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Progressive Politics in Minnesota, the Nation, and the World

Health Care:"Across State Lines"? Nobody Wants It

Category: Health Care
Posted: 04/23/17 13:17, Edited: 04/23/17 13:18

by Dave Mindeman

OK - can we debunk this once and for all? I'm talking about this Republican fantasy that selling insurance across state lines is some kind of competitive fairy tale that will solve the health care crisis.

Politico finally put together an in depth article about it....

Trump's Next Big Idea On Health Care

It goes into some of the problems I have talked about before, plus some other things I didn't know.

Here is the biggest problem....

"The president clearly is committed to the state-line policy. If he wants a small win on health care to distract from the challenges of getting a large-scale repeal through Congress, this idea might meet that goal. But there's one big problem: No one in the health care universe, on either the policy side or the business side, actually thinks selling plans across state lines will make a difference."

So, why is nobody, outside of Republicans in Congress and the President, pushing this forward?

1. It's unlikely to be profitable. Established insurance companies consistently say that they wouldn't pursue this opportunity under any regulatory circumstances. Even if state and federal legislators were to do all the heavy political and regulatory lifting, at best a few niche startups would try selling stripped-down policies in high-cost states--probably under the intense scrutiny of the dismayed insurance commissioners from those states. And since these changes wouldn't apply to most people currently covered by their employers or traditional Medicare or Medicaid, or the Veterans Affairs health system, or the Department of Defense, the opportunity for profit is quite small.

2. It is only a talking point. No substance. The GOP has been pushing the idea for years, but when specifically asked, Republican policy advisers admit off the record that this really is more of a talking point, and then they change the subject. There's just no there there.

3. It is already written it into the current health care law. It's already possible to sell insurance across state lines. This key plank of Trump's health care vision was authorized in 2010 by the very law he's trying to replace, and it remains in effect. The law leaves the decision up to states themselves, and since then, several states--both red and blue--have passed laws that allow insurers to sell policies in other states with similar laws. But the number of insurance companies that have taken advantage of this exciting new opportunity is exactly zero. State-by-state regulation persists. Any proposed sales must meet or exceed Obamacare's standards and can't increase the federal deficit.

4. Stripping regulations doesn't help. Perhaps what the President Trump really means by insurance competition is that he'll strip away the ACA regulations and others that allow states to regulate health insurance, making it easier for insurers to sell plans across state lines. An enterprising insurer in a lightly regulated state could create a bare-bones health plan with limited coverage and very high deductibles and co-payments. The company could offer this plan at a low premium to consumers all over the country. Sure, consumers who didn't read the fine print when they enrolled would have some unpleasant surprises when it came time to actually get health care, but that's the reality of a free market, right? All it would really do is create that "race to the bottom" of health care coverage.

5. Primary obstacle is an operational one. Networks are contracted within the state that the carrier operates. Setting up a network in every other state requires separate negotiations in those states (states will probably not give up their own oversight). This would lead to huge expenses associated within those various states - and make the entire venture unprofitable and unwieldy.


So, there you have it. Even if President Trump thinks this an answer (and obviously, he has not researched the issue), he will find few allies willing to go to the mat on something like this.

Health care is pretty complicated, Mr. President. Tread carefully.
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When "Purifying" Democratic Candidates: Pick The Right Battle

Category: Donald Trump
Posted: 04/21/17 17:53

by Dave Mindeman

To all the Hillary bashers....past and present.

Complaint: Hillary took a lot of money from Goldman Sachs. Too close to Wall Street.

After election: Goldman Sachs runs the Treasury Department. The 1% are heading nearly every cabinet position.

Complaint: Hillary did not emphasize climate change enough.

After election: A climate denier is head of EPA. Climate cannot even be talked about in the government. And oil, gas, and coal get seats at the policy table.

Complaint: HRC ties to Clinton Foundation looked like "pay for play".

After election: Trump is a walking ethics violation. Trump businesses get paid by his campaign. Corporations gave money to inauguration fund - got direct access to NSC and foreign policy. Betsy Devos parlays donation into Ed Secretary. Ivanka promotes her goods directly from White House. Family members get prime positions in White House. Ties to Russia are explicit.

Complaint: HRC's e-mails were "careless" in handling classified info.

After election: Trump uses an unsecure phone. The admin has an unprecedented number of leaks. The chair of the intelligence committee, Nunes, talks to press about classified documents...and mischaracterizes what they say. Trump issued false accusation and ordered his staff to "find something" to corroborate it. Staff people aren't vetted - some even failed a security clearance.

Complaint: Hillary is too much of a "war hawk".

After election: Trump congratulates dictators in Turkey and Egypt. He bombs Syria. He is provoking North Korea. He has questioned the European alliance. He tries to befriend Russia and while doing nothing about Ukraine and Crimea. He insults Mexico, Australia, and Canada. And sends all sorts of mixed signals to China. And Russia and China are on military alert because they don't know what the hell is going on.

Complaint: Hillary is too friendly to bad trade policies.

After election: Well, at least TPP is gone. But Mexico is cozying up to China trade. Canada is causing a dairy crisis. He wants to keep obsolete manufacturing afloat. Does nothing for new job training (budget cuts a lot of it). Has no plan for Brexit. And thinks ending regulations will solve all of it.

I'm fed up with Democratic purists who think denigrating the DEMOCRATIC candidate is the best way to approach electoral politics. If HRC had been elected, everything on the complaint list would be better than what has happened.

I don't mind pushing Democratic candidates to be more progressive. That is a good thing to do. But once we have an endorsed candidate for the ballot, we need to fight like hell to get them elected. Then after the election we can fight harder for policy, with an actual chance of making it happen.

The next time you want to throw an endorsed Democrat under the bus, remember this Trump era.

Pick your damn battles.
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Jon Ossoff Is Proof The Resistance Is Working

Category: Congressional Races
Posted: 04/19/17 14:23

by Dave Mindeman

Outside of the hyped up messages coming out of Georgia, what did we really learn.

First, the Democrat Ossoff had the overwhelming majority of votes. Keep in mind that this district was won by Tom Price, just 6 months ago, by 23 points. That is no small feat and Democrats have concentrated on NOT getting to the 50% threshold...acting as if it was a defeat. Expectations were way, way too high.

Yes, Ossoff will have a more difficult time in a one on one election, but it will be competitive and that, by itself, is pretty amazing.

Secondly, Trump and Republicans will count this as a victory, but no self respecting analyst wouldn't be more than a little worried about how the GA and KS elections turned out. If Democrats can run close in these deep red districts, that has to give pause to the Republican strategists.

Thirdly, the Republican candidates that tried to run on a pro-Trump platform lost badly. They polled in single digits. And the Republican that made the run off didn't even talk about Trump to any extent.

Fourth, Ossoff will give Democrats an opportunity to try some different messaging strategies against Karen Handel. As Secretary of State she tried to purge the rolls with proof of citizenship. That has always been a challenge when trying to match names on registration. But SOS's that have done this have always managed to purge plenty of legal minority voters. She is also a pro-life extremist. She tried to pull the Susan G. Kommen foundation out of Planned Parenthood ties as a member of the Kommen board. It was a fiasco and ended up costing Kommen credibility and she resigned from the board. Ossoff needs to point out this contrast and he should have the resources to do it.

This is a two person race that the DCCC cannot ignore. They need to support Ossoff - he is an exceptional candidate; the type of candidate that can win in the South. This election is in June - and who knows how much of a drag that Trump may end up being for Republicans. Is it a coincidence that Jason Chaffetz decides not to run in 2018 with these things going on? Will more Republicans jump ship?

The pressure is there. The resistance is working. Yesterday was a very good sign.
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