Whither Obamacare?

[Eddie Teach]

The problem with the Democrats is they insist on calling people privileged who don't feel privileged.

[OttoVonBismarck]

Democrats want to promote black people/other dark skinned minorities who represent the poorest groups, while focusing on "social justice" issues for women and homosexuals.

Is the problem with the Democrats that they want to do this to the exclusion of everything else (i.e. they're too caught up in social justice to do anything useful)? Or is the problem that they want to do this at all, while also doing other things (i.e. they may want to useful things, but their pursuit of social justice makes their other intentions irrelevant)?

I think the core issue with Democrats is if you ask me what's a consistent message of theirs over the last 15 years, it's basically been social justice stuff and advocacy for programs that are seen as disproportionately benefiting blacks and other "undesirable" minorities. I'm talking here purely about the lens of politics, not objective reality.

Now I could list 50 other things the Democrats have been about at one time or another in the last 15 years, but this appears to be the only consistent thing. Now, being for greater social justice for disadvantaged populations isn't a terrible thing, but it's not by itself a winning philosophy. The degree to which I feel this was the core of what the Democrats are can be highlighted in Hillary's campaign, where her most aggressive offense against Trump was to highlight ways that he violates the SJ "covenants." Focusing on his spats with the Gold Star Muslim parents, or how he called Mexicans rapists. It ended up that just repeatedly saying Trump is a bigot wasn't enough to really work for Hillary. It was arguably her only consistent, high profile message throughout the campaign.

Hillary's campaign represented a lot of the modern day DNC in that social justice issues appeared to get the most "publicized" attention, while the various wonky policy programs she supported got talked about frequently by her, but never by the press. Why that is I would presume is poor marketing/communication.

People mocked Trump for talking about a wall and a Muslim Ban, but that stuff is unequivocal. It's not really about a wall, but the wall is "simple phraseology" that resonates in people's minds. Being for the wall lets you know Trump doesn't want immigrants here, and doesn't want a bunch of Mexicans coming in to the country. Being for a Muslim Ban speaks for itself. This isn't a word for word paraphrase for either candidate, but compare how Trump and Hillary talked about job creation:

Trump: I'm going to fight China and Mexico who have been stealing your jobs, and I'm going to give them back to Americans. I'm going to end the war on coal that has cost so many American jobs.

Hillary: Globalization has created winners and losers and systemic disadvantages for certain elements of the economy. While coal mining is in decline, and while we are going to be shuttering more mines and coal fired power plans, we need to advocate for the workers in these industries. We plan to introduced economic stimulus to areas disproportionately affected by the decline of coal. We plan to introduced educational and training opportunities for people who lose their jobs due to global factors out of their control.

Hillary is promising some wonky government policy that pushes at the margins of stuff and which people don't really understand because they're dumb. Trump is saying "I'm going to give your job back and I'm going to create new jobs."

Hillary's was closer to being a representation of what Presidents and politicians can actually do, Trump's was a lot closer to being about what people wanted to hear.

For better or worse Trump is probably the first candidate we've had maybe since Reagan who really "fired up" middle class white Americans. There was a major enthusiasm gap in this demographic for Trump vs Hillary. Tons of middle class whites still voted for Hillary, but I would argue most weren't super enthused about it.

[OttoVonBismarck]

It's off topic but the way Democrats should compete is to make elections not about the disadvantaged vs white people, because that's just going to drive more and more whites (America's largest ethnic group) to the GOP. It makes far more sense to make the party a populist party offering very simplistic economic answers to complex problems for non-rich people. There's no reason to have these promises backed up by well-grounded policy.

[The Minsky Moment]

Something I've said for a long time is our basic government structure is causing a lot of this, and that same structure also is almost impossible to change.

It's very difficult to change formally through written constitutional revision, but it has often changed more informally, through court decisions, changes in bureaucratic and legislative practice, changes in mentality.

Notably - in the 20th century:
+ A fundamental revision in the scope and purpose of legislative authority, in response to the challenges of the rise of corporate power in the gilded age, and the economic damage done by the Great Depression. Constitutionally this was facilitated by the death of Lochner and the repurposing of the Commerce Clause, all court decisions.  Although the income tax amendment also played a key role here
+ Significant rise in Executive power and authority, particularly over security and foreign affairs
+ Institution of a professional civil service bureaucracy and the expansion of the administrative state, including major areas of policy (e.g. monetary policy) ceded to technocratic experts
+ Relaunch of the aborted Civil Rights project of Reconstruction and the death of Jim Crow.

There are IMO a couple of key reasons why the system is getting jammed up.  First, a series of catastrophic Supreme Court decisions redefining payment of money of political candidates as a core First Amendment issues, thus making it impossible to control the vast flow of legalized bribery.  Second, a relative lack of true national crises that create a sense of unity and common purpose.  For example Senator Inouye and Senator Dole were of radically politically different political philosophies, but their shared experience of war created a powerful bond that transcended such differences.  That's the last generation that had that kind of shared national experience.  The Cold War could be divisive but also brought together liberal and conservative anti-Communists to pursue commong goals.

The 2008 financial crisis was the closest we had to that kind of experience and it did have a temporary moderating effect: it cooled the temperature of a presidential race, there was cross-party cooperation on some fairly radical measures.  But in a way it succeeded to well.  Americans have become complacent and feel safe enough to indulge in the pleasures of partisanship even if it pushes the risk needle out for the country.

[Iormlund]

It might be the distance, but I honestly cannot see how the Democrats have been pushing for the disadvantaged. The only major "victory" was ACA. Other than that:

• The wealth gap has only grown under their watch.
• So has the amount of information gathered and lack of accountability of the government.
• And it had to be the SCOTUS that actually advanced gay rights.

Seriously, help me out here. How are the Democrats actually promoting a liberal agenda? Or is it all based on rhetoric?

[garbon]

It might be the distance, but I honestly cannot see how the Democrats have been pushing for the disadvantaged. The only major "victory" was ACA. Other than that:

• The wealth gap has only grown under their watch.
• So has the amount of information gathered and lack of accountability of the government.
• And it had to be the SCOTUS that actually advanced gay rights.

Seriously, help me out here. How are the Democrats actually promoting a liberal agenda? Or is it all based on rhetoric?

It might help if you recall we are a collective of 50 states and that national politicians aren't the only ones that can effect change.

[grumbler]

It might be the distance, but I honestly cannot see how the Democrats have been pushing for the disadvantaged. The only major "victory" was ACA. Other than that:

• The wealth gap has only grown under their watch.
• So has the amount of information gathered and lack of accountability of the government.
• And it had to be the SCOTUS that actually advanced gay rights.

Seriously, help me out here. How are the Democrats actually promoting a liberal agenda? Or is it all based on rhetoric?

To be fair, "their watch" only lasted two years, and the Democratic Speaker was Nancy "I'll just indulge my craving for brutality here" Pelosi.

Your [ii] can be fairly be at least partially blamed on the Obama Administration, though.  I'm not sure how avoidable that is, though, given that it has happened almost everywhere in the West.

[OttoVonBismarck]

It might be the distance, but I honestly cannot see how the Democrats have been pushing for the disadvantaged. The only major "victory" was ACA. Other than that:

• The wealth gap has only grown under their watch.
• So has the amount of information gathered and lack of accountability of the government.
• And it had to be the SCOTUS that actually advanced gay rights.

Seriously, help me out here. How are the Democrats actually promoting a liberal agenda? Or is it all based on rhetoric?

You're talking about results and I'm talking about political posturing. Democrats have largely been shut out of policy for much of the last decades. After the Republican wave in 1994 Bill surrendered a lot and became a "Third Way" Democrat which helped his likeability during his term but also eroded a lot of core Democratic positions for better or worse (depends on how you view them.) Since Clinton we've had 8 years of Bush who with the veto pen was never going to let progressive causes come to fruition, regardless of who controlled Congress, and for 6 of Obama's 8 years the Republicans controlled at least part of Congress and could stop most of Obama's legislative agenda that way.

[Admiral Yi]

You're talking about results and I'm talking about political posturing. Democrats have largely been shut out of policy for much of the last decades. After the Republican wave in 1994 Bill surrendered a lot and became a "Third Way" Democrat which helped his likeability during his term but also eroded a lot of core Democratic positions for better or worse (depends on how you view them.) Since Clinton we've had 8 years of Bush who with the veto pen was never going to let progressive causes come to fruition, regardless of who controlled Congress, and for 6 of Obama's 8 years the Republicans controlled at least part of Congress and could stop most of Obama's legislative agenda that way.

Minor quibble: Bubba positioned himself as Third Way as a prelude to running.  What you're talking about is more like Dick Morris' triangulation.

[OttoVonBismarck]

My memory is Clinton tried shenanigans like Hillarycare during his first two years in office then seemed to adopt much more right of center positions after his party was walloped in the 1994 mid terms. I'd concede he was positioning himself as third way before he was elected, but he governed more like third way after '94.

[Razgovory]

The problem with the Democrats is they insist on calling people privileged who don't feel privileged.

The problem is that you don't feel privileged?

[Eddie Teach]

I'm not the issue here.

[Razgovory]

I'm not the issue here.

Then is the issue?  Who are the ones that feel they aren't privileged?  Are you among that group?

[Eddie Teach]

Lower middle class whites. Used to be staunch democrats.

[Syt]

https://www.nytimes.com/2018/07/10/us/politics/trump-affordable-care-act.html

Trump Officials Slash Grants That Help Consumers Get Obamacare

WASHINGTON — The Trump administration announced on Tuesday that it was slashing grants to nonprofit organizations that help people obtain health insurance under the Affordable Care Act, the latest step in an escalating attack on the law that threatens to destabilize its insurance markets.

The cuts are the second round in two years. The government will provide $10 million this fall, down from $36 million last autumn and $63 million in late 2016 — a total reduction of more than 80 percent.

Trump administration officials said the insurance counselors, known as navigators, did not enroll enough people to justify more spending. Insurance agents and brokers do much better, they said.

The announcement on Tuesday, by Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, came three days after the administration suspended a program that stabilizes health insurance markets by paying billions of dollars to insurers that enroll large numbers of unhealthy people under the Affordable Care Act. Insurers said the freeze would cause turmoil in insurance markets and drive up premiums.

The administration is not only cutting grants to navigators, but fundamentally changing their mission. They will, for the first time, help people enroll in health insurance plans that do not comply with the consumer protection standards and other requirements of the Affordable Care Act.

Since they began work in 2013, navigators have helped people enroll in health plans that comply with the Affordable Care Act. Now the Trump administration says they should also inform consumers of other options, like "association health plans" and short-term, limited-duration insurance.

Such plans do not have to provide the standard health benefits like preventive services, maternity care or prescription drug coverage, but administration officials say they will also be more affordable to consumers.

"It's time for the navigator program to evolve, which is why we are announcing a new direction for the program today," Ms. Verma said Tuesday.

In each of the past two years, she said, navigators enrolled less than 1 percent of the people who signed up for coverage in the federal marketplace. In the most recent enrollment period, about 8.7 million people signed up for coverage in states using the federal marketplace, the administration said.

Senator Ron Wyden of Oregon, the senior Democrat on the Finance Committee, expressed outrage at the administration's effort to redefine the purpose of the navigator program.

"This move amounts to federally-funded fraud — paying groups to sell unsuspecting Americans on junk plans," Mr. Wyden said.

Having failed to persuade Congress to repeal the Affordable Care Act, the president is now engaged in a "sabotage crusade" to wreck the law, Mr. Wyden said.

Fred Ammons, who supervises the Insure Georgia navigator organization, said: "This is a huge cut to navigator programs across the country. It will virtually eliminate face-to-face in-person assistance. It means less help, much less help, to underserved, hard-to-reach populations, people who live in rural areas or have low literacy or don't speak English as their primary language."

The House Democratic leader, Nancy Pelosi of California, said, "Yet again the Trump administration is trying to trick Americans into buying junk health insurance plans and making it harder for families to enroll in real affordable, quality health coverage."

President Trump declared last fall that the health law was "dead" and "gone," but it has proved to be surprisingly durable and evidently meets a significant need. Nationwide, in federal and state marketplaces, 11.8 million people signed up for coverage in the last open enrollment period, down from 12.2 million in the prior year but substantially more than many experts had predicted.

The Trump administration on Tuesday defended its decision to cut grants to insurance counselors, saying consumers had many other ways to learn about their options. It said, for example, that insurance companies had "significantly increased their marketing and promotional spending."

However, insurance companies typically push their own products, while navigators are not supposed to favor or recommend a specific company or product.

In addition, the administration said the insurance exchange was now "an established marketplace" for people seeking coverage. "Last year," it said, "we had our most cost-effective and successful open enrollment to date. As the exchange has grown in visibility and become more familiar to Americans seeking health insurance, the need for federally funded navigators has diminished."

Ms. Verma said grants to navigators would be based on their performance in past years. Some, she said, had performed poorly.

In 2016-17, she said, 17 navigator groups enrolled fewer than 100 people each, at an average cost of $5,000 for each person enrolled.

By contrast, she said, agents and brokers accounted for more than 40 percent of enrollment in the federal exchange for the current year, and the cost to the government, for training and technical assistance, was just $2.40 for each person enrolled.

Agents may receive commissions from insurance companies — typically modest payments for marketplace plans — but navigators are generally forbidden to accept compensation from insurers.

The Trump administration said it was also eliminating a requirement that navigator groups have a physical presence in the areas they serve. This would presumably allow federal grantees to provide aid by telephone or through web portals, like online insurance brokers.

Navigators can help consumers fill out applications, complete enrollments and renew coverage online, the administration explained.

Rachel Fleischer, the executive director of Young Invincibles, an advocacy group for young adults, said she was dismayed by the cuts announced on Tuesday. Research, she said, has shown the effectiveness of in-person assistance provided to people shopping for health insurance, a notoriously complicated product.

The cuts, she said, "will result in far fewer in-person assisters and huge swaths of the country lacking any in-person help."