Do you feel sorry for the Republicans? Their effort to repeal Obamacare has failed and most of them are moving on:
“Only 18% of Americans want to go back to the system we had before because they do not want to go back to some of the problems we had,” Whit Ayres, a veteran Republican pollster who works for presidential candidate Sen. Marco Rubio of Florida, said at a recent breakfast hosted by the Christian Science Monitor.
“Smart Republicans in this area get that,” he added.
Whit Ayres also spent some time at that breakfast explaining reality to the attendees about gay marriage and young Republicans.
While a majority of Americans support gay marriage, nearly three-quarters of Republicans do not, according to Gallup. That’s not true for young Republicans, however. More than 60 percent of Republican voters under 30 do support gay marriage, said Ayres, the founder and president of North Star Opinion Research.
“We’re headed to the point where a political candidate who is perceived as anti-gay at the presidential level will never connect with people under 30 years old,” Ayres said, citing the rapidly changing views on same-sex marriage in America.
Now, imagine a competition in Iowa to win the support of the most impassioned conservatives in that state.
These are voters who, by-and-large, hold similar views to Rep. Steve King. This is the man who just this week was accusing the Democrats of passing the Civil Rights Act of 1964 as a way of creating an artificially large electorate. He says the president is trying to do the same thing now with his executive actions on immigration.
King also compared Obama’s immigration actions to the passage of the Civil Rights Act in 1964. The law’s creation allowed many blacks in the segregated south to cast ballots for the first time.
“It erodes the politics of this country, the respect for the rule of law, and it creates this massive electorate that will likely vote in large numbers for Barack Obama and his party, just like African-Americans have done so after Lyndon Johnson signed the Civil Rights Act, which by the way took the majority of Republicans in the House and Senate to make sure that that passed,” he added.
Talking moderately about Latinos, gays, or health care won’t be easy if your job is to attract this crowd. Mike Huckabee knows how to talk to them, however, and he’s going to announce his presidential campaign on May 5th. In fact, he’s already carving out some ground for himself by opposing cuts to Medicare and Social Security.
Rand Paul will commit his own heresies, primarily on a selective and shifting basis, but we can expect him to say some things about foreign policy, surveillance, marijuana, and prison reform that Republican voters aren’t used to hearing. The combo of Huck and Paul will help splice up the Iowa caucus-goers in unpredictable ways.
You can at least say this. The voters will have some choices. I wouldn’t trust any polling, however, as the variables are too complicated to account for in any scientific way. It’ll be a little easier to poll in states with primaries instead of caucuses, but up in New Hampshire people have the opportunity to participate even if they aren’t members of the Republican Party, which means that independents and mischievous Democrats will have a big say in who wins. The Bush family history in New Hampshire shouldn’t provide much comfort for Jeb, though.
After narrowly winning Iowa in 1980, Poppy Bush got clocked by Reagan in New Hampshire, 50%-23%. He did manage to win there in 1988 and 1992, although he was embarrassed in the latter contest by a stronger than expected finish by nativist Pat Buchanan. Of course, John McCain destroyed Dubya in the 2000 Granite State primary.
This time around it could be that Jeb is positioning himself as moderate enough to win in New England, particularly when the voting is open to non-Republicans. But he better hope he’s successful because when the contest turns south, being moderate on things like education and immigration won’t be assets.
It’s interesting that Marco Rubio’s pollster is trying to interject some sanity into this process. Will Rubio listen to his pollster? Was he listening to his pollster when he decided that he no longer believes in climate science?
Where does reality (political or otherwise) intersect here?
My guess is that it intersects after the polls close on Election Night and the Republicans have lost big…again.
It is hard to imagine how they could backtrack on their hatred for Obamacare, teh gays, and decent immigration law in the primaries. Fortunately, they will have the political MSM that won’t hokd their feet to teh fire in the general election on any of this – because that would not be fair.
No Candy Crowleying?
Polling numbers may not be hard but they are trending which likely will mean by the time there are debates there will be even more distance between reality and Rep candidates’ positions.
If the SCOTUS comes down against the ACA, Rep town hall meetings will be in turmoil, with each Rep begging folks to believe the Rep will fix it forthwith.
If SCOTUS ok’s the ACA, each Rep will have to explain why they are losers.
If they can’t come up with policies of their own by the time the debates start up yes, they will lose.
Hey, not so fast, BooMan.
Your Ayers pull quotes are from a very deceptive news report which does not quote an GOP candidate who accepts the point this pollster is making. Yes, we can see that Ayers is trying to break the news to GOP activists and base voters that ripping out Obamacare root and branch would be a disastrous move, both electorally and on policy terms.
Yet, the candidate Ayers is working for, Marco Rubio, is on the stump this very week saying that if elected President he would “repeal and replace Obamacare.” All of the candidates appear to be saying versions of this, except for Cruz who doesn’t want to replace it, and just wants poor people to die more quickly.
Some people say that, well, the GOP POTUS candidates don’t really mean this, and they’ll be compelled by reality if they take office. To which I respond, YOU. ARE. FOOLING. YOURSELF.
The GOP base is going to prioritize repealing Obamacare above anything else. The GOP base, a broader portion of the base than the portion which wants to tear down Roe v. Wade, wants the Black President’s signature law OUT.
If the conclusion to your post here is partially premised on the belief that the Republican POTUS nominee will campaign on repealing Obamacare and will get smashed by the electorate for that, yeah, I would agree with that.
Are you saying that, BooMan? It’s unclear, because your use of the Ayers quote makes it appear that you believe differently.
Well, I expressed skepticism about Rubio listening to his pollster.
Got it.
I read it as a buildup to this line: “My guess is that it intersects after the polls close on Election Night and the Republicans have lost big…again.”
While Nate Silver’s “50-50” comment was unsettling, I just don’t see how the combination of electoral math and the albatross of the GOP base can add up to anything less that a 300+ electoral vote democratic victory in 2016. This article reinforces that belief.
As part of the reality-based community, we should take objective views like Nate Silver seriously. Remember 2004, when there was no conceivable way W. could win because of the Iraq war and because of how obviously stupid he was? Our subjective views of GOP knuckle-dragging doesn’t necessarily guarantee a loss.
Yes. And some members of the reality-based community like me more or less shut up after Kerry had secured the nomination because to speak of what we saw risked being banned from sites like dKos. An odd experience for me as I only began contributing there in the aftermath of the 2002 midterms. Leading up to that election, the leftie blogs were totally confident that there would be large gains for Democrats in that election. Other than the 2000 presidential election when I did pay close attention to the national and FL polls in the last 90 days (and I’ll never be convinced that those polls weren’t accurate), I had no confidence that I could apply all those stat courses I’d taken so long ago to elections. I deferred to those that seemed to have some expertise and they sure were painting a much rosier and preferred outcome than I was seeing. Figured that I had something to contribute at that point.
Have since learned that the reality-community based prefers to fret and hope instead of dealing with reality regardless if their hopes will or won’t materialize in the election results.
They’ll always have “guns, guys, gods (Jupiter and Mars), and capitalism with regressive taxation.
Like all TPGOP members ALL of their Presidential Candidates will say anything they feel they need to, to get elected. Once in office they will support ALL of the numerous hate filled TPGOP policies. If the public does not like it, then it will not be the first time TPGOP do what they want and say FU to constituents and all voters.
Instead of denying reality in their hatred for all things Obama and the democrats, what would happen if they repealed Obamacare and put in Medicare for all? That they won’t do it only shows their utter contempt for democrats and the average person. How do these guys still control congress and so many state houses? That has to say something about the electorate.
Medicaid for all would be a better starting point. Medicare premiums, deductibles, and co-pays aren’t affordable even for many seniors and many Medicare beneficiaries are also on Medicaid. Current total US Medicaid/CHIP enrollment is 70 million, and that’s without the millions that would be enrolled in those states that declined the offer of expanded Medicaid.
No kidding. Medicare covers 100% of hospital expenses, which is really the nuclear bomb of medical bankruptcy, but the rest of it? It’s a glorified PPO — just essentially an agreement that the medical establishment won’t commit highway robbery off your sickness.
Medicaid is absolutely essential to making Medicare work for everyone, and that very much depends on the state. Where I live now, everything is covered as long as I earn less that someone like $2,500/month (with disability check of $1,000 included). In Pennsylvania, that number is $1,300 — which seems a little low especially when you consider I’m on disability for medical reasons.
The Medicare Part A (inpatient hospitalization) is 100% for the first 60 days per benefit period. Generally a coinsurance payment requirement kicks in on day 61. (Also note that beneficiaries pay no premium for Part A and that Part A is funded by employee/employer payroll taxes.)
The original Medicaid funding model in that it recognized that state governments have a better ability to control aggregate medical costs and inflation than the feds do, that medical costs vary by a state’s overall cost of living, and that state and local governments were already providing the lowest cost medical care at public clinics and hospitals. Being penny wise and pound foolish, the public health sector didn’t expand and flourish with the introduction of Medicaid but shrank. Public health facilities became more underfunded because they managed the bulk of indigent care and those patients weren’t direct Medicaid beneficiaries.
As the underfunding led to public health facilities being overcrowded and the plant and equipment being overused and under-maintained and under-replaced, those Medicare beneficiaries that could afford to switched to the private sector. Reducing the funds available to the public sector. Team Clinton “fixed” part of that overcrowding at public facilities by allowing Medicaid beneficiaries to switch to the private sector which in many locations had excess capacity (and some that didn’t built more). Sure the Medicaid reimbursement rates are low, but better a somewhat predictable revenue stream to utilize excess capacity than no revenue at all.
For health outcome measures, the private sector preferred not to admit women that had not received prenatal care for birth deliveries. However, as emergency Medicaid did cover the delivery costs, a portion of those women were admitted to private hospitals. With expanded Medicaid, more women will receive proper prenatal care and more will deliver in private hospitals. Reducing yet again the public sector revenues and increasing adverse selection for the public sector. (The costs of close to half US births were covered by Medicaid before the ACA. That’s not likely to increase or increase by much. Medicaid prenatal care costs will increase but that’s good value for a minor amount of public dollars. To take full advantage of the Medicaid expansion, there are private hospitals that have expanded their maternity facilities. Once again, reducing the public dollars that flow to public health facilities.)
And we wonder why US health care costs continue to rise and now far exceed what other wealthy countries spend for UHC.
Really worthwhile info and assessments.
I wonder if you have stats which substantiate this as a significant trend:
“To take full advantage of the Medicaid expansion, there are private hospitals that have expanded their maternity facilities.”
This is happening here and there, but I don’t get the picture that private hospitals are broadly opening access to care for mothers with Medicaid insurance. My view of this is colored by my experiences with California hospitals.
With Medi-Cal reimbursements to providers ranking 47th among the 50 States’ expressions of Medicaid, hospitals have largely reacted to moms with Medi-Cal by trying to figure out ways to avoid admitting them, shuffling them off to the nearest public hospital.
Object example: the recent decision by Prime Healthcare, the most avaricious for-profit hospital operator in California. Prime’s proposed purchase of the Daughters of Charity hospital chain, a group of six private hospitals all heavily exposed to the Medi-Cal population, gained conditional approval by California Attorney General Kamala Harris in January. The conditions for approval included a requirement that Prime guarantee access to care for a broad range of acute care services to Medi-Cal patients for 10 years.
This was an opportunity for Prime to increase their density substantially and, crucially, gain their first foothold in the San Francisco Bay Area market. Yet, the prospect of being specifically required by the AG to provide OB-Gyn and Labor & Delivery services to mothers and others insured with Medi-Cal was enough to cause Prime to walk away from the opportunity. They explained their decision by complaining that the AG’s conditions made the deal untenable for them.
Here’s a good report on maternal care across several states and by payment type. It’s not complete because it’s not easy to obtain that data. Note from page 25 that 2010 average provider charges for vaginal and c-section births are highest in CA. Average insurer reimbursements for vaginal deliveries are are highest in MA and c-section payments as slightly higher in CA, but both CA and MA are significantly higher than in the other sample states.
2010 was pre-ACA in all states except MA that had “Romneycare.” The reported impact on MA public health facilities was significant and negative.
From this Mercury News report I’d conclude that Prime planned to asset strip the hospital group. Dumping acute care is always a profitable move. The fact that the county is most interested in acquiring the facilities, reveals something about the current state of medical resources in the county. However, only that there is an acute care bed shortage for Med-cal eligible patients (a much larger population with the ACA) in the county and particularly within the county public hospitals that also have to provide health care to those ineligible for Medicaid or subsidized exchange insurance and that’s not an insignificant population. It doesn’t speak to the specific issue of Medi-Cal covered maternity and delivery care which Prime may well have wanted.
“Dumping acute care is always a profitable move.”
Actually, many acute care hospital reimbursements are extremely lucrative. The acute care hospital chains are the most enriched part of the health care system. The key to making money, if that’s the priority, is if they are able to restrict the patients they treat to private insurance/private pay/Medicare Advantage.
Prime’s business model is that they aggressively admit those good-paying patients thru the ER, even when it is not medically necessary, and fraudulently bill Medicare and the private insurers by “upgrading” the billing codes. Essentially, Prime makes it appear that they treated patients for more serious conditions that they actually had, so they can get the higher payments from those billing codes. This steals both public and private money, and raises the cost of health care for everyone.
Fortunately, Prime looks like they’re going to be punished with a big fine from the Federal agency overseeing Medi-Cal or a big $ settlement of these charges. They’ve also been sued by private insurers for their admitting practices. They’re still likely to make a net profit from this damaging behavior, though.
With the inpatient and ER beds filled with better-paying patients, it becomes easier for Prime to deny care to Medi-Cal and uninsured. And Prime specifically complained about AG Harris’ requirement that they provide maternity services to women with Medi-Cal insurance for 10 years. Delivery services are relatively high-risk/high-liability, and hospitals in California lose money big-time providing these services to mothers with Medi-Cal insurance.
“2010 was pre-ACA in all states except MA that had “Romneycare.” The reported impact on MA public health facilities was significant and negative.”
Interested in seeing substantiation of this claim. If all private hospital operators are allowed to behave as Prime Healthcare does, it is possible for me to envision this outcome. Keep in mind, however, that both public and private health facilities benefit when more of their patients have health insurance.
“…big fine from the Federal agency overseeing Medi-Cal…”.
I meant Medicare.
Links?
Not that I’m particularly interested in the specific business model of one, for-profit hospital chain that wants to grow. They’re all similar, but they do have to adjust it by location if the demographics are different. And it’s up to local and state governments to tell them no when their model is inappropriate for the needs and requirements of a local community.
All you’re saying is that when hospitals can charge and collect cost plus X% profit for 100% of its patient population, they are profitable. Amenities (additional costs) is how they compete for that desired population.
Hiltzik did a good overview of the situation, with plenty of helpful facts, in his postmortem column:
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-20150315-column.html#page=1
“When the firm took over Inglewood’s Centinela Hospital in 2007, for instance, it closed seven of its 13 operating rooms, and laid off 13% of its staff. Obstetrics deliveries in 2013 were down nearly 80% from their level in 2006, before Prime took over. Service to traditional Medi-Cal enrollees, for whom government reimbursements are notably low, shrank precipitously to 8,140 patient days from more than 18,000. But from 2006 to 2013, Centinela swung from a nearly $10-million loss to a $38-million profit.
As for the debt-collection mandate, that could be an echo of a 2008 episode. Prime was accused of sending bills to thousands of patients of Kaiser and other health plans — some for as much as $50,000 — who had been treated at Prime emergency rooms or admitted. Their insurers refused to pay what they said were Prime’s inflated charges. Prime eventually settled a lawsuit from the state by agreeing to cease the practice and make a $1.2-million donation to community clinics…
Prime made no commitment to serve California’s uninsured population or to provide service beyond the bare minimum required by law.
That could mean the elimination of labor and delivery services, cancer treatment, cardiac care and orthopedic surgery, among others. Harris’ mandates that such services be continued or expanded for 10 years were among the “onerous and unprecedented conditions” that prompted Prime’s withdrawal.”
Re. your last paragraph, what I’m saying is that profitability should not be the primary quality for how hospitals are judged. The CEO of Prime turns money-losing hospitals around financially, but his business model allegedly achieves that by denying care to lower-income people, by putting higher-income people at greater health and financial risk by needlessly admitting them, and by stealing money from Medicare and private insurers. There is a rich stream of evidence showing this. This mode of operation is a financial success, and a medical service failure.
I’m also saying that government decisions on the funding of health care services for people who have low incomes must see to it that hospitals in neighborhoods with more substantial densities of low-income people, whether private or public, should get the public money they need to be financially viable. In the case of many hospitals which have closed in recent years, the business problem was not that they didn’t have customers. In fact, the problem was that they had piles of patients who could not afford to pay for their services and/or had public health insurance which did not come close to paying the hospital for the cost of care.
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