Good News Everybody! (on Racial Equality in Health Care)

During the last several weeks, it’s been rather depressing recognizing (yet again) that racism (still) is widespread in the United States. We’ve had yet another set of killings highlighting the differences between how police treat whites and people of color. Then we had a sitting U.S. Congressman enthusiastically endorse white supremacy on national television.
And I’m a clueless white dude– if I feel depressed about this state of affairs, imagine how bad it really must be.

When it seems like the median opinion of the national debate is somewhere between “Black Lives Don’t Matter” and “Black Lives Might Sort of Matter Sometimes When We Feel Like It as Long as Black People Keep Quiet and Don’t Hurt White People’s Fee Fees”, feeling the urge to slip into despair is understandable.

But over the last several years one indicator of racial equality has quietly been rapidly improving – a lot more African Americans are getting access to health insurance under the Affordable Care Act.

Quarterly analysis from the office for the Assistant Secretary for Planning and Evaluation (ASPE) at the Federal Department of Health and Human Services (HHS) has been keeping track of changes in the uninsured rate. APSE (and other measures have noted massive across-the-board declines in the percentages of people without health insurance since the Medicaid Expansion and Insurance Exchanges went into effect in 2014.

What’s particularly notable, however, is how well African Americans seem to be doing under the ACA, however.

In the fourth quarter of 2013, 23.2 percent working-age African Americans lacked health insurance coverage, as against 14.3 percent of Whites.  By 2016, the African American uninsured rate had fallen to 10.6 percent, while the White rate had declined to 7.0 percent.  In total then, the gap between the uninsured rates between whites and blacks fell from 8.1 percentage points to 3.6 percentage points  -- a reduction of 55.6 percent.

That’s not perfect, but it’s a heck of a lot of progress.

Getting several southern states with large African American populations to expand Medicaid will likely further cut into this gap (yes, ex-Confederate States not named Arkansas or Louisiana, I’m looking at you).

The other challenge is that, despite improvements, coverage of Hispanics still lag significantly behind both Whites and Blacks.

But these are struggles going forward. For now, two and a half cheers for Obamacare's contribution to racial equality.

ACA exchange plans cost near-poor more than Medicaid

The Commonwealth Fund just released an interesting brief regarding the effects of failing to expand Medicaid on the health care costs of people between 100 and 138 percent of the poverty line.

Yes, that sounds about as exciting as watching paint dry, loyal readers (both of you) but it’s important – so wake up, dammit!

Here’s the score:  the Affordable Care Act expands Medicaid to cover everyone under 138 percent of the poverty line. The problem is that 19 states – generally dominated by Republicans – have

refused to expand their Medicaid programs. This poor public policy has created a “Medicaid gap” consisting of people who are too rich to qualify for legacy Medicaid (in Texas, for example, parents earning more than 15 percent of the poverty line – about $2,400 a year for a family of 2 – don’t qualify) but too poor to qualify for subsidies on the health insurance exchanges, which are available to households earning between 100 and 400 percent of the poverty line.

The 3.2 million people in this gap have no functional access to insurance, since there’s no way a person making, say, $10,000 a year can afford several hundred dollars a month in health insurance premiums.

People earning between 100 and 138 percent of the poverty level in non-expansion states are considerably better off though, because they qualify for both premium subsidies and cost-sharing subsidies for exchange plans. The indispensable Charles Gaba has estimated this group at roughly 1.9 million people.

But do the exchange plans stack up favorably with the generosity of Medicaid for poor people?

The good scholars over at Commonwealth Fund set out to find out. And their general answer is “no.”

Follow me below for more details.

Transitional plans and insurance exchanges II

One day after my last post, the New York Times ran an article on Geisinger Health, an insurance company requesting a large rate increase on the PA exchange. One reason why? Because the transitional plans are keeping considerable numbers of healthy people out of the exchanges. It would have been nice if the article had mentioned it before three paragraphs from the end.

Are transitional insurance plans driving losses on state exchanges?

The ACA's insurance exchanges have generally been successful in helping to reduce the ranks of uninsured in the United States, while providing reasonable quality insurance to its policyholders.

However, several challenges still remain. Most notably, a good number of insurers have had problems with breaking even on the exchange products (though some are making money). That stems from several problems, notably Marco Rubio blowing up the risk corridor reinsurance program that undermined many insurer's business plans, especially non-profit co-ops trying to break into the market. Other insurers, like United Health, have just tended to be bad at competitively designing and pricing plans.

However, the risk pools for the exchanges have also proven to be somewhat older and sicker than predicted, which has also tended to drive up prices in 2016 and will likely do so more in 2017. I haven't seen a great explanation for this other than "predicting new risk pools is hard," -- which it undoubtedly is.

However, the New England Journal of Medicine last week featured a very interesting Perspectives piece (gated unfortunately) by John Hsu that fingers grandmothered plans as the culprit.

Two-tiered justice

On the recent Stanford rape case, I think Scott Lemieux makes a valuable point that helps clarify something I've been struggling with: does asking for a stronger sentence for a privileged person who has gotten off lightly undermine the broader push to make the U.S. criminal justice system less punitive?

Lemieux argues that it doesn't. Indeed, he suggests that the two are complementary goals: If you hold privileged (read: white and rich) defendants to the same standards the you hold underprivileged ones, people with power won't be able to ignore how draconian the system is and push to change it, instead of being able to close their eyes to it because those close to them escape its clutches. Think about the differences in the ways we've treated the opioid addiction problem and cocaine (abused broadly by middle and upper-class whites) in comparison to the way we treated the meth, heroin and crack problems (used disproportionately by the poor and/or minorities).

Finally, good on the survivor for her statement to the court and defendant during the sentencing. I have much respect for her.

GOP's near-total blockade on Obama's appointments continues -- but you can help a bit

While we were all focused on the primary elections on Tuesday, something interesting happened on the Senate floor when Democrats made a conscious, polite and ultimately futile effort to get a few judges confirmed.

Hawaii Senator Mazie Hirono (D-Hawaii) asked for unanimous consent to vote on Obama's eleven district court nominees that have been approved by the Senate Judiciary Committee -- without objection -- and have been awaiting the action of the full Senate (see the full Senate Calendar here).

Sen. Majority leader Mitch McConnell (R-Kentucky)  objected to the request.

Then Chuck Schumer (D- New York) asked for unanimous consent to vote on the seven that have been approved by Judiciary -- again without opposition -- and have been waiting on the floor since November 5. 

McConnell again objected.

Then Ben Cardin (D - Maryland) said, OK, could we vote on the four that have been  waiting on the floor since  October 29 -- six months ago. Those are

Paula Xinis, District of Maryland,
Brian R. Martinotti, District of New Jersey, 
Robert F. Rossiter, Jr., District of Nebraska,
Edward L. Stanton III, Western District of Tennessee

John Cornyn (R-Texas) objected.

Finally,  Cardin said, could we maybe just vote on the Xinis nomination, since she was approved by Judiciary in September, no one has raised any opposition to her and she has been awaiting floor action for seven months?

Cornyn objected again.

We all know about the near complete refusal of Senate Republicans to even meet with, let alone hold hearings for, vote on or even, gasp, approve President Obama's Supreme Court nominee Merrick Garland. 

But we can't forget about the rest of these nominations either that are facing nearly a complete blockade by Republicans. In addition to the eleven awaiting floor action, 41 nominees are awaiting action in the Judiciary Committee.

In the 2015-2016 Congress to this point, the GOP-controlled Senate has only confirmed two circuit court appointments and fifteen district court judges.

For comparison, in the 2007-2008 Congress through April 30, the Democratic-controlled Senate had confirmed seven of George W. Bush's circuit court nominees and 38 of his district court nominees.

And in 2013-2014, by April 30, the Democratic controlled Senate had confirmed fifteen nominations to the circuit courts and 54 to the district courts.

It's reasonable that the GOP wants to scrutinize Obama's appointments a bit more (and even reject a few),  but these 11 judges have had been scrutinized. They've been waiting for confirmation between seven and 14 months.  They have all cleared a GOP-controlled Judiciary committee by voice vote. There is no opposition -- reasonable or otherwise -- to giving them their commissions. This is only about delay.

These are judges that are uncontroversial and needed to help the government perform their basic functions. Unlike Garland, they don't represent huge ideological stakes in themselves, so a bit of pressure might get the Republicans to let a few go.

Consider calling your state's Senators, especially if they are Republicans -- and especially if you're from Texas and have Cornyn as your Senator. (Don't e-mail, that's useless). Here's a list of numbers for their Washington offices. State your name, and give  a brief, polite (don't be a jerk) message asking them to hold a vote on the 11 district court nominees that await floor action.

The 11, including their numbers on the executive calendar are:

#307 Paula Xinis, District of Maryland,
#357 Brian R. Martinotti, District of New Jersey, 
#358 Robert F. Rossiter, Jr., District of Nebraska,
#359 Edward L. Stanton III, Western District of Tennessee
#362 Julien Xavier Neals, District of New Jersey
#363 Gary Richard Brown, Eastern District of New York
#364 Mark A. Young, Central District of California
#459 Marilyn Jean Horan, Western District of Pennsylvania,
#460 Susan Paradise Baxter, Western District of Pennsylvania,
#461 Mary S. McElroy, District of Rhode Island
#508 Clare E. Connors, District of Hawaii

Boring Bureaucrats help save the world: energy edition

When it comes to stopping global climate change, you probably don't think much about vending machines. Fortunately for all us, a lot of non-descript civil servants do.

Don't worry, the government is on it. (Really.)

Nor have you probably ever heard of the Department of Energy's Appliance and Equipment Standards Program (AESP). I'm sure it's staffed by lovely, if slightly nerdy khaki-wearing personnel.

But it's one of the Obama administrations most effective secret weapons in the fight against global warming.

Let's start with the two million beverage vending machines in the United States. Rules issued by AESP in 2015, will lead to machines coming online in 2019 required to be 16 percent more energy efficient in 2019 than today's. Over 30 years, it will save 7 million metric tons of carbon dioxide emissions, an average 233,000 tons a year. That's the equivalent of  shutting down Ohio's First Energy's Lakeshore Power Plant, which is a medium-sized coal plant in Ohio.

It will also save businesses at least $210 million in electrical bills over the same time.

Big deal, you say. The US emitted 6.8 billion tons of CO2 equivalent in 2014,  cutting 233,000 tons a year is a nice gesture, but hardly serious climate reduction.

We're just getting started. Read on to see efficiency standards really start to add up.

If Dems get a chance to confirm Garland in the lame duck session, they should take it

Merrick Garland

At last Thursday's Democratic debate, moderators asked Democratic presidential candidates Hillary Clinton and Bernie Sanders a question from NY Daily News reader Hannah Green regarding Obama's nomination of Merrick Garland to the Supreme Court vacancy left by the death of Antonin Scalia.

Hannah Green (ph) wants to know your position, Secretary Clinton, regarding President Obama's nomination of Merrick Gaarland to the Supreme m Court. President Obama said earlier this week that he would not withdraw the nomination, even after the presidential election. If elected, would you ask the president to withdraw the nomination?

Both Clinton and Sanders said that the currently support the nomination and strongly denounced Sen. Republicans for obstructing Garland's appointment. But they differed on whether they would ask Obama to withdraw the nomination if they were elected president: 

Clinton indicated acceptance of Obama's pick:

I am not going to contradict the president's strategy on this. And I'm not going to engage in hypotheticals. I fully support the president.

Sanders said he would ask Obama to withdraw the nomination:

...obviously I will strongly support that nomination as a member of the Senate. But, if elected president, I would ask the president to withdraw that nomination because.... I think that we need a Supreme Court justice who will make it crystal clear, and this nominee has not yet done that, crystal clear that he or she will vote to overturn Citizens United and make sure that American democracy is not undermined.  

(Debate transcript from CNN.)
I want to be careful about extrapolating inaccurate meanings from their words, but it seems that Clinton is indicating that she'd be open to having Garland confirmed to the court in a lame duck session if Democrats retain the presidency and retake the Senate. Sanders, on the other hand, would want to wait to get a better judge (meaning younger, more liberal and perhaps non-white or female.)

I agree with Clinton.  I think the costs of passing up a chance to get Garland on the bench are greater than the gains of holding out for some one potentially better (in the admittedly extremely low chance that Garland ever actually gets a vote).  Hit the jump for my reasoning.

Cost sharing blocks access to health care

The notion that health cost containment requires people to put “skin in the game” has a long pedigree. Requiring people to pay something through premiums or co-pays for health care, the theory goes makes them more discerning consumers about health services and eliminates unnecessary health care.

The problem is that they also stop  seeking care for things that require medical attention.

Don't forget about Obama's other stalled federal court nominees

Much of the coverage of the federal courts over the last several weeks has rightly focused President Obama's nomination of D.C. Circuit Judge Merrick Garland to fill the Supreme Court vacancy, and the complete refusal of Republican Senators to even pretend to consider him.

But we can't forget about the other court vacancies that exist. As of last month, there are 62 district court vacancies and nine vacancies on the Courts of Appeals.

Sen. Majority leader Mitch McConnell speaks about 

President Obama's nomination of Merrick Garland 

to the Supreme Court.

Obama currently has nominees waiting for 34 of those district court slots and seven of the Circuit Courts.

But Sen. Majority leader and Mitch McConnell and his fellow Republicans will likely drag those nominees out.  In 2015, the Senate confirmed one circuit judge and 10 district court judges. 

In 2007, under an incoming Democratic Senate, George W. Bush was able to get six circuit court justices and 34 district judges appointed.

And during 2014 the Democratic-controlled Senate confirmed 12 circuit court judges and 76 district nominees.

(Gee, holding the Senate in the 2014 elections would have been nice, wouldn't it?)

So far this year they have managed to confirm one circuit judge and four district judges -- all of whom were ready for votes last November.

Now with the Garland nomination taking up a lot of bandwidth, it's possible the McConnell and Judiciary Chuck Grassley can use it to claim that they don't have time to process any lower-level judges.

Progressive activists can't let that happen. We should highlight the near total blockade ongoing in the Senate of Obama judicial appointees alongside our demands for Garland.

Eleven district court nominees have cleared the judiciary committee and await action on the Senate floor. None of them are controversial and all sailed out of committee by voice vote. Waverly Crenshaw of Tennessee's nomination has been waiting on the Senate floor since last July. McConnell could have a vote on him and the other 10 all during the next Senate session and every one of them could be on the job next week, actually, you know, providing justice.

Most of the other district (and likely most of the Circuit judges) are completely uncontroversial as well and would sail through, but Grassley is slow walking them.

I'm not suggesting that we should sacrifice a Supreme Court nominee for district or even circuit judges. However, loudly and continuously reminding the GOP that we haven't forgotten about Obama's other judicial nominees alongside our complaints about the disgraceful treatment of Garland is useful. It might even provide enough political fiber to persuade McConnell to release some district judges and perhaps a few circuit court judges to appease the vulnerable members of his caucus and provide a fig-leaf to rebut charges of total obstruction.

It's small ball, but every Obama appointee that goes through eases delays of justice, makes government work more effectively and likely will help protect Obama's legacy well into the future.

There's not going to be a contested convention

So I'm watching MSNBC and Rachel Maddow is discussing potential permutations of a contested Republican convention in which Trump doesn't win a majority of the delegates.

The one problem that I see with all this talk is that Trump appears to be easily on track to get a majority of delegates, unless things change drastically in the next two weeks, which they haven't in the last two months.

The "establishment" darling Marco Rubio seems to failing to hold up his end of the bargain by continuing to lose. In fact, he's failing to clear 20 percent thresholds necessary to gain delegates in major primaries and as a result is bleeding even more delegates Trump and Ted Cruz in places like Texas.

What/where/who is this GOP "establishment" of which everyone speaks?

Beating swords into plowshares: If you could cut the Pentagon's budget, what would you spend it on?

So with the usual amount of depressing news circulating through, I set myself a happier task, which nicely dovetails with this piece by Daily Kos' Meteor Blades on military spending:

How much could I cut the U.S defense budget and what would I spend the proceeds on?

The rules were designed to make this somewhat realistic. I'm not trying to eliminate the Pentagon's budget entirely, unilaterally disarm, or make the Air Force hold a bake sale to buy necessary equipment. The idea here is simply to identify some reasonable spending limits for the American military machine (kind of like the discussions we have for regulatory agencies, health care funding research and infrastructure spending), and then think about what sorts of programs (or tax cuts, or deficit reduction) we could implement with the savings.

Figure 1 shows U.S. military spending as a percentage of national GDP between 1962 and 2015, based on GDP figures from the Bureau of Economic Advisors and spending figures from the White House's Office for Management and Budget. This number represents military expenditures, but doesn't represent veteran services or health care (i.e. funding for activities under the Department for Veterans' Affairs.) Notice how the figure generally steadily declines, though it does ramp up during the Vietnam War, the 1980s Reagan build-up and the Iraq and Afghanistan wars. The 1990s peace dividend is clearly visible as well, reflecting the end of the Cold War.

In 2015, according to GDP figures, from military spending represented about 3.16 percent of GDP. In a world in which we made decisions that maintained a reasonable military investment, what might defense spending look like? I came up with plausible three candidates.

Scenario 1: We reduce military spending to the lowest level of spending (Fiscal Year 1999) in which we spent about 2.7 percent of GDP on military spending.  This scenario would give us roughly $82 billion (all peace dividends will be rounded down) in funding to allocate elsewhere.

Scenario 2:  We reduce military spending to levels of the Republic of Korea (South Korea), which is about 2.6 percent of GDP, according to the Stockholm Institute for Peace Research in 2014. I thought this seemed reasonable, since the ROK is an advanced industrialized democracy, participates at a reasonably high level in international operations and faces a clear and presents military danger from North Korea, both of which necessitate large investments in the armed forces. Cutting to this level leaves us with a annual peace dividend of about $101 billion.

Scenario 3: We could really give into the hippies and spend only the percentage of our GDP that an average country spends on the military: 2.3 percent of GDP.  This would leave us with a cool $155 billion to spend.

Note that all three of these scenarios would leave use spending at least double any other country in the world in absolute amounts of defense spending.

Head below the fold to see what I came up with to spend my peace dividend under each scenario. Some funding proposals are fairly detailed, but most (e.g. the preschool and parental leave are rough back-of-the-envelope calculations at best) Let me know in the comments what you would do with your surplus.

A crosswalk!

It's about darn time.

I love running along the bayou trail (in fact, I'm about to head that way now.) However, it's considerably less lovely playing live-action Frogger crossing 45 mph five-lane Allen Parkway at Dunlavy St. with no crosswalk, signal or median.

This will increase usage of the Bayou, which is looking a lot more inviting after $58 million in renovations.

Both the renovation and the stop light (and the coming speed reduction on Allen) definitely makes the half-marathon training more pleasant and safer.
  

West Virginia about to fall to "Right to Work"

It looks like West Virginia's new Republican majority is about ram through a Right-to-Work (for less) bill.

It's not a surprise, that's what GOP majorities always do with anti-labor legislation. (See Wisconsin, Michigan, Indiana, and Michigan, oh, and Michigan again.) Once these bills surface, they rocket through the ledge to stop opposition and minimize the public discomfort their backers have to face.

West Virginia's legislative majority could use a visit

from these nice ladies.

In West Virginia, they're drawing on Orwellian inspiration to call it the "Workplace Freedom Act" Guh. Like all (so-called) Right to Work laws, it would give employees the right to stop paying dues to the labor union that represents them, but forces those unions to continue to represent the workers. The goal is to defund the unions, leaving workers out in the cold.

I've always been of the belief that if workers don't want to work in a union shop, they should quit and find an employer without a union. I mean, that's what management tells employees when they demand healthcare or higher wages or better working conditions, right?

Anyhow, back to West Virginia.

Proponents, backed by the usual third-rate think tanks, push the usual bad arguments about RTW improving West Virginia's economic prospects (because gutting workers' rights always improves things for residents). And anti-labor legislation debates always come with a few gratuitous shots at pro-labor protesters .

It was only a matter of time. I thought the GOP would wait until they elected one of their own as governor,  but the state's weak gubernatorial veto (simple majorities of the legislature can override as long as the legislature is in session) made it too tempting to not get done this year.

Kentucky is likely next up, with Missouri, New Mexico, Montana and Ohio potentially on the chopping block depending on how 2016 elections go.

Yes, I am depressed about this.  I'm doubly so because the battles in West Virginia's coal fields rocketed the United National Mine Workers to prominence. But the group has lost more than 90 percent of its membership in the last half century as coal-mining has died and the remaining operators rely on cheap bankruptcy tricks to undercut the few union minors left.

John Cole over at Balloon Juice has more on this and the other predictable horribleness that results when you let vandals take over your state legislature (like apparently now $100 for a five-year gun permit is an unconstitutional infringement on your right to pack heat).

Exploring potential legislative ways to limit the damage of Friedrichs

Public sector labor unions across the country have been grimily preparing for the likely negative results  from the Friedrichs vs. California Teachers Association case heard two weeks ago. The opinion in Friedrichs (undoubtedly 5-4, written by a super smug Samuel Alito, with a vicious dissent coming from Elena Kagan) will likely ban union agency fees on the grounds of free speech.  

Previously, I have outlined why this opinion shouldn’t be conflated with the end of public sector unionism. Here, I outline a legislative step unions and workers might be able to lobby for to blunt some of the impact of yet another depressing Alito majority opinion.

The likely outcome of Friedrichs will hurt labor -- but it won't destroy it

Two weeks ago, progressives had their days ruined by oral arguments in the Supreme Court in the case Friedrichs vs. California Teachers Association. The case has led to numerous breathless headlines declaring that this will be the end of public sector unions in the United States, comparing the case to what happened to unions in Wisconsin, where organized labor has been in a depressing tailspin since the passage of Act 10 in 2011, which eliminated collective bargaining rights for most public sector unions.

Those comparisons are far overblown: Freidrichs will hurt public unions, but they still will retain most of their rights. Here, I’ll discuss what the likely decision against the unions will do to hurt worker’s rights, but I’ll also emphasize that it’s important to remember that workers will retain considerable rights to bargain – unlike in Wisconsin.

Supreme Headaches

What Linda Greenhouse says.  The Friedrichs case is atrocious on so many levels.

Today in counterproductive posturing, LA edition

I fail to see how stopping the construction of housing will make housing more affordable.

Granted, I do live inside the loop in Houston and I recognize from here and my experiences in Ann Arbor concerns about only building super-fancy housing for rich people. But the solution is mandating affordable housing or thinking about clever ways to subsidize housing for working class people, or better zoning rules like cutting parking minima. 

But simply stopping the construction large apartment projects in dense areas only drives up rents in the existing housing stock, which forces out working class and poor people. Or just as badly, it forces the development to the outer rim of the community -- which induces more sprawl, traffic, pollution, wasted time etc.

Good news from Louisiana

This is long expected, but it is good news all the same. Louisiana's new Governor, John Bel Edwards (D) just made it official: the state is expanding Medicaid.  Edwards estimates that the expansion will get 300,000 uninsured residents  coverage. 

One of the biggest immediate bureaucratic hurdles left is the result of former governor Bobby Jindal (R) gutting staffing in the state health department, but the incoming director thinks she has found a way to hire the 200 + staffers needed to help process new Medicaid applications.

There may be a few other hiccups, but most of the pieces are in place: this is now primarily an administrative task, not a legislative one.

Let the good times roll!

Saving the world one state or province at a time: a look at existing carbon-pricing schemes in North America

With the Paris climate accord in place, now comes the hard work of actually implementing emissions reductions goals to, well, save civilization. There are many, moving parts to making this work; one of the largest set of which involve putting a price on emitting carbon.

There are two major ways to do this: cap-and-trade program, and a direct carbon tax. Cap and Trade sets a total cap on emissions for regulated sectors then lets enitities purchase emissions credits they can cash in for their emissions or sell on a secondary market if they don't exceed their cuts. Carbon taxes, in contrast, directly place a levy on carbon emissions from regulated sources. Both have their supporters and detractors, and I'm not going to wade into that debate here (personally, I'd support a well-designed plan of either).

Follow me below the fold for a brief look at the carbon-pricing landscape in North America. I don't have detailed looks at the programs (though I do link to formal reports that detail each of the existing or proposed programs). What this should serve as is a basic lay of the land and give an idea of how these already successful programs lay an extremely important groundwork for the deeper emission cuts that will need to come.

ACA eases extreme financial stress from medical bills, but out-of-pocket costs remain a problem

The Kaiser Foundation and the New York Times have teamed up on an interesting study to measure the number of Americans suffering from financial hardship due to medical bills.

The good news is that by expanding insurance accessibility, ACA has helped steadily curtail the amount of financial stress Americans experience due to health bills.  Insured Americans are much less likely to suffer individual financial stress related to health bills.

The ACA has helped affordability, but we're still

not here yet.

The bad news is a significant portion of Americans between the ages of 18 and 65 with insurance -- 20 percent -- still suffer significant financial hardship. (That's a heck of a lot better that the 53 percent without insurance reporting having problems, but it's a real issue).

Things are getting better, but we haven't reached single-payer nirvana where you can show your provincial ID card and focus on getting well.

The Times and Kaiser go into details in their reporting, which you should read.  However, follow me below the fold for a general overview of the situation.

Threats to Polish Democracy

After two decades of fairly widespread progress toward consolidated democracy, the last several years have brought some notable setbacks, linked to the election of conservative nationalist parties.

First, it was Hungary. A Christian nationalist party called Fidesz won a free and fair election in 2011, which granted it a supermajority in the country's unicameral parliament. The party then used its power to rewrite the country's constitution to permanently hardwire Hungary's political system in its favor. The reforms crippled the independent media and judiciary. They also changed the electoral system and redrew districts to make it extremely difficult for opposition parties to win a majority. Finally, they required 2/3s majorities for any future government to agree on replacing electoral commissioners, judges and other important officials. Read this post by Kim Lane Scheppele for a concise and depressing summary. 

Essentially,  the massive electoral victory allowed Fidesz to engage in a wholesale restructuring of the Hungarian state; the party then forced through a constitutional overhaul that locks those policies in place no matter what future  governing majorities might think.

Now Poland is exhibiting several alarming similarities to Hungary.

The newly-elected government of the Law and Justice Party (PiS) has pushed through reforms that limit the power of the Constitutional Court to review government policy for constitutionality and stack the court with PiS appointees.  A law cracking down on the independence of public media and making it more nationalist in scope appears to be next. We'll see where this goes, but the trajectory is not good.

Both Fidesz and PiS are conservative, nationalist, Christian-identified parties.

While both of these developments are alarming and discouraging, they do raise fundamental points in democratic theory: What issues should merely be "policy" issues that can be changed by regular order, and which ones rise to the level of needing enshrined in a national constitution and requiring supermajorities to change?

Labor's prospects over the next several years look alarming

As another election year dawns, I find myself contemplating the future of the labor movement.

The immediate future looks grim.

That isn't to say that the labor movement is going to die, or that unions won't continue to play a role or help working people. And it certainly doesn't mean that activists should stop fighting for the rights of working people everywhere.

However,  it's much more likely than not that the labor movement is going to suffer some serious hammer blows in 2016 and the remaining years of the decade.

I'll focus narrowly in this post on the spread of (so-called) Right to Work (for less) laws (RTW).

RTW is an insidious concept that cloaks itself in righteous language to divide workers and drastically weaken the power of their organizations.  By the National Labor Relations Act and the state statutes that govern collective bargaining for state and local public employees, unions have to represent all employees in a bargaining unit.  In 25 states, the union has the ability to bargain to charge fair-share fees of all member of the unit, which represent the costs of collective bargaining.  Full dues, which represent political activities engaged in by the union, are only paid by individuals who want to be members who in turn have rights to vote and participate in the governance of the union.

In an aside, remember that in order to represent workers, unions have to win an election to become the bargaining agent, and they are controlled by the members through democratically elected officers. Finally, they can be decertified if a majority of workers vote in an election to remove or replace the union. This is a fact glossed by anti-worker forces.

What RTW laws do is allow workers to free ride of the union's efforts by banning fair share fees. The corporate-backed groups and think tanks pushing RTW argue that workers have a right to not join a union (though they are rather silent on a worker's right to join a union). Of course, though banning fair-share fees, RTW laws still compel a union to represent any one in a bargaining unit. As a result, we create a free-rider problem described by Mancur Olson: why should you pay for something you can get for free?

RTW is insidious because it only appears to cripple a small part of collective bargaining rights: in itself, it doesn't touch the ability to bargain for better wages or working conditions. But by undermining the union finances, it cripples the ability of a union to organize, bargain and protect strong contracts, which can lead to fewer members, which leads to further financial erosion. At worst, a death spiral happens, leaving a bunch of isolated, cynical workers in its wake -- who then can be easily exploited by unfettered bosses.

Currently 25 states have RTW laws, and 25 do not. Since 2011, when Scott Walker eviscerated public sector unions in Wisconsin, three states have jumped on the RTW bandwagon: Indiana, Wisconsin and Michigan.  From a worker's perspective this should be alarming, because all three of these states are in the industrial Midwest, which traditionally has a strong union presence. Michigan was the birthplace of the United Auto Workers (UAW), whereas the Association of State, County and Municipal Employees (ASCME) originally formed in Wisconsin.

As the parties have polarized and the remaining labor-friendly Republicans retire or are overwhelmed by their conservative colleagues, this momentum is likely to continue.

Extreme Risk:

West Virginia: I suspect it's pretty much all over in West Virginia. Like many Appalachian states over the last several election cycles, the legislature has become sharply more conservative, with the GOP breaking the dam in the 2014 elections. A RTW bill was shelved in 2015, but with GOP gains likely in both houses of the legislature and a Republican taking over the governor's chair very likely in 2016, in 2017, RTW's arrival will be a given.

Kentucky:  A slimmer and slimmer Democratic majority in the state House of Representatives is the only thing standing between RTW and Kentucky. The extreme conservative Matt Bevin's win as governor jumps this state from medium risk to extreme risk, as anti-labor policies are core to Bevin's identity -- in two of his first executive orders, he discarded higher minimum wage requirements for state agencies and issued a hiring freeze in filling unstaffed positions.

The Democrats may hang on to their house majority in 2016, since they were somehow able to cling to it in the low-turnout year of 2014.  However, the off-year election of 2018 is another animal entirely.

Several Kentucky counties have already tried to issue RTW laws on their own; these efforts are currently tied up in court, but the winds are very much blowing the wrong way for labor rights in this state.

High Risk:

Missouri:  Democratic Governor Jay Nixon vetoed a RTW bill in 2015 and the Democrats backed by a few nervous Republicans have managed to sustain those vetoes in the legislature, despite the GOP maintaining a supermajority in both chambers. Unlike West Virginia, the Democrats have a fighting chance in the governor's race in 2016, despite Missouri drifting further into the GOP orbit over the last decade. With a Democratic win in the governor's race, Missouri is likely safe for another four to eight years. With a GOP victory, RTW would likely be the very first thing on the government's agenda in 2017.

Medium Risk:

Ohio: With Republicans in strong command of both houses of the state legislature and the governorship for the foreseeable future and likely maintaining the governorship, Ohio would seem to be a likely candidate for a RTW bill -- and one is currently percolating in the legislature.

However, Ohio Republicans have a bitter memory of the last time they tried to push a major anti-worker bill through the legislature holding them back. In 2011,  Ohio Republicans pushed a Wisconsin-style bill designed to strip most collective bargaining rights from public employees. The bill passed, but  Labor and progressive groups gathered more than a million signatures to force a referendum, in which 62 percent of voters rejected the bill. 

That memory may be holding the GOP in check for now, but if other states continue to push through anti-labor laws, Ohio Republicans will likely eventually press forward.

Possible risk

Montana:  Montana's state legislature has been in solidly Republican hands since 2010, but Democrats have held the governor's chair. Incumbent Steve Bullock is in a reasonably strong position for the blue team, so hanging on to labor rights for at least four more years appears possible in this traditional mining state.

New Mexico: New Mexico currently has Democrats in control of the State Senate, but lost control of the House of Representatives in 2014.  Presidential year turnout will help protect the Democratic senate advantage in 2016 and perhaps help them retake the house.  But if Democratic power in the legislature erodes further, anti-labor legislation will be on the agenda when a Republican is governor.

New Hampshire and Pennsylvania might also be at risk. The Granite state occasionally gets massive GOP majorities in the two houses of its legislature, as it did after 2010. In that case a few moderate Republicans helped the Democrats in the house sustain Democratic governor John Lynch's veto of a RTW bill in the 2011-12 session. As long as the Democrats hold the governor's chair, they should be OK here, but elections are close and there is an open seat in 2016.  Pennsylvania is safe as long as Democrat Tom Wolf, elected in 2014 is in office, but the GOP has a built-in advantage in the state house and its majorities are becoming dominated more and more by extremely conservative ideologues.  Protecting Wolf in 2018 and drawing better districts in 2020 will be key to keeping the Keystone state working people from getting their collective bargaining rights curtailed.

The Supreme Court

This list doesn't count the worst probable hammer blow that's going to fall on labor this year. That would be Friedrichs vs. The California Teacher's Association, which has made its way to the Supreme Court a case set for oral arguments on January 11. The case will likely result in a 5-4 decision -- authored by Sam Alito--  overturning nearly four decades of precedent and invalidating fair share fees for all public sector unions on the specious grounds that collective bargaining with the government is a form lobbying (political speech), which cannot be compelled. Of  course, the union will continue to have to represent the interests of all of its members without their financial support, but I guess speech rights for dues payers aren't as important.

I so do weary of Alito's conception of Freedom of Speech in which it becomes much easier for wealthy owners to speak (see Citizens United) and much more difficult for working class people to organize so they can speak.

Again, we shouldn't despair from the likely reverses that are coming. The movement goes on and labor will continue that struggle. However, we should be aware that the struggle is likely going to become more difficult, though if we can win a few important elections -- we can blunt some of the blows.

And remember, that the only way to overcome RTW both legislatively and on the ground is to organize.

Solidarity.