Thursday, April 9, 2015

Montana on cusp of passing Medicaid expansion

In breaking news yesterday, the Montana House of Representatives passed a Medicaid Expansion Bill to a final reading by a 54-46 vote.

The expansion called the Health and Economic Livelihood Partnership Act (HELP Act), is a slightly  amended version of Senate Bill 405, which was approved in that chamber on March 30 by a 28-21 vote. The amended House version, slated for final approval today is almost certain to pass the Senate next week, after which Democratic Governor Steve Bullock will be extremely likely to sign the HELP Act into law.

The bill is slightly different from a traditional Medicaid expansion in that it will require some beneficiaries to pay co-pays; and has a job search component. However, as Section 6 of the bill notes, those co-pays will not exceed caps and regulations established by law.  The job-search component (Section 14) also appears to not affect eligibility for expanded Medicaid and only asks the state labor and industry department to partner with the state health department to match up HELP beneficiaries with potential job openings.

This should get through the Federal Department of Health and Human Services with few problems.

In both chambers, a moderate Republican sponsored the bill. In the House, Democrats managed to get the bill out of a hostile committee that had bottled up both it and Bullock's own expansion proposal this year by using a legislative stratagem called the "Silver Bullet": Under a gentleman's agreement during this session that each party gets to move six bills of their choice that have been blocked in committee on to the House floor for a straight-majority vote. Eleven Republicans helped the 41 Democrats in the chamber get the bill on the floor, while 13 GOPers joined the Democrats to advance the bill to final passage.

There are four things about this that are great news:

1. Poor Democratic Representative Tom Jacobson will finally get to forget about his accidental vote that killed expansion in 2013.
2. These guys spent a lot of money on an astroturf campaign that is going to fail.
3. 29 states now will have expanded Medicaid coverage.
4. Best of all, 27,000 to 45,000 people are going to get access to health insurance.

Saturday, March 21, 2015

Obama judicial appointments slow to a crawl

Much of the focus in the Senate right now is justifiably on the GOP majority's slow-walking Loretta Lynch's confirmation vote for attorney general on the Senate floor. 

But what's getting a lot less attention is the predictable lack of traction that President Obama's judicial nominations are getting.

The Senate has not confirmed a single judicial appointment this year in three months of work.

Contrast that with the first three months of 2014, the Democratic majority confirmed three circuit court judges and 16 district court judges.

In the first three months  of 2007, the incoming Democratic majority confirmed two of George Bush's circuit court nominees and 13 district court nominees.

Four rather uncontroversial district court nominations are waiting for a floor vote --three in Texas and one in Utah -- all which easily cleared the Judiciary committee in February. They'll get through the Senate eventually, but somehow I don't think Mitch McConnell has them as a priority.

Just another reminder that elections matter.

Thursday, March 19, 2015

Obama moves a bit more on the environment

The New York Times reports that President Obama has signed an executive order that will seek to have all federal agencies reduce greenhouse gas emissions by 40 percent from their 2008 levels by 2025.

This isn't earth shattering in itself -- the federal government only accounts for 1 percent of U.S. greenhouse gas emissions. But it's not nothing either, as the government is the single largest purchaser of goods and services in the U.S.  It's policies can create markets for goods and service that can percolate through the rest of the economy, and its ability to bind federal contractors can help spread policies to a broader group of businesses.

The order extends a previous order signed in 2009 that required the government to cut emissions by 25 percent by 2020. The Feds are on track to meet it. Good on the administration for following up on earlier success.

Every ton of CO2 we keep out of the atmosphere helps. And this order will keep several million in the ground.

Wednesday, March 18, 2015

"Orthogonal to reality"

Jared Bernstein summarizes the 2016 House Republican budget about as pithily as possible.

Here's a look at President Obama's proposal.
The New York Times compares the GOP and Obama budgets. Note that they accept the assumptions implicit in both documents. For how strong those assumptions are, see Bernstein's comments -- the GOP budget is full of magical thinking and assumptions about how their tax cuts will magically transform into lower deficits.

And finally, here's an outline of the Congressional Progressive Caucus' "People's budget", which won't go anywhere because it's not Very Serious or something.



Tuesday, March 17, 2015

Oregon's new motor-voter law drastically eases registration, but still leaves a few blind spots



Newly minted Oregon Governor Kate Brown kicked her administration off with a bang on March 16, signing a motor-voter bill on steroids into law.

The law is good policy and will remove some considerable hurdles to voting for a large number of people. However, it does leave out potential voters and may not in itself increase voter turnout all that much.

The bill makes voting registration automatic for any eligible potential voter existing in the Oregon State Department of Motor Vehicles database. This feature goes far beyond current federal requirements, which only make it mandatory to allow an eligible resident to register to vote while obtaining a driver's license or conducting business at a state DMV. According to Reuters, the bill could expand registration by 300,000 voters – an increase of about 13.7 percent over the most recent voter roll.  

That’s good news and brings Oregon’s policies much more in line with most other industrialized democracies, which automatically register voters whenever they move. Coincidentally, most of those countries traditionally have had higher turnout than the United States. Better yet is that these policies will automatically keep track of people who tend to move around a lot and who have their registration fall through the cracks, like younger people – particularly students – and working families.

But the law doesn’t cover everyone. People without driver’s licenses (who often will not be in the DMV’s files) likely won’t be automatically registered; and those individuals tend to be disproportionately poor and people of color as we know from the battles over voter ID in numerous states.

Additionally, political science strongly suggests that easing barriers to voter registration doesn’t necessarily increase voter turnout. Candidates and parties still have to give people a reason to vote and activelywork to effectively mobilize and get them to the polls.[5]

So raise two-and-a-half cheers for Oregon making it easier to participate in the democratic process.  Now progressives just have to make it worth the new voters’ time to actually, you know, vote.

Monday, March 16, 2015

How Minnesota barely escaped Wisconsin's fate



On March 15, American Federation of Teachers President Randi Weingarten published an Op-ed in the Huffington Post contrasting the recent economic performance of two very similar upper Midwestern states that have chosen drastically different governments: Minnesota and Wisconsin.

But what we often forget is that Minnesota came perilously close to following Wisconsin to the dark side.

We know the policy story. Wisconsin has been under unified Republican control since the 2010 elections. Governor Scott Walker has spearheaded a hard-right push in state politics: crushing public sector unions, signing “Right-to-Work” legislation that will cripple private sector unions, cutting taxes for the wealthy, stiffing Obamacare's Medicaid expansion, gutting funding for public schools and universities, centralizing power in the governor’s offense, gutting environmental protection, killing useful transportation projects…. Sigh… frankly, to go into detail and finding links is just too depressing. Go read Charlie Pierce so at least you can laugh along with the despair. As Weingarten and others have noted, though, Wisconsin hasn’t performed that well in economic growth or jobs growth.

Minnesota, on the other hand as Weingarten argues, elected Democrat (technically Democrat-Farmer-Labor) Mark Dayton to the Governor’s chair in 2010. Dayton raised taxes on the wealthy, invested in public schools, worked with organized labor and aggressively implemented the Affordable Care Act. The state has performed much better on the economic front than Wisconsin, and indeed the U.S. at large.

But that critical 2010 election actually looked pretty similar in the two states.  In an electoral disaster, Democrats lost majorities in both houses of the Minnesota State Legislature, turning an 87-47 majority in the House into a 72-62 minority. A 46-21 Senate supermajority became a 37-30 minority. In Wisconsin narrow Democratic majorities became a medium-sized 19-14 Republican majority in the Senate and a 58-41 majority in the Assembly.

The Minnesota legislature was interested in many of the same things that Walker wanted – after a budget standoff with Dayton in 2011, they tried to push a “Right-to-Work” law through in a constitutional referendum in 2012, though it failed to make the ballot.

The difference was in the Governor’s Race. Walker beatDemocrat Tom Barrett in a clear though reasonably close election by 120,000 votes out of about 2.2 million cast (52.3 percent to 46.5 percent). Dayton, in contrast, barely squeaked by conservative Republican Tom Emmer by an 8,730 vote plurality out of 2.1 million cast (43.6 percent to 43.2 percent).

Maybe it was Dayton’s higher name-recognition as a former Senator; maybe it was the fact that the incumbent in Minnesota was a Republican and not a Democrat.  But whatever the reason, those 8,730 votes put Minnesota progressives in position to block the attacks on labor and public services that took place in Wisconsin. And they left them in position to push a progressive agenda when Democrats managed to take back both chambers of the state legislature in 2012.  

Let that be a bit more motivation to knock on one more door, make one more phone call and give $10 more in the next state election.

Tuesday, March 10, 2015

Medicaid Expansion Keeps Stumbling Forward -- and Proves Surprisingly Resilient



With the results of the 2014 elections, the pace of Medicaid expansion has become frustratingly slow for progressives.  However, the overall picture has two very important positive points for those seeking to provide universal health care in this country. First, despite meeting several setbacks and roadblocks recently, the expansion continues to grind ahead –excruciatingly slowly, but ahead all the same -- to new states. Second, recent developments in Arizona and Arkansas suggest that a state’s expansion may be durable even in states that get taken over by hard-right governments.

On the first point, Indiana joined the parade of Conservative states expanding Medicaid under a waiver in January. Pennsylvania, under its new Democratic Governor Tom Wolfe, has thrown out the complicated waiver plan submitted by outgoing governor Tom Corbett and is replacing it with a traditional expansion more congenial to beneficiaries (elections matter). Frustrating setbacks have happened in Tennessee and Wyoming, when legislative committees defeated plans negotiated by their governors to expand Medicaid, at the behest of an Americans for Prosperity pressure campaign. However, Utah and Montana are still considering their own plans – and Kansas(!) of all places looks like it may join soon too. Vox, as usual, has the snappy summary.

The second point is more interesting and, for now, just as encouraging. In 2013, Arkansas had negotiated an expansion with waivers under Democratic Governor Mike Beebe to mollify the Republican-controlled legislature. However, it looked like the plan might not survive new Republican Governor Asa Hutchinson and a much larger and more conservative Republican majority elected in 2014. But Hutchinson got behind the program with a few tweaks and convinced the legislature to approve it for another two years while forming a committee to seek a new waiver in 2017.   

In Arizona, the situation appears more ambivalent. Outgoing Republican governor Jan Brewer choose to expand Medicaid in 2012 over howls of protest from conservatives in her legislature. Incoming Governor Doug Ducey has suggested he’s against the expansion, while conservatives made gains in the Arizona statehouse in 2014. Medicaid expansion looked doomed.

But an in-depth examination of legislation Ducey just signed trying to curtail the expansion is instructive. The legislation consists of two Republican pet rocks: attaching work requirements to Medicaid recipients, and limiting beneficiaries to five years total of receiving Medicaid before throwing them off the program. It’s an ugly bill. But notice that the law doesn’t eliminate the expansion, it only attempts to modify it with issues a GOP legislator could plausibly defend as “common-sense reforms.”More importantly, any of these changes would have to be negotiated with the Federal Department of Health and Human Services.

At least for the next two years, those negotiations are going to go like this:

ARIZONA: “We want you to give us a waiver to create work requirements for beneficiaries and throw them out of Medicaid after five years” (hands over proposal).

HHS SECRETARY BURWELL: “Would it annoy you if I did this?” (Folds proposal into paper airplane and tosses it back at Arizona’s forehead)

The bill binds Arizona state officials to go back to the Feds every year and beg for the waiver.  Those conversations are going to go like this:

ARIZONA: “We want you to give us a Medicaid waiver to…”
BURWELL: (Takes proposal. Blows nose on proposal. Crumples it up and hands it back)

What we have here is Politics 101: it allows Arizona Republicans to both whine loudly about how horrible the federal government is, while looking like they are doing something to fight the dastardly Obamacare Medicaid expansion by writing sternly worded letters. They also get to quietly take advantage of all its benefits (including federal funding) that will remain at least as long as a Democrat controls the White House.

So at first glance, at least, the Medicaid expansion is looking surprisingly resilient, even in its infancy. Despite the poor results of the 2014 elections, the expansion continues to meander forward in several states. And every state that takes the expansion may have quite a hard time getting rid of it. This stickiness is good news for justice and for hundreds of thousands of people who get access to health care.