Why States Should Not Be Allowed to Alter the ACA with Waivers
CMS is allowing states to seek waivers to alter parts of the ACA. According to Republicans, state government knows better than the federal government the needs of its citizens and can design a better healthcare plan for them. Michigan along with Kentucky and another state have applied for waivers. Michigan and Kentucky have been approved. The Michigan bill has made it through the Republican legislature and will go to the governor to be signed (hopefully vetoed). The troublesome part of Michigan State Senate Bill 0897 (2018) can be found in SEC. 107B.
(E) If A COUNTY’S UNEMPLOYMENT RATE REACHES 8.5%, ALLOW A RECIPIENT IN THAT COUNTY TO MEET THE WORKFORCE ENGAGEMENT REQUIREMENT IN THIS SECTION BY ACTIVELY SEEKING EMPLOYMENT ACCORDING TO THE MICHIGAN EMPLOYMENT SECURITY ACT, 1936 (EX SESS) PA 1, MCL 421.1 TO 421.75. IF, ONLY AFTER A COUNTY’S UNEMPLOYMENT RATE HAS REACHED 8.5%, THE COUNTY’S UNEMPLOYMENT RATE SUBSEQUENTLY DROPS TO 5.0%, THE RECIPIENT MUST, AGAIN, MEET THE WORKFORCE ENGAGEMENT REQUIREMENTS AS REQUIRED UNDER THIS SECTION.
This is a relief valve for “counties” with high unemployment. In effect if Michigan counties have a high unemployment rate (8.5% or above), the unemployed workers in that county can have Medicaid until such time as the Unemployment Rate drops to 5%. Then the workers are expected to seek employment to be eligible for Medicaid. Ok, that should cover Detroit, Flint, Saginaw, Muskegon, etc. high unemployment rate. which exceeds 8.5%. Or does it qualify them?
The issue with SEC 107B is the word “Counties.” By using solely the word counties, SEC 107B does not make an exception for townships, villages, or cities. For example, Wayne County has an unemployment rate of 5.5% and not 8.5% or greater. As a result, Detroit which does have an unemployment rate greater than 8.5% does not qualify because it is not a county. Neither would the other Michigan cities in other counties with low unemployment rates qualify. Set this aside for a moment.
As many of you may know, Amazon rejected Detroit as a site for HQ2. While mentioned in the Amazon response, the claim of a lack of talent can be refuted as there are 52 million people living within 5 hours of Detroit, plenty of schools of higher education located in and around the Detroit, and also far more of each than exists Seattle. What Fortune Magazine pointed out as the primary issue for Detroit being rejected was the lack of a regional transportation system similar to what may be found in Chicago. Dan Gilbert fleshes out the bones of the reason with this detail:
“What became crystal clear to us from countless surveys, discussions, observations, studies, and even Amazon itself, is that having a strong mass transit solution is the ante to play for a ‘millennial’ workforce, as well as for the most successful and dynamic companies in the world.
Amazon conducted an internal survey of their employees, and the results showed that the ability to move seamlessly around a city with strong mass transit was a critical priority.
Companies like Amazon and their employee base require and depend upon a dynamic and reliable transit. If we are determined to attract exciting opportunities to metropolitan Detroit, then it’s time to get in a room and figure it out.”
The last go-around for a mass transit system was rejected.
The largest citizen cohort in the US wants to utilize public transportation rather than tool-around in pickup trucks to get to work. Amazon and other companies are looking beyond the baby boomer generation requirements to satisfy this new and larger cohort of citizens – Millennials. Automotive OEMs are in for another rude awakening in the next decade after they cut back on building smaller vehicles in favor of ever larger SUVs and Pickups. Gasoline sits at $2.90 today. If demand goes away and gasoline goes up in price, the OEMs will be retooling again.
Now back to high unemployment rates in cities as compared to the counties in which they reside.
Detroit Free Press, Nancy Kaffer:
“Sen. Patrick Colbeck, R-Canton, who is a gubernatorial candidate, told Gongwer that there were 31,000 job openings within an “easy commute” of his district. Colbeck, an Islamophobe and general holder of screwy beliefs, failed to mention that Canton opts out of SMART, the regional bus system. Commuting how, Senator?”
If Amazon believes there is not enough Public Transportation available for its “desired” labor force to get back and forth to work, then why would the legislature believe it is possible for the residents of cities to be able to travel outside of city limits? The cost and insured ownership of an automobile is expensive by national standards. Senate Bill 0897 will require residents in high unemployment cities to travel a distances even if there is no regional transportation available or a community with jobs opts out if the already low income and unemployed want Medicaid. It begs a question:
Is the failure to allow Michigan cities the same exemption as counties a feature or a bug?
The Great Lakes Beacon’s Danielle Emerson had this to say about the application of the exemptions.
So, who will get exemptions? Based on the unemployment information collected, there are 17 counties with unemployment rates meeting or exceeding 8.5 percent: Kalkaska, Oceana, Alcona, Iosco, Lake, Emmet, Chippewa, Ogemaw, Ontonagon, Arenac, Schoolcraft, Roscommon, Alger, Montmorency, Presque Isle, Cheboygan and Mackinac.
The majority of those counties (15) are represented solely by the Republicans with only parts of two counties being represented by Democrats.”
It is a feature and meant to penalize cities of which, by-the-way, the population is predominately minority. SEC 107B pits cities against rural areas. Michigan is going back to pre-ACA when it penalized single adults and under employed married adults with or without children if they were not working enough hours to satisfy the state mandated minimum. In the end the hidden costs of no insurance surpass the cost of Medicaid.
In 2013 upon the passage of Medicaid Expansion in Michigan, Michigan State Senator (Fowlerville) Joe Hune said; “I voted ‘no’ because I could not stomach pushing this garbage forward.”
Here is what Senator Joe Hune had to say in 2018 on Senate Bill 0897: “Making people reliant on the government for life’s necessities does not empower them or improve their situation, I heard a lot of absurd language calling this bill disgraceful. What I think is truly disgraceful is trapping people in a cycle of poverty and victimhood so that they have no choice but to relinquish their God-given freedom to certain politicians who genuinely disdain them.”
During his first term, Senator Joe Hune voted himself and other Senators a lifetime of taxpayer paid-for healthcare insurance in 2012. Soon to be citizen Joe Hune has had little experience in the private sector; but, he has little to worry about as his healthcare will still be intact if he loses a job there.
Of course the trapping of people in a cycle of poverty only applies only to cities with a predominantly minority population and not those populations living in rural areas outside of cities. Go figure what the reasoning is . . .
HT to Charles Gaba at ACAsignups.net whose article caught my attention.
run75441 at angry bear blog
Nice blue state they got there in MI.
According to Princeton Consortium and Sam “the man” Wang, Michigan is a part of a gaggle of states which vote Dem in national elections but are gerrymandered to allow for the election of Repub House Reps. Since 1992 until this last election (Ballotpedia), Michigan has voted Dem in national elections for the “Pres” and mostly for its Fed Senators. House Reps and State legislators have not been so consistently Dem.
Some seem to thing or think this can all be fixed and go away with a popular vote for the “Pres” so to speak. This is like taking your finger and swiping the frosting off the cake leaving the cake’s main substance behind. In effect, you have not fixed the “main” problem of gerrymandering districts to impact the results of state and federal elections . . . hence swiping the frosting and leaving the cake.
A good example of the issue is Pennsylvania with the drawing of its Congressional districts. Large Congressional districts on average are 700,000 and are super easy to gerrymander. Cut that in half and its gets harder to gerrymander (I wrote about this in “Reign of Witches”). Even though Michigan has consistently gone Dem in national elections for the “Pres” by ~52% to ~48%, the Fed House Reps number 9-5 Repub, and there are other factors which came into play here. Stein and other candidates achieved a higher percentage of the vote than in other elections probably due to the lies about HRC, failure to pay attention to Michigan needing help, and slow voting in densely populated areas such as Detroit.
The same holds true for state districting for State Reps and the Senators. It is an issue in Michigan.
It gets to be fun when I appear on facebook and answer self – proclaimed Repubs about Michigan and who has controlled the governor’s office and the legislature since 1990. The state Senate has been controlled by Repubs. The State house has been mostly controlled by Repubs. Dems never had a trifecta to include the Governor which occurred since 2011 and during some of Engler’s reign. Yet the state went Dem in national elections from 1990 till 2016?
Presenting the facts is not welcome on either side and I have been made aware of it. Repubs call the facts hateful. I guess the truth hurts. When supporting Dem candidates in the state, I am told they have to walk a fine line. I do not need a blue-dog representing me as it is the same as swiping the frosting off of the cake and leaving the cake behind of what Dems really mean.
It gets really cantankerous when you start to show them how Reagan, Bush II, and Trump are undermining their manufacturing jobs with the tax cuts that went into place and skewed heavily to moneyed and political interests (Cheney’s “Finally something for us), 1% of the household taxpayers making >$500,000 annually, and corporations.
Yep, the white people in rural areas have dominated since the civil rights act in many states. And especially in state elections.
Which is why we have policies like these. And why we see white people making it harder and harder for minorities to vote. The amazing thing to me is how many white people vote to cut off their noses to spite their face.
And I see no change possible until progressives increase their appearance at the polls in every election.
Progressives increasing their numbers at the polls, by itself, won’t do it. Lots of recent analyses have shown that, in general, the cities are blue and the rural areas are red. There is a huge disparity between blue counties and red counties nationwide. Progressives are going to have to face up to the need to sell to the rural areas as well as the urban ones, given the way our political jurisdictions are structured. Given recent experiences, healthcare ought to be very salable out in the countryside these days.
Of course states should not be allowed to alter ACA. The US Constitution grants Congress plenary power over interstate commerce, which quite obviously includes intra-state commerce. And everyone knows that the commerce power extends even to each individual’s economic decisions, and just as no person has the authority to spend his own money as he pleases, no state has the authority to regulate commerce within its borders. It is all perfectly reasonable.
EFFECTS ON THE NATIONAL ECONOMY AND INTERSTATE
COMMERCE.—The effects described in this paragraph are the following:
(A) The requirement regulates activity that is commercial and economic in nature: economic and financial decisions about how and when health care is paid for, and when health insurance is purchased
Judge Gladys Kessler (Mead v. Holder):
For the foregoing reasons, the Court finds that Congress had
a rational basis for its conclusion that the aggregate of individual decisions not to purchase health insurance substantially affects the national health insurance market. Consequently, Congress was acting within the bounds of its Commerce Clause power when it enacted § 1501
Ginsberg et al(NFIB):
First, Congress has the power to regulate economic activities “that substantially affect interstate commerce.” Gonzales v. Raich, 545 U. S. 1, 17 (2005). This capacious power extends even to local activities that, viewed in the aggregate, have a substantial impact on interstate commerce. See ibid. See also Wickard, 317 U. S., at 125 (“[E]ven if appellee’s activ- ity be local and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress if it exerts a substantial economic effect on interstate commerce.”
sigh . . . I really appreciate you explaining all of that to me . . . GFY
The Dems gave rural people healthcare. The GOP is taking it away as fast as they can.
Nothing will make most white rural voters vote Dem in state or federal elections. Even when they were excluded from coverage by their GOP state pols, and now when they are losing coverage because of their GOP state and federal pols.
“But these Trump administration actions seem to be hurting the exact same people who put the president in office. One of the findings that surprised Collins was that the uninsured rate rose only for Republicans, not Democrats.
“I can’t explain the increase among people who identify as Republicans,” Collins says. “I can speculate that it might have to do with the repeal and replace efforts, or a general sense of confusion. But right now it’s confusing and perplexing, and I don’t really know the cause.”
I’m also speculating here, too, but my hunch is that this could have to do with how different states responded to the Trump administration’s work to dismantle the Affordable Care Act. Liberal states kept investing in outreach work, while Republican-led states did not. That might be one other reason you see this political divergence in uninsured rates, too. “”
Anyone who is below 400% of FPL will not be hurt by the snatching of the CSR or the elimination of the mandate. The increase in premium was picked up the federal government for them. Later today, I will have a post up showing how many have abandoned Silver Plans as all the increased cost was put against them. Instead they went to now freebie Bronze plans and less costly Gold plans. Waivers will hurt anyone on Medicaid if classified as able bodied. People with ESI will have higher premiums although not as bad as those in the individual market who are unsubsidized.
I doubt these attacks on the ACA will stop. I cannot think of any issue that could rile the gop base more than running against the ACA, and blaming it, not what Reps have done to it, for the cost of healthcare. Cause gop voters will believe what fox tells them to believe.
And not to mention the white evangelicals who decidedly lack morals of any kind.
” The justification evangelical leaders most often offer for Trump’s decidedly unbiblical actions—after “it’s fake news” and “but he’s not doing it anymore”—draws on the Bible itself. Throughout history, they say, God has enlisted imperfect people to fulfill his perfect will. Jerry Falwell Jr., president of evangelical college Liberty University, put it this way: “God called King David a man after God’s own heart even though he was an adulterer and a murderer,” adding, “I think evangelicals have found their dream president.”
This argument is a bit suspect. In 2011, a PRRI–Brookings Institute poll asked Americans, “Do you think an elected official who commits an immoral act in their personal life can still behave ethically and fulfill their duties in their public life?” Only 30 percent of white evangelicals agreed. But asked again in 2016, days before Trump was elected president, 72 percent said that they believe that the two can go together. It is hard to escape the conclusion that the biblical argument Falwell and others are offering is pure rationalization for their support for Donald Trump. ”
I agree they will not stop. It is always good to understand the impact of Repub and Trump’s actions and who they hit the hardest. I have to be right to maintain credibility.
EM, the Democrats don’t have win the “majority of white males” in rural areas. They have to win more of them than they have been and white females there as well. Bear in mind that a congressional district here and a state legislative district there can make a huge difference in overall results. They aren’t all Fox News addicts. Some of them are just flat exasperated that nothing seems to get better for them. Some are purely ignorant like the Kentuckians who thought “Kentucky Care” was different from Obamacare.
Control of state legislatures with its resultant gerrymandering is a large part of Democratic weakness nationally. In most states that means getting some rural and small city votes is necessary.
” They aren’t all Fox News addicts”
Of course they are not, just the ones that have been voting Rep their entire lives starting(coincidentally) with the signing of the Civil Rights Act.
They are never going to change; they are never going to vote for a Dem; and there is no need to single them out for any special attention. As an example, the white working class received the same help from the ACA as the entire working class did. Let me know when you find a Dem program that excludes white working class members from the benefits.
Y’know, like Michigan’s new health law excludes blacks from benefits received by whites.
I think you mean cities with high unemployment rates (8.5% or more) located in counties with an unemployment rate less than 8.5% can not get Medicaid unless they are working. Detroit, Flint, Muskegon, etc. are predominantly black. Rural in Michigan is predominantly white. White Michigan does not want mass transportation as it will extend into white communities. Even so, minorities are moving west in Michigan along the I94, I96/696 corridors. It is just a matter of time.
Can’t happen fast enough.
EM, you’re missing my point, but you knew that.
I think your point is that you can change these peoples' voting habits. I totally disagree that can happen. I have seen no evidence in 4 decades of it happening, and have actually seen those voting habits solidified more.
The only question in our national election is the amount of turnout for each party.
Partially true; but if I may point out, Jack is also looking at what I talked about in my comment:
Jack: “Control of state legislatures with its resultant gerrymandering is a large part of Democratic weakness nationally. In most states that means getting some rural and small city votes is necessary.”
Me: “Michigan is a part of a gaggle of states which vote Dem in national elections but are gerrymandered to allow for the election of Repub Federal House Reps” and Repubs state legislatures. Since 1990 Repubs have had control of drawning state districts and congressional districts.
This gives far greater power in deciding policy. If there are any Repubs who would vote with us, they are canceled out by the politics in drawing the districts.
Today Connecicut went to awarding their EC votes to whoever gets the highest popular vote. Sure it works for the president; but, it completely ignores the House as being represntative of the population of each state and the balance to the Senate.
I am aware of that. Does not change the fact that my belief is there is absolutely zero chance of having the rural white working class vote democratic.
After all, these are the people that elected people that made their state(states) right to work states. They have even started legislation for a national right to work law(not going anywhere as far as I can see).
These people od not vote GOP because of the GOP”S labor policies, but rather in spite of those policies. Look what the trump admin has done to labor 16 months.
“January 20th marks the one-year anniversary of President Donald Trump’s inauguration. Since taking office, President Trump has overseen a string of policies that will harm working people and benefit corporations and the rich. Here we present a list of the 10 worst things Congress and Trump have done to undermine pay growth and erode working conditions for the nation’s workers. ”
and you still hear people talking about trump the populist, as opposed the real description, trump the racist. He won because he took the gop’s 5 decade racist dog whistles out of the closet and put it on his sleeve.
And the white working class rejoiced. Well, the ones that voted for him.
The waiver procedure was written into the the ACA aka “Obamacare” by the Democrats.
“Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.”
Not a single Republican (aka on this blog “racists”) voted for it.
Section 1332 : Read it again .
EM, I’m not talking about all of them or a majority. I’m talking about enough of them to win an election. Last time with Trump, whites who had previously voted for Obama, voted for Trump. Enough of them did it to swing 3 states. There’s no reason why we shouldn’t try to turn them back around.
That’s not to say we should ignore turnout and not fight voter suppression. Those things are important but so are those folks out there.
Jack, that’s where we differ.
I have seen no proof that there were any substantial amount of voters who switched from Obama to trump. I have met a lot of screwed up people in my life, but the idea people voted for a black man and then voted for a racist is too strange for me to accept.
Yeah, I know counties shifted. Until you can prove to me that the same people voted in those counties in both elections(which cannot be done, I admit) I will refuse to believe it. What better way to cover up voting for a racist than to tell pollsters they voted for a black man before?
Lots of reasons for the loss, not the least was clinton and her campaign(Georgia? Seriously?), but I see no reason to believe it was these mythical swing voters from dem to gop.
If anything, if was dem voters not voting(suppression, depression from berniebros) or voting for neither dem or gop. Look at PA, the amount of voters that voted for someone other than dem or gop increased more than 140,000 from 2012 to 2016.
Interesting. Wis, Ohio and Michigan all had non gop or dem voters increase by more than 100,000
I do not know how to make it any plainer.
Michigan has a history of voting for Dems in a National Election since 1992.Take my word for it, I have argued this repeatedly. The issue was the number of votes Stein and the Libertarian got which was more than the difference between HRC and Trump. The percent split is always close in Michigan. Michigan Congressional districts are gerrymandered to yield more Repub Congressmen than the almost 50-50 split in vote with the majority of the vote being Dem.
Wisconsin has a longer history of voting Dem in national elections than Michigan.
I think much of what happened is the result of Repub story telling and Trump’s blather.