For Progressives-- Wins, Losses And The Road Forward

Start calling her Congresswoman Bush

Last night there were two gigantic progressive wins-- both in Missouri. After a decade of dogged and vicious Republican opposition in the state legislature and from the governors, the state's voters passed a Constitutional Amendment to give health care to nearly a quarter million of the state's poorest citizens (people earning less than $18,000 annually) through Obamacare Medicaid expansion, making Missouri the 38th state to adopt it. Thanks to massive popularity in St Louis, the amendment passed 52-48% statewide, with right-wing governor Mike Parson continuing to lie that the state can't afford it-- even after a credible study from the Institute for Public Health at Washington University, found that providing health care for more people would actually save the state money. Since the federal government will match 90% of the costs of the newly eligible-- down from 100% had Missouri decided to be part of the program from the beginning-- that state will save about half a billion dollars a year in federal income taxes because residents pay into the system that funds Medicaid expansion without getting the benefits of that expansion."

The other huge progressive win in Missouri was Cori Bush defeating corrupt Congressman Lacy Clay in their St. Louis congressional race:

Cori, a nurse, a Black Lives Matter activist and Berniecrat was great news on a night when other movement activists didn't around the country didn't fare as well. Clay raised $740,525 compared to Bush's $562,309 but a massive $150,000 I.E. on her behalf from Justice Democrats evened the playing field.

The biggest disappointment was that Blue Dog and "ex"-Republican Tom O'Halleran in Arizona managed to avoid being ousted by another Berniecrat and movement activist, Eva Putzova, who won the districts's biggest and bluest county, Coconino, but was dragged down by the more conservative counties that backed O'Halleran. With 94% of the votes counted, he won 34,095 (58.65%) to 24,037 (41.35%). This was Cori's second try against Clay-- and Eva's first try against O'Halleran. I expect she will try again.

In Michigan, Rashida Tlaib handily beat back a challenge from corporate shill Brenda Jones, with a 2-1 landslide. And in the southwest district, with all precincts now counted, voters have chosen the progressive state legislator, Jon Hoadley over garden variety Democrat Jen Richardson-- 52.3% to 47.7%. Hoadley is in a good position to beat Trump enabler Fred Upton in November.

In Washington state, progressives lost their congressional runs against right-of-center incumbents Rick Larsen and Derek Kilmer and in WA-10, conservative Marilyn Strickland seems to be beating progressive Beth Doglio for first place for the seat opening up after Denny Heck's retirement. It looks like they will square off in November-- with a sharp contrast between a progressive and a conservative.

This morning, Roots Action, led by Berniecrat Norman Solomon, announced that his group has launched a grassroots campaign aimed at "swing voters on the left," to persuade Bernie supporters and other progressives in swing states to "Vote Trump Out-- and Then Challenge Biden."

The Vote Trump Out swing-states initiative will include a highly-targeted social-media program and other digital outreach, utilizing messages from national and state progressive luminaries-- people who are widely respected on the left in ways that establishment Democrats are not. The campaign will urge progressives in the dozen battleground states to vote for Joe Biden rather than sit out the election or cast a third-party protest vote. Directed heavily toward young people, the effort will be entirely independent of-- and often in opposition to-- corporate Democratic leaders.

The RootsAction campaign has assembled a group of national endorsers who are likely to be persuasive to progressives on the fence about voting for Biden. They include: Ady Barkan, Medea Benjamin, Leslie Cagan, Noam Chomsky, Marjorie Cohn, RoseAnn DeMoro, Barbara Ehrenreich, Daniel Ellsberg, Bill Fletcher Jr., Jim Hightower, Rep. Ro Khanna, Jamie Margolin, Annabel Park, Linda Sarsour, Winnie Wong and James Zogby.

The #VoteTrumpOut campaign will assert that-- while President Trump is unfailingly immune to progressive persuasion or protest-- the fight for a full progressive agenda (ranging from major climate initiatives and anti-racism to universal healthcare, free public college and taxing the wealthy) would have the potential to win some victories with Biden in the White House.

The campaign’s mission statement declares: "We are not going to minimize our disagreements with Joe Biden. But we’re also clear-eyed about where things stand: supporting the Democratic nominee in swing states is the only way to defeat Trump... If Biden wins, we’ll be at his door on day one, demanding the kinds of structural reforms that advance racial, economic and environmental justice."

Renowned linguist, author and political activist Noam Chomsky contributed this comment to the initiative: "I live in the swing state of Arizona, and I’d vote for a lamp post to get Trump out." Chomsky is featured in a campaign-launch video [above].

"Our organization fought fiercely in the primaries for Bernie and against Biden," said RootsAction.org cofounders Jeff Cohen and Norman Solomon. "But the general election is far less about Biden than it is about Trump-- the most dangerous president in modern U.S. history, who opposes virtually every policy and principle that progressives are fighting for."

   

Even In Oklahoma Some Voters Realize Trump Sold Them A Bill Of Goods

Cone Of Shame by Nancy Ohanian

Oklahoma is a Republican hellhole. The Governor is a crackpot Republican as are both U.S. Senators. Of the 5 members of Congress, the only Democrat is Blue Dog Kendra Horn, who is so far right that there are, from time to time, mainstream House Republicans less extreme than she is. The state Senate has 9 Democrats-- and 39 Republicans and the state House has 76 Republicans and 25 Democrats. In 2016, Trump won every one of the state's 77 counties and beat Hillary 947,934 (65.3%) to 419,788 (28.9%).





And yet, long-suffering Oklahoma Democrats actually had reasons to be cheerful last Tuesday. I first noticed that something seemed amiss when I was checking the returns from Oklahoma City, where progressive Tom Guild had challenged aforementioned Blue Dog Kendra Horn. She won but what was unexpected was that, though the 4-way Republican primary to pick a nominee to try to beat her in November was red hot, just 61,822 people voted, while 70,182 Democrats voted. How the hell did that happen?

Oklahoma has had 14,539 coronavirus cases so far, 3,674 cases per million Oklahomans, not bad for the U.S., but nearly as many per million as Italy. But what makes it worse-- much worse-- is that Oklahoma has the second-highest uninsured rate (after Texas) and is one of just 14 states where the Republicans have succeeded in not expanding Medicare. It's one of the only places in America where you can be employed and still get sick and die, untrusted, in the street-- pure Republican ideology on display.

Obviously, the legislature and governor had no intention of expanding Medicare... so citizens decided to do it with a constitutional amendment via ballot initiative. Almost 314,000 people signed to get it on the ballot, an Oklahoma record. That's what happened Tuesday-- a measure that requires Oklahoma to expand Medicare, for about a quarter million people, by July 1, 2021. The measure also thwarts the GOP from going forward with their plan to cap Medicaid. It passed narrowly-- by just 6,488 votes, less than one percent-- but it passed. Reporting for The Atlantic yesterday, David Graham called the vote "a warning sign for Trump, because it shows how he’s at odds with even many conservative voters on health care. Last week, the Trump administration asked the Supreme Court (again) to throw out the Affordable Care Act. Meanwhile, voters in a state so red that the president chose it for his big comeback rally have voted to adopt an expansion of coverage under the law-- the fifth time voters in a Republican-governed state have done so... It’s not entirely shocking that amid a pandemic and a massive unemployment crisis, voters would rather have more health coverage than less.

“Obamacare repeal” as a concept may still be popular with some core Republican voters, but it’s not as potent as it was before the pandemic-- and besides, the coverage itself is popular. Sooner State voters effectively circumvented the will of Republican Governor Kevin Stitt, who had sought a more limited expansion. That’s in keeping with a pattern: When voters in GOP-led states have gotten the chance to vote on Medicaid expansion, they’ve tended to favor it. In other cases, Republican governors and lawmakers have sensed the political wind and moved forward themselves.

Active Shooter by Nancy Ohanian

...In a sense, Trump has fallen into a trap of his own making. He grasped that entitlements were popular among Republican voters in his 2016 campaign, and while other GOP candidates trotted out the usual talking points about social spending, Trump promised to protect Social Security and Medicare. In office, however, he has waffled, proposing budgets that cut entitlements programs, though the budgets have not been enacted. Having tapped into the latent popularity of social spending among Republican voters, he now risks their anger if he reverses course.

Medicaid, which is aimed at the poor, has not always been as popular as Social Security and Medicare, both of which are aimed at older Americans. The latter two have been viewed as “earned” entitlements, while Medicaid has sometimes been viewed as a welfare program, with the same negative racial connotations that other welfare programs carry. So it’s notable that Oklahoma voters joined their fellow citizens in Idaho, Nebraska, and Utah (2018) and Maine (2017) in supporting a Medicaid expansion.

Oklahoma is not the final test this year. In August, Missouri voters will also vote on Medicaid expansion. There, too, Republican Governor Mike Parson opposes the expansion. In a sign of the way that Obamacare has gone from a salubrious wedge issue for Republicans to a pain point, Parsons moved the referendum from the November ballot to an August primary.

Even if Missouri votes down the expansion, the results in Oklahoma and elsewhere make the overall trend clear. As Donald Trump recognized in 2016, and as the 2018 election reinforced, entitlements are popular with voters. By flouting that popularity and trying to sink Obamacare a few months before the election, he risks a painful reminder of the lesson he once taught.

What's Worse-- Biden's Sincere Belief In Austerity Or Trump's Belief In Nothing But Personal Corruption?

Trump's a monster, no doubt about it. He's a grifter who has not an ounce of patriotism nor the will towards public service in his bloated orange body or his misshapen shriveled soul. That said, unlike Joe Biden, Trump is not driven-- the way his party is-- to destroy Social Security and Medicare. And it isn't just the Republican Party that is eager to destroy the social safety net; it is also the Republican wing of the Democratic Party, faction of the party that has largely rallied behind Biden, one of the worst pro-Austerity warriors in our lifetimes, worse on that count than Trump, who doesn't care enough about it to want to stir up the ultimate hornets nest.

Over the weekend, Washington Post reporters Jeff Stein and Erica Werner looked at how Trump's proposed budget "is expected to lay bare how much he has adjusted to the political and practical limits of Washington, with some of his biggest campaign promises from 2016 cast aside and replaced with more limited policy ambitions. On immigration, health care, infrastructure and the deficit, the final budget pitch of Trump’s first term will look much different from the campaign platform he offered four years ago."

Those advising Trump are as eager to cut Social Security and Medicare as Biden and his faction are. If Trump was interested in issues beyond his own prospects of emptying the treasury into his own pockets, he might be as bad, or even worse, than Biden on the social safety net. So far, though, he has only let the Austerity hawks chip away around the edges. His campaign promises to protect Medicaid from cuts, wrote Stein and Werner have "been repeatedly ignored, as he has sought to slash some $800 billion over a decade from the health program for low-income Americans. The latest evidence of this came on Saturday, when he wrote on Twitter that the budget proposal 'will not be touching your Social Security or Medicare.' He made no mention of protecting Medicaid, even though he had vowed to guard it during his first presidential campaign. He is also seeking to gut the Affordable Care Act through the courts despite pledging to safeguard one of its key tenets: insurance coverage for people with preexisting conditions."

Biden, who has advocated deep cuts to Social Security, Medicare and Medicaid for his entire career, would be much less likely to beat around the bush. Trump is reticent because of the political blowback. Biden would ignore the blowback and see himself as the ultimate political martyr who only has one term anyway. He sees Austerity as an ultimate good. Trump only sees graft and corruption as ultimate goods.

During the 2016 campaign, Trump vowed to deliver a major infrastructure plan, but there has been virtually no progress on this issue.

And the president’s promise to eliminate the government’s roughly $20 trillion debt within eight years has also gone unfulfilled. Instead, Trump has added almost $3 trillion to the debt in three years, and that number is only expected to balloon, according to nonpartisan estimates. Proposals to cut domestic programs have evaporated in massive year-end budget deals with Congress that have actually raised spending limits.

Trump’s first budget proposal relied on questionable math when it sought to eliminate the budget deficit after 10 years, but even that goal has slipped out of reach.

Trump has scored a string of victories in recent months, including securing a bipartisan revamp of the North American Free Trade Agreement and being acquitted by Republicans in the Senate on impeachment charges. He signed a partial trade deal with China and marshaled through a massive tax-cut package in 2017.

But Monday’s budget proposal will demonstrate that a number of the president’s loftiest campaign promises from four years ago have largely been abandoned, because of political realities as well as simple budget math.

“I have no idea how he can live up to his campaign promises to reduce the deficit, not address entitlement programs, and at the same time cut taxes,” said Bill Hoagland, a Republican who served as staff director for the Senate Budget Committee. “I have not figured out how to square this circle, and neither have they.”

...[E]ven more so than under prior administrations, Trump’s budget proposals have been largely rejected by lawmakers who’ve agreed on a bipartisan basis to restore and even increase spending for agencies and programs that the administration has tried to cut, including health and education programs and foreign aid.

Trump in the past few years has sought to backpedal on some of the proposed budget cuts, facing blowback after seeking to cut funding in states central to his reelection campaign, such as Michigan.

That has led to some dejection among career officials at agencies and within the White House Office of Management and Budget, who are forced to devote enormous time and attention to developing a budget document they know Congress will largely reject, according to several people with knowledge of internal administration dynamics who spoke on the condition of anonymity to describe them.

In prior years, Trump’s budgets have reflected the irreconcilable contradictions of his campaign promises in part by relying on overly rosy economic forecasts and glossing over how he would achieve big cuts.

In 2017, Trump’s budget predicted that economic growth would surge to an annual rate of 3 percent by 2021 and stay at that healthy rate indefinitely. This goal has proved elusive. The economy grew 2.9 percent in 2018 but slowed to 2.3 percent in 2019, and is projected to slow even more this year. Relying on rosy economic estimates in the budget plans allows the White House to assume that prospering families and companies will generate high levels of tax revenue as a way to offset the widening deficit. Instead, the deficit estimates have proved faulty.

Trump’s budgets have also proposed enormous cuts to domestic spending programs as a way to try to bring the deficit down. But nondefense domestic spending, aside from what are considered mandatory programs, makes up just a sliver of the overall $4.6 trillion federal budget. Mandatory programs, including the domestic programs Medicare and Social Security, make up more than 60 percent of federal spending. And since Trump has promised repeatedly to wall off Medicare and Social Security from cuts, while also increasing the Pentagon and Department of Homeland Security budgets, he has fewer agencies available for cuts if he wants to seek reductions.

Rep. Charles J. “Chuck” Fleischmann (R-TN), a member of the Appropriations Committee, said the deficit cannot be addressed until Congress and the administration take on entitlement programs such as Medicare and Social Security. But he noted that Trump has promised to protect those programs, “and I will certainly respect that.”

“So I think right now, this year, is probably not the year to deal with the mandatory side of the equation,” Fleischmann said. “But perhaps that’s something that President Trump will look at with the Congress in his second term.”

Ironically, Fleischmann's bloodthirsty instincts would undoubtably better-served by a Biden (or, likely, a Bloomberg) administration that would go right in for the kill. "Although," wrote Stein and Werner, "Trump has talked publicly about wanting to cut spending, he has also signaled an indifference toward the federal budget... [and] rarely speaks of it. Leaked audio from a dinner the president attended in January with donors at Mar-a-Lago, his private resort in Florida, captured the president brushing aside those who are critical of rising defense and federal spending as part of the growing national debt. 'Who the hell cares about the budget? We’re going to have a country,' the president said."





Biden and the Republican wing of the Democratic Party-- the Blue Dogs, New Dems, so-called "Problem Solvers"-- care. Which is why the 2020 primary is the ultimate crossroads for the Democratic Party. Bernie wants to lead a party that embraces the philosophy of governance espoused by FDR. The B-Team embrace, albeit never openly, Rockefeller, Eisenhower and Nixon Republicanism.

Seniors In Kentucky Need Coverage For Eyes And Teeth, No?

In July, 2015, Alan Grayson introduced a bill, H.R. 3308, Seniors Have Eyes, Ears, and Teeth Act. It was a short, easily understood piece of legislation, an amendment to the Expansion of Medicare Coverage: "To expand Medicare coverage to include eyeglasses, hearing aids, and dental care." Sounds good to me, as it did in 2015. If Grayson gets back into Congress and the Democrats win back both houses of Congress, this bill will be on Trump's desk. If he vetoes it, he'll have to explain that to the American people and then, in 2020, it will be on the desk of Bernie or whomever follows Trump into the White House. But in Kentucky, Governor Bevin got it ass-backwards.

Monday, Deborah Yetter reported for the Louisville Courier Journal that Kentucky's right-wing governor had "abruptly cut Medicaid dental and vision benefits to nearly half a million Kentuckians after Bevin's Medicaid overhaul plan was rejected Friday by a federal judge. Bevin's sweeping Medicaid plan would have requiried "some Kentuckians to work or volunteer at least 20 hours a week and meet other requirements, including paying monthly premiums to keep health coverage."

The judge vacated Bevin's entire plan and sent it back to officials at the U.S. Department for Health and Human Services for further review, saying the Trump administration, in reviewing the plan, didn't consider the basic provisions of federal Medicaid law.

The ruling followed a legal challenge on behalf of Kentucky Medicaid beneficiaries who argued the changes are outside the scope of federal Medicaid law, designed as a safety-net program to provide health coverage to low-income, vulnerable citizens.

...Bevin, who was elected in 2015, has been highly critical of the Medicaid expansion enacted by his predecessor, Democrat Steve Beshear.

Medicaid, an $11 billion health plan in Kentucky, covers about 1.4 million people, more than 600,000 of them children. The federal government provides about 80 percent of the money for Kentucky's Medicaid program.

Healthcare advocates condemned Bevin's quick move as "rash" and possibly illegal.

The Trump regime has been encouraging states to impose work requirements and other changes on health insurance programs for poor and disabled people. Judge Boasberg's ruling is a blow to The GOP's plans, at least for now. Bevin's radical reaction was almost revenge against poor people for the ruling. His diktat goes into effect immediately and he tried blaming it on the judged. "They no longer have access to dental and vision coverage as a result of the court's ruling."

One Democrat pointed out that people are "showing up for dental appointments that they made months ago and neither they nor the providers are really certain what the rules are. And that's just unacceptable for government to be operating this way."

Jason Westin And The Children’s Health Insurance Program

Last year Blue America looked carefully at the race in the west Houston congressional district held by Paul Ryan rubber stamp John Culberson. The district, which went from a pretty red area with a PVI of R+13 in 2015 voted 48.5% to 47.1% for Clinton (after giving Romney a 59.9-38.6% win over Obama) and now has a more manageable R+7 PVI. There's more than one good candidate running for the nomination to take on Culberson but the best candidate with the best chance of beating Culberson in the general election is award-winning cancer researcher and doctor Jason Westin. Blue America endorsed him. Today we asked him to give us his perspective on the GOP sabotage of the Children’s Health Insurance Program (CHIP). Technically, Paul Ryan and his rubber stamps like Culberson have allowed the funding for the crucial program-- crucial for millions of children and their families-- to expire in September. Now states-- Connecticut and Colorado were the first two-- are starting to inform families there is no more money left for treatment. A new Congressional Budget Office report shows it would be effectively cost-free to fund the program for the next decade and Ryan has still done nothing. By the end of February half the states in the country will have no more money for the program unless Congress acts.

Please take a look at Dr. Westin's guest post below. The Take Back Texas ActBlue thermometer on the right is a simple way you can contribute to Jason's grassroots campaign. You'll find him-- and other progressives-- running in Texas this year. Even $5 and $10 contributions add up and help beat back the corporate flood of money that has kept characters like Culberson in office and serving the interests of the corporations and wealthy families who have subsidized his political career for years. Jason is running a grassroots campaign. Last cycle, Culberson spent $1,193,411 to defeat a conservative oily Democrat, James Cargas, who is running again and who spent just $62,159. This cycle a very different race is shaping up and, besides Culberson, 4 Democrats have already raised over $100,000. Dr. Westin has raised $261,590 compared to Culberson's $640,744. In a wave election, challengers don't need to raise as much as the incumbent but they do need enough money to effectively get out their message. Please consider tapping on that thermometer and doing what you can.




Medicaid Work Requirement And CHIP
-by Dr. Jason Westin

Why are Mr. Trump the GOP allowing states to require a job to receive Medicaid? Because they are "all in" that healthcare is a privilege-- there is no other explanation. They are wrong. I learned in my first days in medical school that Healthcare is a human right.

Almost 20 years ago during medical school, I volunteered at and eventually helped lead the Equal Access Clinic, a student run center to give care to those who had no access. Most were hard working people who knew they were sick, but could not afford care. Those who did not work were unable due to mental or physical illness. There were no people seeing us because they were lazy or trying to "game the system." They came to us for help, because they knew if they didn't get care, eventually they'd get really sick and end up in the ER or worse. They were constantly fearful of what would happen next, and if they'd be able to support their family.

When we helped them with blood pressure or diabetes meds, they were so grateful, I can still see their smiles almost 20 years later. The medications we gave them were helpful, but the true reason for their gratitude was being seen by another human being as worthy, that someone cared. They walked around everyday knowing they were a ticking time bomb and that no one would help them-- and that takes a real toll on how you perceive your own worth. It hardens people-- it makes them withdraw. When we reached out and said "you matter to me," they could barely contain their joy.

The idea that people who need Medicaid are freeloaders is a common misconception. The majority of Medicaid recipients work but don't have healthcare benefits or earn so little that they still qualify.

For the few on Medicaid who aren't working, almost all have a valid reason. Those who don't have a reason listed are only 3%, not of the total, but of the 40% who aren't working. That's right-- we're talking about 1.2% of Medicaid recipients.

This is the target of this rule change, 1.2%. Seriously. If that's all they are targeting, why make a big deal of this? Because the consequences will be widespread. Studies show Medicaid expansion actually reduced the number of unemployed. By making it harder to get access, this will backfire and result in more people falling through the cracks. Their approach is backward, and is clearly aimed at reducing the size of Medicaid not by helping people get to work, but by deeming them ineligible.

How could this play out? An example: A 45 year old mother of three has bad asthma. She needs medication to avoid a crisis and so she can work. If she loses her job, she wouldn't qualify for Medicaid as she would be hard pressed to prove she isn't able bodied, she just had a job! Thus, she and her family would be stuck in a spiral. Too well to be "ill or disabled," but too sick to actually work. This is what "health care is a privilege" can do.

Another example of "health care is a privilege" is the debate over the Children's Health Insurance Plan, or CHIP. I'm running for Congress against the vulnerable John Culberson in TX-07. Mr. Culberson has a lot of dangerous opinions, but it surprised even me to learn that he refuses to support insurance for 9 million poor children. Does he want them to work?

It comes down to this: Does America believe healthcare is a right or a privilege? Are we ok with allowing preventable deaths and kids to go without care? I'm not. I'm running for Congress to fight back for people like my patients.

How can we do that? I believe that a single payer system like Medicare for all is the best way for us to fulfill that healthcare as a human right. The system we have now has been cobbled together with no clear organization, like building a car by designing one part at a time. It’s not a surprise that some parts just don’t work well with the others. When there is no overall strategy, you’re just making the best of a bad situation. The Affordable Care Act tried to improve some of the parts that were most in need of repairs, but it wasn’t able to guarantee coverage, and now without the individual mandate it’s weakened further still. The Gallup poll asked "do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage?" For the past three years, the majority said that it is the responsibility of the government-- and that position keeps gaining strength. In 2017, 56% said yes vs. 42% that said no. This is clear: The American people are increasingly coming to support my core belief: Healthcare is a human right, and that the only way we can fulfill this obligation is with a single payer system like Medicare for all.

These attacks by Trump and his enablers in Congress on earned benefits like Medicaid and on innocent children with CHIP show what they believe: healthcare is a privilege. Candidate Trump said he wouldn’t let people "die on the streets" if elected-- and Ted Cruz mocked him for that position. Sadly but not surprisingly, after the election Mr. Trump has seemingly moved away from this pledge. We can do better than their heartless approach, and by electing people who know these issues first hand, we will.

I’ve gotten so mad about this attack on our care that I’ve decided to do something about it. I’m running for Congress to fight back for people like my patients. I’m in a flappable district running against a Trump Rubber Stamp named John Culberson. I can actually win, and make a real difference for our healthcare system. But many have asked-- don't we need you to fight cancer? Wouldn't we be wasting your talents in DC? I can do so much more for my patients, for healthcare, in Congress than in the clinic. When I take care of a patient, they receive benefit, but it doesn't help anyone else. When I write a clinical trial, if it succeeds I can help thousands of people by developing a new treatment. In Congress, I could help millions.

Maine-- The 1st State To Pass Medicaid Expansion At The Ballot Box-- A Guest Post By Jared Golden

There's a battle raging in Maine right now because, after the Trumpist governor of the state, Paul LePage, kept vetoing the legislature's Medicaid expansion, the citizens voted to expand it in a ballot initiative. LePage then announced he would "veto" that too! Yesterday, Jared Golden, the House Majority Whip and a candidate for Congress (endorsed by Blue America) penned an OpEd for The Hill explaining the situation to folks outside the state who might not be following it as closely. This is something the whole country needs to understand.

Give Maine voters what they want and expand Medicaid in the state
by Jared Golden

Maine made history last Tuesday by becoming the first state to pass Medicaid expansion at the ballot box. After five unsuccessful attempts to override Governor Paul LePage’s vetoes, Maine people took matters into their own hands and elected to expand healthcare coverage to 70,000 of their neighbors.

On the heels of the GOP’s attempt to repeal the Affordable Care Act (ACA) earlier this year, Medicaid expansion received a majority of the vote in both of Maine’s Congressional Districts, including Maine’s Second Congressional District (ME-2) which went for President Trump in 2016.

In 2016, ME-2 also supported a referendum to increase the minimum wage from $7.50 to $12 by the year 2020, and approved a bond to invest in the state’s infrastructure.

Taken together these three voter-approved initiatives say a lot about a district that voted for President Obama in 2008 and 2012, and for President Trump in 2016. Voters are tired of feeling left behind as the district’s economy continues to struggle to recover from the Great Recession.

The voters have spoken. But like most things in government these days, the fight is not over, it’s just beginning.

The day after Medicaid expansion passed, Governor LePage and his allies in the Legislature immediately issued public statements saying they would refuse to implement the voter-approved law.

In Maine, you can count on a few things: snow in the winter, tourists in the summer, and the governor manufacturing political and financial crises that don’t actually exist. Earlier this year, Republicans in the Maine House blocked several voter-approved referendums and even shutdown government as a tactic to defy the will of the people.

Now they are at it again, using misleading data and information to claim Maine can’t afford to expand Medicaid, when in fact, Maine can’t afford not to. For every state dollar invested, Maine will get nine back, bringing almost $500 million in federal investment into the state’s economy.

This isn’t just about the health of Maine’s citizens, it’s also about the health of Maine’s economy. The healthcare sector is one of the largest employers in the state and that infusion of federal healthcare dollars is expected to create 3,000 new jobs in Maine. Without Medicaid expansion, rural Maine hospitals and healthcare providers will continue to struggle to keep their doors open and we will lose more jobs. With it, we create new forms of revenue and we create new jobs.

The reality is that one in five people in Maine are on Medicaid. Many of them are seniors living in poverty and in need of long-term care and housing. Meanwhile, 70,000 people with no healthcare coverage continue to seek treatment from a system that can’t continue to provide it without reimbursement.

Congressman Poliquin and Governor LePage can’t accept that they are on the wrong side of one of the chief moral issues of our time: whether or not all Americans should have access to affordable healthcare.

Bruce Poliquin may think he knows better than the people he represents but the majority of them agree with me that income shouldn’t determine your ability to obtain medical care. And in a sharp rebuke to Poliquin’s vote to repeal the ACA and cut Medicaid, his constituents chose to expand it instead.

As the House Majority Whip in the Maine State House of Representatives I am prepared to take every fair and sensible measure necessary to ensure the people's voice is heard and respected, and that thousands of Maine citizens without health care get it. Last week, Republicans made false claims that I would raise taxes on working and middle class Mainers to pay for Medicaid expansion in Maine.

To be clear, the only folks talking about raising taxes on working and middle class people in this country are Republicans in Washington so they can pay for massive tax cuts to the wealthy and corporations, many of which don’t provide healthcare benefits to their employees.

The Republican tax plan also doubles down on the total assault on health care by seeking to repeal the medical expense tax deduction, a tool thousands of Maine’s elderly and seriously ill take advantage of each year.

There really may be no limit to the lengths that Congressman Poliquin will go to protect and promote the interests of the mega-wealthy. Instead of giveaways to the rich, he should work to eliminate the loopholes that the wealthy use to get out of paying their fair share.

Ultimately, Bruce Poliquin may decide to keep playing to his base. But it’s hard to imagine they’re excited about losing deductions and tax credits as a partial payment for tax cuts for millionaires, while adding $1.5 trillion to the national debt. That’s not exactly fiscal conservatism.

Meanwhile, when the Maine Legislature reconvenes in January, my colleagues and I will begin work immediately to fund and implement the Medicaid expansion that Maine voters have demanded.

Jared Golden is Maine’s House Assistant Majority Leader and Democratic candidate to represent Maine’s 2nd Congressional District. You can contact him by emailing info@jaredgoldenforcongress.com.

Yesterday Maine Voted For Progressive Healthcare-- Ohio Didn't

There was one dark side to the election results Tuesday night: Ohio. Issue 2 would have required state agencies to not pay more for prescription drugs than the federal Department of Veterans Affairs. Big Pharma put together a massive $60 million confuse-the-voters media campaign... that worked. Issue 2 lost-- and lost big: 474,741 (20.72%) to 1,816,074 (79.28%). Ohio voters overwhelmingly decided to be ripped off by drug companies and pay more for pharmaceuticals. It lost every single county-- even the most progressive blue counties like Cuyahoga, Franklin, Lucas and Athens. Are voters there more vulnerable to false claims? Maine's weren't. Well... most Mainers weren't.

Maine had their own ballot proposition-- also numbered "2"-- and it was whether or not to expand medicaid eligibility, something the state legislature approved 5 times, only to see the Trumpist governor, Paul LePage veto it each time. Tuesday Maine voted 202,329 (59%) to 140,808 (41%) in favor. From Portland, Lewiston, Auburn, Scarborough, Brunswick, Bangor and Augusta to Bath, Winslow, Belfast and Brewer, it won in all of the most populated townships.

Writing for the NY Times right after the election was called for the YES side, Abby Goodnough reported that the vote was a rebuke to LePage. what it does is allows something like 80,000 more Mainers to qualify for Medicaid coverage under the Affordable Care Act. "Maine," she wrote, "will be the 32nd state to expand the program under the health law, but the first where voters, not governors or legislators, decided the issue. Other states whose leaders have resisted expanding the program were closely watching the campaign, particularly Utah and Idaho, where newly formed committees are working to get Medicaid expansion on next year’s ballots."

LePage and other opponents, including several Republicans in the state Legislature, said Medicaid expansion would burden the taxpayers and the state budget, and described it as a form of welfare.

“The truth is that Medicaid expansion will just give able-bodied adults free health care,” Mr. LePage said in a recent radio address. “We don’t mind helping people get health care, but it should not be free. ‘Free’ is very expensive to somebody.”

...The health law gives states the option of allowing any citizen with income up to 138 percent of the poverty level-- $16,642 for an individual, $24,600 for a family of four-- to qualify for Medicaid, which states and the federal government both pitch in to pay for.

Under the Affordable Care Act, the federal government picked up the cost of new enrollees under Medicaid expansion for the first three years and will continue to pay at least 90 percent. States cover a significantly larger portion of the expenses for the rest of their Medicaid population.

Maine’s Legislature, which is controlled by Democrats in the House and Republicans, by one vote, in the Senate, could try to block the referendum, but since it voted for Medicaid expansion five times already, supporters and opponents alike believe it is unlikely to meddle. And the governor has no authority to veto the outcome, although he could may try to delay putting it in place during his remaining year in office. And if Congress eventually succeeds in repealing the Affordable Care Act, states with expanded Medicaid will likely have to scale back their programs.

Governor Pig-Man (R-ME) announced today that he doesn't care what the voters said yesterday; he's not expanding Medicaid, challenging Maine to do something about it if they don't like it. This was his statement to Mainers today:

The last time Maine experimented with Medicaid expansion in 2002 under then-governor Angus King, it created a $750 million debt to hospitals, resulted in massive budget shortfalls every year, did not reduce emergency room use, did not reduce the number of uninsured Mainers and took resources away from our most vulnerable residents-- the elderly and the intellectually and physically disabled.

Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget. Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated, and I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.

As Assistant Majority Leader of Maine's state House of Representatives, Jared Golden issued a statement in response to LePage's defiance. "Mainers don’t leave each other behind. Despite any efforts by Governor LePage and his allies, we will not abandon the families who, for too long, have had to choose between putting food on the table or paying for needed medical care. Access to affordable healthcare is a basic promise to Maine and we moved towards fulfilling it last night. Every representative who continues to oppose that right should know they're on notice by the people of Maine." Jared has been endorsed by Blue America and if you'd like to help him defeat Trump rubber stamp Bruce Poliquin, please click on the Blue America congressional ActBlue thermometer on the right.

A Week From Tomorrow Maine Voters Decide On Medicaid Expansion

A week from tomorrow voters in Virginia and New Jersey will pick between lesser-of-two evils candidates the two corrupted political parties selected for them. That night I'll be watching returns for the Virginia House of Delegates, where there are some extraordinarily good candidates running who have a real chance to win. And I'll be watching what's happening in Maine. Maine? Yeah, Maine has the first referendum in the country on expanding Medicaid under the Affordable Care Act. The state legislature passed it 5 times and the TRumpist governor, Paul LePage vetoed it 5 times.

Mainers want it. Last year all 16 counties in Maine rejected Clinton and backed Bernie in the state's caucuses. He won the urban centers, the suburbs and the rural areas. Bernie's win numbers by county:

• Androscoggin- 64.7%
• Aroostook- 54.9%
• Cumberland- 63.2%
• Franklin- 67.2%
• Hancock- 66.0%
• Kennebec- 59.6%
• Knox- 68.1%
• Lincoln- 67.0%
• Oxford- 72.2%
• Penobscot- 66.0%
• Piscataquis- 65.0%
• Sagadahoc- 63.3%
• Somerset- 62.0%
• Waldo- 73.3%
• Washington- 73.3%
• York- 65.2%

Statewide, Bernie beat Hillary 64.3% to 35.5%. On election day a proposition passed legalizing recreational marijuana use (56.4% to 43.6%). Maine's a hunting state and a proposition to ban large-capacity ammunition magazines and requiring a background check to purchase ammo passed 62.7% to 37.3%. A $2.00/a pack cigarette tax passed 63.8% to 36.2% and a proposition preserving bilingual eduction passed 72.8% to 27.2%. Over the weekend, the NY Times looked at the proposition for expanding Medicaid Mainers will vote on next week.

The referendum on Nov. 7 represents a new front in the pitched political battles over health care. Maine is one of 19 states whose Republican governors or legislatures have refused to expand Medicaid under Obamacare, and the other holdouts-- particularly Utah and Idaho, where newly formed committees are working to get a Medicaid expansion question on next year’s ballot-- are closely watching the initiative, whose outcome may offer clues about the salience of the issue in next year’s midterm congressional elections.

After President Trump and Republicans in Congress spent much of the year trying to repeal the health law and cut spending on Medicaid, a half-century-old entitlement program that covers one in five Americans, the pro-expansion side in Maine is hoping to benefit from energized public support for it.

Turnout may be the biggest challenge for the advocacy groups leading the effort. There are no national or statewide races here to drive people to the polls this year. And Mr. LePage’s stance on government safety net programs appeals to many voters in the state’s more rural regions. He derides Medicaid expansion as “pure welfare” that would burden the state’s taxpayers.

Senator Susan Collins of Maine, one of the few Republicans who firmly opposed the Obamacare repeal bills, is not taking a position on the ballot measure-- she never does on referendums, according to her staff. But leaders of the campaign are hoping her outspoken support for Medicaid during the repeal battles will help.

About 80,000 additional Mainers would become eligible for the program if the ballot measure were to succeed, according to the nonpartisan Maine Office of Program and Fiscal Review, although those with income above the poverty line currently qualify for subsidized coverage through the Obamacare marketplace. In all, more than 2.5 million poor uninsured adults across the country would gain access to Medicaid if the holdout states expanded the program, joining about 11 million who have already signed up under the law.

...The main arguments for expanding the program here are that it would help financially fragile rural hospitals, create jobs and provide care for vulnerable people who have long gone without it.

But Mr. LePage and other opponents say that Maine should know better. The state undertook a more modest expansion of Medicaid in 2002, under former Gov. Angus King, an independent. Afterward, Maine struggled with budget shortfalls and fell behind on Medicaid payments to hospitals.

“People don’t want to acknowledge the unintended consequences that Maine has already experienced,” said Brent Littlefield, a political adviser to Mr. LePage who is serving as the spokesman for Welfare to Work, the committee leading the opposition. He said that even with the federal government paying most of the cost-- a situation that could change if Congress eventually succeeds in repealing Obamacare-- the state could owe close to $100 million a year, according to estimates from the LePage administration.

The Office of Program and Fiscal Review has estimated a lower state cost, about $54 million a year once the federal share drops to 90 percent in 2021. Maine would not receive the full 90 percent match for parents of young children because many already qualify for the program.

Maine’s legislature, which is controlled by Democrats in the House and Republicans, by one vote, in the Senate, could move to block the referendum if it were to pass, but since it voted for Medicaid expansion five times already, supporters and opponents alike believe it is unlikely to meddle. And the governor would have no authority to veto the outcome. The only other threat would be if Congress succeeded in repealing the Affordable Care Act and ended the Medicaid expansion program.

Supporters of the measure have knocked on 150,000 doors since July and have run four television ads statewide. Mainers for Health Care had raised about $480,000 as of early October, including $375,000 from the Fairness Project, a left-leaning group founded in California. It is putting out national appeals for donations, including through Organizing for Action, the political group that grew out of former President Barack Obama’s campaigns.

Welfare to Work had raised $192,500, with its contributions coming from a handful of frequent Republican donors in the state. Mr. Littlefield would not discuss the opposition’s strategies, but the group has at least two ads running on television statewide and Mr. LePage has been blasting the initiative on talk radio and in other public comments.

This is what voters will see at the polls:

Do you want Maine to expand Medicaid to provide healthcare coverage for qualified adults under age 65 with incomes at or below 138% of the federal poverty level, which in 2017 means $16,643 for a single person and $22,412 for a family of two?

So far all the newspapers that have weighed in, have supported expansion. The Press Herald: "A 'yes' vote," they wrote, "would bring in more than $500 million a year from the federal government, which would be distributed throughout the state to hospitals-- including struggling rural hospitals-- along with clinics and doctors’ offices, supporting an estimated 4,000 health sector jobs. Those workers will cash their paychecks, buy houses, pay taxes and contribute to the economic health of their communities, generating another 2,000 jobs.

For economic impact alone, we would enthusiastically support this referendum, which would give the state a much-needed shot in the arm.

But there are many other reasons to vote yes that are just as compelling. This is a bill that will make Maine’s health care system more reliable and secure for everyone. It will extend access to preventive care and treatment for people who can’t now afford it. And it will save lives.

By passing this referendum, Maine would extend health coverage to an estimated 70,000 people who are not currently eligible for MaineCare, despite earning less than $16,642 for an individual, or $22,411 for a family of two. Some of the people covered would be childless adults who earn less than the federal poverty limit of $12,060 a year, but still can’t get coverage now. More than two-thirds of those who’d be newly eligible are currently working, or actively looking for work, but don’t have employer-provided insurance.

At those incomes, visits to a doctor or filling a prescription are not in the budget. Low-income people often wait until they are very sick before they start to seek help, often at hospital emergency departments. By then, their care might be much more expensive than preventive care would have been. It also might be too late to help them at all.

Even if they have no insurance, those patients are not turned away by hospitals. Instead, they receive “free” care, the cost of which is shared by all the hospital’s paying customers. That results in higher insurance premiums for everyone else.

Opponents typically argue that Maine can’t afford to expand because the state’s 10 percent share of the program, projected to cost $54 million by 2021, would be too much of a burden.

But they are ignoring the benefit the state would get in return from the federal spending on health care. Most investors would be willing to put up $10 dollars to get $100 back, and Maine should be willing to take that deal, too.

Thirty-one states have participated in Medicaid expansion, and there is plenty of evidence that it has not broken the bank.

Instead, expansion states report not only that their state budgets are stable, but that their hospital balance sheets are positive and insurance rates are lower than in non-expansion states.

This is a good deal. It’s time Maine took part in this program.

This is a good deal for Maine, and voters shouldn’t let this opportunity slip away again.

Jared Golden, the Majority Whip of the Maine state House, is the progressive running in Maine's 2nd congressional district. He reiterated that "the Maine Legislature has passed Medicaid expansion five times but the governor has killed it with his veto pen each time. Passage of Question 2 would bring about a half billion federal dollars per year into Maine to extend coverage to roughly 70,000 Mainers that have lacked health coverage for all these years because of the governor's opposition to a functioning government and his lack of compassion for people that are living in poverty. The governor says they need to pick themselves up by their bootstraps but they don't have boots. He's forgotten that his were given to him by kind people that were there to give him a hand up but not everyone is so fortunate. The frustrating part is that expanding Medicaid to those 70,000 folks would also create thousands of good paying, middle-class health care jobs in Maine, giving our economy a much needed boost, particularly those jobs that would be supported in our rural hospitals and health care providers. In Congress, I'll fight to protect Medicaid funds so that Maine's elderly, many of whom use it for long-term care and assisted living, and people struggling in poverty with low-wages can continue to receive health care coverage through this important program."

So Paul Ryan Thinks The GOP Can Run In 2018 On Cutting Medicaid, Medicare And Social Security?

If you missed Bernie on CNN with Jake Tapper yesterday, the interview is above. Bernie's plans are the polar opposite of what Paul Ryan (plus Mike Pence, Mitch McConnell and the rest of the Republicans) are trying to do. He explained to Tapper how he's working to perfect a Medicare-For-All bill that can-- eventually-- pass Congress. Meanwhile the Republicans are not just trying to defund Medicaid in their "healthcare" bill but are also using their budget plan to weaken and start defunding Medicare and Social Security. And this is what the GOP wants to run on? Last week Priscilla Alvarez, writing for The Atlantic reported that "On Tuesday, House Republicans released a 2018 budget plan that would make cuts to Medicare and Social Security, despite President Trump’s campaign pledge to keep those entitlement programs intact. The proposal calls for more than $200 billion in cuts to mandatory programs. It also serves 'as a vehicle for changing taxes,' CNN reports, which is 'the primary legislative focus of the 2018 budget.'"

Ryan's core dream is that, with Trump still willing to sign any man-made-catastrophe he can get through Congress, he can implement the Ayn Rand plan to make America into a jungle where only the "strong" survive.

“In past years, our proposals had little chance of becoming a reality because we faced a Democratic White House,” said House Budget Committee Chairman Diane Black in a statement. “But now with a Republican Congress and a Republican administration, now is the time to put forward a governing document with real solutions to address our biggest challenges.”

The spending plan will likely face hurdles within the Republican Party: While it may alleviate concerns from deficit hawks and fiscal conservatives, it may also receive pushback from moderate Republicans for the entitlement cuts.

Those reductions drew approval from the president’s budget director, Mick Mulvaney, who previously served on the House Budget Committee. “It is a bold effort that follows the leadership of President Trump in making America great again,” he said. “Critically, this budget lays a pathway for Congress to pass, and President Trump to sign, pro-growth tax reform into law.”

Mulvaney has conceded that his stance on entitlement programs diverges from Trump’s purported views. During his confirmation hearings, Mulvaney defended his support for raising the eligibility age for Social Security to 70 years old and said he continues to back means-testing for Medicare. While the president’s budget this year didn’t cut Medicare or Social Security’s core retirement benefits, it did include cuts to Social Security’s supplemental-income and disability programs.

Whether the House proposal could pass remains unclear. Members of the conservative Freedom Caucus have been pushing for more cuts, and moderates are raising concerns over the $200 billion in mandatory spending reductions. Republicans may face more pressure to pass the proposal after the Senate health-care bill fell through late Monday night.

Randy lives in Caledonia, between Racine and Franklin, but since he declared his candidacy last month he's been traveling to every part of the first district. Yesterday when I asked him what he thought about Ryan's budget plans he said, "No one at the Rock County Fair came up to me and said, 'Hey Randy, can you lower Social Security payments' and no one I met in the towns near Beloit, which the Republicans gerrymandered out of the district to make it 'safe' for Ryan, asked me to make sure to gut Medicare for them. Everyone I've met in Kenosha and Janesville wants government to work, not to fail. I'm running to represent the interests of working families in Wisconsin, not Paul Ryan's special interest donors. The voters are going to have a very clear choice in 2018 and I hope Democrats across the country give the voters a clear choice in their districts too. If they do, a whole lot of new members will be able to hit the ground running and work with dedicated members of Congress like Mark Pocan, Jan Schakowsky, Ted Lieu, Ruben Gallego, Raul Grijalva and Barbara Lee to start fixing some of the damage the establishment in DC has dealt out to our families."

Nancy Ohanian asks: “White House Shakeup: Who’s Next?"

Are The Republicans Really So Unconcerned About The Health Of Their Own Constituents That They Would Leave Them High And Dry?

When I worked for Time-Warner, I was a divisional president. Presidents and chairmen got the best health insurance corporate American has to offer. When i retired I was very nervous because I had a pre-existing condition and was basically uninsurable. But what I soon found out-- much to my relief-- is that my Time-Warner platinum-plated health insurance would continue until I turned old enough for Medicare. Almost as soon as that happened, my doctor told me a had a are form of cancer. I wondered if Medicare would cover it. They did-- and in every single way better than the platinum-plated stuff I got from Time-Warner. In the end-- well, there is not end... it goes on and one forever-- the bills came to something around $2 million, which included some very cutting edge experimental treatment. At no time was Medicare anything but completely fantastic (except for the Republican Medicare Part-D part, which is a complete mess and governs access to pharmaceuticals).

What Ryan and McConnell-- but especially Ryan-- want to do, as do many Republicans, is abolish the New Deal and Great Society social safety net including Medicare and Medicaid. This TrumpCare bill is part of that, which is why it's the most unpopular major bill in contemporary history-- even less popular than Bush's Wall Street bankster TARP bailout! In a statement Friday, Ohio Governor John Kasich (R) said "The Senate plan is still unacceptable. Its cuts to Medicaid are too deep and at the same time it fails to give states the ability to innovate in order to cope with those reductions... These shortcomings flow from the fact that the Senate plan commits the same error as Obamacare-- it’s not bipartisan. It fails to bring solutions from both sides to the table that can ensure we aren’t simply replacing one divisive plan with another."

A Kaiser Family Foundation poll released yesterday found that 61% of Americans "continue to hold unfavorable views of the plan to repeal and replace the Affordable Care Act (ACA), including over four in ten (44 percent) who say they have 'very unfavorable' view. The share of the public with negative views of the law has increased slightly in the past month, from 55 percent to 61 percent. Views of the Republican plan to repeal and replace the ACA continue to vary widely by party and a large intensity gap remains, with Democrats being nearly three times as likely to hold a 'very unfavorable' view as Republicans are to hold a 'very favorable' view (71 percent versus 25 percent, respectively)." And there's more:

• Nearly two-thirds of the public opposes (65 percent) major reductions in federal funding for Medicaid as part of a plan to repeal and replace the ACA, and most continue to oppose these reductions even after hearing arguments in support of them. About half of Republicans and those who approve of President Trump support major reductions in federal funding for Medicaid.
• Seven in ten (71 percent) Americans would rather see Republicans in Congress work with Democrats to make improvements to the ACA but not repeal the law, while one-fourth (23 percent) say they would rather Republicans continue working on their own plan to repeal and replace the ACA. Large shares of Democrats (91 percent) and independents (72 percent) would like to see Republicans in Congress work across the aisle to make improvements to the ACA. Trump supporters are divided with similar shares saying Republicans in Congress should continue working on their own plan (47 percent) as saying they want them to work with Democrats on improving the ACA (46 percent). Slightly more than half of Republicans (54 percent) want Congressional Republicans to continue working on their own plan to repeal and replace the 2010 health care law.
• The majority of the public thinks the current replacement plan being discussed does not fulfill most of the promises President Trump has made about health care.

Now let me go back to where I started-- government insurance vs private insurance. Yesterday's NY Times made the case that it would be better to not assume private insurance is better, which is exactly what I discovered personally. [I]t’s better for patients to have Medicaid than to be uninsured, contrary to critics of the program. But is having Medicaid, as those critics also say, much worse than having private insurance? This idea has become a talking point for conservatives who back big changes to Medicaid, as the Senate health bill proposes. The poor would benefit simply by being ushered off Medicaid and onto private insurance, they write. But it’s far from proven that Medicaid is worse than private insurance. A lot depends on what kind of insurance is compared with Medicaid, and how they are compared."

Many studies that measure Medicaid against private insurance suffer from the same flaws that compare Medicaid with being uninsured. They’re terribly confounded, and can show only associations, not causation. People with private insurance are healthier and wealthier than those on Medicaid, and in ways not fully controlled for in statistical analyses. These factors almost certainly predispose someone on Medicaid to have worse outcomes than someone with private insurance.

Perhaps the most convincing way to compare Medicaid and private insurance would be with a randomized controlled trial that pits them head to head. No such trials exist. Recall that the Oregon Medicaid study randomly offered, via a lottery, the opportunity for low-income adults to enroll in Medicaid. It did not have another study arm that offered private insurance.

But we do have a decades-old trial that looked at varying levels of cost-sharing: the RAND Health Insurance Experiment. This is relevant because one substantial difference between Medicaid and most private coverage is the level of cost-sharing. Medicaid is nearly free. Most private coverage comes with deductibles and co-payments.

The RAND study randomly assigned 2,750 families to one of four health plans. One had no cost-sharing whatsoever-- kind of like Medicaid. The other three had cost-sharing (money people had to pay out-of-pocket for care) at levels of 25, 50 or 95 percent-- capped at $1,000 at the time, which is about an inflation-adjusted $6,000 today. This level of personal liability acts like a deductible, making the plan with a 95 percent level of cost-sharing comparable to a “Bronze” plan on the Affordable Care Act’s exchanges today.

The RAND study found that the more cost-sharing was imposed on people, the less health care they used-- and therefore the less was spent on their care. The study also found that, over all, people’s health didn’t suffer from lower health care use and spending.

Lower spending and no decline in health-- these are the results that everyone cites to justify increased cost-sharing, and to justify shifting people from Medicaid to private plans with high deductibles.

But the results of the RAND study, like so much in health care, are complicated. A deeper dive into the data shows that people decreased their consumption of necessary health care in equal measure to unnecessary health care. As a rule, people are terrible discriminators of what care is needed and what’s not. Since most people under the age of 65 are healthy, even in the RAND study, that doesn’t matter much.

But even if most people are healthy, some are not (and particularly those on Medicaid). In the RAND study, poorer and sicker people-- exactly the kind more likely to be on Medicaid-- were slightly more likely to die with cost-sharing.

Free care also resulted in improvements in vision and blood pressure for those with low income. As an influential 1983 New England Journal of Medicine paper put it: “Free care does make a difference.”

One limitation of the RAND study is its age. It took place between 1971 and 1982. There have been no studies of cost-sharing to rival it since. Still, the best recent evidence we have is that giving free care to poorer and sicker people improves health and saves lives. It is reasonable to conclude that switching them to a plan with high cost-sharing (even a private plan) would do the opposite.

Some of the more recent studies were nicely summarized in a paper by Katherine Swartz for the Robert Wood Johnson Foundation’s Synthesis project. She found that increased cost-sharing for low-income populations was associated with a shift toward more costly services, like increased emergency room visits because people skipped taking their drugs. She also found that increased cost-sharing affects poor people differently than everyone else, confirming RAND’s findings. A more recent study found that enrollment in plans with high deductibles led to reductions in necessary care, which would have consequences for the poor and sick.

Austin wrote previously here how increased cost-sharing may lead people to take fewer drugs for their high cholesterol, hypertension and diabetes. In his first Upshot column, Aaron wrote that parents delay taking their children for asthma treatment when cost-sharing rises.

Even small premiums can lead to problems. A $10 increase in monthly Medicaid premiums was followed by a 6.7 percent reduction in Medicaid and coverage of CHIP (Children’s Health Insurance Program) for people just above the poverty line.

Unquestionably, private coverage can work very well for many people. Take us, for instance. The insurance that we each have from our employers is probably better for us than Medicaid would be. Though these plans come with cost-sharing, we have incomes that can handle it. Our plans cover things that Medicaid often does not, like dental checkups.

Our plans have great networks, and they reimburse well for the care we receive. Just like Medicaid enrollees, we also receive support from the federal government, which waives tax collections on dollars contributed to premiums. That tax break is higher than the cost of Medicaid in many cases.

We’re also relatively healthy and would probably be fine on any plan (unless and until our health deteriorates).

But because our plans require considerable cost-sharing, even Medicaid enrollees would struggle on them. More important, neither House nor Senate repeal and replace bills offer poor Medicaid enrollees plans as generous as ours.

The Senate’s health care plan, for example, would offer much less generous plans. A 64-year-old woman with an income of $11,400 would face a deductible of at least $6,000. For her, such a plan is not better than Medicaid; it is most likely much worse if she is also sick. Because of the deductible, the care she’d need would be financially out of reach.

A recent paper in Health Affairs documented that outcomes in Arkansas, which allowed poor people to buy private plans on the exchanges, were similar to those in Kentucky, which expanded access to poor people through Medicaid. But those private plans came with significant cost-sharing subsidies, which would be stripped away by the Senate’s bill. Even so, the evidence did not suggest that the private coverage of Arkansas was better than the public coverage of Kentucky.

There are certainly private plans for poor and sick Americans that are better than Medicaid. But plans with very high cost-sharing-- which are the ones being offered in Congress as A.C.A. replacements-- are not among them.

That letter above is an unprecedented joint statement from the major American insurers who are clear that Ted Cruz's amendment is "unworkable in any form" and that it will lead to "widespread terminations of coverage." They sent it to McConnell and Schumer. So... will the repeal bill pass the Senate? Right now, they're certainly bribing every Republican senator who will take bribes. And, no dobt, we should find out by mid-week... maybe even before the new CBO scores are released.