Friday, July 29, 2016

In which Republican pundits hear Obama for the first time

A hard-baking meme in the commentary following the Democratic convention is that the Democrats stole traditional Republican thunder  -- projecting American exceptionalism, support of the military, economic optimism.

Granting that the speaker selection and crowd chants may have been a bit more rah-rah than the Democratic norm, this meme has its root in Republican reaction to Obama's speech on Wednesday night that says more about them than him.  The Times' Nick Confessore cites this example:
“What is Obama talking about? He’s talking about the Constitution. He’s talking about personal freedom,” said Craig Shirley, a conservative author and Reagan biographer, referring to the Wednesday speech in which President Obama invoked his Scotch-Irish roots and the homespun values of humility and hard work.

“Moving out several paragraphs, Reagan could have given that speech,” Mr. Shirley added. “This might be part of a dialectical change in American politics.”
Twitter abounded with similar sentiments:

Thursday, July 28, 2016

When a democracy offers "one choice": Obama's haunted celebration

One of the enduring themes in  Obama's rhetoric is to embrace the messiness of democracy: to remind listeners that 'the other side may sometimes have a point,' to urge the necessity of compromise, to affirm that people on opposite ends of the ideological spectrum share some core values.  

It was all the more striking, then, that in his convention speech last night he placed Donald Trump outside the pale of this consensus allegedly underpinning all our battles over policy. In his 2008 convention speech, Obama praised John McCain's service to country and personal decency effusively while lambasting his polices; in fact the whole convention was structured to kill McCain with kindness. With Romney he was more caustic, suggesting in his 2012 convention speech that to vote Republican was to choose oligarchy. But oligarchy is on the democratic spectrum. The U.S. has always been an oligarchy to greater or less extent.

In this his valedictory paean to democracy, in contrast,, Obama asserted that there was only one choice. He ultimately placed the Republican nominee in the company of the destroyers of democracy, the nation's worst enemies: fascists, communists, jihadists. And the context in which he made that shocking but wholly appropriate charge is fascinating.

He began by evoking the "real America" as portrayed by Trump's precursor, Sarah Palin: the small town Bible belt heartland -- where ironically he, in a very real sense, came from. He then carried that "heartland" through space and time, to Hawaii and working class black Chicago and to the present -- and then to the entire world from which the U.S. draws its immigrants.

Wednesday, July 27, 2016

In which Bill fleshes out Hillary's boilerplate

After Bill Clinton's long narrative tribute to his wife last night, Republican operative Nicole Wallace allowed that while the second half of the speech was effective, the first 25 minutes "meandered."

Nope. The speech was long, it was narrative, it was may or may not have been engaged or sympathetic. But it was the opposite of meandering. It was methodically building a case, fleshing out a set of claims Hillary Clinton has been reiterating over and over so that they feel like boilerplate.

The claims: She 's been committed to children's welfare specifically and improving people's lives in concrete ways generally all her life. She is practical and analytical and gets things done. She is a joiner, a leader and  a changemaker.

Toward the end, contrasting "the real Hillary" with the imaginary one created by her enemies Bill said, "The real one had done more positive change-making before she was 30 than many public officials do in a lifetime in office." In those "meandering" first 25 minutes, he had made that case in detail, so it was hard not to agree. Leaving out the humanizing, sanitized, personal remembrances, here are the resume points:

Tuesday, July 26, 2016

Michelle Obama took the high road to lay Donald Trump in the dust

Michelle Obama pulled off a Houdini trick in her magnificently distilled framing of the choice in this election in her convention speech last night.

On the one hand, she articulated a humane, inclusive vision of what America is and of what's required to lead America. At the same time, she framed the choice in this election as absolutely Manichean.

She managed at once to take the high road -- "our motto is, when they go low, we go high"--  while
leveling the most devastating attack on Trump yet articulated.  It was devastating because she didn't deign to name him. She refrained not out of delicacy, but to demonstrate that she didn't have to. He was so instantly recognizable -- as were his dual alter egos, Obama and Clinton. as she had earlier portrayed them:

Saturday, July 23, 2016

By Trump's edits shall you know him

Josh Marshall details various ways that Trump's current business is dependent on funding from Russian oligarchs and operatives dependent on Putin, then notes Putin's hand in the GOP platform:
The Trump Camp was totally indifferent to the platform. So party activists were able to write one of the most conservative platforms in history. Not with Trump's backing but because he simply didn't care. With one big exception: Trump's team mobilized the nominee's traditional mix of cajoling and strong-arming on one point: changing the party platform on assistance to Ukraine against Russian military operations in eastern Ukraine. For what it's worth (and it's not worth much) I am quite skeptical of most Republicans call for aggressively arming Ukraine to resist Russian aggression. But the single-mindedness of this focus on this one issue - in the context of total indifference to everything else in the platform - speaks volumes.
This sparked a recent memory.  Tony Schwartz, Trump's "co-author" of The Art of the Deal (actually its sole author, as the publisher verifies), recounts the sum of Trump's input:

Thursday, July 21, 2016

Brookings bombshell: ACA lowered premiums, subsidies aside. Some caveats....

In a rigorous study of health insurance premiums in the individual market pre- and post-ACA, the Brookings Institution's Loren Adler and Paul Ginsburg come to a startling conclusion: in 2014, the year the ACA marketplace launched, average premiums were 10-21% lower than in 2013 -- leaving aside the subsidies accessed by over 80% of marketplace enrollees. Further: even accounting for the steep increases coming into effect in 2017, premiums will remain lower than they would have been if the ACA had not become law.

Based on CBO estimates and  projections of premiums from 2009 and later years, and data from the Medical Expenditure Panel Survey (MEPS), Adler and Ginsburg conclude:
According to our analysis, average premiums for the second-lowest cost silver-level (SLS) marketplace plan in 2014, which serves as a benchmark for ACA subsidies, were between 10 and 21 percent lower than average individual market premiums in 2013, before the ACA, even while providing enrollees with significantly richer coverage and a broader set of benefits. Silver-level ACA plans cover roughly 17 percent more of an enrollee’s health expenses than pre-ACA plans did, on average. In essence, then, consumers received more coverage at a lower price.

In Covered California, deductibles get steeper and narrower

As deductibles have risen steadily in health plans sold in the ACA marketplace, plans are offering more services that are not subject to the deductible. HHS has embraced this trend and incorporated it in the standardized benefit designs launching in the 2017 (which are optional for insurers).

California, which has had mandatory standard plan designs since the launch of the marketplace in 2014, has always included benefits not subject to the deductible in those designs -- and they have expanded outside-the-deductible services periodically, as deductibles and copays have also risen steadily.

In 2014, bronze plans offered on Covered California had a $5,000 deductible, with no separate deductible for drugs. Three primary care doctor visits were not subject to the deductible, as were three urgent care, outpatient mental health or substance abuse visits. In 2016, when the medical deductible was raised to $6,000, a $500 pharmacy deductible was added, and laboratory tests were put outside the deductible.

Tuesday, July 19, 2016

Whither the 70,000 Louisiana marketplace enrollees who are newly Medicaid eligible?

Louisiana's Medicaid expansion continues apace, with a bit over 250,000 state residents gaining coverage since the program went live on July 1. As I noted in a prior post, most of those enrollees, about 190,000, were transferred from existing public limited-benefit plans. At present, about 2,500 people per day are enrolling. The state is aiming for about 375,000 new enrollees overall.

According to Andrew Tuozzolo, Chief of Staff at the Louisiana Department of Health, that target does not include enrollees in ACA marketplace plans rendered newly eligible for Medicaid. (In states that refused to implement the ACA Medicaid expansion, which included Louisiana until this year, eligibility for private plan subsidies begins at 100% of the Federal Poverty Level. In expansion states, residents with incomes up to 138% FPL are eligible for Medicaid, and not for private plan subsidies.)

Thanks to enrollment data released by CMS early this month, we now know that almost 85,000 Louisianans who had enrolled in private plans in the ACA marketplace as of the end of Open Season on Jan. 31 -- 40% of all enrollees -- reported incomes in the 100-138% FPL range. Most of those 85,000, though not all, should now be eligible for Medicaid, the chief exceptions being legally present noncitizens subject to the federal "five-year" bar to Medicaid eligibility.  About 15% of the state's marketplace enrollees had dropped out (or in most cases, probably, never paid a premium) as of March 31.  Most likely, then, about 70,000 current private plan enrollees are now Medicaid eligible (as well as perhaps 10-15,000 dropouts).