Showing posts with label Medicaid. Show all posts
Showing posts with label Medicaid. Show all posts

Thursday, July 27, 2017

Parallels between 2010 and Todays Healthcare Debate


All of the hoopla over the Russia investigation may be providing a needed temporary distraction from Mitch McConnell's efforts to ram through the repeal and possible replacement of the Affordable Care Act (aka ACA or Obamacare).  John McCain's speech on the Senate floor provided some added drama for the vote to simply allow debate on the bill to move forward.  In their zeal to get something passed how much are they thinking about their impact on ordinary folks?

Looking back on the struggles to get the ACA passed in 2009-2010 we see some parallels to today's debate.  The Democrats had a super majority of 60 votes in the Senate but with the threat of a filibuster, could not afford any defections to pass a bill.  No Republicans supported the ACA (including Susan Collins).  One of the largest sticking points back the was the public option.  The two holdouts for passing the law were Senators Ben Nelson and Joe Lieberman.  They opposed the public option.  There were other disagreements over whether abortion and other procedures would be covered.

This time around the Republicans have a bare majority in the Senate and can afford at least one defection from support for the law to prevent it from passing.  Susan Collins and Lisa Murkowski were the lone holdouts on the vote to have a debate on the bill (both voted against the ACA in 2010).  However there are several potential holdouts for the final vote.  One glaring difference between the two situations is this time the GOP is voting on the bill under budget reconciliation which cannot be filibustered.  Seven years ago the Democrats could have voted on the ACA with a public option under reconciliation but chose not to.  



Adding to the drama over the laws passage was sen. Ted Kennedy's brain cancer.  He did not live to see the vote.  His replacement, Martha Coakley lost the special election to former cosmopolitan model republican Scott Brown.  McCain will stay on with brain cancer to avoid the risk of losing his seat before the final vote which is expected soon but it's a race against time just as it is a race against time for us.

Seven years ago the GOP hammered Nancy Pelosi for saying "we have to pass the bill to find out what's in it."  Now few people really know what's in the GOP bill.  Bills always get rewritten and amended right before they come up for a vote.

**Update**


Last night provided drama and ooohs and aaahs from the Senate Gallery with Sens. Collins, McCain and Murkowski voting no on the last ditch effort to repeal and replace the ACA thus killing the effort at least for now. While Barack Obama and Nancy Pelosi are enjoyng this debacle, Single Payer advocates can learn thins from both instances.  These instances provide insights into how difficult it is to pass meaningful legislation in today's political climate even ones as flawed as these measures are.  Our founding fathers did not want a king but they were equally afraid of rule by the mob.

   **Related Posts**

As The ACA (Obamacare) Replacement Fails, the ACA and Single Payer are More Popular than Ever


Wednesday, November 18, 2015

Post Paris Politics, Fear of Refugees, and Medicaid

The horrific attacks in Paris have sent a wave of fear around the world.  As of this writing, 28 governors in the US have said that they will not accept refugees from the civil war in Syria for fear that ISIS members will sneak into their states.  26 of these 28 governors (84%) are Republican.  10 out of the 18 Democratic governors (55%) have said that they will accept these refugees.  This difference is significant according to Fisher's exact test (p < 0.001).  The full numbers are displayed in the table below and the political affiliation of each states' governor is displayed below that.



Accepting Syrian 
Refugees     
Governor Political Party (% of Party)
D
I
R
Total
  no        
2 (11%)
0
26 (84%)
28
  undecided    
6 (33%)
1 (100%)
5 (16%)
12
  yes      
10 (55%)
0
0
10
Total
18
1
31
50

I have written extensively about which states have been willing to expand medicaid under the Affordable Care Act.  Below is a current map of the states expanding Medicaid.  Currently none of the 17 states which are refusing or considering to expand medicaid are accepting refugees. 10 states (all with Democratic governors) which are implementing some form of Medicaid expansion. are accepting refugees.  This difference is not as sharp as that for states with Republican Governors (p=0.003).

Accepting Syrian Refugees     
Expanding Medicaid (% of Column)
considering
no
yes
Total
  no        
1 (20%)
14 (82%)
13 (46%)
28
  undecided    
4 (80%)
3 (18%)
5 (18%)
12
  yes      
0
0
10 (36%)
10
Total
5
17
28
50
 

  Where the States Stand
Via: The Advisory Board Company

The relationship between the party affiliation of governors and medicaid expansion is similar to that of accepting refugees and medicaid expansion (p=0.004).  16 out of 31 republican governors (52%) are either expanding or considering to expand Medicaid.  It could be that the party that controls the governor's mansion changed in the last election in states that are expanding.  Kentucky just elected a new republican governor who is promising to reverse expansion but other republican governors such as Chris Christie (NJ) and John Kasich (Oh) have implemented expansion and have not suffered adverse political consequences (but may have in their Presidential Campaigns). 



Political Party of Governor     
Expanding Medicaid (% of Column)
considering
no
yes
Total
  D
1 (20%)
2 (12%)
15 (54%)
18
  I   
1 (20%)
0
0
1
  R      
3 (60%)
15 (88%)
13 (46%)
31
Total
5
17
28
50


This analysis shows that there is high probability of a partisan component to the governors not wanting Syrian refugees in their state.  This shift in medicaid expansion among republican governors could similarly happen with the right public pressure for the Syrian refugees (even Jeb Bush who is advocating that only Syrian Christians be allowed in the US)Below is a discussion of the the true nature of the refugees from Syria.

**Related Posts**



The Affordable Care Act Having an Impact in Some States but not Pennsylvania

Immigration: An International Issue

 

The World Wars and Today's Wars