Kynecting the elections to policy

And now that officially sucks.

Tue Nov 03, 2015 at 5:22 PM PT (David Jarman): To recap, Republican Matt Bevin (whom you might remember from losing his tea-flavored primary challenge to Mitch McConnell in 2014) has won a surprising (to the extent that no poll had given him the lead) victory in Kentucky’s gubernatorial race.

Bevin (R-Sociopath) had run on a promise to repeal as much of PPACA as he could.  That means shutting down Kynect, the Kentucky exchange and turning down the very successful Medicaid expansion.  As Charles Gaba noted, he was promising to take away health insurance from 9% of the state.  And he looks like he won going away and with coattails.

There are two major health policy implications of a Bevins win.  The first is the switch from Kynect to Healthcare.gov.  This is not that big of a deal in and of itself.  It is a different portal and a different set of branding but subsidies flow to people who buy insurance from healthcare.gov after the King case.  The biggest downside is if Kentucky wanted to go the Wyden Waiver route, having their own exchange makes plumbing a Wyden Waiver, even a very conservative Wyden Waiver a whole lot easier.

The big policy change is Medicaid expansion.  Medicaid expansion covered approximately 420,000 Kentuckians as of this morning or 9% of the state. Bevin ran against expansion.  The best case scenario is the hospital groups march into  Bevin’s chief of staff office tomorrow and tell him flat out that their books don’t balance without expansion of some sort and they’ll lay covering fire for an extremely punitive waiver application.  That is the best case scenario and I’ll give it a 10% chance of happening.  The probable case scenario is 420,000 people are fucked as of February 1, 2016 and most of Appalachian Kentucky has medical care and medical financing resembling Third Wold nations again.

Kentucky, a red state, is highly likely to return to being a purple state on the New York TimeUpshot map of uninsurance rates:

NYTIMES Uninsurance Rate

It was a good two years of actually connecting people to health insurance without the death defying worry that a toothache could either be immediately fatal or financially destroying.

 



Open Thread: Another One Bites the Dust

Per Politico:

Harvard University professor Lawrence Lessig abandoned his Democratic presidential run on Monday, capping a candidacy that failed to get any real traction at all.

Lessig, an outspoken academic who had been a vocal proponent of campaign finance reform, said he was dropping his bid for the White House in a YouTube video.

The Harvard academic didn’t raise a notable amount of money and failed even to get into the Democratic presidential debates. He acknowledged as much in his announcement…

I watched the video. Unless you enjoy whiny self-justification, or need a sleep aid, I wouldn’t bother.

Professor Lessig has chosen a most worthy and important issue, and if he’d had the smarts to aim his doomed candidacy at the Republican party — which even he acknowledges is the source of the big-money rot and its greatest enabler by a huge factor — I’d have had more sympathy for the man. As it is, he’s just the Goo-Goo cherry on our Second Gilded Age’s shit sundae, a high-minded bludgeon aimed at exactly the wrong target.



Obamacare a failure or Obamacare a success

Conservative healthcare connector and wonk Robert Laszewski on the failure of Obamacare:

On Thursday, the Obama administration said they expect to have 10 million people enrolled on the Obamacare insurance exchanges in 2016. They further said they expect to sign-up only one in four of those still uninsured and eligible during the 2016 open enrollment scheduled to begin on November 1.

These are astonishing admissions.

In 2013 the Congressional Budget Office (CBO) estimated that the Obamacare insurance exchanges would enroll an average of 22 million people during 2016.

Given the original expectations how can we now not say this program is a terrible failure?

Note how he elides Medicaid expansion as a means of coverage and collapses all of PPACA to the Exchanges. This rhetorical trick is a kissing cousin of the discussion about total tax burden by income decile collapsing into a discussion of top marginal federal income tax rates by income decile.

Kevin Drum on the success of Obamacare:

 In 2010, just after Obamacare passed, CBO estimated that the uninsured rate would hit 8 percent by 2016. This was based on the original law, but in 2012 the Supreme Court made Medicaid expansion voluntary and most red states opted out. In July CBO updated its projections to account for this, increasing its estimate of uninsured by three percentage points. The next CBO estimate thus projected that the uninsured rate would be 11 percent by 2016. So how does that compare to reality? In its most recent survey, the CDC estimates that in the first quarter of 2015 the actual number of uninsured clocked in at 10.7 percent, and that’s likely to decline to about 10 percent or so by the end of 2016.

In other words, once you clear away all the underbrush it looks like Obamacare is meeting or beating its goals.

The overall objective of PPACA is to reduce the uninsurance rate while at least reducing if not eliminating medical cost growth over the general rate of economic growth in the country.

The Exchanges are seeing less people because a lot more people are still on Employer Sponsored Coverage (ESI).  The CBO originally projected that quite a few employers would eat the employee mandate penalty and dump ESI coverage to send their employees onto the Exchanges.  That has not happened.  PPACA is less disruptive than originally projected while still meeting or slightly beating its goals.

 

 

 



The soft bigotry of no expectations

(Trigger Warning: Politico link)

Bush can tweak his message on a day to day basis, cut costs around the margins and even reduce or reallocate staff. But he remains committed to the large campaign infrastructure he has built to run a national campaign, staff members say. What’s changed is the desire to avoid any appearance of extravagence…..the campaign’s early state organizations do surpass those of most rivals, Bush’s other major investments — in paid advertising and a policy shop that’s churning out his speeches — have yet to pay real dividends….

Bush is also pitching serious policy proposals. He has close to 10 staffers working in his campaign’s policy shop

The “wonky”, “serious”, “smart” “technocratic” Republican campaign is making “major” investments in his policy shop. That major investment is under 10 full time employees. I am betting it is eight or nine people including the 23 year old making $23,000 to buy binders, collate TPS reports and fetch coffee. It costs the Bush campaign under $1 million a quarter (my bet is under $300K/quarter) or the price of a mid-level fundraising manager.

Truly the soft bigotry of no expectations of policy competence is at play here.



Destructive but not purely crazy

Via Lawyers, Guns, and Money:

The House Freedom Caucus seems nice:

Yesterday, Politico published the House Freedom Caucus “questionnaire” which it described as pushing for “House rule changes.” The document does do that. But it also does a lot more. It seeks substantive commitments from the next speaker that would effectively send the entire country into a tailspin…..

The government will run out of money on December 11. Unless additional funding is approved before that date, the government will shut down.

The House Freedom Caucus wants the next speaker to commit to not funding the government at all unless President Obama (and Senate Democrats) agree to defund Obamacare, Planned Parenthood and a host of other priorities. This is essentially the Ted Cruz strategy whichprompted at 16-day shutdown in 2013. This would now be enshrined as the official policy of the Speaker Of The House.

The House Freedom Caucus wants the next speaker to commit to oppose any “omnibus” bill that would keep the government running. Rather, funding for each aspect of government could only be approved by separate bills. This would allow the Republicans to attempt to finance certain favored aspects of government (the military), while shuttering ones they view as largely unnecessary (education, health)

Just as a reminder, the House Freedumb Caucus is roughly 40 Congress critters who hold the balance of power as long as the rest of the House Republicans believe that maintaining in-group norm of only passing major legislation with only Republican votes is worthwhile. They are the power bottoms of the House GOP caucus.

But they are not intrinsically crazy if the goal of the Freedumb Caucus is to both protect their own ass and make it less likely for a Democrat to be elected to the White House in 2016. Extraordinarily destructive and cynical, yes, but they are not completely crazy.

The first goal of assuring their own re-election for most of the HFC is achieved if they can get out of the Republican primary.  Right now the Republican primary electorate is extremely pissed at the “Establishment” Republicans as those Republicans have overpromised and under-delivered (ie they could not repeal Obamacare nor impeach Obama for making them think that he would take away all of their guns due to the Democrats controlling some veto points against maximalist Republican goals).  Being a Republican who the Establishment (2nd DW dimension positive) hates is a good thing in the Republican primary in R+5 or redder districts.  The few HFC in D+0 or bluer districts can only win in waves or due to local idiosyncratic circumstances.  They’re irrelevant as long as the rest of the HFC controls the 218th vote.

This is fairly straightforward playing to the base.

Now the second contention that I’ll make that the HFC demands for a shutdown or default or far more likely large contractionary policies increases the odds of a Republican being elected is pure political science cynicism.

Read more



Morning Open Thread

There’s a Super Moon and a lunar eclipse tonight. It should make for pretty skywatching.  You can find details HERE.

I went to Salt Lake Comic Con on Friday and Saturday.  A good time was had by all.  Here in SLC, the Comic Con ran Thursday-Saturday.  There’s not a lot going on Sundays here.  I think I’ll drive up in the mountains later and look at the leaves changing.

My new job is going well for the most part. It’s a small facility, but I also support entomologists and naturalists deployed to various places around Utah, southern Idaho, western Colorado, and eastern Nevada, so I’m driving a lot.

I saw a thing on CNN this morning about Boehner’s retirement from Congress.  All the talking heads were going on about how it’s a sure sign of “the dysfunction in Washington.”  They were wrong, of course.  It’s a sign of the dysfunction in the Republican party.  The Democrats are doing just fine, thank you very much.  But our media is so cowed by the right wing, and in many instances controlled by them, that there has to be some way the Democrats are at fault.  It’s been like this for most of my life, and I don’t expect it to change anytime soon.

Dana Milbank at the WaPo has an editorial up about Carly Fiorina, the Flavor of the Week.  The media is never better at self reflection than when they’re sniping at each other.

Also, Berkley Brethed has hit upon one of the signal issues of our time.

GO Broncos!  Beat the Lions!

 



In Which David Brooks Sets The World Record For Long Jump Over A Shark*

David Brooks is an embarrassment — not news, I know.  But while he’s always been glib, his intellectual sloth has only deepened as over and over again, reality has refused to accord his views the respect he believes they deserve.

Case in point:  today’s column, titled “The Anti-Party Men: Trump, Carson, Sanders and Corbyn”.

The entire thing is a dog’s breakfast — centered on a cynically ahistorical description of political parties, an argument that, in effect, the Republican Party’s inability to rein in its crazies is caused by a rise in “assertive individualism.” That, of course, blissfully omits all that uncomfortable record of explicit radicalization built into the fabric of Nixon’s southern strategy and its sequels.

But that’s Brooks’ problem:  he aims to dismiss Trump, and to a lesser extent Carson, as betrayers of an imagined American ideal, and he doesn’t want to confront what their current success says about the Republican Party as a whole.  So, enter Bernie Sanders.

The problem Brooks has there is that Sanders is not the same type of candidate as the GOP’s id-sters: he’s running a conventional Democratic campaign, drawing on a conventional subset of the Democratic base, and he’s advancing ideas that are, for the most part, absolutely within the Democratic party mainstream.  Brooks entire anti-party indictment of Sanders is that he is an independent who merely caucuses with the Democrats.

That’s weak tea, which Brooks seems to sense, which may account for this, the straw of nonsense that breaks this column’s back:

These four anti-party men have little experience in the profession of governing.

These sudden stars are not really about governing. They are tools for their supporters’ self-expression. They allow supporters to make a statement, demand respect or express anger or resentment. Sarah Palin was a pioneer in seeing politics not as a path to governance but as an expression of her followers’ id.

Let’s review:  Carson and Trump:  no experience in any elected office.

Sanders:  four terms (eight years) as mayor of Burlington, VT.  Member of the United States House of Representatives for sixteen years.  Currently a second term United States Senator with almost nine years on the job.  Among other roles, he serves now as the ranking member of the Budget Committee — one of the big three committees that have jurisdiction over taxes, appropriations and budget policy.**  The ranking member, of course, is the senior member of the minority party on a given panel, which is to say that Bernie Sanders is currently serving as the Democratic party’s lead force on the committee that articulates the large scale policy structure of federal spending.

But David Brooks has said that Bernie Sanders has little experience in the profession of governing, and Brooks is wants to appear to be an honorable man.

Brutus_and_the_Ghost_of_Caesar_1802

Seriously:  Sanders has managed departments that plow snow and fill potholes; he’s handled constituent services for the state of Vermont for more than two decades.  He’s caucused with Democrats and carries a full portfolio of the bread-and-butter of legislative work, the committee duties where so much of the legislative process really happens.  Whatever you think about his politics, his self-identification, his campaign, one thing is simply a fact:  Bernie Sanders has spent most of his adult life immersed in the daily practice of governing.  (And his supporters, pace Our David, include among their number those who are less interested in self-expression than in Sanders’ emphasis on the need to reform the US economy.)

Put it another way:  Sanders has a deep history of explicit policy experience behind him, a set of views and arguments that inform an extensive body of proposals in his presidential campaign.  Trump and Carson?  Not so much.***

Which is to say:  Brooks is not just wrong here, he’s guilty of one of two sins here:  either he’s utterly, contemptuously, slothfully ignorant, or he knows Sanders’ record, and he’s chosen to hide that knowledge from his readers.

I could go on (you know I could) — but there’s no point.  When a piece of work is based on a false premise, that’s pretty much it.  An interesting question would be why the challenges to perceived front-runners in our two parties are so different in kind and quality.  But actually engaging that mystery (not!) would require explicit acknowledgement that the Democrats remain the kind of civic institution, a coalition across a range of interests, backgrounds and views that Brooks extols, while the Republican party, increasingly, does not.  And if the two parties are not the same, what’s a faux-centrist water carrier for the GOP elite to do?

I gotta confess to an journeyman’s complaint here.  I disdain Brooks’ argument and the view he’s attempting to advance, but there’s nothing new (or terribly wrong) in that — what’s political writing for if not to dispute public life?  What really gets me here is the sheer contempt the basic craft, the job of any writer making a case.  Brooks’ attempt to lump Sanders into a category in which he manifestly does not belong is purely lazy.

And obvious!

And unnecessary!

Brooks could have written the entire column on Trump and Carson as case studies in the rise of iconoclasm in politics and the piece would have read fine. He wouldn’t perhaps, have been able to write the same jeremiad about “solipsistic bubbles”**** in which his adopted countrymen choose to ignore the reasoned advise of the wise men Brooks has chosen for them.  Too high a price, I suppose.

*An homage to my grandfather Tom, as it happens, who once held the world record for long jump on horse. Truly. An insight into his horsemanship — and perhaps his post-dinner judgment — can be found here.  Also — title updated as of 3:44 EDT to reflect what I actually meant to call the damn thing.

**It’s the weakest of the three committees involved in managing the federal budget; Appropriations and Finance have more direct power.  But Budget is where the large scale policy agenda for federal spending gets its day.

***You could make the case that Carson has lots of positions, and you’d be more or less right.  That said, a slogan and a paragraph do not a policy position make.

****That the phrase better describes the media village in which Brooks resides than it does most of America is a case of projection we can pass over in silence.

Image: Edward Scriven, engraving from an original by Richard Westall, “Brutus and the Ghost of Caesar,” 1802.