonathan Easley reports at The Hill that “Dems Have the Edge in the Health Care Debate.” Further, writes Easley, “A majority of voters trust Democrats more than Republicans on the issue of healthcare and most say that ObamaCare is working fine, according to data from the latest Harvard-Harris poll…The survey, provided exclusively to The Hill, found that 52 percent of voters trust Democrats to provide the best way forward on healthcare. Twenty-seven percent said they trust President Trump and only 21 percent said they trust Republicans in Congress, bringing the total GOP figure to 48 percent…In addition, 53 percent said they believe ObamaCare is working, rather than failing.”

Some Republican senators are apparently trying to have it both ways on health care reform– to appear concerned about the health security of their constituents, while at the same time throwing a little red meat to wingnuts in their states, as Jonathan Cohn reports at HuffPo. “GOP senators who have warned they can’t support legislation that produces big coverage losses ― including Shelley Moore Capito of West Virginia, Bill Cassidy of Louisiana, Dean Heller of Nevada, and Rob Portman of Ohio ― all voted yes” on the ‘motion to proceed’ discussing Republican health bills. “So did Arizona’s John McCain…But hours after the procedural vote, the Senate took up the Better Care Reconciliation Act ― the proposal from GOP leadership that would leave 22 million more people uninsured, by CBO’s reckoning. McCain voted aye. So did Capito, Cassidy, Heller and Portman ― with the latter citing, as his reason, an amendment he’d helped obtain providing $100 billion in extra funding to help people pay their out-of-pocket medical costs…The bill needed 60 votes, because of parliamentary rules, and got just 43. Because everybody knew in advance it would fail, the vote was effectively a free one ― and potentially a chance for the likes of Capito and Portman to get some credit for supporting repeal, even if they end up opposing whatever comes up for a final vote when this week’s deliberations end.” It would be up to Democrats to expose this charade.

Of John McCain’s vote for the “motion ot proceed,” Ezra Klein writes at Vox: “McCain had the decisive vote — to say nothing of the moral and emotional authority of his dramatic post-surgery return to the Senate. He could have forced McConnell to run health care through the committee process. Everything McCain lamented of the Senate he had the power, in that moment, to improve…But McCain instead voted to continue the rushed, partisan process he said probably wouldn’t work, and probably shouldn’t work. He had the power to create the change he hoped to see in the institution he loves. Instead, he embodied and deepened its dysfunction.” McCain coupled his vote with comments in support of a more bipartisan approach to health care reform, and once again he failed to back up his rhetoric with action. As Klein concludes, “Our political system is built on the assumption that words have some meaning, that the statements policymakers make have some rough correlation to the actions they will take. But here, in the era of bullshit politics, they don’t. If this becomes the new normal in policymaking, it will be disastrous.”

‘Medicare for All” is a simple enough rallying cry for Democrats and progressives, in that many voters likely associate it with a single-payer system. But actually, that’s not the case, as Ed Kilgore explains in his post, “Why ‘Medicare for All’ Is a Misleading Term for Single-Payer Health Care” at New York: “Medicare is by design an “acute care” program. It does not cover long-term hospital stays or nursing-home care, and excludes some routine care (e.g., dental and vision care). Presumably a single-payer program designed to replace all or most private insurance would be more comprehensive than Medicare. Perhaps more importantly, from a political point of view, Medicare is neither free nor easy for beneficiaries,” since parts A, B, C and D have substantial out-of-pocket costs for beneficiaries. “The more you look at it,” writes Kilgore, “the more “Medicare for all” is, well, misleading. And it is politically perilous to mislead people about sweeping new health-care programs…Maybe it’s time for single-payer advocates to place less emphasis on alleged simplicity, and more on health care as a right that Americans should enjoy universally and equally. It might avoid some hard feelings down the road.”

Slate’s Leon Nefakh weighs the pros and cons for progressives of Trump’s firing A.G. Jeff Sessions, not that liberal views on the topic matter in Trump’s making his decision one way or the other. As Nefakh writes,”There’s no question that the attorney general has been a very detrimental force to civil rights progress and has undermined civil rights for so many communities even in the short time he’s been attorney general,” said Vanita Gupta, the former head of the Civil Rights Division and the president of the Leadership Conference on Civil and Human Rights. “[But] I think it is really alarming that a president is attacking the Justice Department’s independence and its institutional mandate to ensure that no one is above the law…I think the concern for civil rights advocates is the way in which this fundamentally undermines the rule of law.” From a raw politics perspective, it’s likely that Sessions will leave by resignation or firing. But if he stays, he could do more damage to the Republicans as a constant reminder of Trump’s instability and bad judgement. Further, Sessions’s archaic war on marijuana could energize enough voters in some districts to vote Democratic. Either way, the spectacle dragging on can only hurt the GOP brand.

Regarding all of the fuss about the Democrats’ inability to come up with a slogan that resonates (e.g.  here, here and here}, it may be that crafting a party-wide slogan is a waste of time, especially for the midterm elections, when a one-size-fits-all approach is more likely to create problems for a big tent party than a unified message. Democrats rightly want the public to perceive their party as the one that advocates for working people. Voters want to feel that about candidates, but they are not going to be persuaded one way or the other by a windy slogan. The real message is up to the candidates, and it is best-expressed in their deeds, policies and attitudes. Calling attention to a big, unweildy slogan isn’t going to persuade many voters. The soundbites the candidates craft to describe their issues and their adversaries are probably more consequential than any party-wide slogan.

The plan behind the slogan, however, has merit. In his Washington Post Perspective article, “Democrats say they want to go after monopoly power. Here’s why that’s a great idea,” economist Jared Bernstein writes, “The part of the Democrats’ Better Deal plan that I find most interesting is the piece that would push back on monopolistic corporate power. It’s neither radical nor “left.” I can’t say if it’s particularly good politics (although their internal polling suggests it is). But assuming this proposal eventually grows into something real, it’s likely to prove to be increasingly important economic policy with significant benefits for working families….But whatever the cause, the fact that Democrats recognize and are showing interest in going after the problem is a good thing. And that’s not just my view. David Dayen, a hard-hitting, left-leaning journalist who’s often critical of ideas from the center-left, wrote that by going after “corporate power, and in particular monopoly concentration,” Democrats finally “hit the target.” Bernstein concludes, “If Democrats truly get back to trustbusting, they will be making a powerful, progressive statement about what and for whom they really stand.”

At The Nation John Nichols has a reminder that one Democratic President who railed against corporate power did rather well: “The greatest progressive populist campaign of the past century, Franklin Roosevelt’s 1936 reelection run on a anti-oligarchy platform that held out the promise of American social democracy, secured the greatest landslide win for Democrats…Roosevelt pulled absolutely no punches, declaring in one of the last speeches of the campaign that he was running not against hapless Republican Alf Landon but against the “employers and politicians and publishers” who defend “business and financial monopoly, speculation, reckless banking, class antagonism, sectionalism, war profiteering…Today’s Democrats must echo FDR’s old renunciations of “economic royalists” and align them with an 21st-century moral agenda…”

At Sabato’s Crystal Ball, Kyle Kondik writes about “the importance, to Democrats, of fielding as many credible challengers as they can…That’s because even if there is a positive environment for Democrats next fall, they are not going to knock off every clearly vulnerable GOP incumbent. Many Republicans who sit in districts that Hillary Clinton won last fall are proven vote-getters who ran well ahead of President Trump last fall, like Reps. Mike Coffman (R, CO-6), Carlos Curbelo (R, FL-26), Barbara Comstock (R, VA-10), Dave Reichert (R, WA-8), and others. Democrats probably will have to beat some of these incumbents in 2018 to win the House — or hope that some decide not to run for another term, like Clinton-district Rep. Ileana Ros-Lehtinen (R, FL-27) — but defeating all of them is unrealistic. Hence, the necessity of expanding the map…At this point in the cycle, Democrats have more than 200 filed House challengers who have raised at least a small amount of money ($5,000 or more). That’s more than the combined total of Democratic challengers at this point of the cycle in the last four cycles, and way more than either party has had in midsummer of the off year over the last decade and a half.” Sabato reports that, according to  Crystal Ball’s ratings, “187 Republican seats and 173 Democratic seats are Safe. That’s 360 of 435 seats (83%)” currently, with 218 House seats needed for a majority.


Creamer: How to Really Make the Affordable Care Act Even Better

The following article by Democratic strategist Robert Creamer, author of Stand Up Straight: How Progressives Can Win, is cross-posted from HuffPo:

Republican fantasies about “repealing and replacing” the Affordable Care Act (ACA) are crashing on the rocks of two-to-one public opposition, and a tidal wave of ordinary people who are demanding their Members of Congress vote NO.

So what about a real plan to make the ACA even better? What about a plan to provide even more access to health care and make premiums more affordable – especially for working people — rather than the GOP plan to take health care away from millions?

The Affordable Care Act has massively increased coverage at much more affordable prices for many, many Americans. What’s more, it has prevented insurance companies from discriminating against people with pre-existing conditions, installed many consumer protections for consumers and helped lower the rate of health care inflation. Most importantly, it established that in a civilized society, health care is not a commodity to be bought and sold, but a right.

The ACA was a major step in the right direction. And in many respects, the United States has a spectacular health care delivery system. But in others we still have a great deal of room to improve.

Let’s start by remembering that health care costs per capita in the United States remain the highest of any industrial nation, even though our health care outcomes remain well below the best performing nations in the world.

The ACA has indeed improved outcomes for many, many Americans. And it has bent the cost curve. Health care cost inflation is much lower today than it was in the pre-ObamaCare era to which the GOP seeks to return.

The last way to “improve” the health care system is to repeal the ACA and return to the bad old days before health care was considered a human right in the United States. The same obviously goes for partial repeal proposals like the House or Senate TrumpCare repeal and replace bills.

In fact, to the extent the ACA could be improved it’s because it doesn’t provide enough of a good thing.

There are three major factors driving health care costs in the United States. First are payment systems that incentivize the numbers of procedures that are performed rather than the outcomes they produce. Second are the costs of prescription drugs – which are much higher than they are in the rest of the world. Finally are the excessive costs of administration, marketing and profit that are associated with private insurance companies. Remember, Medicare’s administrative cost is a fraction of the combined costs of profits, administration and marketing for private insurance companies.

The best way to improve the health insurance system in America and simultaneously cut costs would be to follow the lead of most other industrial countries and set up a single-payer system for everyone like the Medicare system that covers senior citizens in the U.S. today.

Such a system would not only assure that everyone has health care, it would also allow the purchasing power of the single-payer to negotiate with drug companies for much lower prices, eliminate massive amounts of insurance company bureaucracy and allow for new systems of provider payments that would incentivize results rather than the number of procedures that can be billed out to insurance.

A single-payer system would without doubt be the best way to finance health care in the United States. Regardless of what is done with health insurance today, the odds are good that one day the U.S. will ultimately have a single payer system.

Short of a single-payer system, there are, however, three specific policies that would greatly improve the availability and affordability of health insurance.

The current ACA system has three major shortcomings.

  • First, some especially hard to serve markets have only one – or in some cases potentially fewer – insurance plans offered on their ACA exchange. That leaves consumers captive and defeats to purpose of the exchanges. Of course a big part of this problem results from intentional policies of the Trump administration that are intended to sabotage the ACA. Many of the companies who have exited these markets have done so because of uncertainty whether Trump would fund the subsidies provided by the ACA.
  • Second, the ACA left in place policies that allow the pharmaceutical industry to charge U.S. consumers much more than they charge consumers abroad.
  • Third, subsidies for insurance plans stop at income levels that still make individual or family policies purchased on the Exchanges unaffordable to many working families.

These two problems could be effectively addressed by three progressive policies that are all very politically popular:

1). Increase substantially the income levels at which working people can receive subsidies on the exchanges. The dollars needed to finance these subsidies should come from additional taxes on the wealthy, health insurance companies and especially the giant pharmaceutical companies.

Remember that the pharmaceutical companies have made record profits by gouging U.S. consumers substantially more than they can charge consumers in other countries. That is especially due to the limits on re-importation of pharmaceuticals and the fact that Medicare is prevented by law from negotiating with pharmaceutical companies for cheaper drug prices. So a pharmaceutical company tax is a fair source of revenue for increased subsidies for working people.

Recall, by the way, that when the Medicare Part D plan was passed that outrageous provision banning negotiation was itself negotiated by Republican Energy and Commerce Committee Chair Bill Tauzin who then promptly left Congress to make millions of dollars as head of the Pharmaceutical Research and Manufacturers of America.

2). Repeal the prohibition against Medicare negotiating with the drug companies for lower prices and require that they provide pharmaceuticals to consumers on the exchanges at the Medicare-negotiated rate. In addition, allow re-importation of pharmaceuticals from suppliers in other countries who can obtain drugs at prices below which these companies sell to U.S. consumers.

3). Set up a public insurance option offered nationwide that can compete in every market in America. A public option, like Medicare, would have low administrative and marketing costs and major market clout, and would provide an affordable insurance option whenever private carriers abandoned insurance markets. In addition, competition from a public insurance option would force down private insurance costs.

A public insurance option is pretty much a no-brainer. It was passed by the House of Representatives when the ACA was on the way to becoming law, but ultimately dropped by the Senate as a result of a massive insurance industry lobbying and the work of the former “Senator from Health Insurance” Joe Lieberman.

Together, increased subsidies for working people, a public insurance option and lower pharmaceutical prices would solve most of the shortcomings of the current Affordable Care Act.

They work as policy – unlike GOP proposals like health savings accounts that mainly benefit the wealthy. And they are also very popular politically. They represent the high political ground.

Once ordinary people have administered the coup de grace to GOP proposals to “repeal and replace” ObamaCare, Democrats should forcefully advocate these three policies to make ObamaCare even better.

And they should dare the Republicans to pass these proposals that would actually address the issues people care about – increasing the availability and affordability of health insurance coverage – rather than taking health care away from millions of their fellow Americans.


Working America: Be Bold, Be Visible: Central Ohio Midterm Voters’ Outlook on Policies and Politicians

The following article is cross-posted from the Working America Front Porch Focus Group Report:

OVERVIEW

Working America canvassers held face-to-face conversations with 355 likely midterm swing voters in central Ohio in early June. During these front-porch discussions, we surveyed midterm voters on their top issues and 11 public policies designed to address economic and public health concerns. The list included eight middle-class-oriented policies, two policies targeting low-income workers, and the American Health Care Act, or Trumpcare. We wanted to understand if and where working people are feeling pinched and what solutions they believe will deliver meaningful change to their lives. We also asked about their source for political news and views of politicians. Here are our findings:

There is strong support in Ohio for an array of progressive policies to expand and strengthen the middle class. During our 355 face-to-face conversations, we found solid support across partisan lines and income levels to curb the outsourcing of jobs, address the opioid crisis and pass paid family leave. These three policies have such high levels of support and intensity that they could prove persuasive even for Trump swing voters in 2018. In addition, five other progressive policies promoting middle-class well-being are backed by more than 70 percent of Clinton voters and at least a plurality of Trump voters we spoke with during this project.

Trumpcare is intensely opposed by Clinton swing voters and weakly supported by Trump swing voters. Only 39 percent of Trump voters — and a mere 2 percent of Clinton voters — support the passage of Trumpcare. Overall, 60 percent of Ohio swing voters we spoke with chose it from a list of 11 policies as the one that would have the most negative impact on their family. Voters in both camps identify health care as their most important issue, so a candidate’s stance on Trumpcare could be hugely persuasive in 2018.

While there is a path forward for Ohio progressives in 2018, voters’ low information about elected officials is helping to drive a low opinion of all politicians. Our conversations with Ohio swing voters reveal they know little about their elected officials; half of them say they do not know or have no opinion of either U.S. senator. And a substantial share of voters told us they get their news from right-leaning media sources; 49 percent of Trump voters rely on Fox or other TV news as their primary news source. Overall, voters are far more likely to hold “all politicians” responsible for the state of the economy rather than one political party, Wall Street or corporations. In 2016, Democrats in Ohio tried and failed to use conventional paid media to push back against right-wing messages. In 2018, progressives need to change the way we get information to voters and do far more direct outreach. Having better policies won’t make a difference if voters never hear about them.

KEY FINDINGS

  1. Policies to expand and strengthen the middle class have broad and intense support among Ohio swing voters. Stopping outsourcing, addressing the opioid crisis and establishing paid family leave are all backed by at least two-thirds of Trump voters and an overwhelming majority of Clinton voters with whom we spoke. These policies are strongly supported across income and party lines, and appear to have sufficient intensity to be persuasive with voters.
  2. Health care is currently Ohio voters’ No. 1 issue, and the deep unpopularity of Trumpcare could make it a highly persuasive issue. A full 87 percent of Clinton swing voters oppose Trumpcare. Even among Trump voters, the bill is unpopular, with a majority either neutral on (44 percent) or outright opposed (17 percent) to its passage. When queried about health care, voters from both parties and at all income levels prioritize affordable and accessible care. Given the highly negative perception of Trumpcare, even many Trump swing voters could be persuaded by arguments against it.
  3. Ohio voters are highly polarized over raising the minimum wage, but it has strong support with the lower-income voters that Democrats struggle to get to the polls in midterm elections. The partisan divide over the minimum wage is stark: 79 percent of Clinton voters support it, while 58 percent of Trump voters oppose it. However, 68 percent of all low-income voters, including Trump voters, back a minimum wage increase. This could make the issue a powerful mobilization tool for progressives.
  4. Conventional paid media has not been getting through to voters, leaving them with little information about elected officials. In Ohio’s 2016 race for the U.S. Senate, the two top candidates and their supporters spent an estimated $90 million, with a huge share going to TV ads and other paid media. Yet 53 percent of the swing voters we surveyed did not know or had no opinion of Sen. Rob Portman, one of the candidates in that race. This shows the limited effectiveness of conventional advertising and paid media in reaching voters.
  5. Voters’ low information is combining with right-wing media narratives to cement a low opinion of all politicians.Progressives need to change how they get information to the public. Our conversations reveal that voters across the political spectrum do not differentiate between Democrats and Republicans when assigning responsibility for their economic woes during the last decade. Two out of five voters we spoke with told canvassers “all politicians” were at fault. Voters repeatedly said they do not see elected officials dealing with issues important to them. The upshot is that voters blame elected officials writ large for the state of the economy more than they blame the corporate beneficiaries of rigged rules. If progressive candidates want to change that narrative in 2018 and beyond, direct outreach to voters like door-to-door contact will be essential.

The findings in this report are based on “front porch focus groups” — interviews held in person at voters’ front doors.Working America canvassers conducted the interviews from June 5 to June 16 in working- and middle-class neighborhoods in Columbus and several surrounding towns as well as in Circleville, Delaware and Mansfield. The people we spoke with voted in at least one nonpresidential election since 2010, which suggests they are likely to vote in 2018. These voters landed squarely in the middle of the partisan spectrum with an average Catalist Vote Choice partisanship score of 48.2 (on a scale of 0-100, 0 being most Republican and 100 being most Democrat). The estimated household income of voters averaged roughly $88,000 a year. Ninety-eight percent of voters were white, 1 percent were African-American, none were Latinx and 0.3 percent were Asian; the ethnicity of 0.3 percent was unknown.

DISCUSSION OF FINDINGS

1. What Voters Think About Policies to Strengthen the Middle Class

Working America canvassers talked with Ohio swing voters about eight policies designed to strengthen and expand the middle class. Their responses show there is broad support, even among Trump swing voters, for many progressive policies.

In South Columbus, one of our canvassers talked with Robert, a 51-year-old white Trump voter who wanted Democrats “to stop with the [Russia] investigation crap.” But Robert supported all eight progressive policies, including making it easier to unionize. He related how he’d tried to form a union at work and feared he’d lose his job. On many issues, Trump swing voters shared powerful stories from their own lives that explained why they backed progressive policies. This doesn’t mean Trump swing voters will automatically pull the lever for a progressive in 2018. But it’s a good reminder that some of these voters swung from Barack Obama to Trump and that policies relevant to their lives may help swing them back in a progressive direction.

For all the policies that follow, we measured both the level of support and the level of intensity that voters had for each policy. We measured the level of support by asking voters whether they supported, opposed or felt neutral about each policy. We measured intensity by asking voters which policies they thought would have the greatest positive or negative impact on their families. For the full set of results, please see the charts in the Appendix.

1.A. Broad, Intense Support for Three Policies to Bolster the Middle Class

Chart 1 shows three middle-class-oriented policies that garnered the support of at least two-thirds of Trump voters and an overwhelming majority of Clinton voters. Trump voters also ranked these policies as the top 3 out of 8 middle-class-oriented policies that would have the greatest positive impact on their lives. All three policies had strong support across income and party lines, and they appear to have sufficient intensity to be persuasive with voters in 2018.

Looking at support, three policies rose to the top across partisanship: curbing outsourcing, addressing the opioid crisis and passing paid family leave. Looking at intensity of support, we see that among the broadly supported policies, these three also ranked as the most likely to have a positive impact on the lives of Ohioans. They resonate across the board. Beneath the charts is a more detailed analysis of each policy.

CHART 1. MIDTERM VOTERS’ MOST POPULAR POLICIES

Stopping Outsourcing – Overall, 79.3 percent of Ohio swing voters told us they want lawmakers to discourage companies from outsourcing jobs and encourage them to provide good wages and benefits through tax incentives. Voters ranked it first among the eight middle-class-oriented policies as the one that would have the greatest positive impact. Stopping outsourcing received more support from Trump swing voters than any other policy, with 83.2 percent of them backing the measure. And it wasn’t just displaced factory workers who complained about outsourcing. White-collar workers had concerns as well.


Teixeira: How Vulnerable Is Trump?

The following article, by Ruy Teixeira, author of “The Optimistic Leftist: Why the 21st Century Will Be Better Than You Think” and other works of political analysis, is cross-posted from his blog, The Optimistic Leftist:

Some have argued that the emotional bond between Trump and his supporters is so strong that it’s nearly impossible to break.

I don’t believe this is true for a couple of reasons. First, Trump is attached to the GOP and the GOP is remarkably out of touch with the voters who supported Trump. This is a non-trivial problem, as Ron Brownstein explains in The Atlantic.

The Senate Republican health-care bill has been repeatedly crushed in a slow-motion collision between the party’s historic ideology and the interests of its modern electoral coalition. Yet congressional Republicans appear determined to plow right through the wreckage.

Even as the Senate’s latest effort to repeal the Affordable Care Act collapsed on Tuesday, the House Republican leadership released a 10-year federal-budget blueprint that points them toward a similar confrontation, between their dominant small-government dogma and the economic needs of their increasingly blue-collar and older white base.

The Urban Institute found that 80 percent of those who would lose coverage under the Senate repeal-and-replace bill were non-college educated, 70 percent worked full-time and 60 percent were white. Rural areas would be particularly hard hit by the Medicaid cuts and so on. Candidate Trump of course said he would do none of this stuff but that went out the window once he started dealing with Congressional Republicans and their libertarian proclivities.

This matters. Brownstein notes that Trump’s approval ratings among white noncollege women is now 19 points lower than his vote support among this group back in November. Will all of these voters abandon him? No, but if a serious chunk does it will hurt both him and the GOP.

But isn’t it true that Trump’s overall support has been rock-steady? On net, aren’t his voters sticking with him? This is a myth. It is certainly true that he retains most of this support. But that’s different from all. Brendan Nyhan points out in a New York Times Upshot column that the seeming stability in Trump’s approval rating among GOP partisans may be an illusion. This is because Republican identifiers who disapprove of Trump may cease identifying as Republicans, thereby propping up his numbers among that group. But he’s still losing support.

A new Ipsos poll finds that one in eight Trump supporters from last November now say they aren’t sure they’d do it again after the last six months. We don’t know of course whether these voters would actually follow through on their sentiments. But it is not a good sign, either for Trump or the GOP.

People are reluctant, understandably so, to believe in Trump’s vulnerability. People will not soon forget the night of November 8, 2016 when nothing turned out like it was supposed to. But if his supporters have a fear of falling downward economically, what happens if they conclude he can’t stop the fall, much less lift them up? He will be punished like all politicians. It is just a matter of when and how much.