Good job Florida

That is the third Red to Blue flip this year in special elections. The seat in a neutral environment leans Republican but will flip in this environment. This is the type of seat that will determine the majority in November. Democrats need to pick up a double handful of these types of seats assuming that they pick off most Republican-Clinton seats in November.

Given that it was a twelve point swing, this is useful information for November.



Good news

Give a call to your state’s governors and secretaries of state tomorrow morning. For those who refused to share information with this voter suppression commission, thank them. For those that did share your information, give them a piece of your mind.

Open thread



GOTV for Health this weekend

Maine is trying to expand Medicaid. There have been bi-partisan bills that have routinely passed both chambers of the Maine Legislature. Governor LePage (R-ME) has routinely vetoed these bills. That cycle may be broken next week as Maine has a ballot question on whether or not the state will accept Medicaid expansion.

So if you are in Maine or New Hampshire and have some time this weekend, help with the GOTV and help your fellow Mainiacs.



Time to call the Senate again

Orange Alert

Graham-Cassidy would shift money from states that have successfully implemented the ACA to non-expansion states and then ratchet down the block grants.

Time to call the Senate again.

We need to run out the clock to 12:01 October 1, 2017 at which point the healthcare reconciliation instructions expire. Encourage Senate Democrats to submit bills to the CBO for scoring so that they are back-logged and can not rapidly score anything that needs to be scored for reconciliation. Call and encourage the Sanders budget team to go to town with the Parliamentarian. 24 days need to be burned.



An end may be in sight

The dramatic vote at 2:20 AM where all forty eight Democrats and three Republican Senators voted against Skinny Repeal did not kill the bill. It merely killed an amendment in the form of a substitute to the underlying reconciliation compatible repeal measure. Senator Majority Leader McConnell then pulled the vehicle from consideration at that time. He reserved the right to put it back on the calendar.

The big question remained as to when the reconciliation vehicle dies. It will die if it is not passed in the fiscal year for the budget it was created from. That means it is only a viable vehicle until midnight on September 30, 2017. Once must-pass bills are taken care of (CHIP, Harvey, flood insurance, debt limit, FY-18 funding) Democrats must insist on either immediate adjournment until 12:01 AM October 1st or promise to filibuster everything including post office renaming bills to run out the clock.

Once FY-18 begins, the reconciliation instructions need to be written again and it basically forces a choice between tax cuts or the repeal buzz saw for Republicans.



How do you like your blue-eyed boy, Mister Death

This is an amazing ad. Tough to watch, but important in terms of the issues it raises. It’s by Randy Bryce, who is running against Paul Ryan.

I’m trying to stay away from the catnip of raising money for marquee races, but fuck, this guy’s running against Paul Ryan and he’s put together one hell of an ad. I think he deserves some money.

Goal Thermometer



California single payer

California is studying a single payer system. It is doing the homework to make explicit the assumptions that are needed to make the system work. Modern Healthcare has some details:

SB562 would guarantee health coverage with no out-of-pocket costs for all California residents, including people living in the country illegally. The state would contract with hospitals, doctors and other healthcare providers and pay the bills for all residents similar to the way the federal government covers seniors through Medicare.

The measure envisions using all public money spent on healthcare — from Medicare, Medicaid, federal public health funds and “Obamacare” subsidies. That’s enough to cover about half of the $400 billion cost, according to the legislative analysis.

The rest would come from higher taxes on businesses, residents or both. It would take a 15% payroll tax to raise enough money, the analysis said.

Matt Bruenig makes one very good point before I want to look at some details:

After the implementation of single payer, the report says, health expenditures in the state of California would total $400 billion per year, or 15 percent of the state’s GDP. This is 3 percentage points lower than the share of GDP the US overall spends on health care.

I have a couple of questions about the finances.

Does the analysis assume or not assume the AHCA will be passed? If it does not assume the AHCA, there is a potential $10 billion Medicaid annual gap in the financing. More importantly it is assuming some incredibly complex and currently not authorized in law much less by rule making waivers.

What happens when there is a recession? California has a balance budget constraint. Wage and capital gains income taxes tend to be pro-cyclical. They go up in good times and crash in bad times. How is this program financed in bad years?

Finally, we need to look at the distributional fight inherent within universal access programs. Single payer is exceptional for the fifty two year old making $11 an hour with either no benefits or Bronze level benefits. It is not as good of a deal for a twenty nine year old independent contractor making $39,000 a year who has a cheap policy in the individual market. It is a really bad deal for the mid-40s couple making $200,000 with exceptional coverage through work.

The American political system is most responsive to people who have a lot to lose, people who have power and people who can mobilize significant resources. In this case, that is an apt set of descriptors for the mid-40s couple making very good money.

Single payer is hard. California is trying to make explicit the trade-offs needed to get a single payer system off the ground. There are choices to be made with winners and losers from each choice made. And each set of people whose current situation is changed for the worse will scream.

Update 1 And oh yeah, how does this play nicely with ERISA, the controlling law on most employer sponsored benefits including health insurance?