Saturday, December 21, 2013

Court upholds Ohio Medicaid expansion

Good news, via Ideastream (NE Ohio's public broadcaster)

The state’s highest court says it is constitutional to allow the controlling board, a panel of legislative leaders, to allow the Medicaid department to accept the federal funds that would allow for expansion of Medicaid. 

The Ohio General Assembly didn't vote to expand Medicaid, but Gov. John Kasich used the state's budget controlling board -- made up by several legislative leaders (several handpicked by Kasich) to accept the federal grants. The state Supreme Court ruled 4-3  that the board acted within its rights to accept the money for Ohio's Medicaid.

I'd have rather it gone through the legislature, but I'll take it -- as will the 275,000 Ohioans who are going to get health insurance.

Also, there's a long-term issue here -- the board has the power to accept grant money, but it has very limited power to expend state funds. Starting in 2017, the legislature is going to have to vote state monies to cover the state's share of the expansion or lose the federal money. By then of, course, we hope that the expansion will be tough to take away and the ledge will come in line. 

Friday, December 20, 2013

Raise the minimum wage to reduce the Medicaid gap

Aaron Carroll of at The Incidental Economist (a must-read blog for those with interest in health care policy) has a really thoughtful post up on the people who fall into the Medicaid gap in states that aren't choosing to expand Medicaid at the Academy Health Blog. These people are in a bind; they're too rich to be covered under most of these states' existing Medicaid plans, but they fall below the poverty line, and aren't eligible for subsidies on the health exchanges. In describing this population, Carrroll writes a paragraph that really got me thinking:

It’s worth considering, though, that the majority of people in the coverage gap are working poor who, ironically, make too little to be helped out by the government. If they made just a bit more, they might qualify for insurance that is so subsidized that it is almost free. But because of the coverage gap, the people with the fewest resources get less help (none)  than those who have a bit more money. (Italics mine)
If only the working poor made just a bit more money, we could lift hundreds of thousands of them above the poverty line and get them eligible for subsidies that would massively cut their monthly premiums and limit their out-of-pocket expenses. Hmm... what could we possibly do to get the working poor some more income?

Oh I don't know, it's crazy, but maybe we could just raise the minimum wage.

Thursday, December 19, 2013

Some minimum wage comparisons Or "Yes, we can most certainly afford to raise the minimum wage"

So it appears one of the next big issues that's coming to a head is a debate over raising the national minimum wage. New Jersey raised its minimum wage and linked it to inflation during the last election, while the town of SecTac in Washington State raised its minimum wage to $15 an hour. Washington D.C. and two neighboring counties just voted to raise their wage to $11.50 an hour over the next several years, while California has voted to jump its minimum to $10 over two years.

Texas Republican Joe Barton, naturally, wants to go the other way.

Right now, the current minimum wage of $7.25 is worth about what it was in 1950 in inflation-adjusted dollars. I show the fluctuation of the minimum wage's value in this fairly well-known chart (figure I) that I reproduced with data from the Bureau of Labor Statistics.

What should we raise it to? Thinking about it's relationship to the poverty line is a good place to start, (though the limitations of the poverty line makes it a bad place to finish.) 

The poverty line for a single parent raising one child is $15,510 for 2013 and for a family of three (a single parent with two children) it's $19,530. For a full-time job at minimum wage to earn enough to lift a family of two above the poverty line, it would have to pay $7.76 an hour-- a raise of about 7 percent from the current wage. To lift a family of three with one worker out of poverty, it would need to be $9.77 -- a raise of about 35 percent.

Of course, that's assuming a full-time job. Many minimum wage jobs in fast-food and retail require lots of flexibility and limited hours (hey, if we gave workers over 28 hours a week, they'd be full time and we'd have to provide health benefits and we couldn't have that!). So let's assume a 25-hour work week, which is more typical at a minimum-wage service job. Keeping a single-parent family of two above the poverty line now requires $12.41 and hour, while a family of three requires $15.63; increases of 71 and 115 percent, respectively.

For historical context,  the minimum wage peaked at a value of $10.74 in 2012 dollars in 1968, which would be a raise of about 48 percent. If the wage had kept up with gains in worker productivity, we'd be looking at a minimum wage of $17.65 an hour, which is an increase of 143 percent. 

I stack all these possible wage gains in Figure II below:

We can debate how high the minimum wage should be, but America needs a raise, and their bosses can afford it. Based on the figures above, D.C's $11.50 over the next three years is easily justifiable, and fast food workers arguing for $15 an hour have a good case to make. Indexing to inflation is a must and future increases arguably should also account for productivity gains above the rate of inflation.

Tuesday, December 17, 2013

Post nuclear update III: The Senate grinds on... two nominees in, two up and eight more on deck

The Senate cleared one big appointment and one medium-sized one on Monday, confirming Jeh Johnson as Secretary of Homeland Security and Anne Patterson to be Assistant Secretary of State for the Near East. A steady stream of nominations will be on the floor this week as well. Follow all the action here.

Johnson’s case was particularly interesting, as Republicans yielded back their 15 hours of post-cloture debate time (For a cabinet official, there would be normally 30 hours of post-cloture time. The Democrats had been yielding their time back to save time, while the Republicans had been keeping theirs to slow things down). Maybe the GOP has realized it would like to get home for Christmas……

Senators also voted to end debate on two nominations. First up is Alejandro Mayorkas, the nominee for Deputy Secretary of Homeland Security (Yes, I know – a cabinet secretary and a deputy secretary in the same department confirmed in one week, that’s incredible). Second, the John Andrew Koskinen was cleared for a final vote to run the Internal Revenue Service. Koskinen moved out of a committee hearing last week and will be confirmed over the objections of Orin Hatch, a Utah Republican who is the ranking minority member on the committee.  Both will be confirmed today.

Reid also filed for cloture on eight more nominees. By far the biggest one is Janet Yellen, slated to become the first chairwoman of the Board of the Federal Reserve. I suspect the GOP will yield back their post-debate time on her too, since she seems to be a fairly popular nominee, despite some opposition.

After that, it’s the parade of deputies; aka the people who actually implement a lot of policy but aren’t that well known. Here we have six appointments up for consideration:

Sloan D. Gibson: Deputy Secretary of Veterans Affairs
Sarah Sewall: Under Secretary of State (Civility Security, Democracy, and Human Rights)
Michael L. Connor: Deputy Secretary of the Interior
Sarah Bloom Raskin, of Maryland: Deputy Secretary of the Treasury
Jessica Garfola Wright: Under Secretary of Defense for Personnel and Readiness 

Then we have one judge thrown in for good measure:
Brian J. Davis: United States District Judge for the District of Florida

Finally, one member of an investigative board:
Richard Engler: Member of the Chemical Safety and Hazard Investigation Board 

I suspect we're going to see some more district judges (there's eight with committee approval awaiting a floor vote after Davis) and Robert Wilkens, Obama's third DC Circuit pick confirmed this week before the Senate recesses (perhaps  Carolyn McHugh for the 10th Circuit as well, who is also out of committee). I also speculate Reid will only let everyone go home after he gets unanimous consent to carry over all the existing nominees to the New Year.

For those of you scoring at home, we now have 12 nominees confirmed post-nuclear action (including one cabinet secretary, two circuit court judges, one housing secretary and four district court judges)

Thursday, December 12, 2013

Post-nuclear Senate update: Pillard confirmed; more confirmations on the way

In a majority rule Senate, apparently a bit of Chai is enough to keep everyone working all night.

The "Chai" in question just happens to be Chai Rachel Feldblum, President Obama's long-stalled nominee for reappointment to the Equal Employment Opportunity Commission.

As I write this, she's not stalled any more.

On Wednesday evening, Senate Majority Leader Harry Reid asked for unanimous consent  to waive the post-cloture debate time on District Cornelia Pillard's nomination (which would have expired at 1 a.m. today) and invoke cloture on Feldblum, with confirmation votes to follow early this morning. As a result, every one could go home and get some sleep.

Iowa Republican Chuck Grassley objected.

So Reid kept the Senate in session all night.

This appears to be the equivalent of assigning Senate Republicans an eight-hour detention.

 Democrats confirmed Pillard at 1 a.m. by a vote of 51-44 and invoked cloture on Feldblum, 57-39.

After Feldblum gets confirmed for the EEOC this morning, the next up are four district court judges for the districts of Western New York, New Hampshire, and Montana (which has two vacancies). The appointments for New York and Montana will fill three judicial emergencies.

For those keeping score at home, that's two Circuit-Court judges, one chair of the Federal Housing Administration and one EEOC member. Incidentally, that's also three more well-qualified women and one more well-qualified African American in powerful positions in federal government. But who's counting?

This majority rule thing is kind of refreshing.

Tuesday, December 10, 2013

Post-filibuster stream of confirmations nears: Pillard first up followed by four district judges

So life in a post-nuclear Senate kicked off on Monday night.

We'll take the play-by-play from the Senate Democrats' floor report.

Majority Leader Harry Reid (D- Nevada) opened the proceedings at 6:43 p.m. by causally strolling up to the mike and agreeably asking for unanimous consent to move on all 80 executive and judicial nominations on the calendar.

(Watch closely kids, this is how you troll a legislative minority.)

Naturally, a Republican Senator (Lamar Alexander of Tennessee) objected, noting acidly that he wanted to see how the Senate would work without rules.

At 6:55 p.m. Reid then filed for cloture votes on 10 nominations. The first one of these for will occur on Wednesday morning at 11 a.m.

After each cloture vote, the motion will have to "ripen," meaning that debate and other parliamentary maneuvers can consumer up to a certain amount of time post-cloture.  According to the current rules, this time can exceed no more than 30 hours for cabinet-level posts or equivalents (Supreme Court Justices, Circuit Court Justices Federal Reserve Chairs, etc). For all other executive appointments, the amount of time is 8 hours, and for district judges the time is two hours.

So the first confirmation up is Nina Pollard at 10 a.m. local time for the D.C Circuit Court (Her cloture motion passed before the Thanksgiving recess, so the 30 hours on her motion has expired)

Starting Wednesday, we'll see cloture votes on four district court judges, five mid-level executive appointments and the Secretary for Homeland Security, Jeh Charles Johnson.

List of upcoming confirmations:

Elizabeth A. Wolford (Western District New York -- a judicial emergency)
Landya B. McCafferty (District of New Hampshire)
Brian Morris (District of Montana -- judicial emergency)
Susan P. Watters (District of Montana -- judicial emergency)

Executive appointments:
Jeh Charles Johnson (Secretary of Homeland Security)
Deborah Lee James (Secretary of the Air Force)
Heather Anne Higginbottom (Deputy Secretary of State for Management and Resources)
Anne W. Patterson (Assistant Secretary of State, Near Eastern Affairs)
Chai Rachel Feldblum (Member, Equal Opportunity Commission)
Patricia M. Wald (Member, Privacy and Civil Liberties Oversight Board)

 Some of these are boring, but putting them in place makes the government work that much better.

I would imagine that the other D.C. circuit justices, Melvin Watt at the Federal Housing Administration and Janet Yellen at the Federal Reserve, along another half dozen or so district judges and numerous other mid-level appointments will follow in short order next week.

The gears of functioning government are grinding slowly into motion.

Friday, December 6, 2013

Notre Dame notes

Sure, I'm Catholic, but there are many, many reasons I'm glad when the Irish lose to my Wolverines.

This is not least among them.

What is their president thinking?

Wednesday, December 4, 2013

Bring on the death panels!: Senate Confirmations and the IPAB

After the Senate eliminated the filibuster on most nominations, the focus has been on judges, and rightly so.

However, one of the lesser-appreciated parts of the power of the Senate to run under majority rules is that now Democrats can fully stock the death panels and get to work denying care to those pesky, expensive senior citizen-- darn it, I just let the cat out of the bag.

All jokes aside, the demise of the filibuster does lift one of the major hurdles to getting what could be a critical part of the Affordable Care Act's bureaucracy running -- the Independent Payment Advisory Board.

The idea behind the IPAB is simple -- if Medicare spending per-person spending increasing increases by a number more than, a panel represents cuts. Those cuts can't charge recipients more or deny access to Medicare.What they can do is limit reimbursements to providers for certain procedures or possibly pharmaceuticals.  (See the ever helpful Kaiser Foundation for an overview)

This ability to say "no" is pretty constrained, but it should get providers' attention and grant Medicare some new leverage to keep costs down. (Think about how much lower drug costs are at the VA where the system negotiates drug prices across the system; the IPAB doesn't have that much power for Medicare, but it moves it in the right direction; better yet, the board can make some recommendations for private health insurers, which should do a bit more to cut costs)

Better yet, the system fast-tracks any recommendations through the House and Senate, where they automatically take effect unless both branches vote with 3/5s of their members to reject them and replace them with other cost savings (which means that some lobbyists' jobs just got a lot tougher).

The president appoints 15 people -- 3 nominees from himself, and three each in consultation with the majority and minority leaders of both houses of Congress. the GOP has been refusing to consult on their six members, but will likely be more likely to bargain now that the Democrats will be able to get their nine members confirmed through the Senate over GOP opposition.

All this is moot for now -- because Medicare expenses increased by 1.15 percent last year,  but thanks to getting rid of the filibuster,controlling health care costs in way that won't hurt patients is about to get a lot easier.