Senate confirmation update -- Obama getting more appointments through

Later today, the Senate is going to vote to confirm Michelle T. Friedland to be a judge on the Ninth Circuit Court. You can read up on her here – she’s pretty darn impressive in both competence and politics. 

Oh, and by the way, the Senate will also appoint David Weill as the administrator of the Wages and Hours Division for the Department of Labor, you know, the people who stop low-wage workers from getting ripped off by their employers.

You probably haven’t read much of anything about either nomination. These appointments seem entirely unremarkable and ordinary. Frankly, they should be, it’s a routine part of making government function. And in the post-filibuster world, routine nominations, judicial and otherwise actually seem to be proceeding fairly smoothly for the first time in five years.

During the first four months of 2014, the Senate has confirmed 20 judicial nominations – the most of any of the first four months of any calendar year of the Obama administration. On average, Majority Leader Harry Reid seems to be confirming either one appeal court nominee or four district judges per week the Senate has been in session this year.

Things aren’t perfect.  In some cases Republicans are still blocking qualified nominees in committee through the blue slip system– like North Carolina’s Jennifer Prescod May-Parker. In other cases, Republicans aren’t providing any input on nominees at all – like in Texas while the state’s federal bench languishes, as Houston's ever-handy Charles Kuffner has pointed out. And in some cases, they are driving a hard line – insisting on having Obama nominate a large number of their nominees in exchange for seating a few of his, like in the Northern District of Georgia -- a deal that has irked the state's civil rights community. 

Even the Friedland nomination should have been voted on before the Senate left town for the Easter recess on April 10, but Republicans insisted upon using their allotted 15 hours of debate to slow down the nomination (though none of them actually planned to debate).

However, overall the nominees are both flowing in a more orderly manner through the confirmation process.  There are currently 50 judicial nominations awaiting action in the Senate (eight appeals and 42 district). Thirty-one of those have moved through the judiciary committee and are awaiting final confirmation.

Among those 31 include several  nominees from Arizona and South Carolina, who had been languishing for months in committee.

Once those are confirmed (hopefully by August) that will leave Obama with 50 appellate appointments and 214 district appointments – roughly on track to match George W. Bush’s total number of appointments.

Overall then, move to end the filibuster for most executive appointments seems to have been a good one.

Medicaid Expansion -- an Historical Perspective

Since the Supreme Court made the Affordable Care Act’s Medicaid Expansion optional, many state legislatures and governors; well at least many of them dominated by Republicans, have loudly declaimed that they will not accept the expansion.

Proponents of the expansion – meaning those of us who understand public policy and/or have a soul – have been bitterly disappointed in the states which are preventing millions of people from getting access to health insurance.

But let’s have a bit of historical perspective here.  The original Medicaid was a voluntary program as well and it took a bit of time for the states to get their act together. When federal matching funds became available in January of 1966, a grand total of six states had programs set up, as this Kaiser Foundation brief shows (see page 6). By the end of the year, 26 states had signed up.

Coincidentally, when New Hampshire expands its Medicaid program in July, 26 states will have signed up for the expansion (plus DC).

For the original program, 37 states had jumped on board by the end of 1967, 41 by the end of 1968 and 48 by Jan. 1 1970. (Alaska joined in 1972 and Arizona finally dragged itself into the program in 1982)

The point is that we tend to forget that it took more than a decade for all states to get into the Medicaid program. The beauty (sarcasm alert) of American federalism is that instead of merely having to get things enacted through an inefficient national legislature and executive, we often have to get them enacted through 50 inefficient regional legislatures and executives as well. Give it some time – often  states will see what’s working in other states and try to pick up on programs (or free money) that work. The Children's Health Insurance Program is another example -- it took three years for all 50 states to get on board after the federal government created the program in 1998. 

This analysis doesn’t necessarily mean that the ACA’s Medicaid expansion will be picked up as quickly – political parties weren’t as polarized in the late 1960s as they are today, which means that opposition to the latest expansion may be more entrenched, even when the results are crystal clear.  And in any case, delays to extending the program will result in thousands of unnecessary deaths.

However, we shouldn't despair -- Medicaid wasn't built in a day; so there's no reason to expect the expansion to become universal in a year either. The important thing is to keep grinding forward and organizing to gain political power to make states do the right thing for their residents. 

New Hampshire joins the Medicaid Party

It's been lost over the general noise of the debate surrounding the recent close of the enrollment period for the health exchanges, but on March 27, New Hampshire became the 26th state to accept the Medicaid expansion.

New Hampshire --split between a Democratic governor and lower house on one hand, and a GOP-controlled upper house on the other -- negotiated an interesting path to expansion, as

Ann Marie Marciarille over at her highly informative Missouri State of Mind blog discusses.

States seeking a modified Medicaid waive have generally tried to work the waiver out first then implement the program. For states that got a late start or that faced GOP-induced delays to considerations -- Pennsylvania and Michigan come to mind -- this has led to the delay in the start-up. Of course, this has led to frustrating delays in getting needy people health insurance and left federal money on the table (since the Feds pay for 100 percent of the expansion until 2017.)

New Hampshire reversed that strategy by jumping into the Medicaid pool now while attempting to negotiate a waiver over the next year to 18 months to reach an Arkansas- or Iowa-style program in which individuals between 100 percent and 138 percent of the poverty line will get steered into purchasing subsidized plans available on the state exchange.

The law also contains a stipulation that program will sunset at the end of 2016 (when the federal match is reduced from 100 percent to 95 percent) unless the legislature votes to renew it.

Of course, it's a bit frustrating that New Hampshire simply didn't accept the expansion straight-up, but it's a good thing that they decided to start up the program now and dicker about the details later.

Most importantly over the short term, 50,000 people are going to get access to health insurance -- and by extension, health care -- that they didn't have before.  After all, that's the point of the Affordable Care Act, right?

It's also a milestone of sorts now that more that half of the states are in the expanded Medicaid program. Of the 26, five are under split control (New York, Nevada, New Hampshire, Arkansas and Iowa) and four are under complete GOP control (Michigan, Ohio, North Dakota and Arizona). The Medicaid expansion isn't just a program for dirty hippies and effete coastal elites any more.

The current state of play in the states regarding Medicaid expansion can be found at the ever-useful Kaiser Foundation.