"This is a No-Brainer...It's Just Math"

Tierney Sneed at TPM has written about an interesting report on the costs of Medicaid expansion.

A new Kaiser Family Foundation report released last week suggests that the Republican-controlled non-expansion states are seeing their share of Medicaid costs rise more sharply than expansion states.

Here's the graph that tells the story.

In summary, not only are the non-expansion states covering fewer people, their state's Medicaid spending is rising at a higher rate than the expansion states.

Sneed describes the non-expansion states as "Republican-controlled" for a reason. Just imagine if we were to overlay this map with one showing red and blue states.

According to a report by Wade Goodwyn at NPR, if you want to see a state that is willing to throw money away in order to satisfy a political agenda, you need look no further than the red state of Texas. Not only does that state have the highest rate of uninsured people in the country (25%), refusing Medicaid expansion has some of their business leaders hopping mad.

"It's our money that we are sending to Washington, D.C.," says Bill Hammond, CEO of the Texas Association of Business, which includes many of the state's richest and most powerful business owners. "We are not getting it back," he says. "We pay for it with corporate income tax, we pay for it with our personal income tax and we pay it in the fact that our premiums are higher than they would be if everyone was insured."

Texas has the second-highest health insurance premiums in the country, right behind Florida...

He says if the state expanded Medicaid it would save Texas business billions of dollars a year that could be invested in upgrading equipment, hiring new employees, providing raises and rewarding shareholders.

For every dollar the state would pay into Medicaid expansion, it would earn back $1.30 from the economic activity created, according to an analysis by Ray Perryman. He's an economist who has consulted for the Texas Legislature and six governors. That economic activity would top out at $3 billion in 10 years, creating 300,000 new jobs each year, he says.

One of the reasons health insurance rates in Texas are so high is that, with the implementation of Obamacare, the federal government stopped subsidizing uncompensated care at hospitals...assuming that with Medicaid expansion, that would no longer be necessary. For states like Texas that refused expansion, hospitals are hurting and passing the pain on in higher insurance premiums and property taxes. For example:

Last year it cost Parkland Hospital three quarters of a billion dollars to provide what is called "uncompensated care" — mostly treating patients without health insurance...

Texas has the third-highest property taxes in the country. In Dallas...more than half of property owners' county property tax bill goes to reimburse Parkland Hospital for the uncompensated care it has to provide.

This quote pretty well sums it up how states should be looking at Medicaid expansion:

Totally aside from the health benefits, Perryman says, when you look at the numbers, "You look at them and you say, 'This is a no-brainer. We need to be doing this.' It's really an apolitical situation. It's just math."

One wonders when/if the voters of the great state of Texas (and all the other red states that refused Medicaid expansion) will finally wake up to the fact that their representatives are selling them down the river simply to make a political point.

There are times I think that at some point pragmatism will have to break through on issues like this and finally start to break up the red/blue divide that is so prominent in our politics today. But then I remind myself of the economic costs the South was willing to pay in order to maintain Jim Crow. Much as we often assume that money is God to conservatives, that's not always the case.

An Explanation for Why Trump is Ahead Right Now

After the second Republican debate, I saw something happening among GOP voters that I attempted to define as the difference between Trump supporters and what I called "Goldwater Republicans." Then, along came John Judis with his description of the former as Middle American Radicals (MARS). Ultimately, what this is all about is the difference between blue collar and white collar Republicans. When it comes to actual voters, rather than the candidates or their degree of experience or their connection (or lack thereof) to the establishment, or even their religious affiliation, this is the difference that matters when analyzing the current contest for the Republican presidential nomination.

Apparently Ron Brownstein (with an assist from GOP pollster Glen Bolger) has come to the same conclusion.

The blue-col­lar wing of the Re­pub­lic­an primary elect­or­ate has con­sol­id­ated around one can­did­ate.

The party’s white-col­lar wing re­mains frag­men­ted.

That may be the most con­cise ex­plan­a­tion of the dy­nam­ic that has pro­pelled Don­ald Trump to a con­sist­ent and some­times com­mand­ing lead in the early stages of the GOP pres­id­en­tial nom­in­a­tion con­test.

Here is why that is important.

That dis­par­ity is crit­ic­al be­cause in both the 2008 and 2012 GOP nom­in­a­tion fights, voters with and without a four-year col­lege de­gree each cast al­most ex­actly half of the total primary votes, ac­cord­ing to cu­mu­lat­ive ana­lyses of exit poll res­ults by ABC poll­ster Gary Langer. With the two wings evenly matched in size, Trump’s great­er suc­cess at con­sol­id­at­ing his “brack­et” ex­plains much of his ad­vant­age in the polls.

You might recall that Judis pegged the number of MARS voters at approximately 30-35% of Republican voters and 20% of the electorate.

For those who are either convinced of Trump's eventual demise or think that he can't be beat, here's what it comes down to:

Bol­ger pre­dicts that up­scale and white-col­lar Re­pub­lic­ans will even­tu­ally uni­fy around a single al­tern­at­ive to Trump after the early vot­ing culls the field. “Giv­en how much Trump is dom­in­at­ing the cam­paign, the fact that he does so much worse with col­lege gradu­ates un­der­scores that they are not buy­ing in­to either his mes­sage or per­sona,” Bol­ger said. “That’s not who he is tar­get­ing his mes­sage to.”

But be­cause so many can­did­ates are run­ning com­pet­it­ively with those voters—in­clud­ing Car­son, Fior­ina, Ru­bio, some­times Bush, Kasich, Christie, and Trump him­self—they face the com­mon risk in the race’s early stages that they will splinter the white-col­lar vote so much that they can’t over­come Trump’s blue-col­lar sup­port. If that pat­tern al­lowed Trump to win not only Iowa, which has fre­quently favored con­ser­vat­ives, but es­tab­lish­ment-friendly early states such as New Hamp­shire and South Car­o­lina, a more cent­rist op­pon­ent may find it dif­fi­cult to re­verse his mo­mentum.

In other words, either white collar Republicans coalesce around a Trump alternative soon, or he starts winning primaries and becomes difficult to beat. How's that for pinpointed political prognostication? It might not be terribly definitive. But it just so happens to be spot-on when it comes to the Republican presidential nominating process right now.

Yglesias Gets it Wrong About Which Party is in Trouble

Matt Yglesias has written a column that is sure to ignite a discussion (Ed Kilgore and djw at Lawyers, Guns and Money have already weighed in). His title tells you a lot about where he's going: Democrats are in denial. Their party is actually in deep trouble. Here's the gist of the point he's trying to make.

Yes, Barack Obama is taking a victory lap in his seventh year in office. Yes, Republicans can't find a credible candidate to so much as run for speaker of the House. Yes, the GOP presidential field is led by a megalomaniacal reality TV star. All this is true — but rather than lay the foundation for enduring Democratic success, all it's done is breed a wrongheaded atmosphere of complacence.

The presidency is extremely important, of course. But there are also thousands of critically important offices all the way down the ballot. And the vast majority — 70 percent of state legislatures, more than 60 percent of governors, 55 percent of attorneys general and secretaries of state — are in Republicans hands. And, of course, Republicans control both chambers of Congress.

Yglesias is right to highlight this problem. But in doing so, he hypes it so out of proportion that it becomes hard to take him seriously. For example, to draw the contrast between "complacent" Democrats and the success of Republicans, he actually writes this sentence.

Not only have Republicans won most elections, but they have a perfectly reasonable plan for trying to recapture the White House.

Given that he just mentioned the fact that the GOP's leading candidate to accomplish that task right now is a "megalomaniacal reality TV star," and that none of their establishment candidates seem capable of holding their own against him, it's hard to take that sentence seriously. But later on in the article, Yglesias get's more specific about that "perfectly reasonable plan."

The GOP, by contrast, has basically two perfectly plausible plans for moving its agenda forward. One is to basically change nothing and just hope for slightly better luck from the economic fundamentals or in terms of Democratic Party scandals. The other is to shift left on immigration and gain some Latino votes while retaining the core of the party's commitments. Neither of these plans is exactly brilliant, innovative, or foolproof. But neither one is crazy.

I don't know that it's crazy for a political party to count on an economic downturn or the possibility of finding and hyping a Democratic scandal as their plan for winning the White House. But it's a pretty good indication that their agenda is weak and inept if that's all they've got. And please...wake me up when Republicans decide to shift left on immigration. The entire Trump-mania phenomenon has been based of shifting right on that issue (look no further than Marco Rubio's flip-flop on that one).

While everyone else is noticing that the Republican Party is in chaos right now, Yglesias actually thinks they're doing just great.

Much of the current Republican infighting — embarrassing and counterproductive though it may be at times — reflects the healthy impulse to recognize that the party lacks the full measure of power that it desires, and needs to argue about optimal strategies for obtaining it.

I fail to see how the efforts of the Ted Cruz and Freedom Caucus wing of the Republican Party to stall any attempt to actually implement an agenda since 2014 are a "healthy impulse."  At the beginning of this legislative session Majority Leader McConnell hoped to pass legislation that would force vetos from President Obama and make him look like the obstructionist. The chaos sparked by the Republican insurgents kept that from happening.

Yglesias is right to point out that Democrats have a problem with losing control of Congress as well as too many state legislatures and governor's races. But his analysis of why that has happened and what to do about it is deeply flawed.

First of all, he suggests that they haven't even admitted the problem and are instead focused on the competition in the presidential race between Clinton and Sanders about how far left to go. My response to that is that we are in the midst of a primary and that's what happens during this phase of an election. But here's how Yglesias sees things:

Consequently, the party is marching steadily to the left on its issue positions — embracing same-sex marriage, rediscovering enthusiasm for gun control, rejecting the January 2013 income tax rate settlement as inadequate, raising its minimum wage aspirations to the $12-to-$15 range, abandoning the quest for a grand bargain on balancing the budget while proposing new entitlements for child care and parental leave...

Yes, the Democrats are embracing a platform that has broad-based appeal among voters while the Republicans continue to paint themselves into a more extremist corner. You are going to have to convince me how that is a problem.

While it's true that Democrats have done poorly in the 2010 and 2014 midterms (and there has been no shortage of handwringing in the Party about that), Yglesias does a good job of summarizing why that happened.

1. The natural distribution of population in the United States tends to lead the average House district to be more GOP-friendly than the overall population.

2. GOP control of most state legislatures lets Republicans draw boundaries in a way that is even more GOP-friendly than the natural population distribution would suggest.

3. Incumbents have large advantages in House elections, and most incumbents are Republicans.

4. So-called "wave" elections in which tons of incumbents lose are typically driven by a backlash against the incumbent president. Since the incumbent president is a Democrat, Democrats have no way to set up a wave.

Too few of the people analyzing this issue have acknowledged #4. Our memories sometimes don't take us back far enough to remember that the 2006 midterms during the Bush/Cheney presidency were a bit of a wave in the other direction.

The problem with midterms is that we seem to have come to a place where anger at an incumbent president is the motivating factor for the few who actually turn out to vote. That is not only what happened in terms of control of Congress in '06, '10 and '14, it also has an effect on state elections. That is a problem we should all be concerned about.

But we're not facing a midterm election in 2016. Control of the Senate is in play this time around, but Democrats probably won't win a majority in the House (even though they are likely to pick up House seats as they did in both the 2008 and 2012). Rather than complacency, the Democratic presidential front-runner is offering a platform that not only provides a vision for going forward, she is making a clear distinction between the Democratic agenda and the Republican extremist fear-mongering. The choice for voters going into 2016 cannot be more clear.

If, as so many did in 2014, Democrats shy away from that distinction going into the 2018 midterms, we can raise the specter of complacency and denial.

Why Jeb Bush is in Trouble (updated)

The latest news from team Jeb! is not looking good.

Jeb Bush’s campaign slashed hundreds of thousands of dollars in salaries over the last three months as the struggling candidate's fundraising machine slowed to a more middling pace, new campaign-finance reports indicate.

So what's the deal here? Isn't Jeb the "shock and awe" candidate when it comes to campaign cash? Didn't his superpac pull in the largest stash ($100 million) ever recorded in campaign history? Aren't we living in an oligarchy where the guy with the most cash from the 1% automatically wins?

It's true, Jeb Bush's superpac is the largest war chest ever captured in U.S. presidential history. But as we've discussed before, that money can't be used to pay for the nuts and bolts of his campaign. Hence, if you work for Bush, you're likely getting a pay cut right about now.

When it comes to cash for the actual campaign operation, so far Bush is hauling it in at about the same rate as Rubio and Cruz (all in the $24-$26 million range so far). But I suspect that someone in Jeb's finance team noticed the same thing I did about the huge difference between these campaigns. Of the money raised so far, only 5% of Bush's has come from small donations (under $250). For Rubio that number is 27% and for Cruz it's a whopping 42%.

If my assumption is correct that the majority of the large contributions came in the form of the maximum allowed - $2,700 - Jeb could be in big trouble because his donors have already given as much as they can until after the convention. Hence, all the cutbacks right now. On the other hand, Rubio and Cruz have a larger cadre of supporters/donors who can continue to give money to their campaigns.

That is precisely why one Bush supporter nailed it with this statement:

“We’ve reached one million people [via voter contacts] and we’re in fifth place nationally?” said one Bush supporter who didn’t want to be identified. “I trust the campaign. I just don’t know about the voters. It’s like the more Jeb is out there, the less well he does.”

If, for one, take heart in the fact that no matter how much money a candidate's superpac is sitting on, it's still the voters who get to decide in the end.

UPDATE: Confirming my assumption that Bush raised most of his contributions from people who gave the maximum amount ($2,700), Paul Blumenthal at HuffPost provides this chart (based on July - September contributions).

This chart also suggests that Christie (and perhaps Kasich) might run into the same problem.

Elizabeth Warren: Glass-Steagall as Symbol

Wow, I'm not sure how I missed this one. Back in 2012, Andrew Ross Sorkin wrote a column about how Glass-Steagall wouldn't have affected the 2008 financial crisis which led to the Great Recession. As part of that, he had a phone conversation with Elizabeth Warren on the topic. Here is what she said at the time:

In my conversation with Ms. Warren she told me that one of the reasons she’s been pushing reinstating Glass-Steagall — even if it wouldn’t have prevented the financial crisis — is that it is an easy issue for the public to understand and “you can build public attention behind.”

She added that she considers Glass-Steagall more of a symbol of what needs to happen to regulations than the specifics related to the act itself.

And yet, here she is in July 2015 introducing the 21st Century Glass-Steagall Act on the Senate floor using all the scary things that happened during the financial crisis as a backdrop.


We also know that reinstating Glass-Steagall is one of the five things she prioritized for Wall Street reform. One has to wonder if anything else on that list is "more of a symbol."

But perhaps most importantly, during the Democratic debate, both Sanders and O'Malley jumped all over Hillary Clinton for not including the reinstatement of Glass-Steagall as part of her own proposal for Wall Street reform. That's what happens when the patron-saint of "populist anger" toys with the public by using symbols to ratchet up an emotional reaction.

The basis for much of Elizabeth Warren's appeal has always been that she is both smart and sincere. This is the kind of thing that calls one or both of those things into question.

Obama as the Quintessential Anti-Trump

How can I fail to respond when my favorite pearl-clutcher-in-chief comments on the reason for the rise of Donald Trump? I give you Peggy Noonan at her best:

The only thing I feel certain of is how we got here. There are many reasons we’re at this moment, but the essential political one is this: Mr. Obama lowered the bar. He was a literal unknown, an obscure former state legislator who hadn’t completed his single term as U.S. senator, but he was charismatic, canny, compelling. He came from nowhere and won it all twice. All previously prevailing standards, all usual expectations, were thrown out the window.

Anyone can run for president now, and in the future anyone will.

Steve Benen suggests that this might be the ultimate "Thanks, Obama" meme. But, as I often do, I get a kick out of his way of using understatement as a kind of delicious irony.

Noonan complains, “Anyone can run for president now.” Well, yes, and anyone could run for president before. President Obama has had an enormous impact on the nation’s direction, but eligibility standards for the White House remain unaffected.

I just have to add that, for this writer, Barack Obama as presidential candidate was the quintessential anti-Trump. The opposite of "the Donald's" pattern of labeling anyone who disagrees with him a "looser" or "stupid," was this:


And when it comes to Trump's message based on fear mongering about what it is that makes America great, that Obama guy inspired us with something pretty different.


If Republicans had ever bothered to learn something from the power of messages like that, we'd be in a very different place today.

The Real Effect of Citizens United on the GOP (updated)

Regular readers might have already figured out that I am extremely skeptical of the conventional wisdom that is currently embraced by many people about the effects of the Supreme Court's decision on Citizens United. It has certainly changed things. But not always in the way we've been led to believe. Here are some of the things I'm paying attention to in terms of how it's impacting the 2016 presidential race.

Insurgent Candidates

What we saw happen in the 2012 Republican presidential primary is that several insurgent candidates were able to hang on longer than they would have otherwise because of funding from their big superpac donors (i.e., Newt Gingrich). This is at least one of the reasons why 17 candidates threw their hat in the ring this time around.

A Weakened RNC

RNC Chair Reince Priebus has tried his best to reign in the extremism currently gripping the Republican Party. But because candidates no longer need the Party establishment to survive (see above), he's pretty much been neutered. The Koch brothers are even threatening to set up their own "shadow party" when it comes to some of the functions normally carried out by the RNC.

SuperPacs Can't Replace Hard Money

While donors can make unlimited contributions to superpacs, they are limited to $2,700 for a candidate's campaign. As we saw with Scott Walker when he dropped out of the race, his superpac still had approximately $20 million in the bank. But he wasn't raising much of anything when it comes to the hard money candidates need from donors to operate their basic campaign functions.

We're now hearing some of the same issues with Jeb Bush's campaign - even though his superpacs are likely sitting on something like $100 million. Jeb might be running into the same problem Hillary Clinton faced in her primary against Barack Obama. Once a donor has given the limit to the campaign, they can't give again until after the convention (when they can give another $2,700). Based on the latest fundraising report, Jeb is only getting 5% of his campaign cash from small donations. So I suspect that a lot of his supporters have already maxed out. If he can't widen his donor base, he'll continue to be in trouble.

What Can All That Superpac Money Buy?

The traditional view is that superpacs are all about buying expensive air time for TV ads. But we're seeing more and more reports indicating that those ads aren't making any difference. And yet, Republicans continue to invest...big time.

The question becomes, if not TV ads, what do you do with all that superpac money? Some candidates, like Carly Fiorina, are experimenting with "creative" ways to get around the laws about campaigns not coordinating with superpacs. I'll be watching to see, not only how far Republicans are willing to push those limits, but how successful the strategies will be.

Overall, it's beginning to look like Citizens United has had a pretty de-stabilizing impact on the Republican Party. There are plenty of places to point when looking for the source of the chaos they're currently experiencing. But I think we miss a big one if we don't consider the impact of this Supreme Court decision that everyone assumed would simply be a windfall for them.

UPDATE: It's interesting to note that Rachel Maddow is one of the few people in the media who are just beginning to ask some of these questions.