Let’s Talk About Federalism

Ah, federalism! In the abstract, “laboratories of democracy” and a component of those “checks and balances” the Founders established.

Two hundred plus years later, a mess.

Very few students came into my classes with an understanding of the term or the multiple and often confusing ways in which federalism operates in the 21st Century. (That confusion was clearly shared by the author of a recent Washington Post essay who didn’t seem to understand when state-level prosecutors like Bragg can charge violations of both state and federal laws in a single prosecution. In all fairness, however–as I so often told my students– it depends, and it’s complicated.)

Actually, in addition to gerrymandering, the Electoral College, the filibuster, and the number/ terms of Supreme Court Justices, it’s also past time to revisit and revise the divisions of authority between state and federal governments.

Our relatively strong federal government was founded in reaction to the serious and multiple problems the country experienced under the Articles of Confederation, which gave states far too much authority.  In recent years, however, we seem to have forgotten about the very negative consequences of government fragmentation that prompted the Founders to establish a strong central government.

Obviously, not all policies need to be nationally uniform–there are plenty of areas where local control is appropriate. However, questions about who is entitled to fundamental rights–and what those rights are–isn’t one of them, as the patchwork of approaches to reproductive freedom that’s emerging is likely to demonstrate. Forcefully.

The (belated) application of the Bill of Rights to state and local governments was meant to establish a floor–to ensure that a citizen moving from say, New York to Indiana, would not thereby experience a reduction of her fundamental rights as an American citizen. Justice Alito’s evisceration of the substantive due process clause is–among other incredibly negative things– a step back toward the fragmentation of the Articles of Confederation.

The need for substantial national uniformity isn’t confined to civil liberties. Over the 200+ years of American statehood, the need to rationalize and unify large areas of the law gave rise to the work of the Uniform Law Commission; that body developed the Uniform Commercial Code– a comprehensive set of laws governing all commercial transactions in the United States. It has national application, but it isn’t a federal law–it had to be adopted by each state’s legislature.

As the Commission’s website explains,

Uniformity of law is essential in this area for the interstate transaction of business. Because the UCC has been universally adopted, businesses can enter into contracts with confidence that the terms will be enforced in the same way by the courts of every American jurisdiction. The resulting certainty of business relationships allows businesses to grow and the American economy to thrive.

Commerce is hardly the only area where uniformity is desirable and/or necessary. Federal action in the face of a pandemic would certainly seem to qualify, and before the incompetence and massive ignorance of the Trump administration, the federal government largely directed public health responses to threatened outbreaks.  A lot of people died as a result of Trump’s decision to leave COVID response to the states.

I won’t even address the insanity of leaving gun laws to the states in a country as mobile as the U.S.

Then there’s the environment. ( Air and water don’t stay in Indiana.)

The Indiana Capital Chronicle recently reported on efforts by Indiana lawmakers to give the General Assembly power over decisions that are currently left to state agencies  staffed with experts who implement state and federal environmental laws— a move that  would put Hoosiers’ health and environment in jeopardy.

A sweeping, 54-page amendment was added last week to the administrative rulemaking bill, which additionally seeks to put lawmakers in charge of new pesticide regulations and prevent state environmental regulators from making stricter coal ash rules than federal ones.

Indiana’s legislators already believe they know more than doctors; now they think they’re experts in environmental science. Given their consistent subservience to the state’s utilities, passage of this bill would be a huge step backwards.

No serious student of governance believes that, in a country as large and diverse as the United States, all decisions should be made at the federal level. The question with which we should be grappling is “which responsibilities are properly federal and which matters are properly left to state or local governments?” .

What laws need to be uniform if we are to be the United States of America, rather than a haphazard collection of Red and Blue fiefdoms?

I’m willing to leave zoning decisions up to local municipalities, and a substantial portion of criminal justice measures up to the states. When it comes to guns, the environment or fundamental rights, not so much…

Comments

Health And Wealth

Speaking of health…

When I was still practicing law, I did a fair amount of work for nonprofit organizations.

Most of the nonprofits for which I drafted articles of incorporation or amended bylaws, or those I simply represented in various transactions, were “true” nonprofits–everything from Little League teams to small “do-gooder” groups focused on addressing a social ill. I want to be clear that I am not talking about those organizations, or criticizing their tax-exempt status–a status that was intended to facilitate the provision of socially-beneficial goods and services.

But. (You knew there was a “but,” didn’t you.)

There are also far too many “nonprofit” organizations that are really cleverly-veiled for-profit business enterprises. So long as talented lawyers can describe the business with language indicating  a charitable mission of some sort, these enterprises escape both income and property taxation, padding what would otherwise be the bottom line.

And about that bottom line–rather than sending  what are actually profits to shareholders or other investors to be taxed, as for-profit enterprises do, sizable chunks of those dollars are used to inflate the salaries paid to  management personnel (who–surprise!– often were the founders of the organization), transforming them into expenses of the enterprise.

Legal magic!!

Back in my lawyering days, this was one of the many things that royally pissed me off. I  revisited that annoyance when I read a recent article by Michael Hicks in the Capital Chronicle. Hicks has periodically focused on the economic shenanigans of Indiana’s hospitals–all of which are theoretically nonprofit, and many of which actually are.

Hicks reminds us that the benefits bestowed by nonprofit status are in exchange for the  “well established notion that nonprofits advance the public good.”

Today, nearly every hospital corporation in Indiana is a not-for-profit. I’m pleased to report, that insofar as I can judge from the data, most are focused on that well established notion of ‘advancing the public good.’

In fact, it would seem that only five or six of Indiana’s not-for-profit hospital firms have dispensed with any pretense of “advancing the public good.” Now, this doesn’t mean they aren’t doing good things that folks are willing to pay for. But, so do Walmart, J.P. Morgan Bank, Amazon, and McDonalds. One key difference is that we tax these for-profit firms.

Hicks then tells us that, in 2020, the nation’s largest for-profit hospital, HCA, reported a 7.3% profit. That same year, Ascension Health in Indiana reported a 41% profit, Community Health Network reported 23.3%, IU health reported 22% and Deaconess reported 13.8%. As he writes, this is flagrant misuse of the not-for-profit status.

If these were for-profit firms, their investors would’ve had a windfall. Instead, they put that money in money market accounts, or offshore investments. That money should flow back into Hoosier communities instead of leaving the state. The losses are startling. Roughly 60% of all the economic growth in Muncie over the last decade was swallowed just by the profits of IU Health and Ball Memorial Hospital.

The article then focused on Ascension St. Vincent, which recently announced plans to close 11 clinics in Indiana.

Now, I’m sure this was a random coincidence that had nothing to do with pending legislation aimed at their monopoly power. If reporting is true, most of these clinics were profitable. Of course, system-wide, Ascension is fabulously profitable. In the last year for which we have data, they reported making a profit of more than $308, 000 per employee, less than half of which was from healthcare services.  Ascension Health is today a financial services firm that claims heritage from Catholic charities, but now only dabbles in healthcare.

The decision to close less profitable clinics would be a typical business decision of a venture capital firm. But, it is wholly incompatible with the “notion that nonprofits advance the public good.” Ascension is a ‘not-for-profit’ entity in name only. Its behavior is that of a large conglomerate. They are not alone. In 2020, IU Health reported a tad more than $4 billion in physical assets in Indiana. Their investment holdings were $7.8 billion. They also made $49,600 per worker in profits in 2020.

There is much more data in the article, all of which supports Hick’s thesis that “these big ‘hospitals’ are really just large financial services firms, who own construction firms, physician offices, restaurants and yes, hospitals.” If Indiana had a legislature that focused on the welfare of Hoosiers, that body might remove the nonprofit status of systems behaving like venture capitalists.

 Removing the not-for-profit status would generate huge tax dollars for cities across Indiana, expose these hospitals to federal laws on non-compete and increase the probability of enforcement of anti-trust regulations.

Welcome to yet another aspect of privatized health care…It costs Americans a lot to reject the “socialism” of a national health system.

Comments

A Pyrrhic Victory

I never thought I would view Justice Alito’s deeply dishonest opinion in Dobbs as a gift, but I’ve come to that conclusion. 

Whatever one’s position on abortion, it is impossible to ignore the political effect of that Supreme Court decision. Some (male) strategists insist that Democrats’ continued emphasis on the issue is risky or misplaced, but I respectfully disagree. Absent the presence of some other massively salient issue, GOP candidates now look a whole lot like the dog that caught the car. (Furthermore, two of the most salient issues these days are gun control and democracy–both of which also favor Team Blue.)

As Michelle Goldberg recently wrote in the New York Times, 

Having made the criminalization of abortion a central axis of their political project for decades, Republicans have no obvious way out of their electoral predicament. A decisive majority of Americans — 64 percent, according to a recent Public Religion Research Institute survey — believe that abortion should be legal in most cases. A decisive majority of Republicans — 63 percent, according to the same survey — believe that it should not. When abortion bans were merely theoretical, anti-abortion passion was often a boon to Republicans, powering the grass-roots organizing of the religious right. Now that the end of Roe has awakened a previously complacent pro-choice majority, anti-abortion passion has become a liability, but the Republican Party can’t jettison it without tearing itself apart.

Back in September of 2021, I wrote:

This year, the Supreme Court will review Mississippi’s ban on virtually all abortions after the 15th week of pregnancy. A Court created by Donald Trump is likely to overrule–or eviscerate–Roe v. Wade. If it does so, Republicans may come to rue the day.

Without Roe, the single-issue anti-choice voters that have been a mainstay of the GOP will be considerably less motivated. Pro-choice voters, however, will be newly energized–and polling suggests they significantly  outnumber “pro-life” activists.

The de-nationalization of Roe wouldn’t just mobilize pro-choice voters who’ve relied on Roe to protect their rights. It would redirect liberal and pro-choice energies from national to state-level political action. And that could be a huge game-changer….

As I have repeatedly noted, the current dominance of the Republican Party doesn’t reflect  American majority sentiments–far from it. GOP membership has been shrinking steadily; some 24% of voters self-identify as Republican (and thanks to vaccine resistance, those numbers are dwindling…) GOP gerrymandering and vote suppression tactics are artifacts of state-level control. With Roe gone, purple states–including Texas–will more quickly turn blue.

If Roe goes, the game changes. File under: be careful what you wish for.

In her Times column, Goldberg enumerated the the multiple, continuing GOP assaults on abortion rights at both the state and federal levels, including but not limited to the following:

In the last Congress, 167 House Republicans co-sponsored the Life at Conception Act, conferring full personhood rights on fertilized eggs. In state after state, lawmakers are doing just what the R.N.C. suggested and using every means at their disposal to force people to continue unwanted or unviable pregnancies. Idaho, where almost all abortions are illegal, just passed an “abortion trafficking” law that would make helping a minor leave the state to get an abortion without parental consent punishable by five years in prison. The Texas Senate just passed a bill that, among other things, is intended to force prosecutors in left-leaning cities to pursue abortion law violations. South Carolina Republicans have proposed a law defining abortion as murder, making it punishable by the death penalty.

Goldberg’s column preceded the decision by the Trump-appointed federal judge in Texas, suspending FDA approval of mifepristone, one of the two drugs commonly used for medication abortions, despite its demonstrated safety over the past 20 years–a decision certain to raise the stakes–and the immediacy– of the abortion debate.

I agree with Goldberg that Republicans “are adopting a self-soothing tactic sometimes seen on the left”–blaming messaging. They insist they’re losing elections because they’ve failed to communicate clearly, not because their position is unpopular.

“When you’re losing by 10 points, there is a messaging issue,” the Republican Party chairwoman, Ronna McDaniel, said on Fox News, explaining the loss in Wisconsin.

But you can’t message away forced birth. Republicans’ political problem is twofold. Their supporters take the party’s position on abortion seriously, and now, post-Roe, so does everyone else.

As Alex Shepard wrote in The New Republic, the problem Republicans face is both simple and unsolvable, because an idealized middle ground that would be palatable to the diehards in the GOP base simply doesn’t exist.

In Dobbs, Justice Alito gave the Republicans something they had long claimed to want–a complete victory on an issue that the GOP had used for fifty years to motivate its base and generate turnout.

Sometimes, victories are pyrrhic.

Comments

Oh, Indiana…

I recently read that Indiana’s legislative overlords are taking time out from their attacks on women and trans children, and deigning to address an actual issue–the health of Hoosier citizens.

I haven’t been following those health measures, and to be honest, I lack the background to properly evaluate them in any case, so I thought I’d pose a question to my new research assistant, otherwise known as ChatGPT.

Here’s what I asked:

Please locate Indiana’s relative performance in health related areas, especially drug and alcohol abuse rates, infant mortality, smoking statistics, suicides, life expectancy, and other wellness markers like mental health.

Here’s what I got:

 Sure, here is some information on Indiana’s relative performance in health-related areas:

Drug and alcohol abuse rates: According to data from the National Survey on Drug Use and Health (NSDUH), Indiana has higher than average rates of substance abuse, particularly with regard to prescription pain relievers and synthetic opioids. In 2019, Indiana had the 9th highest rate of drug overdose deaths in the United States, with a rate of 27.5 deaths per 100,000 population.

Infant mortality: Indiana has one of the highest rates of infant mortality in the country, with a rate of 6.8 deaths per 1,000 live births in 2019. This is higher than the national average of 5.6 deaths per 1,000 live births.

Smoking statistics: Indiana has one of the highest rates of smoking in the United States, with an adult smoking rate of 21.1% in 2019. This is higher than the national average of 14.0%.

Suicides: Indiana has an above-average rate of suicide, with a rate of 16.9 deaths per 100,000 population in 2019. This is higher than the national average of 13.9 deaths per 100,000 population.

Life expectancy: Indiana’s life expectancy is slightly lower than the national average, at 76.7 years in 2019 compared to the national average of 77.3 years.

Mental health: Indiana has lower than average rates of mental health care access and high rates of mental illness. According to Mental Health America’s 2021 report, Indiana ranks 45th out of all states and the District of Columbia in terms of overall access to mental health care. Additionally, Indiana has the 5th highest rate of adult mental illness in the United States.

It’s worth noting that these rankings and statistics are subject to change over time and may vary depending on the specific sources and data used.

You might think that–given the sad state of Hoosiers’ health–healthcare might take priority over efforts to stymie DEI investing and destroy the state’s public schools–but of course, this is Indiana….Even a superficial look at General Assembly priorities is enough to demonstrate lawmakers’ utter disregard for public health.

In the wake of Dobbs, Indiana lawmakers couldn’t wait to ban abortion–despite overwhelming evidence that reproductive care–including abortion–is an essential element of women’s healthcare.

Then, of course, there’s the legislature’s ongoing love affair with guns, despite polling showing that a majority of Hoosiers (including a majority of NRA members) support additional regulation.

Perhaps the most direct evidence of our legislature’s lack of concern for the health of their constituents was this session’s mean-spirited denial of appropriate health care to trans children. I went back to ChatGPT for an explanation of the health consequences involved.

Denying appropriate medical care to transgender young people can have serious medical and emotional consequences. Here are some of the potential outcomes:

Delayed or absent puberty: Transgender young people who are denied appropriate medical care may not undergo puberty at the same time as their peers, or may not undergo puberty at all. This can lead to social isolation, low self-esteem, and feelings of dysphoria.

Increased risk of mental health problems: Transgender young people who are denied appropriate medical care may experience depression, anxiety, and other mental health problems as a result of the distress caused by their physical dysphoria.

Increased risk of suicide: Studies have shown that transgender young people who are denied appropriate medical care have a higher risk of suicidal ideation and suicide attempts.

Increased risk of physical health problems: Transgender young people who are denied appropriate medical care may be at increased risk of physical health problems related to their gender dysphoria, such as urinary tract infections or other complications from avoiding the use of restrooms that do not match their gender identity.

Reduced life expectancy: Transgender people who are denied appropriate medical care may have reduced life expectancy due to the physical and mental health problems they experience as a result of their gender dysphoria.

Overall, denying appropriate medical care to transgender young people can have serious and potentially life-threatening consequences. It is important for healthcare providers and society as a whole to recognize and respect the healthcare needs of transgender youth, and to provide them with the necessary medical care and support to live healthy and fulfilling lives.

Our legislative culture warriors don’t care.

Comments

Gerrymandering And The Tennessee Three

I’ve repeatedly inveighed against gerrymandering on this blog. (Anyone who wants to revisit the multiple ills that flow from that nefarious practice need only put “gerrymandering” into the search box and re-read those periodic rants.) I wouldn’t test the patience of my regular readers by returning to the subject, but for the vivid and shocking example provided by lawmakers in Tennessee.

The bare-bone facts are these: Three members of the Tennessee legislature joined an estimated thousand protesters who had marched to the statehouse in the wake of that state’s school shooting, demanding gun reform. According to several reports, they had bullhorns, and disrupted the order of the assembly. The protest itself was described by the media as peaceful–giving the lie to the hysterical Republican lawmakers who compared it to the January 6th insurrection.

Tennessee has a Republican supermajority–courtesy of gerrymandering–and that supermajority responded by voting to eject two of the three–the Black ones.

The three lawmakers did violate House rules, and a reprimand of some sort would have been appropriate. They could have been censured, or removed from committee assignments. But as the Washington Post noted

Republicans charged them with breaking House rules of conduct, which they don’t deny. But the protests, while raucous, were peaceful, and according to the Tennessean, no lawmaker has ever been expelled for breaching decorum rules….

All of this mirrors a larger story. Red states are sinking deeper into virulent far-right culture-warring — banning books, limiting classroom discussion of race and gender and prohibiting gender-affirming care for transgender youth. GOP legislatures passing these things were of course legitimately elected by majorities, though in some cases gerrymanders increase their power.

I would amend that last sentence to read “in most cases, gerrymanders increase their power.”

Those legislatures are also finding onerous ways to use power to tamp down on the unexpectedly ferocious dissent their culture war has unleashed among numerical minorities, largely concentrated in cities and suburbs inside red states. As analyst Ron Brownstein argues, this often pits an overwhelmingly White, older, rural and small-town Republican coalition against an increasingly diverse, younger and more urban coalition.

“These Republican legislatures are stacking sandbags against a rising tide,” Brownstein told CNN. Call it the GOP retreat into Fortress MAGA.

As the article notes, Republican-dominated state legislatures are pushing “preemption” laws that restrict cities and counties from making their own policy choices. It listed examples from DeSantis’ Florida, and from Georgia (and could easily have found similar ones from Indiana)

Yet this retreat into Fortress MAGA faces a problem: Whenever state-level Republicans undertake another reactionary lurch, it often goes national in a big way. Attention has poured down on everything from insanely broad book bans to shockingly harsh proposed punishments for abortion to anti-transgender crackdowns with truly creepy implications.

The Tennessee super-majority expelled these lawmakers simply because they could–because their supermajority (courtesy of gerrymandering) allowed them to demonstrate their rejection of democratic norms and to display their animus toward colleagues who were young, Black and Democratic.

As the AP has reported

A growing chorus is pushing back against Tennessee Republicans seeking to oust three House Democrats for using a bullhorn to shout support for pro-gun control protesters in the House chamber, while the GOP has previously resisted removing its own members even when weighing criminal allegations.

Most recently, the Republican-controlled Statehouse declined to take action against a member accused of sexual misconduct, as well as those who have faced indictments or came under pressure for liking nearly nude social media posts.

Ah–but those members were White Republicans.

The Hill interviewed one of the two legislators, Justin Jones of Nashville, who said his race played a role in his expulsion from the state House on Thursday.

“I basically had a member call me an uppity Negro,” Jones, who is Black, told MSNBC’s Joy Reid after the 72-25 vote that expelled him….

“What we saw in Tennessee yesterday was an attack on democracy and very overt racism, as you can see that the two youngest Black lawmakers were kicked out, but our colleague, my dear sister, Gloria Johnson, a white woman, was not,” he said. “And we see clearly, the nation has seen clearly what is going on in Tennessee.”

What this incident very clearly underlines is the critical importance of systemic reform. It isn’t enough to elect better people–although that would certainly be helpful.

We need to reform the institutions that are not working properly. We can start with the Supreme Court, which has declined to notice that gerrymandering is incompatible with fair elections. The recent confirmation that Clarence Thomas’ corruption extends well beyond his refusal to recuse from cases implicating his wife’s political activities should provide a wake-up call.

Then we can move on to the Electoral College….

Comments