Public Policy and Governance – Page 114

Dishonesty And Healthcare

As the blizzard of political television ads becomes ever more annoying–and less informative–one thing about them has become very interesting. Even Republicans who have previously made it clear that they don’t want government involved in healthcare are airing advertisements touting support for Medicare and willingness to protect pre-existing conditions.

I’ve been particularly struck by the U Turn in Indiana’s Fifth District, where a radically-reactionary, pro-Trump Republican noted for opposing “socialism” (which she has defined to include pretty much anything done by government) has begun running commercials supportive of Medicare and coverage of pre-existing conditions. Evidently, her polling has overcome her previously expressed belief that government should have no role in health care.

She’s not alone.

When the Affordable Care Act (aka Obamacare) passed, several Republicans went on record with their concern that its trajectory would mirror that of Medicare and Medicaid: despite initial resistance, the public would come to expect/demand/approve of the program. Survey research has confirmed those fears, which is why GOP officeholders continue to pretend that they will protect access to healthcare at the same time as they are feverishly working to eviscerate it.

The Brookings Institution recently published a report detailing six ways Trump has sabotaged the ACA.The report began by stressing that its authors did not use the term “sabotage” lightly.

For analytic purposes, the term “sabotage,” should not be used lightly. Presidents upon taking office typically have priorities that trigger executive actions strengthening some programs while weakening others. The losing programs often face resource reductions, pressure to deemphasize certain goals, directives to alter their administrative approaches, and other measures that can undermine their effectiveness. In doing so, a president often pays lip service to the program, claiming it has been “modernized” or otherwise improved. In contrast, Webster’s defines “sabotage” as efforts to foster “destruction and obstruction” and to “cause the failure of something.” In the context of the administrative presidency, it reflects a commitment to program emasculation and termination through executive action. As such, it sharply departs from the constitutional requirement that the president “take care that the laws be faithfully executed.”

There were six actions detailed in the report.

1) The administration dramatically reduced outreach about, and opportunities for enrollment in, the ACA’s insurance exchanges. The administration sharply reduced support for advertising and exchange navigators and reduced the annual enrollment period to about half the number of days.

2) Together with Congressional Republicans, it reneged on commitments to private insurance companies. Those insurers had been offered various subsidies that reduced the risks of participating in the exchanges. The GOP failed to honor those commitments.

3) The administration has constructed what the report calls “off-ramps to cheaper, lower-quality insurance.” One goal of the ACA was to improve the quality of health insurance by specifying essential benefits, guaranteeing coverage of those with preexisting conditions at reasonable rates, and prohibiting insurers from imposing certain spending caps. The Trump administration expanded access to coverage that was cheaper because it didn’t meet these standards and that siphoned off the healthier enrollees whose participation is needed to make the ACA work.

4) It allowed–indeed, promoted– a variety of state waivers that decreased ACA enrollments and undermined its regulatory structure.

5) It discouraged legal “aliens” from enrolling in Medicaid. In a particularly evil move, Homeland Security promulgated a “public charge” rule authorizing officials to treat Medicaid enrollment as a negative factor when reviewing the requests of legal non-citizens to extend their stays or change their status (e.g., from temporary to permanent resident).

6) And then there’s the existential threat. The Trump Administration brought the lawsuit that is now pending at the Supreme Court, attacking the constitutionality of the ACA. If that suit is successful–despite a legal argument that has been widely characterized as ridiculous, despite its endorsement by an appellate court composed of Trump-appointed judges– millions of Americans will lose access to health care.

As a student once reminded me, the United States doesn’t have a health-care system; we have a health-care industry. As a result, millions of Americans remain underinsured or completely uninsured, other millions are bankrupted each year by medical costs, and our health outcomes are among the absolute worst in the developed world.

Deeply dishonest political rhetoric to the contrary, the current Republican Party wants to keep it that way.

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Bananas

During the past four years, assertions that the U.S. is devolving into a “banana republic” have become almost commonplace.

“Bananas” is also a term used to describe people or behaviors that range from bizarre to insane. Bananas thus describes our everyday political reality in the Time of Trump.

There was the plot to kidnap Michigan’s Governor Gretchen Whitmer. The FBI described the plan as a months-long effort that also saw members of a rightwing militia “consider forgoing the kidnapping and instead executing Whitmer on her doorstep.”

According to the affidavit, plotters twice surveilled the governor’s vacation home and discussed blowing up a bridge leading to the house and using a boat to flee with the captured Whitmer.

The plot continued to gather pace into October, before the FBI arrested Fox, Barry Croft, Ty Garbin, Kaleb Franks, Daniel Harris and Brandon Caserta in a series of raids on Wednesday night.

“When I put my hand on the Bible and took the oath of office 22 months ago, I knew this job would be hard,” Whitmer said on Thursday. “But I’ll be honest, I never could have imagined anything like this.”

In addition to the militia primarily responsible–the “Wolverine Watchmen”–there was evidently a connection to the “boogaloo boys” movement, which is mostly dedicated to eradicating the government and killing law enforcement officers. (Boys will be boys!)

There has been steady growth of these groups of rightwing, anti-government, racist lunatics over the past twelve years. Hysteria over the election of a Black President apparently gave them impetus, and the subsequent election of a psychological fellow-traveler has been seen as permission and encouragement.

More bananas: Trump has always been unhinged, but evidently a combination of impending electoral loss and steroids has magnified his psychoses. As David Von Drehle recently wrote at the Washington Post

President Trump on drugs. Wow. I have to admit that I failed to see this one coming. Trump’s political career has been such a wild ride all by itself, it never occurred to me to wonder what would happen if this grandiose narcissist with the bombastic flair were to be filled to the gills with a powerful steroid. Just as I never looked at Usain Bolt, the great Jamaican sprinter, and mused: What would he be like on a rocket sled?…

Even after the president returned to the White House from the hospital, his docs continued to pump in dexamethasone, a steroid normally given to covid-19 patients struggling for life on a ventilator. Its purpose is to tamp down an overly intense immune reaction known as a cytokine storm but, in this case, it may be ramping up the chaos known as Donald Trump.

And talk about chaos! As Heather Cox Richardson described Trump’s recent behavior,

The major, obvious, in-your-face story of the day is that the president is melting down. He has spent much of the last two days calling in to the Fox News Channel and Rush Limbaugh’s radio show and ranting in a manic way that suggests he is having trouble with the steroids he is taking for his illness.

In an interview with Rush Limbaugh today, Trump boasted that “our nuclear is all tippy top now,” and said about Iran, “If you f*** around with us, if you do something bad to us, we’re gonna do things to you that have never been done before.” He tweeted that “Obama, Biden, Crooked Hillary and many others got caught in a Treasonous Act of Spying and Government Overthrow, a Criminal Act. How is Biden now allowed to run for President?” This is pure fiction, of course, but his campaign later put it in a fundraising email.

Trump’s doctors have yet to clear him for interactions with people, but that hasn’t stopped the narcissist-in-chief; he invited 2000 people for a rally on the South Lawn of the White House. (That, as Richardson points out, is yet another violation of the Hatch Act–but in an administration as corrupt as this one, that’s barely worth a footnote.)

Von Drehle cites the Mayo Clinic for an enumeration of side effects of the drug the President is receiving: “agitation,” “anxiety,” “irritability,” “mood changes,” “nervousness” and — perhaps most apt — “trouble thinking.”

What happens when you give a drug with those side effects to a man who already exhibits those behaviors–and whose level of intellectual development is best displayed by his description of America’s nuclear capability as “tippy top”?

Friday, my husband and I made another trip to the City-County Building to cast early in-person votes. At 8:15 in the morning, the line was once again incredibly long–and as it moved (briskly, I’m pleased to report), it was steadily replenished. When we drove by yesterday, the line was nearly twice as long.

I am cautiously optimistic that sane Americans have developed an allergy to bananas.

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Restoring The Rule Of Law

In early September, a post to the Lawfare blog considered what it would take to repair the Trumpian assault on the rule of law.

For those unfamiliar with Lawfare, the blog–launched in 2010– is devoted to what it describes as “that nebulous zone in which actions taken or contemplated to protect the nation interact with the nation’s laws and legal institutions.”

I often talk about the rule of law without bothering to define it, but at this juncture in our shared national experience, I think it would be useful to step back and do so. The American Bar Association definition will do nicely:

The rule of law is a set of principles, or ideals, for ensuring an orderly and just society. Many countries throughout the world strive to uphold the rule of law where no one is above the law, everyone is treated equally under the law, everyone is held accountable to the same laws, there are clear and fair processes for enforcing laws, there is an independent judiciary, and human rights are guaranteed for all.

The linked post begins by stating the obvious: Trump’s tenure has been a constant, unremitting assault on those principles, and the behavior of his administration has inflicted considerable damage on America’s most fundamental values.

His attacks on the free press, the independent judiciary and the independence of the Department of Justice have all created significant damage. His abuse of executive discretionary authority has made a mockery of the concept of checks and balances. His gaming of the judicial system has revealed weaknesses in our legal process. His attempts to place himself (and his family and his business interests) above the law have called into question foundational national conceptions of equal justice. In short, President Trump has led a wrecking crew (aided and abetted by William Barr and Mitch McConnell) that has severely damaged American legal norms of behavior.

The question, of course, is “what can we do about it?” Assuming a Biden victory in November, what are the remedies available to policymakers to restore respect for and adherence to the fundamental principles of the rule of law?

Because Lawfare’s focus is on foreign policy, the linked post primarily describes specific aspects of Presidential authority and Congressional oversight that are important to the conduct of foreign affairs. But most of the recommendations sweep more widely–for example, tightening the conditions under which Presidents can place “acting” officials in important government positions, and for how long–a process that currently allows a President to avoid having the Senate determine whether that individual is qualified and should be confirmed. As the post reminds us, the Trump administration “has exploited this authority to avoid the Senate confirmation process while placing preferred individuals in key positions.”

Other reforms with broad implications would make disclosure of Presidential tax returns mandatory (this one needs no explanation), and significantly narrow Presidents’ ability to declare “emergencies” and thus exercise emergency powers. Added protections for Inspectors General would likewise seem obvious–and important.

There are other reforms suggested, and the post is worth reading in its entirety. I hope incominglawmakers take its recommendations seriously.

Assuming–as hopeful people must–a wholesale repudiation of this lawless and dangerous administration and its GOP enablers, Americans can decide to make a silk purse out of the Trumpian sow’s ear–we can see from the lawless behaviors and the assaults on democratic norms where the legal and structural weaknesses are, and move to strengthen them. We can re-commit this country to the rule of law and to our founding aspirations.

Or, of course, we can lapse further into tribal conflict, and thereby accelerate America’s decline.

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Taxes, Politics And The Urban/Rural Divide

Michael Hicks directs the Center for Business and Economic Research at Ball State University. His columns appear in the Indianapolis Business Journal, among other publications, and while I have my disagreements with certain of his research perspectives, he often raises issues worth considering.

Last week, he focused on the urban/rural divide–and what we might call a “maker/taker” taxation paradigm.

Hicks began by cautioning against the prevailing image of rural America as a monolith. It’s an important caution: rural communities differ from each other economically and in the degree of diversity of their populations.

That said, they also share common challenges and characteristics.

Over the last century, America’s rural counties haven’t really grown. We have roughly the same number of rural residents as we did in Teddy Roosevelt’s administration, but urban America is more than five times larger. Four out of five Americans live in urban counties as designated by the Office of Management and Budget. To be fair, many of the urban counties have plenty of row crops in them, and rural counties have many small cities. Also, much of the growth in urban places came in formerly rural counties, as has always been the case. Still, urban counties differ in other meaningful ways that are likely to influence future policy. The second big issue is taxes and spending.

Rural places are large beneficiaries of federal dollars. By some estimates, per capita spending by the federal government is twice as high in rural than urban places. Most of this goes into agriculture subsidies, so rural communities probably don’t perceive the spending. Most may not actually benefit from it. Still, that is a legitimate critique offered by urban taxpayers, who foot most of the bill. Rural residents ought to be more conscious that these large subsidies provide few benefits for their community, while alienating urban taxpayers.

There’s no national study, but here in Indiana, rural places are also big beneficiaries of state tax dollars. This is per a 2011 study jointly authored by Ball State and the Indiana Fiscal Policy Institute. In that study, we estimated that rural places get more than $560 more per resident in taxes than they pay, while urban places get almost $160 less per resident than they pay. It is a plain fact that state and federal taxpayers subsidize rural places at the expense of cities and suburbs. What is not so clear is whether or not this spending makes a meaningful difference in the lives of rural people. I suspect it does not. This is almost certainly true in every other state.

Not only do state and federal distribution formulas advantage rural areas over urban ones, but Hicks notes that rural communities tax themselves less than urban places. In Indiana, per capita taxes are approximately ten percent lower in rural areas than they are in urban counties, and it is likely that this is true nationally.

As Hicks acknowledges, this pattern means that taxpayers in growing metropolitan places–places that need to repair and extend their infrastructures and municipal services–are subsidizing static and declining rural areas. He suggests there will be a reckoning–and certainly, in Indiana, with our ill-advised constitutionalized tax caps, that reckoning will come sooner rather than later, because the state’s urban areas are being starved of desperately needed resources.

What Hicks doesn’t mention is a significant political reason for this disparity in resources: gerrymandering.

In Indiana–and other red states where Republicans control redistricting– a majority of electoral districts have been drawn to ensure that they contain majorities of reliably Republican voters–and those voters are overwhelmingly rural. The result is that a super- majority of the state’s lawmakers are responsive to rural interests and dismissive of the needs of the urban areas that have been carved up by map-makers–despite the indisputable fact that the urban areas are the state’s economic drivers.

Talk about “makers” and “takers”!

It’s one more inequity we won’t get rid of until we get rid of gerrymandering.

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FIXING it

Yesterday’s post focused on legal reforms aimed at official corruption. Important as those are, they aren’t the only reforms we need to make.

We need to fix our elections.

Even those of us who follow politics closely and who are familiar with the country’s legal framework often miss the way in which demographic shifts have upended America’s electoral system and shifted power to an unrepresentative minority of voters– aided and abetted by America’s minority party.

Over the last few years, more people have come to recognize the inequities caused by gerrymandering and the Electoral College, but beyond that, our comfort with “the way it is” has blinded us to the equally troubling consequences of equal Senate representation, for example. Currently, over half the U.S. population lives in just nine states. The result is that less than half of the population chooses 82 percent of the country’s Senators. And that means that the Republicans hold their current Senate majority despite the fact that the Democratic Senate minority represents more than half of the American people.

A recent article from Vox, which led off with that example of distorted representation, offered eleven proposals to fix what has evolved into an unfair and unequal system. The article began with a recitation of several of the most egregious elements of our decidedly undemocratic reality.

Intentional efforts to make it harder to vote, such as voter ID laws, are increasingly common throughout the states — and the Supreme Court frequently approaches such voter suppression with indifference. Gerrymandering renders many legislative elections irrelevant — in 2018, Republicans won nearly two-thirds of the seats in the Wisconsin state assembly, even though Democratic candidates received 54 percent of the popular vote. Wealthy donors flood elections with money, as lawmakers spend thousands of hours on “call time,”dialing the rich to fund the next campaign.

And looming over all of this is the problem of race. In some states, Republican lawmakers write voter suppression laws that target voters of color with, in the word of one federal appeals court, “almost surgical precision,” knowing that a law that targets minority votes will primarily disenfranchise Democrats.

After the Democrats took the House in 2019, the first bill they passed was the “For the People Act.” If that act passed the Senate– which did not happen and will not happen so long as Mitch McConnell is in charge of that body–Vox says it would be the most significant voting rights legislation since the Voting Rights Act of 1965. (A companion bill, HR 4, would strengthen that original Voting Rights Act by restoring sections of the law that were eviscertated by the Supreme Court.)

That said, as the article correctly noted, even if those measures are enacted, they would still fall short of addressing the major and troubling challenges facing Americans’ electoral system. They wouldn’t address Senate malapportionment or the Electoral College –both systems that hand control of the government to an unrepresentative, predominantly rural minority of our citizens.

The eleven “fixes” identified by Vox include much-discussed measures like eliminating the filibuster and revitalizing the Voting Rights Act, but also less-often suggested changes like eliminating advance registration in favor of same-day voter registration. (A number of states are moving in that direction, which has the benefit of also eliminating flawed and partisan purges.)

Then there are the changes that would make it easier to vote: more early voting, no-excuse absentee voting and other measures that would actually facilitate the process of casting a ballot. What if we emulated Australia, for example?

In Australia, over 90 percent of eligible voters typically cast a ballot in federal elections. The nation achieves this feat by turning Election Day into a celebration, where voters gather at community barbecues to eat what are often referred to as “democracy sausages.” But Australia also uses a stick to encourage voting — nonvoters can be fined about $80 Australian dollars (about $60 in US currency) if they do not cast a ballot.

You really need to read the whole article, but even those who disagree with some of its specific recommendations will find it hard to argue with the proposition that it is past time for lawmakers and citizens alike to focus on the numerous, fundamentally unfair elements of the way we choose America’s leaders.

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