I’ve emphasized that progressives have very little leverage over people like Blanche Lincoln and Kent Conrad—they’re basically in a position to do whatever they want, for good or for ill. One can’t really say the same about Senator Dianne “I just find that if you’re going to remake a sixth of the American economy, it’s very difficult at this time of great economic angst” Feinstein of California. Feinstein frets that “there is real concern over debt and deficits” but she didn’t seem to have that concern when she voted for the 2001 Bush tax cuts, or when she voted for the invasion of Iraq.
Steve Benen says Feinstein “makes comments like these because she believes them.” Maybe yes maybe no. What I would say is that to have a progressive movement that’s effective at enacting legislation, we need to live in a world where senators from states like California don’t say this kind of thing whether or not they believe it. California has been about as blue across the past three presidential elections as Alabama has been red. And any senator from Alabama would worry that breaking with the right could cost him his seat. Democratic incumbents, by contrast, are currently living in a world where even if you do lose the Democratic primary you can hang on to your job.
Advocates of Medicaid expansion — a program that is financed with state and federal funds — are running into one major problem: how to pay for the expansion without shifting too much cost to the states. “For many members of Congress, as well as for governors and state legislators around the country, Medicaid expansion is even more important than issues like the “public option” or illegal immigrants that have tended to get far more publicity,” the New York Times reports. Sens. Dianne Feinstein (D-CA) and Olympia Snowe (R-ME) have expressed concerns about shifting the costs of the expansion to the states and the Senate Finance Committee has been grappling with the issue.
Today, Senate Finance Committee Chairman Max Baucus (D-MT) hinted that he has worked out a deal in which “the Medicaid costs with expansion are not going to cost states nearly as much as was originally feared.” The Committee is hoping to expand the program to all Americans below 133% of the federal poverty level (FPL) and cover approximately 1/3 of the uninsured:
That’s based on the interaction of lots of other programs too including rebates, drug rebates, which is more expansive, more generous to states compared to current law. I think the changes in the SCHIP program also help states. On that basis, states are going to be pleasantly surprised. There is going to be some additional cost but much less than they originally expected.
So what will the final expansion look like? Below is a table comparing the provisions in the House bill and Baucus’ reform framework:
House Health Bill
Who is eligible?
All children and adults with incomes up to 133% FPL.
Newly eligible Medicaid beneficiaries who don’t have children may enroll in the Exchange if they were insured for six months before becoming eligible for Medicaid.
Parents and children aged 6 and older with incomes up to 133% FPL eligible in traditional Medicaid.
Non-elderly childless adults with incomes below 133% FPL will enroll in a different plan where they will be offered less benefits (the benefit package is equivalent to a Silver-level).
Newly eligible applicants with incomes 100-133% of the FPL may enroll in coverage through the Exchange. (States would be required to continue providing services not covered by plans in the Exchange). Individuals with incomes bellow 100% FPL would not be eligible to receive subsidies in the Exchange.
How Will Medicaid Pay Doctors?
Increases Medicaid payment rates for primary care providers to 100% of Medicare rates by 2012.
No provider provisions.
Who Will Pay For The Expansion?
Coverage expansions and the enhanced provider payments will be fully financed with federal funds through 2014 and 90% federal financing beginning in 2015.
Federal assistance will be provided to help states cover the newly eligible. Details still in negotiation.
What Happens To Children’s Health Insurance Program (CHIP)?
Most CHIP enrollees are required to obtain coverage through the Exchange once it is established. CHIP enrollees will not be enrolled in an exchange plan until the Secretary certifies that coverage is at least comparable to coverage under an average CHIP plan. Stand-alone CHIP programs would provide 12-month continuous eligibility to all enrollees with income below 200% FPL.
Beginning in 2013, CHIP enrollees above 133% FPL would obtain coverage through the Exchange and states would be required to continue to provide services not covered by plans in the Exchange.
Under current law, states are required to cover pregnant women and to children under age 6 from families with income under 133% FPL and children 6-18 from families with income below the poverty line. Only 7 states provide Medicaid coverage for low-income childless adults and only 16 states (plus DC) offer parents coverage at 100 percent of the federal poverty level (FPL). In 43 states, adults without dependent children “are ineligible for Medicaid no matter how low their income.”
As I’ve said before, the argument that there should be a test of immigration status before someone becomes eligible for subsidies to buy health insurance is reasonable clear even if it’s not a sentiment I find particularly compelling. But the idea of adding an immigration status check to letting people buy insurance on a regulated exchange with their own money is genuinely nuts. Andrew Romano points out that this will make health insurance more expensive, not cheaper:
Consider a few statistics. According to a July article in the American Journal of Public Health, immigrants typically arrive in America during their prime working years and tend to be younger and healthier than the rest of the U.S. population. As a result, health-care expenditures for the average immigrant are 55 percent lower than for a native-born American citizen with similar characteristics. With the ratio of seniors to workers projected to increase by 67 percent between 2010 and 2030, it stands to reason that including the relatively healthy, relatively employable and largely uninsured illegal population in some sort of universal health-care system would be a boon rather than a burden. “Insurance in principle has to cover the average medical cost of all the people it’s serving,” explains Leighton Ku, a professor of health policy at George Washington University. “So if you add cheaper people to the pool, like immigrants, you reduce the average cost.” More undocumented workers, in other words, means lower premiums for everyone.
We’re talking about implementing, in essence, a policy based on pure spite that’s not going to accomplish anything to improve citizens’ lives. Meanwhile, folks should attend to Andrea Nill’s point that stringent verification mechanisms tend to mostly wind up excluding legal residents who just have problems with their paperwork. Members of congress ought to consider the reality that voting mostly happens retrospectively. If you’re going to vote yes on a controversial health care package, your best defense is going to be making sure the package works well when implemented. These efforts to deflect immigration-related criticism are undermining the more important need to make the bill work as well as possible for most people.
In one symbolic development, organizers of next year’s Conservative Political Action Conference — the country’s biggest annual meeting of activists on the right — said last week that they had rejected a request to schedule a panel on whether Obama was a native-born U.S. citizen.
“It would fill a room,” said event director Lisa De Pasquale. “But so would a two-headed monkey. There really are so many more important issues, and it’s only a three-day conference.”
CPAC officials said WorldNetDaily’s Farah asked the group to hold the panel.
Last Friday afternoon, Rush Limbaugh slammed Sen. John McCain (R-AZ) for choosing not to lie about undocumented immigrants receiving health care reform benefits. While many Republicans have used Rep. Joe Wilson’s (R-SC) outburst as an opportunity to “drum up a false debate,” McCain resisted his party’s fear mongering instincts when Today Show host Matt Lauer asked him if the reforms that President Obama is proposing will cover undocumented immigrants:
MCCAIN: They do not. Everything that I’ve seen they do not, and it changes the number of uninsured in America down to about 30 million instead of the 47 or so that they talked about before. They do not as far as I can see, nor should they.
Limbaugh decided that McCain’s tepid truth-telling was completely out of line and vehemently attacked him on his show:
LIMBAUGH: McCain said that Obama wasn’t lying? This was on the Today Show today? And they asked McCain if he thought Obama was lying?…That’s why McCain lost. Really no surprise there….You know, he’s just a useful idiot. They bring him in to do exactly what he did, and that has undercut everything that the Republican opponents, conservative opponents of Obama and health care are saying. He just falls right in line with it. But this is why Senator McCain lost.
Limbaugh should rest assured that most Republicans are still lying about Obama lying and even some Democrats have acceded to the GOP’s false claims. McCain might not be concerned about undocumented immigrants receiving free health care, but it’s unlikely that he’ll speak up against the flawed and costly citizenship verification requirements that Sens. Kent Conrad (D-ND) and Max Baucus (D-MT) are suddenly willing to adopt. Even the White House has come out saying that they’d work with Congress to make sure verification requirements are adopted and additionally indicated that undocumented immigrants should be barred from purchasing private insurance at full cost on the proposed public exchange — glazing over the fact that the private insurance market will likely shrink if health care reform passes as is. After all, it’s not like McCain dared to point out that making it more difficult for undocumented immigrants who can even afford insurance from buying it and denying coverage to those who can’t might actually be a bad idea.
Limbaugh also accused McCain of “throw[ing] Sarah Palin under the bus” when he confirmed that the President’s plan doesn’t explicitly create “death panels.”
Today’s Washington Post poll also gets at an issue I’ve been trying to raise relative to the tea party phenomenon. Is it actually the case that there’s some large group of people who are newly outraged by Barack Obama’s conduct in office, or are the people who don’t like Obama today basically just the same people who didn’t like him a year ago. One question the Post asked was: “Would you say Obama is doing a better job as president than you expected, a worse job, or what? Is that much better/worse or somewhat better/worse?”
Basically no tidal wave of disappointment with Obama here. More people claim to be pleasantly surprised by his presidenting than say he’s done worse than they thought. And of course many of the disappointed will be progressives who blame him for not being more effective at pushing progressive policy through.
On Monday morning, [Arlington Superintendent Jerry] McCullough announced that he has changed his mind about allowing students to attend the Super Bowl event, which he said has become a “local and national issue and a distraction for the AISD.”
“I have informed the North Texas Super Bowl XLV host committee that the AISD will not participate in the kickoff event on Sept. 21 in order to maintain our focus on instruction,” McCullough wrote.
I love historical counterfactuals, but I think I’m not buying this one from James Suroweicki:
What if Congress had passed the TARP bill the first time around, instead of voting it down on September 29th? While it’s certainly true that Lehman’s failure provoked a global panic, and in the days immediately after it went under we saw credit markets start to freeze up, stock-market sell-offs, and the like, it’s also true that the news that the U.S. government was working on a toxic-asset bailout plan for the banks actually did stabilize the markets. By Friday, September 26th, for instance, the S&P 500 Index was trading only slightly below where it had been before Lehman went under. At that point, it seemed, investors were reasonably confident that the government’s actions would bring some order to the chaos in the system.
That confidence disappeared, obviously, on September 29th, when the House of Representatives voted down the TARP. The S&P fell nine per cent on the 29th alone, and in the weeks that followed kept plummeting, falling almost twenty-five per cent in the next month, even though Congress did pass the TARP the second time around. In effect, the House’s failure to pass the TARP demolished investors’ confidence that they could rely on the government to act, and massively amplified the sense of panic that Lehman’s failure caused. This doesn’t necessarily mean that voting against the TARP was a bad idea (although I think it was): if you think government bailouts of big financial institutions are a mistake, then this was not a bill you could support. But I think it’s inarguable that the vote against the TARP did make things significantly worse in the markets. And I think it’s plausible that had the bill passed on the 29th, much of the chaos that followed over the next couple of months could have been averted.
I think it’s pretty clear that there’s no good case on the merits for having voted “no” the first time and then “yes” the second time. Nothing was gained by doing the flop, so this alternate reality would be all upside with no downside. Still, I think the basic reality is that there were large real losses. A lot of individuals and a lot of firms were making financial decisions that were predicated on false ideas about the value of real estate assets. When both the extent to which people were mistaken about those real estate prices, and the extent to which broader economic trends were predicated on those ideas became clear, some kind of substantial downturn became essentially inevitable.
I think a better counterfactual concerns the timing of the stimulus. What if ARRA had passed in late September when it became clear that massive stimulus would be necessary, or at a minimum in early November when it became clear that politicians who believed massive stimulus would be necessary would be governing the country by February? Instead, we had the three month transition period during which the economy just deteriorated. Faster stimulus wouldn’t have prevented the recession from happening, but it certainly might have made it shorter and somewhat shallower.
Mr. Obama was right when he said last year that “You don’t muddle through the central front on terror . . . You don’t muddle through stamping out the Taliban.”
Asked about Afghanistan back in Nov. 2003, McCain stressed that Iraq was the more important effort, but that he thought that we would be able to “muddle through”:
MCCAIN: I am concerned about it, but I’m not as concerned as I am about Iraq today — obviously, or I’d be talking about Afghanistan — but I believe that if Karzai can make the progress that he is making, that in the long term we may muddle through in Afghanistan.
None of the three hawkish senators, all of whom shilled relentlessly for the invasion of Iraq, have ever owned up to the now widely-accepted fact that the diversion of troops and resources and attention away from Afghanistan toward Iraq was the critical factor in the resurrection of the Taliban insurgency. Read more at the Wonk Room.