Sunday, April 20, 2014

Expanding help to the poorest

When the Supreme Court ruled that the Affordable Care Act (ACA) was constitutional, there was an overlooked provision that the Supreme Court ruled was unconstitutional.  The Supreme Court ruled that the mandatory expansion of Medicaid at the state level was unconstitutional.  Despite some claims from op-ed writers at Forbes, President Barack Obama didn't overrule the Supreme Court when they made a decision he didn't like.  Instead, states could choose to voluntarily expand Medicaid to include coverage for those making 138% of the federal poverty level.  With the Medicaid expansion, the federal government would cover 100% of the cost for the first three years.  Then in 2017, the federal government would cover 95% of the cost of expanding Medicaid gradually declining to 90% in 2020 and beyond.  Before the federal government announced the enticing benefits to expand Medicaid, the federal government paid for about 58% of the cost for current Medicaid recipients.  At least one prominent Republican politician used the wrong figures to calculate the costs of expanding Medicaid in his state. Note: The politician has since changed his mind and now supports Medicaid expansion. 

Prior to the ACA, states could set their own eligibility requirements for Medicaid.  Some states were quite generous with their Medicaid eligibility, such as New York which allowed you to be eligible for Medicaid at 150% of the poverty level.  It should be noted that all states have significantly expanded coverage to children with Medicaid and Children's Health Insurance Program (CHIP).  Parents of children and adults without dependent children were not included in these expansions.  The subsidies for health insurance given at the federal level do not appear until you make 100% of the poverty level.  There are literally millions of people who are making too much money to qualify for Medicaid in their state but not nearly enough to qualify for the federal insurance subsidies.  For instance, in Alabama, if a family of three people is making $4,500 in a year, they do not qualify for Medicaid in the state.  Or in Mississippi, if you make more than $5,677, in a family of three you would no longer be eligible for Medicaid.  In Nebraska, a state that I am including because I know the Democratic candidate for Governor is running on expanding Medicaid, a family of three making more than $11,342 is not eligible for Medicaid.  For the most part, the states with the lowest Medicaid eligibility levels are not expanding Medicaid to cover those who may not qualify for the health insurance subsidies.  These states are overrepresented by states that are typically Republican.  Overwhelmingly, they are located in the South.

The non-partisan Kaiser Family Foundation (KFF) estimated that in the states that have not expanded Medicaid, there are five million people who make too much to qualify for Medicaid and not enough to qualify for health care subsidies. This number may decrease as Florida has since decided to expand Medicaid on a trial basis.  They are likely to remain uninsured as they have little options to purchase health insurance.  Of those who are uninsured, nearly half (47%) of them have incomes at or below the Medicaid expansion level (138% of FPL).  The table below shows the percentage of the uninsured who are at or below the Medicaid expansion level of incomes by race:

Whites
42%
Blacks
59%
Hispanics
51%
Other
46%

That table does not look at how many of the uninsured will fall into the coverage gap because of the states not expanding Medicaid. Over one-third of uninsured adults at incomes at or below the Medicaid expansion level will fall into the coverage gap.  40% of Blacks who are uninsured who are at or below the Medicaid expansion level will fall into the coverage gap.  Disproportionately, poor blacks reside in the South.  These states are not moving forward with the expansion of Medicaid.  About 24% of uninsured Hispanics who are at or below the Medicaid expansion level in income fall into this coverage gap.  The rates are lower with Hispanics because states that have high population of uninsured Hispanics, California, Arizona, and New York, have all announced that they are moving forward with Medicaid expansion.  In total, 47% of those falling into the coverage gap are white.  27% of those falling into the coverage gap are black; 21% are Hispanic; 6% are another race.  

Not all Republican states are refusing to expand Medicaid.  One of the more prominent "red" state is Kentucky.  According to the Governor of Kentucky, Steve Beshear's office, there were approximately 200,000 Kentuckians who would fall in this coverage gap without the expansion of Medicaid.  79% of Kentucky adults supported the expansion of Medicaid in Kentucky, according to a poll conducted by the University of Cincinnati.  87% of Kentuckians said that it's important to them for the state to provide health insurance to low income individuals.  Both Kentucky Senators, Mitch McConnell and Rand Paul do not approve of the expansion.  McConnell believed that Kentucky could not afford it and Paul warned that rural hospitals would be bankrupted. The federal government is cutting the Disproportionate Share Hospital (DSH) by $18.1 billion over 7 years based on the assumption that states would expand Medicaid.  This funding helped cover 95% of uncompensated care costs for state-owned hospitals, 69% for local public hospitals, and 38% for private hospitals in Kentucky.  Without the expansion of Medicaid, there would be a sharp increase in costs for uncompensated care. The Kentucky Cabinet for Health and Family Services issued a report recommending the expansion of Medicaid because the hospitals would suffer.  The Robert Wood Johnson and the Urban Institute issued a report concluding that Medicaid expansion greatly favors hospitals.  

Without all states expanding Medicaid, millions of Americans will remain uninsured.  There will be widening disparities between racial and ethnic groups in insurance coverage.  The non-expansion of Medicaid seems to be entirely predicated on political grounds rather than what is good policy.  This is something that should be troubling us all, instead of saying that it's only the poor in those other states that will remain uninsured.




Saturday, April 19, 2014

Good news for people who love bad news about Wendy Davis

Soon after her famous filibuster in the Texas Senate, Wendy Davis's favorability measured by Public Policy Polling (PPP) was 39/29.  In a hypothetical match-up against Texas Attorney General Greg Abbott, she trailed by only 8 points, 48-40.  There was an idea out there, I was one of them, who thought that Davis could pull off the upset over Abbott in a gubernatorial election.  The thought was that Davis could keep her net favorability around the same as she increased her name recognition throughout the state.  That thought was ultimately foolish.

In November of 2013, Davis's net favorability had already plummeted.  It had been +10 in June and had fell to -6 by November.  While Abbott's net favorability had also fallen, he was getting his name out there.  Davis's favorability plummeted with Republicans and Democrats and fell slightly among Independents.  In Texas, without bipartisan support a Democratic candidate will not have a chance to win.  Davis was losing popularity with Democrats in Texas, even.  Many people wanted Davis to be able to pull off this upset, so they ignored these numbers in conjunction with the party registration advantage for Abbott.

By April of 2014, Davis's favorability fell even more.  Republican Governor Rick Perry's favorability had rebounded and his net favorability finally ventured into positive territory.  Abbott's favorability has skyrocketed since November.  All of this has led to Abbott leading Davis by 14 points in the most recent poll.  It would take some type of miracle for Davis to be able to get back into this election.

While people talk about the possibility of Texas becoming a swing state in every election cycle, the 2014 election was supposed to be the tipping point to move it further.  Julian Castro has suggested that Texas can be a swing state by 2016.  This isn't a change that can happen overnight.  There will have to be unsuccessful runs by various politicians to get Texas to the point of becoming a swing state.  The political infrastructure is starting to get put in place for Texas to change.  Those doing groundwork in Texas for Davis should not get discouraged if they want to change Texas.  They should be encouraged by the amount of work that they were able to do for Davis.  Even an unsuccessful campaign can lead to eventual change.  If we were expecting Davis to be successful this time, we should change our way of thinking.

Michigan Senate

Democrat Senator Carl Levin announced that he would retire instead of running for another term.  Since the announcement of the retirement, there have not been many candidates who announced that they would run to fill the seat.  Gary Peters, Representative of Michigan's 14th district in the U.S. House of Representatives, is essentially the Democratic nominee.  Former Michigan Secretary of State Terri Lynn Land is the Republican nominee.  Despite the Democratic leaning of the state, the Senate race has been competitive and the Republican Party thinks that this Senate race is one that they can steal from the Democratic Party.

In the most recent poll from Public Policy Polling (PPP), we have a better idea of what is happening in the state.  Peters who has a favorability of 26/27 overall leads Land (28/31) by 5 points, 41-36 in the match-up PPP asked. The most recent polls not put out by PPP have basically alternated the lead between the two candidates.  This is a little surprising as the early polls on the Senate race had Peters consistently leading.  One campaign manager who has run campaigns in Michigan is very surprised that Michigan is showing as a toss-up as the registration for the state and his own experience indicates that the state will look more Democratic as the election draws near.  So, let's dig a little deeper to the PPP poll that was released.

Let's look at party id and this poll:


Democratic
Republican
Independent/Other
Land
9
70
33
Peters
75
11
33
Not sure
16
19
33

In December of 2013 where Land had a slight lead overall, Land led Peters among independents by 17 points.  So, what has changed in the last 4 months?  Let's look at other factors that PPP polled.  

The simplest answer would be that all politics are presidential and the approval ratings for Barack Obama are driving this decrease.  The simplest answer does not answer the entire question.  In December of 2013, Obama's approval ratings in December of 2013 among independents were 37/59.  In April of 2014, the rating is 38/50.  We see a general decrease in the unfavorable ratings but not a major increase in the favorable ratings.  The decrease in unfavorable ratings among independents certainly helps Peters but it does not explain the 17 point difference.

One of the questions that PPP asked is whether or not people support or oppose repealing the right to work law in Michigan.  In December of 2013, 42% of independents supported repealing the right to work law.  In April, the support for repealing this law increased by 6 points.  39% of independents opposed repealing the law in December compared to 31% who opposed repealing the law in April.  Even though the right to work law is more of a local issue, it would not be surprising to link repealing the law to the Senate candidates based on party lines. This might explain a few points for how Peters has been helped.

The Republican Party has decided that they want to make this year's election all about the Affordable Care Act (ACA), just like 2010 and 2012.  The favorability for the ACA among independents in Michigan was 29/57 in December and 33/52 in April.  That's only a few points but certainly helps Peters.  It continues the trend that we are seeing that the ACA is gaining popularity as it is implemented.  The views on how the ACA was implemented has also dramatically changed fitting with what we see elsewhere.  In December of 2013, only 18% of Michigan independents saw the implementation as a success.  76% of Michigan independents viewed the implementation of the law as unsuccessful.  But a few months later, in April, 35% of Michigan independents viewed the implementation as a success.  60% of Michigan independents viewed the implementation as unsuccessful.  That's a HUGE swing.  If the GOP continues to make the ACA the central point of the campaign in 2014 and these trends continue, Michigan will not be a toss-up.


Friday, April 18, 2014

Definition: Gerrymandering

As we get closer to Election Day in November, a term that will be constantly thrown about is gerrymandering. Gerrymandering is a term that is used to describe how states creatively decide Congressional and Legislative districts to keep a particular party or in some cases particular people in power. Congressional and legislative districts are drawn, in most cases, by each state legislature after a Census has been taken of the United States. There are not very many rules governing how states can draw up these districts. The legislatures who are in power after the Census can divvy up the state into their allotted number of Congressional districts. This leads to some states having creatively drawn maps and Congressional districts. The idea is to make Congressional districts as safe as possible while also taking power away from the out party to allow the in party to have the maximum amount of power. The term gerrymander came about because a state had the Congressional districts shaped like a salamander after one of these re-districting occurred.
What is and isn’t gerrymandering
One of the problems with identifying gerrymandering is the geographical locations of political parties. For the most part, those who identify as a member of the Democratic Party are more likely to live in urban areas or highly populated areas whereas those who identify as a member of the Republican Party are more likely to live in suburban and rural areas, or otherwise less popular areas. States that may look gerrymandered by the numbers may not look so when the map is involved. For instance, in Pennsylvania, the most heavily Democratic part of the state is in Philadelphia. The rest of the state is fairly divided with a Republican leaning. That’s exactly what we see when we look at the map. Ohio is another example of the same phenomenon. There is probably slight gerrymandering going on in those states but it’s not dramatically different.
Why gerrymander?
The primary reason for gerrymandering is self-evident. Most of the time, state legislatures are trying to construct a system in which their party will have the most Congressional districts and other legislative districts in their favor. A Republican led legislature will try to make the state more advantageous for Republicans. Democratic led legislatures will try to make the state more advantageous for Democrats. There is at least one other reason for gerrymandering.
One of the more popular reasons to gerrymander districts is to load up a district for a popular politician to discourage them from running for a higher office. The best example of this is in Illinois. The Illinois legislature strengthened Representative Aaron Schock’s district to discourage the young Congressman from running for Senate or for Governor in later years. The idea behind this is that if the politician can continue to get re-elected, he or she may not want to risk his or her political clout with an unsuccessful campaign.
Effects of gerrymandering
The effects of gerrymandering are often overstated. Nate Cohn, now at The New York Times, estimates that the latest round of re-districting has given the Republican Party a 10 seat advantage in the House of Representatives. This is significantly more than zero but not nearly as big of an advantage that has been stated by some. Part of the problem with measuring the effects of gerrymandering is the geographical location of political parties that was mentioned above. The other difficulty is that while the districts may have been drawn for a particular party early on after the census, by the end of the decade the demographics of the district could have rapidly changed. While there may currently be a 10 seat advantage due to redistricting, this could fluctuate greatly by 2020.
Long-term effects of gerrymandering are more concerning to me. The biggest problem is the effect of gerrymandering on voting habits. Convincing someone to vote for the first time is extremely challenging. The studies in the political science literature indicate that people are more likely to vote if there is a competitive election. Gerrymandering ruins the competitiveness of elections. We, also, see the effect of less people voting. Political discussion leads to voting but voting also leads to political discussion. The idea is that if less people are voting then there will be less political discussion which will lead to even less people voting and round and round we go. Less political discussion will be felt because we need more people trying to find solutions and we need more ways of thinking about issues.
Solutions
So, how do we go about fixing the issue of gerrymandering? Perhaps the simplest way to combat this problem is to take away the power of redistricting out of political hands. In the state of California, they have done just that. The state has an independent board that goes through and redistricts the state after the census. The board is made up of five Democrats, five Republicans, and four members who are either decline to state or a member of another party. The commission holds public meetings and must take the public comments into account when drawing the lines for the districts. The commission has to draw bordering districts and follow nonpartisan rules when drawing up the district. The districts have to be voted on prior to going into effect. The map must be approved by at least three members of each political party on the commission and three from the declined to state members of the commission. The solution put out by California seems to be an easy fix although there are some notable detractors who believe that any changes in redistricting are plots to cement power.
Another solution that I have seen thrown about in conjunction with the idea of an independent commission is the establishment of minimum population guidelines for federal House districts. The idea is that federal districts could not be smaller than the population of states with at-large House representation. I would imagine that the idea would continue at the state level, determining that each legislative district for the state legislature would have their own population minimums to ensure that districts are not decimated on the way to build up other ones.









Saturday, April 12, 2014

Michigan gubernatorial

In November of this year, Governor Rick Snyder will be up for re-election in Michigan. Governor Snyder signed contentious Right to Work legislation into law in 2013. The law was seen as highly unpopular and seen as a way for Snyder to lose the election in November of 2014. In fact, 44% of Michiganders support a ballot measure that would repeal the right to work legislation, compared to 34% who oppose, according to the most recent Public Policy Polling poll. Despite this general support for repealing right to work legislation, Snyder is currently leading his re-election bid against Mark Schauer 43%-39%. This is pretty consistent with what the polling has shown for a few months.
The good news for the Democratic Party and Mark Schauer is that there are a number of factors working in their favor. While Michigan is regarded as a swing state during presidential elections, Michigan has fairly consistently voted Democrat in recent presidential elections. There is a larger number of Democratic voters in the state of Michigan than there are Republican voters. The other factor working in favor of Schauer is that not many people know who he is, still. Governor Snyder has a favorability of 40% favorable/48% unfavorable among Michigan voters. Snyder’s name recognition is both high and negative. Meanwhile, Schauer’s favorability is 22/23. Not even half of Michigan voters have formed an opinion of Schauer. It is important to note that it is easier to gain name recognition than it is to flip opinion on you. Schauer could, very easily, gain points on Snyder in the next 7 months and close that 4 point gap. That’s the quick idea, anyway.
At least in this poll, it is easy to see where Schauer could pick up some of these points. Schauer’s name recognition among women is at 40% while it is 53% among men. It is in part because of that that he is only leading Snyder by 3 points, 42-39, in a head-to-head matchup among women. Schauer’s net favorability among women is +4 (22/18) compared to Snyder’s -3 (39/42). But Scahuer is actually underperforming what you would expect. Public Policy Polling asked about a generic legislative ballot and women overwhelmingly stated they would vote Democratic on the legislative ballot 50-33. Women also support repealing the right-to-work law more than men, as 45% said they would support repealing the right to work law compared to 25% who stated they oppose it. Men barely support repealing the right to work law (44-43). I am curious to see how women, nationally, view right-to-work legislation as the wage gap between men and women among union members is half the size of the wage gap among non-union workers.
The difficulty to Schauer could be that he is not appealing to independents, as much as he should be. Among independent/other voters, Governor Snyder has a -6 net favorability (39/45) compared to Schauer at -3 (18/21). Despite these numbers, Snyder holds a 10 point lead, 42-32, among independents. To make matters more confusing, on the generic legislative ballot the Democratic legislative spot holds a 11 point lead, 38-27. 48% of Independent/Other voters support repealing right to work legislation and 31% oppose repealing the right-to-work legislation. It’s easy to suggest that the governor’s race is just noise because Snyder holds a 35 point lead in name recognition. The numbers certainly indicate that they are noise. There are not really any numbers really indicating that it is not. The Republican led legislature is receiving the most blame for the unpopularity of conservative laws being passed. Most casual observers in politics focus only on executive elections, but changing the party dynamic of the state legislature, would be a significant accomplishment for the Democratic Party.

Monday, April 7, 2014

Bias, objectivity, and the biases of processing: Part 1

One of the biggest complaints when I scroll through Facebook, especially from older people, is that the news is biased against their political views.  I do not want to pick on Republicans but it is almost always a Republican complaining about the liberal bias about a news source that day, MSNBC, ABC, The Los Angeles Times, The New York Times, Forbes, CNN, even The Wall Street Journal, I have seen it all.  Democrats are almost as bad.  Democrats complain incessantly about Fox News being terrible.  They complain about how Conservative The New York Times or NPR is.  The end result of these complaints is the same.  They want objective or otherwise bias free news sources.  The truth is people do not want objective or bias free news sources.  They want news sources that agree with them.  Even if people actually wanted bias free news sources, they, largely, don’t exist.  The truth is, everything has a bias.


People do not want objective or bias free news sources.  Fox News was found to be the most trusted name in news by Public Policy Polling, yet again.  Fox News is the most watched news network.  Despite the claims of “fair and balanced” it is almost universally recognized as right-leaning if not fully on the Right (meaning Conservative) side of the political spectrum.  Those not on the Right distrust Fox News and it was found to also be the least trusted name in news by Public Policy Polling.  During the 2012 Presidential election calendar and even while states were counting votes, Fox News was confidently predicting a Mitt Romney victory.  On election night, former presidential advisor Karl Rove (in)famously stated it was too early to call the state of Ohio for Barack Obama.  To some of the Fox News audience, there was an almost instant belief that voter fraud cost Romney the election; after all, how could all these presidential advisors be wrong?  Another segment of the audience believed confidently that Romney wasn’t Conservative enough and that’s what cost him the election, Rove was merely in disbelief that a conservative nation wouldn’t elect Romney.  Still others believed that the Obama administration fudged the unemployment numbers to steal the election and Rove couldn’t have predicted this impact.  Others strongly believed that Hurricane Sandy cost Romney the election and that’s why the presidential advisors were wrong, as Rove is not a weatherman.  To those moderates who didn’t fully trust Fox News, it was just the latest indicator that Fox News was not to be trusted.  Those looking for “non-biased” news sources, the fact that Rove was in denial was because the internet group Anonymous had stopped Rove from stealing the election.  Those to the Left saw Rove’s refusal to concede Ohio as just the latest indicator that Rove (and all conservatives) couldn’t accept the United States changing.   For an event where literally millions of people watching, there were thousands of various opinions on Rove’s refusal to concede defeat.  Each one of them shaped by ideology, political preference, age, etc.  Each one of them formed by someone who fully believed they were the only one with this opinion. Each one of them formed by someone who witnessed an event and did not think twice that there was an unconscious bias working its way in there. 

Saturday, April 5, 2014

National opinion on the Affordable Care Act for 2014

NPR recently released a  bipartisan poll to see the electorate's thoughts for the 2014 elections.  Among the major findings in the poll, 51% of those polled oppose the Affordable Care Act while only 47% support the law.  For Republicans, it is easy for them to say that the law is unpopular.  I am sure Senator Ted Cruz will say that we should make DC listen because the slight majority of Americans oppose the Affordable Care Act.  But the NPR poll also found what is consistent with other polls, 47% support the law, while 7% oppose the law because it does not go far enough with health care reform.  Only 44% of those oppose the law and believe that it goes too far.  It's not all good news for Democrats that support the Affordable Care Act.

Let's look at how people view the law, based on party id.  Not surprisingly, support and opposition for the law falls largely on party lines.  We look at how Democrats view the law:
Support
84
Oppose; not far enough
4
Oppose law; too far
8

Then, Republicans:
Support
11
Oppose; not far enough
13
Oppose law; too far
76
If the election is going to hinge on the Affordable Care Act, then it will largely depend on how independents view the law:

Support
38
Oppose; not far enough
5
Oppose law; too far
54
Just judging by this poll, it does not look like the 2014 election will end well for the Democrats if the election is all about the Affordable Care Act.  The problem with extrapolating too much from this poll is that it is a national poll as opposed to a series of state polls that are holding the Senate elections.  What we should be doing if we want to predict how the Senate will turn out if the Affordable Care Act is the focus of the election is to look at a series of state polls. Unfortunately, this poll is just the latest example of how people can use political polls and other political information to prove whatever you want about politics.  If you're a Democrat you can point to the overall numbers and show that the Affordable Care Act is approved by a majority of Americans.  If you're a Republican, you would look at the political party numbers that show that independents do not support the law and that they will ultimately decide the election.