GOP pays price for healthcare stubbornness


In a democracy, a political party that steadfastly sets itself against the public will is asking for defeat and will likely get it.

That’s the GOP these days on healthcare.

For a dozen years, Republicans have fought an unrelenting campaign in Congress, state legislatures and courts against expanded government help for Americans who need health coverage. At first, that effort yielded the party some big wins, then it became a loser. Now it’s become a trap.

How do we know voters disagree with the Republican stand? They’ve been asked. Six times in six states, all but one with Republican majorities. As of this week, the score stands 6-0.

The result teaches an important lesson for the presidential campaign and forecasts where policy likely will head if Joe Biden wins in November.

Medicaid’s growing popularity

At the high point of his Great Society, President Lyndon Johnson won passage in 1965 of legislation creating Medicare and Medicaid — government-provided healthcare for, respectively, the elderly and the poor. For years after, as a common saying had it, the programs’ names described their difference: Americans would care for the elderly; they would, sometimes grudgingly, aid the poor.

Even as Medicare gained steadily in popularity — and cost — becoming politically all-but unassailable, Medicaid initially languished, attacked by conservatives as a form of welfare.


Over the past couple of decades, that’s changed, in part because of expansions of the program engineered by one of its champions, former Los Angeles congressman Henry Waxman. With the program now covering one in five medical bills in the U.S. and serving more than 75 million Americans, Medicaid has largely lost the stigma that so often attaches to programs for poor people.

Polling by the nonpartisan Kaiser Family Foundation has found that roughly three-quarters of Americans have a favorable view of Medicaid. That includes a large majority of Democrats, unsurprisingly, but even among Republicans, 65% had at least a “somewhat favorable” view of the program, Kaiser found in a 2018 survey.

That shift in attitudes, however, has by and large not reached Republican lawmakers.

In 2010, as part of the Affordable Care Act, Congress approved expanding Medicaid to cover more low-wage working Americans — people with incomes of up to 135% of the federal poverty level, or slightly more than $17,000 per year for an individual. Under the law, the federal government would pick up 90% of the cost, with states covering the rest.

Once the Supreme Court ruled that states had the right to opt out of the expansion, Republican legislatures and governors in 19 red states did so. Many of them had won their elections in 2010, when voters, fearful of the changes Obamacare might bring, swept Republicans into office.

But while voters warmed to the new law, Republican lawmakers remained firmly opposed, and they’ve fostered a no-compromise position among their core supporters that now gives them little room to maneuver.

In 2016, beaten back in efforts to change the minds of elected officials, Medicaid advocates, led by California healthcare unions, decided to take their case directly to voters in a series of ballot initiatives.


As Dave Regan, president of SEIU-United Healthcare Workers West, told Noam Levey in 2018 after the first three victories in their campaign, on healthcare, at least, “we are showing that people in Utah and Idaho and Nebraska want the same thing as people in California.”

Maine later joined the other states on that list. Earlier this summer Oklahoma did, too. Now add Missouri.

On Tuesday, Missouri voters, by 53% to 47%, approved a constitutional amendment expanding Medicaid. The measure only won majorities in the state’s two big-city regions, St. Louis and Kansas City and their suburbs, and its two university centers, Columbia and Springfield. But even across heavily Republican swaths of rural Missouri, it ran well ahead of the vote share that former Democratic Sen. Claire McCaskill got in her unsuccessful reelection effort two years ago.

What does that string of victories, five of them in solidly Republican states, mean for the wider course of politics and policy? Two lessons jump out.

First, Democrats have learned over the past decade that complex efforts at market-based solutions to expanding healthcare, like the Affordable Care Act’s subsidized marketplaces for low- and middle-income families who lack job-based coverage, don’t work politically on two levels: They fail to win over the Republicans they were designed to attract and they aren’t as popular with voters as straightforward expansions of public programs.

Biden opposes Medicare for All, but if he wins in November, some form of Medicaid for Many — a public option built around further expansion of the program — will likely form a key part of his administration’s program.


And, second, over the next dozen weeks, look for healthcare to once again move into the spotlight of the campaign.

In 2018, Republican efforts to repeal healthcare coverage proved far and away the most effective issue for Democratic congressional candidates.

This year, that issue has been eclipsed by the coronavirus. But if the spread of the virus slows, which President Trump‘s campaign strategists hope will allow him to start a comeback, he will still face a host of issues on which he was vulnerable long before the pandemic began. His efforts to repeal healthcare coverage for millions of Americans remain high on the list.

Remember that before the coronavirus outbreak, one of the previous low points in Trump’s job approval came during his 2017 effort to repeal Obamacare.

Trump knows that, which is why he periodically promises to unveil a “tremendous healthcare plan,” as he pledged in his interview last month with Chris Wallace of Fox News. In that interview, he promised a plan in “two weeks” — a standard Trump trope meaning roughly the equivalent of the 30th of February.

He can’t develop a real healthcare plan, not only because he’s uninterested in the policy issues, but also because he’s shackled himself to an ideological faction of his adopted party that firmly opposes any expansion of government help.


In 2016, voters by and large perceived Trump as a moderate. He was hard-line on immigration, of course, but in his campaign, he carefully avoided previous Republican pledges to slow spending on Medicare, Social Security and other entitlements, made supportive statements about same-sex marriage and stepped around many other hot-button ideological issues.

As president, by contrast, he’s allied himself firmly with the far-right of the party, and voters have noticed. A series of CBS polls in battleground states this week, for example, found that only about one in eight voters in North Carolina and Georgia viewed Trump as a moderate, compared to well over half who saw him as conservative.

That’s fine, of course, with voters who see themselves as conservative, but it’s a problem for Trump with the swing voters in closely divided states whose support he barely won four years ago.

Missouri stands as the latest reminder that for Democrats seeking to remind voters why that ideological contrast matters to them, healthcare provides a potent weapon. If the presidential campaign tightens in the fall, as contests typically do, expect to see them wield it far more widely.

Relief negotiations remain deadlocked

Chances are waning for unemployment relief for millions of Americans, Jennifer Haberkorn reported. Talks continued to sputter on Thursday evening, with the two sides still separated by a wide gulf.

Neither side wants to walk away from the table — too much remains at stake, especially for Republican senators running for reelection in swing states — and both Speaker Nancy Pelosi (D-San Francisco) and Senate Majority Leader Mitch McConnell (R-Ky.) say they remain committed to getting a deal, but right now, the prospects don’t look good.


Trump may take some form of executive action to restore some benefits, including the federal moratorium on home foreclosure, and perhaps a cut in payroll taxes, although the legality of that is under debate. But he’s been largely absent from the talks. That’s a sign of how he’s increasingly wielding less influence, even as crises mount, Eli Stokols and Chris Megerian wrote.

“Congressional Republicans don’t want to cross Trump, but they also don’t want to carry his water,” Republican strategist Alex Conant told them.

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Clock running out for TikTok

Trump’s bigger scope for executive action, as past presidents have found, lies in foreign policy, and he’s taken a number of actions recently aimed at China — consistent with a major theme of his campaign.

Thursday, he signed an executive order to ban TikTok and WeChat, two popular Chinese-developed apps, from the U.S. within 45 days. As Wendy Lee and Sam Dean wrote, the order comes as Microsoft continues to look at the possibility of buying TikTok’s operations in the U.S. and Europe. Trump has said he wants the U.S. Treasury to get a cut of the sale price if that happens.

Combatting campaign disinformation

Black and Latino voters are a main target of disinformation efforts launched by Russia and other foreign actors. As in 2016, the campaigns seek to exploit existing divisions in U.S. society to persuade some voters, especially voters of color, not to show up at the polls.

Unlike in 2016, however, there are now organized efforts to push back at the disinformation campaigns. Evan Halper took a close look at one, run by a group of young activists under the heading of Win Black/Pa’lante.

In theory, the Federal Election Commission might be one agency that could help police illicit efforts to influence U.S. campaigns. In practice, however, the FEC, long toothless, has now been debilitated to the point that it can’t even meet. Arit John explains why.

Biden closes in on a running mate

The search for a No. 2 for the Democratic ticket has reached its final stage. Biden is expected to announce his choice sometime next week.


Sen. Kamala Harris remains a leading choice, but several other candidates continue to be in the running, including Rep. Karen Bass of Los Angeles, former national security advisor Susan Rice, and Sens. Elizabeth Warren of Massachusetts and Tammy Duckworth of Illinois.

Supporters of Bass and Harris have waged an intense lobbying campaign that has divided California Democrats, as Melanie Mason and Phil Willon reported.

Haberrkorn and Adam Elmahrek examined Bass’ record, which raises risks for Biden, but also some powerful attractions.

Bass has a low-key manner that has allowed her to work successfully with a wide range of political figures — much like Biden. But she also has a voting record and political background far to the left of the former vice president. It includes elements, such as trips to Cuba, that could hurt his campaign in some key states, especially Florida.

Once the announcement comes, what happens to the candidates who don’t get the nod? Some might end up in the Cabinet or other senior positions if Biden wins, as Michael Finnegan reported.

Pandemic’s toll reinforces inequality

California’s Latinos and Black people feel harsher effects of the pandemic, a new poll from UC Berkeley’s Institute of Governmental Studies finds. The poll also examines the deep partisan gaps that have emerged in attitudes toward the pandemic.

Orange County needn’t provide better coronavirus protections for inmates in its jails under an order from the U.S. Supreme Court. As David Savage wrote, the justices blocked a lower court’s order that mandated increased protection. The order is part of a busy summer for the justices, who have ruled on a string of emergency petitions, with conservatives winning nearly all so far.


Not only are there questions about whether jails are adequately protecting people, but the California agency for protecting workers can’t protect its own, according to accounts from current and former staff members. Jie Jenny Zou reported on the latest indications of dysfunction at Cal/OSHA.

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