Phony federalism: On health care, GOP leaves dirty work to states

Republican congressional leaders have offered health insurance solutions based on phony federalism.

In Maine, Gov. LePage and Sen. Collins provide sharply different views about this way of dealing with health insurance.

The GOP congressional ploy would shift some tough decision to the states. That might look like an effort to enhance the role of states, but it just sheds congressional responsibility, when compromise is impossible. Or it allows special sweeteners for select states.

Members of Congress can say, “I did not vote for that measure, but left it to the states to decide.” Each member could then claim to have supported or opposed the new law, as it suited them.

This supposedly appealing boost to federalism has been used by the Republicans on several issues. Now, with complete control of Congress, they should be able to pass any bill that can avoid the Senate filibuster.

But the health care debate has cost the GOP critically needed votes from both the most conservative and moderate members. The state option is meant as a solution for both sides.

With only a handful of states under solid Democratic control, Republicans leaders might conclude they can repeal the Affordable Care Act and pursue other conservative policies through state action.

The Supreme Court ruled that states cannot be required to accept Medicaid expansion to cover more people, but they could do so voluntarily. Somewhat surprisingly, 31 states and D.C. opted in, while 19 did not take the option.

Among the 30 states that voted for Donald Trump in 2016, 13 have opted in and another seems to be on the way. Thanks to federal government financial support, those states have placed expanding of the number of people with health insurance ahead of partisan politics.

Only two states that voted for Hillary Clinton have refused the option. One is Virginia, where the state government is divided between the two parties.

Maine is the other, having failed to opt to expand Medicaid coverage, as Gov. LePage’s allegiance to GOP conservatism with his party’s legislative support, overrode extending health care access in the state. Voters will vote in November whether to override the governor by adopting a citizen initiative to accept expanded coverage.

Based on the Medicaid experience thus far, the GOP leave-it-to-states approach may not work well. Only if appearances, not substance, are what matter to members of Congress, would this ploy be useful.

One result of the Republican scheme is to enhance the role of many governors in the federal legislative process. In the past, senators and House members infrequently consulted governors.

Now, in states that voted Republican in 2016 but opted for expanded Medicaid, governors are making clear they want no ACA retreat, as has been part of every GOP health reform alternative. Governors won’t strip people of coverage they only recently obtained.

That leaves congressional Republicans caught between the demands of national party policy opposing Obamacare, and the demands of their own states as voiced by their governors. Being opposed by Trump when running for reelection next year may seem preferable to being opposed by the governor.

Though LePage has blocked expansion, Sen. Collins courageously opposes slashing Medicaid nationally and has never supported outright ACA repeal.

The split between GOP governors and Republican congressional leaders may influence the 2020 presidential election, assuming Trump is not assured of the nomination. Because most senators are under pressure to stick with the party line on health care and other issues, their ability to influence the debate is limited.

A hopeful like Florida’s Marco Rubio has little room for maneuver. Like many other congressional Republicans, he must vote for reform proposals that are more like repeal to keep faith with electoral promises made by his party.

By contrast, Ohio’s GOP Gov. John Kasich, whose state opted for expanded Medicaid, is free to come up with his own ACA reform proposal. He has offered his ideas as the basis for negotiations on a compromise, favored by many voters. He shows his independence, and his visibility is enhanced.

Two key points emerge from this attempt to use federalism for purely partisan reasons.

First, Congress cannot effectively dodge its own responsibility to adopt legislation of national scope. States cannot be relied upon to be partners in party policies when they run counter to state interests.

Second, states can experiment with policies before they are adopted nationally. But that means if Washington supports any state option, it should support all options from single payer to subsidized private insurance, not only those choices that are barely disguised repeal.

Media in crossfire: Fact checking vs. fake news

The U.S. is deeply divided about public policy and society’s values. The media, the supposedly neutral chronicler of events, is caught in the crossfire and losing public support.

In a rapidly changing news world, many people believe that newspapers and electronic media are biased. They have doubts if there is any reliable source.

Politicians view the media with discomfort and even hostility. As has always been true, some of them object to the scrutiny of an independent media, failing to understand its essential role in a functioning democracy.

Gov. LePage openly wishes for the demise of newspapers. President Trump labels any report that displeases him as “fake news” and uses Twitter to circumvent the media.

Trump is a denizen of the electronic media world. He openly says he intends to go around the traditional media by his use of tweets. His approach inevitably stimulates his opposition to resort to the same strategy.

The media is supposed to represent the voice of the people in the political process. But something has happened to that voice. The people themselves trust it less. At either end of the political spectrum, partisans believe only sources whose bias corresponds with theirs.

Newspapers, once dominant, and the three television networks had a financial incentive to be neutral. That way they could attract and retain the widest audience. But cable and the Internet greatly expanded access to news sources and opinion.

Unlike traditional media, where an editor could require evidence to back up reports, blogs and social media publish unproven assertions as if they were fact. Readers and viewers have no way of being sure of accuracy, contributing to the falling confidence in the media.

Reliable, objective reporting is harder to find. Much of the media resorts to relaying two sides of an issue and lets that serve as objectivity. Relatively little reporting independently seeks evidence to examine partisan assertions.

The result is that much news is really opinion, not fact-based. Opinion articles, which should be supported by facts, can be untethered to reality while asserting its author’s beliefs as if they were fact.

Even more of a problem is the intentional statement of facts as news when the author knows it is false but uses it to support a viewpoint or political position. The Data and Society Research Institute has recently published a report detailing how this is done and by whom.

Take a conservative column about Trump’s Warsaw speech that you may have read. The president defended the West and hailed it as a notable civilization worth saving. The author, a blogger, said Trump’s words were cheered, “while American leftists writhed in torment before their heads exploded.”

The mainstream media had barely covered the content of his speech. If there was a “leftist” reaction, it was in the same social media world in which the author lives. In that world, such extravagant language promotes division. Because millions participate, it creates a problem for the more responsible media.

Daily newspapers have a news cycle with deadlines. For cable and the electronic media, there’s no cycle and a strong desire to scoop the opposition by getting a story out first. Events are subject to exhaustive interpretation before they happen, when the consumer could know the truth by simply waiting a couple of hours.

The goal is to commandeer the media by the scoop and posting attention-grabbing headlines, even if they are knowingly false. That’s fake news, but successful clickbait. It matters little if this “news” can later be proven wrong; the initial report leaves a lasting impression.

Is the traditional media, trying to report objectively, doomed to disappear under a wave of opinion-based news? Not necessarily.

London’s Financial Times columnist Gillian Tett finds that her paper plus the New York Times, the Washington Post and the Wall Street Journal are all holding their own or gaining. These newspapers have experienced staffs that can seek the truth and provide “real news.”

The model for journalism should not be a balance between conservative Fox News and liberal MSNBC. Few people have the time to watch them both, so they choose to get their news and comment in line with their own bias.

Fact checking, a growing form of journalism, is a better answer. Reporters search out facts to validate or reject major public claims. This approach is growing. More than 190 fact checkers from 54 countries met earlier this month and adopted a code of principles.

Facts, consistently pursued, may be ignored or ridiculed by partisans, but they are the best answer to fake news.

Trump: West's survival threatened by radical Islam, Russia, paperwork

“The fundamental question of our time is whether the West has the will to survive.”

Those were the weighty words of President Trump when he spoke to an enthusiastic crowd in Poland. Though they sound more like the work of his speechwriters than of the tweeter-in-chief, they were both momentous and generally ignored by the media in the flood of news about the G-20 summit.

Trump did more than wring his hands about the future of the West. He outlined the three causes of concern about the fate of North America and Europe, facing threats from “the East” and “the South.”

It’s not surprising that the first threat came from “radical Islamic terrorism.” He warned about the confrontation with an “oppressive ideology – one that seeks to export terrorism and extremism all around the globe.”

This issue gave him the opportunity both to exhort the Arab leaders to whom he had spoken in Saudi Arabia “to drive out this menace” and to justify his policy of limiting immigration or expelling those who don’t “share our values and love our people.”

While he made a widely agreed point about terrorism, he ignored the conflict among the Arab countries that emerged right after the Saudi Arabia meeting in which the U.S. has taken sides, undermining the very leadership role he had recalled.

And his love-me-or-leave-me policy is a standard never employed by the government, because it’s impossible to apply.

His second threat to the West comes from powers that use “new forms of aggression,” including “cyberwarfare.” This concern might apply to China, but because Trump was speaking in Poland, it seemed obvious he was talking about Russia, that country’s neighbor.

In his next breath, he named Russia for its action in seizing territory in the Ukraine and its support for Syria and Iran. He invited Russia to join the West to “fight against common enemies and in defense of civilization itself,” implying that Russia was outside the West, but could change sides.

The President had difficulty sustaining this stern attitude toward the Russians. Denying the findings of all American security agencies, he wondered aloud if Russia had been the only country trying to undermine the 2016 election. He met Russian President Putin and left the impression he had accepted Putin’s denial of responsibility.

Compared to these major world challenges, his third threat to the West seems almost trivial and not nearly as serious. He warned against “the steady creep of government bureaucracy that drains the vitality and wealth of the people.” This threat to the West comes from “paperwork and regulations.”

Dealing with this challenge is “firmly within our control.” If government successfully declares war on rules, that will represent a major contribution to the survival of the West.

In this confrontation, Trump has been causing executive agencies to withdraw rules and to refrain from adopting new ones. There’s no need to amend laws you oppose, if the agencies tasked with carrying out those laws are prevented from adopting the necessary, detailed rules.

In effect, the West will be saved if laws are blocked from application by undercutting the power of government agencies to carry out the requirements of those laws. All that’s necessary is to run around the laws, ignoring the legislative process.

Trump’s concern echoes Alabama Gov. George Wallace in his 1968 run for the presidency as an avowed racist. A famous phrase attributed to him was his attack on “pointy headed bureaucrats” (though that’s not exactly what he said). Those bureaucrats were busy implementing the civil rights laws.

It seemed fitting that the president of the leading country of the free world, the U.S., should deliver the remarks he made in Poland. It sounded like a reassertion of American leadership.

But that broader purpose of setting the priorities for the West did not resonate. The words of warning were belied by the actions of the person speaking them.

At the G-20 gathering of the world’s major powers, Trump led the U.S. delegation away from consensus and toward isolation. On trade, the final statement was left at broad generalizations. On climate, there was a statement by 19 participants and a separate one by the U.S.

Trump’s slogan is “Make America Great Again.” That seems to mean that the U.S. has decided to go its own way, happily relinquishing world leadership to focus on narrow and short-term national issues. Can that help give the West “the will to survive?”

If not, Trump is laying the groundwork for the next president whose slogan could well be, “Make America Great Again.”

GOP can’t fix Obamacare; Dems lack a plan

Health care “repeal and reform” is a mess, and both parties must share the responsibility for what now appears to be a national crisis.

It’s worth recalling the essential elements of the Affordable Care Act – Obamacare – that have led to the crisis.

The ACA extended health insurance coverage to tens of millions of people who could not be assured of decent medical care because they couldn’t pay for it. They would be required to buy insurance in the marketplace, but would receive financial help to pay for it.

Obviously, expanding coverage with government financial help requires more public funds, so the ACA provided for tax increases on the wealthiest individuals and on employers providing luxury, “Cadillac” insurance plans.

If people did not have employer-provided plans, they would turn to state market places in which insurers would compete for their business. However, there could be no public, nonprofit option available as a competitor and a backstop, because congressional Republicans blocked it.

The ACA worked, but not entirely well. Millions more gained coverage. But some states, like Maine, refused federal aid to extend low-income coverage. Costs rose because of uncertainty in Washington about federal funding. Some insurers dropped out of state markets. The wealthy fretted.

President Obama did a poor job selling a major new policy, and the GOP attacked it successfully, gaining control of Congress. Then, more than 50 times, it voted outright repeal of the ACA without an alternative, knowing that Obama could prevent their gesture from ever becoming law.

Finally, Republicans gained control of both houses of Congress and the presidency. Though President Trump made generous promises about a replacement, he had no proposal, leaving the solution to congressional Republicans who could pass a bill without a single Democratic vote.

As David Brooks, the New York Times columnist wrote, many Republicans ignored conservatism, with which they were identified, for a simple solution: reduce the number of people covered and the coverage, while eliminating the tax increases supporting the ACA.

This approach is consistent with a broader GOP policy that calls for reducing the size of government and cutting taxes. Reducing coverage saves money. It does not matter that millions would lose or be denied health insurance and find themselves forced back into emergency rooms for their care.

Part of their “repeal and replace” policy would allow younger people with fewer health problems not to purchase coverage, reducing the insurance pool supporting the costs of older citizens.

These reforms would all take place by modifying, but not repealing, the ACA. Hard-line conservatives thought they did not go far enough and opposed the proposed changes. Moderate Republicans thought they cut off too many people and they, too, opposed the proposed changes.

Result? No bill that can command the nearly unanimous Republican support required.

Meanwhile, conservative institutions have come up with reform proposals. They start by accepting that all people should have insurance coverage. They suggest reducing costs by lowering the income cap for Medicaid eligibility, cutting any federal subsidy for help above that level.

People should be allowed to use their health savings accounts to buy prepaid care, under which a medical procedure would be priced as a whole instead of by each provider in the process. And the “Cadillac” tax on luxury plans would remain.

Congress would also lift its prohibition on Medicare conducting competitive bidding for drugs. That would save the program billions that could support health coverage.

The conservative view is that reforms need to be made that can survive a change in political control in Washington. Otherwise, if the voters don’t like the GOP “reforms,” they will elect Democrats to repeal the repeal.

What’s wrong with the Democrats? They are acting just as Republicans did. They have not said a word about the changes to ACA they would propose to fix its problems. They hope to gain support simply by opposing the Republicans.

The obvious leader should be Barack Obama, who should lead in developing ACA improvements instead of washing his hands of Washington. A former president, even one with a namesake program, staying in the fray is unusual, but Trump proves these are unusual times. Other Democrats could accept his leadership, because they know he can’t run again.

Nothing can be expected from the White House that simply wants to take credit for whatever is passed. Everybody needs to accept almost universal coverage, but there should be Republican and Democratic alternatives from which both sides could negotiate.

The risk of failure not only threatens the health care system, but government itself.