The Obamacare Hail Mary That Could Save The Senate For Democrats

[ProSense]

The Obamacare Hail Mary That Could Save The Senate For Democrats

The 2014 handicapping is underway, and the consensus is clear: Democrats face a tough battle to maintain control of the Senate...But Democrats might have a secret weapon in a couple of those key Senate races. Activist groups and state lawmakers are working to get Obamacare's Medicaid expansion on the ballot in Louisiana and Montana, where they have vulnerable candidates and GOP officials have refused to adopt the provision.

"Turnout is the biggest challenge that Democrats face," one Democratic operative told TPM. "There are a variety of ways that you can meet your turnout goals, and one of them is certainly ballot initiatives. Medicaid expansion really could be a powerful tool to turn voters out."

The first trick is getting the question on the ballot. In Montana, activists are required to gather a little more than 24,000 signatures by June 20. The order is taller in Louisiana: getting the GOP-controlled legislature to approve it. Its odds probably aren't great, local reporters say, but a few GOP lawmakers did express an openness to the expansion last year. The bill has already been introduced in the state Senate by a Democrat.

South Dakota serves as a cautionary tale for the success of this gambit. Democrats there, where the party is trying to hold onto the seat of the retiring Sen. Tim Johnson, had attempted to get Medicaid expansion on the ballot, but it was defeated by Republicans in the state legislature.

- more -

http://talkingpointsmemo.com/dc/obamacare-medicaid-expansion-ballot-initiative

Medicaid expansion sure is popular

By Steve Benen

Medicaid expansion under the Affordable Care Act enjoys quite a bit of support from health care experts, hospital administrators, most of the nation’s governors (from both parties), advocates for low-income families, and those with policymakers with access to calculators.

But it’s worth keeping in mind that voters are on board, too. The Washington Post reports today on a new survey from the Wason Center at Christopher Newport University, which found that 56% of Virginia residents support expansion – a top priority for Gov. Terry McAuliffe (D), who made this a key part of his 2013 platform.

The poll found that supporters of a federally funded expansion included 55 percent of self-identified Republicans and majorities in every region of the state. <…>

Virginia would initially receive about $2 billion a year from Washington if it expanded Medicaid, which would offer coverage to about 400,000 of the state’s uninsured. A recent estimate from the state Health Department projected that expansion would save Virginia about $1 billion over eight years. Among other factors, Medicaid expansion would move many indigent patients to federally funded care.

And it’s not just Virginia. Two weeks ago, a statewide poll in Kentucky found that 79% of state residents agreed with Gov. Steve Beshear’s decision to expand Medicaid coverage. Even 60% of Kentucky Republicans support the idea, suggesting Senate Minority Leader Mitch McConnell (R) hasn’t exactly persuaded his own in-state allies on the issue.

And the week before that, a statewide survey in South Dakota found 63% of state residents are on board with Medicaid expansion.

It’s one thing for the right’s arguments against Medicaid expansion to fall short in states like Vermont and Hawaii, but these polls suggest the conservative talking points aren’t connecting in Virginia, Kentucky, and South Dakota, either.

- more -

http://www.msnbc.com/rachel-maddow-show/medicaid-expansion-sure-popular

Uninsurance Rate Falls To Five-Year Low As 3.3 Million Enroll In Obamacare
http://www.democraticunderground.com/10024555270

[ProSense]

1. Kick! n/t

[riqster]

2. Size 13 kick and rec nt

[ProSense]

3. LOL! Thanks. n/t

[riqster]

5. These oversized dogs are useful for big kicks, at least.

[Scuba]

4. Wisconsin law does not allow for referendums, but Democrat Mary Burke needs this issue ....

... to be the difference-maker in her candidacy for Governor. I believe this might be the one issue that motivates large numbers of voters to turn out for her. Hopefully she will make it the centerpiece of her campaign.

[HereSince1628]

9. Well, maybe, since there is no other choice, she gets default support, but

Personally, I don't think a Harvard MBA, daughter of the founder of the company for which she was CEO for a couple years, a person whose public face is largely focused in Madison, is going to bring out large numbers of usually non-midterm voters.

She's undeniably a corpo-dem, a business school wonk whose work outside the family business is about a dozen years as a DC lobbyist, and 2 years as WI Sec of Commerce. Her big issues in community life are about throwing money at things--Duncanish pro-charter school education reform--and housing for the homeless.

I don't think the dems who don't usually turn out are going to be motivated by a hollow promise re medicaid expansion. I think they sense that she (or any Dem) can't deliver on that promise without a bluer and more social program friendly legislature. I'm not at all sure that a campaign promise to support Medicaid expansion is really going to bring them out for her.

And I don't think progressives in WI are looking to link up with a Harvard MBA, DC lobbyist for Financials, private charter school advocate.

It's a shame the dems have no one. We are stuck in Rahm's dilemma, vote for the lessor of 2 evils or don't vote. I don't think that looks good for GOTV.

[Scuba]

13. Don't get me wrong; I'm not gung-ho for Mary Burke, but I do want to oust Walker.

Burke's our candidate, that seems obvious. So I've decided to support her publicly and to privately use my very limited influence to try to move her in a more progressive direction.

As you may have seen, I believe the Democratic Party has to stand for more than just "not the Republican". The Medicaid money is a big deal, and should be an major plus for our side. If we can leverage that one issue into a win in November, and oust the Koch's puppet - if not their legislature and State Supreme Court - it can help us.

Perfection is the enemy of progress. I keep trying to remember that.

[HereSince1628]

16. I'm really not talking about perfection, I'm talking about what is going to be hard

to grow it into a significant issue.

Over 90% of Wisconsinites aren't affected by the decision to not expand medicaid.

That makes it a limited issue.

Leveraging such a limited issue into something big depends upon stirring voter sentiment about something that doesn't directly affect them. The issue must be turned into something that produces passion:clear images of right vs wrong or what's fair vs what isn't...

Currently, most WI voters seem to think what's unfair is that they personally pay taxes that get spent on others...and the others are being stereotyped as "lazy people of color in urban areas" who make up a large fraction of the people who need the medicaid expansion. Denying things to 'those people' is the default sentiment in the legislature.

Moving that sentiment just to reach neutral is a very large lift. Corpo-dems usually do the most doable in their 'pragmatic' way. And there is little doubt that Burke is a Harvard trained, DC honed corpo-dem.

[ProSense]

6. Debunking RW fantasies about the death of Obamacare

Debunking RW fantasies about the death of Obamacare
http://www.democraticunderground.com/10024555756

[Flatpicker]

7. I just can't get past

the concept that Dems have to be afraid of losing the Senate.

You would think that after the mess that the Republican's have made of the Congress, they would be rode out on a rail.

[mdbl]

30. No kidding!

These weird articles I read about Dems losing the senate are just as whacky as the articles that all predicted Mitt Romney would be pres. Same rightwing propaganda tactics, that I hope, for the sake of the country, don't work a second time.

[1StrongBlackMan]

32. It's good to be skeptical ...

With any kind of GOTV effort ... I expect that Democrats will expand the Senate and flip the house.

[JEFF9K]

8. The cost of your Expanded Medicaid is deducted from your estate ...

The cost of your Expanded Medicaid is deducted from your estate ... leaving your loved ones with nothing. That's good?

[ProSense]

11. That was

"The cost of your Expanded Medicaid is deducted from your estate ...The cost of your Expanded Medicaid is deducted from your estate ... leaving your loved ones with nothing. That's good?"

...a feature of Medicaid before Obamacare, and it doesn't apply to everyone. It's interesting that the program is now being attacked because it has been expanded for the first time since it was implemented.

<...>

From very early in the Medicaid program’s history, however, there has been a concern that people who could otherwise afford to pay for at least some long-term care services would voluntarily impoverish themselves, transferring assets to their children or to others to make themselves eligible for Medicaid. Congress and the states have therefore adopted laws and regulations to limit asset transfers by Medicaid recipients. These prohibitions were initially evaded through the use of trusts and other financial devices, resulting in the enactment of additional laws to bar these evasions.

<...>

The Affordable Care Act creates a new category of Medicaid recipients — adults with incomes under 133 percent of the poverty level. It also changes income and asset eligibility rules for parents, children, and pregnant women, who were already eligible for Medicaid. Eligibility for these categories of recipients is now calculated based on “modified adjusted gross income,” or MAGI. There are no asset requirements for persons who become eligible for Medicaid under MAGI rules. The question thus arises as to how existing rules regarding asset transfers, liens, estate recoveries, and post-eligibility income apply to persons eligible for Medicaid based on MAGI.... Although the federal and state law governing Medicaid liens and estate recoveries are primarily concerned with recipients who receive high-cost long-term care services, federal law that existed prior to the ACA allows states to recover from the estates of any Medicaid recipient age 55 or over for the cost of any Medicaid services, and a number of states have existing laws that would allow such recoveries. ACA opponents have been spreading the word that if people age 55 or over sign up for expansion Medicaid, the government will recover from their estate when they die. The Memorandum attempts to address these concerns.

<...>

Medicaid rules prohibit Medicaid coverage of LTSS for persons who have equity in a home that exceeds a certain value, which for 2014 is set at $543,000 (or, at a state’s option, at $814,000). Although, again, there are no asset restrictions on MAGI eligibility, the home equity requirement applies to eligibility for LTSS services, not for Medicaid, and thus applies to MAGI-eligible individuals who receive LTSS services.

Individuals who receive institutional and home and community-based LTSS services as traditional categorically- or medically-needy Medicaid recipients must generally spend all of their income on LTSS, except for a small personal needs allowance and funds necessary to maintain their spouse or family in the community, with Medicaid paying for the additional cost of the services. These post-eligibility treatment of income (PETI) rules do not explicitly apply to MAGI-eligible individuals. CMS recognizes, however, that it is inequitable to apply these rules to other Medicaid recipients but not MAGI individuals. It is contemplating rulemaking, therefore, to extend these rules to MAGI eligible individuals...most of the rules that apply to traditional Medicaid recipients with respect to LTSS (except for lien requirements) are likely to apply to MAGI-eligible individuals who receive LTSS. CMS intends, however, to take steps to avoid applying estate-recovery rules to MAGI-eligible individuals who do not receive LTSS to keep this from becoming a barrier to Medicaid expansion eligibility.

http://healthaffairs.org/blog/2014/02/24/implementing-health-reform-medicaid-asset-rules-and-the-affordable-care-act/

[JEFF9K]

21. Thanks. Helpful info, but ...

Thanks. Helpful info, but ... my uncle, working part-time and in his early 60s needs more certainty. So far, this issue has stumped my friend who is an estate planning attorney and has taken the offices of my Congressman and Senator by surprise.

[Liberal_Dog]

10. K & R

This is a very sound strategy. Hopefully we will be able to get it on the ballot in a few states.

[CSStrowbridge]

12. Do this, and ....

Do this, and add minimum wage hikes as well. The left will come out in record numbers for a midterm election.

[rtracey]

14. you can only hope because...

You can only hope because if the Senate falls to Republican control, kiss everything President Obama has passed out the window. Repeal will be the keyword for this congress, and if you can imaging Mitch McConnell as Senate Majority Leader, nothing will be off the table with him....

[ProSense]

15. Senate Democrats have to fight hard

if they want to hold on to their chairmanships. Being the minority party in committee means no control of the agenda.

[jeff47]

17. They'd still have to get past the veto stamp.

And 2016 has "better" states for Democrats up for Senate.

[blkmusclmachine]

22. A veto?!?! HA! I wouldn't count on it!

[jeff47]

24. Yeah, Obama's going to sign a bill repealing the ACA.

[polichick]

18. "There are a variety of ways that you can meet your turnout goals..."

The best way to meet turnout goals is to govern like you campaign, instead of campaigning for the people and governing for the corporations.

If Dems worked for the people 100% of the time, a whole lot more people would be pleased to show up at the polls.

[RBInMaine]

19. Thanks for the chirp from the TeaLeft section.

[merrily]

28. Oxymoron.

[polichick]

34. Sorry the truth hurts...

Election year gaming wouldn't be necessary if they just did the job they were elected to do FOR THE PEOPLE.

[RBInMaine]

20. God damn corporate media narrative about losing the Senate. Just campaign hard and forget this crud.

[blkmusclmachine]

23. Damn lib'rul Media!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[grahamhgreen]

25. Good, smart move! Imagine how good were it Medicare for All!!!!

The whole country would turn out

[Warren DeMontague]

26. K&R

[merrily]

27. Of course ballot initiatives GOTV. Rove proved that.

However, the best and most moral way to GOTV is to get people on your side with good policies that help the 99%.

For example, my parents would never dream of missing an election. Social Security and pro-union policies were enough to get them to the polls to vote Democratic in every single local, state and federal election.

[Cha]

29. K&R!

[1StrongBlackMan]

31. Except ...

Landreau (in Louisiana) is running from ObamaCare. How can she talk up Medicaid expansion AND run from ObamaCare?

[ProSense]

33. She's getting

"Landreau (in Louisiana) is running from ObamaCare. How can she talk up Medicaid expansion AND run from ObamaCare?"

...hit hard by the Kochs, and part of her problem is that she once tried to distance herself from her vote. She's now trying to pivot back.

Koch Brothers Pay Actors to Pose as Louisianans Upset with Obamacare
http://www.democraticunderground.com/10024503894

Democratic Sen. Landrieu Walks A Fine Line In Red Louisiana
http://www.npr.org/2014/02/25/281396562/democratic-sen-landrieu-walks-a-fine-line-in-red-louisiana

It was stupid for Democrats to run away from Obamacare. Kentucky's Governor Beshear showed that standing up to Republicans can work, and now Mitch McConnell is forced to dance.

Josh Marshall:

What?

Team McConnell starting to hedge on Obamacare?

http://talkingpointsmemo.com/dc/mitch-mcconnell-chamber-of-commerce-ad

New Ad Muddies Whether McConnell Wants To Fix Or Repeal Obamacare
http://talkingpointsmemo.com/dc/mitch-mcconnell-chamber-of-commerce-ad

Kentucky's Democratic Governor expanded Medicaid and put Mitch between a rock and a hard place.

60% Of KY GOPers Buck McConnell, Support Medicaid Expansion
http://talkingpointsmemo.com/livewire/poll-kentucky-obamacare-medicaid-expansion

Some Republican Governors knew that being against the Medicaid expansion was a political loser.

Pro-Medicaid GOP governors well placed for reelection
http://www.politico.com/story/2014/02/2016-election-medicaid-republican-governors-103892.html

[1StrongBlackMan]

36. Okay ...

I hadn't heard that she was pivoting back. GOOD! ObamaCare is a winner for everyone except folks that wouldn't vote for a Democrat, anyway.

[Silent3]

35. I know it's a stretch goal, but I'd like to hear more talk about pushing for taking the House...

...not just holding on the Senate. Holding the Senate only helps maintain a bad status quo, keeps us from sliding into an even worse mess.

Even with a Democratic House and Senate, of course, I have no illusions that the result would be a liberal dream come true. But quite a bit that is worthwhile could be accomplished in Obama's last two years.