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From Vox
The Supreme Court made the GOP’s new voting restrictions possible -
Justice Neil Gorsuch, left, talks with Chief Justice John Roberts on the steps of the Supreme Court following Gorsuch’s official investiture at the Supreme Court in 2017. | Win McNamee/Getty Images
Voting rights mean little if the Court refuses to enforce them.
On Thursday morning, Florida Gov. Ron DeSantis (R) signed legislation that restricts absentee voting, discourages voters from registering through voter registration campaigns, and potentially prohibits volunteers from giving food and water to voters waiting in line to cast their ballot.
Many provisions of this new Florida law mirror similar provisions in a Georgia voter suppression bill that became law last March. The Georgia law also takes aim at absentee voting, among other things, but its most troubling provision allows the state’s Republican-controlled legislature to effectively take over county election boards — boards that have the power to disqualify voters and to close polling places.
Meanwhile, Republicans in Texas are pushing legislation that would redistribute polling precincts in urban areas in ways that would make it harder for many voters to cast a ballot, and that would require local election officials to potentially purge thousands of voters from their rolls. In Arizona, Republicans have proposed an array of new hurdles that voters would have to clear to cast a ballot — all whileconducting a haphazard “audit” of the 2020 election that appears designed to justify such laws.
All of this is possible because the Supreme Court has spent the past decade and a half dismantling safeguards against these kinds of laws. Not that long ago, these attacks on democracy would have run headlong into a skeptical judiciary. Now they are likely to be upheld.
A little over a decade ago, federal statutes and well-established constitutional doctrines provided a robust shield against state laws that serve little purpose other than to restrict the right to vote. But the Supreme Court started poking holes in this shield not long after President George W. Bush appointed Chief Justice John Roberts, a longtime crusader against strong voting rights laws, and Justice Samuel Alito, the Court’s most reliable Republican partisan.
States like Florida and Georgia are making in harder to vote, in other words, because they think the courts will let them get away with it. Due to some crucial decisions by the Roberts Court, they’re probably right.
Not that long ago, the Supreme Court would have struck down laws that target trumped-up allegations of voter fraud
Though the right to vote is the essential building block of any democracy, not all laws that make it more difficult to vote are unconstitutional. As the Supreme Court recognized in Storer v. Brown (1974), “as a practical matter, there must be a substantial regulation of elections if they are to be fair and honest and if some sort of order, rather than chaos, is to accompany the democratic processes.”
States may legitimately require voters to cast their ballots at a particular location, and it may require these voters to do so by a particular time and date. They may impose reasonable restrictions on who may qualify as a candidate whose name appears on the ballot. And states may require voters to use a standardized ballot rather than, say, simply writing a bunch of names on a blank sheet of paper and dropping it off at a polling place.
Yet while many election rules are permissible even if they prevent some small cohort of voters from casting a ballot, the Supreme Court as recently as 13 years ago forbade states from enacting laws that serve no purpose other than to restrict the franchise. As the Court held in Anderson v. Celebrezze (1983), when confronted with a law that makes it harder to vote, federal courts must weigh “the character and magnitude of the asserted injury” to the right to vote against “the precise interests put forward by the State as justifications for the burden imposed by its rule.”
Laws that imposed minimal burdens on the right to vote, while serving legitimate state interests, were typically upheld. But laws that burdened the right to vote without achieving any other real purpose would be struck down under the Anderson framework.
Anderson is technically still good law. But the Supreme Court watered down Anderson’s balancing test so severely in Crawford v. Marion County Election Board (2008) that it’s unclear whether Anderson still provides any meaningful safeguard against laws enacted primarily to disenfranchise voters.
Crawford was an early challenge to what was, at the time, a cutting-edge method of restricting the franchise: strict voter ID laws. Proponents of such laws, which require voters to show a photo ID before they can cast a ballot, typically claim that they are necessary to prevent anyone from impersonating a voter at the polls. But this kind of voter fraud is so rare that it barely exists.
A study by Loyola Law School professor Justin Levitt, who led much of the Justice Department’s voting rights work in the Obama administration, uncovered only 35 credible allegations of in-person voter fraud among the 834 million ballots cast in the 2000-2014 elections. A Wisconsin study found seven cases of any kind of fraud among the 3 million votes cast in the 2004 election — and none were the kind that could be prevented by voter ID. In 2014, Iowa Secretary of State Matt Schultz, a Republican, announced the results of a two-year investigation into election misconduct within his state. He found zero cases of voter impersonation at the polls.
The primary opinion in Crawford was only able to identify one case of in-person voter fraud at the polls in the preceding 140 years.
So, under Anderson’s framework, the Indiana voter ID law at issue in Crawford should have been struck down. A state’s power to regulate elections is at its nadir when it targets an imaginary or virtually nonexistent problem.
Yet the Court allowed Indiana’s voter ID law to go into effect in Crawford.
The Court’s conservatives were unanimous in favor of this result, but it’s worth noting that the vote in Crawford was 6-3, with the five conservative justices splitting between two separate opinions. The primary opinion in Crawford was authored by Justice John Paul Stevens, a moderate Gerald Ford appointee who frequently voted with the Court’s liberal bloc.
Stevens later described Crawford as “a fairly unfortunate decision.” And, shortly after Stevens’s death in 2019, election law scholar Rick Hasen speculated that Stevens’s opinion in Crawford may have been a “tactical move that saved the country from a much worse decision” — Stevens’s opinion was joined by Chief Justice Roberts and Justice Anthony Kennedy, who might have joined a more radical opinion by Justice Antonin Scalia if Stevens hadn’t voted for a conservative outcome.
Regardless of why the justices voted the way they did in Crawford, however, the decision was still a disaster for voting rights. It established that states may enact laws restricting the franchise, even if the only justification for the law is an imaginary or greatly exaggerated problem.
The Court dismantled key protections against racist election laws
Beyond the balancing test recognized by cases like Anderson, federal law is also supposed to provide very robust safeguards against racial discrimination in elections.
The most potent provision of the federal Voting Rights Act was Section 5 of the law, which required that states and local governments with a history of racist voting practices “preclear” any new voting rules — either with the Justice Department or with a federal court in Washington, DC — before those new rules could take effect. The idea was to stop racist election rules from ever having a chance to disenfranchise anyone.
Section 5 also provided very broad protection against racial voter discrimination in the jurisdictions where it applied. Under Section 5, covered states and local governments were required to seek preclearance for any new “voting qualification or prerequisite to voting, or standard, practice, or procedure with respect to voting.” And preclearance would be denied if the new election rule had either the “purpose” or the “effect of denying or abridging the right to vote on account of race or color.”
Before Shelby County, in other words, Texas would not have been allowed to implement a law that shuts down voting precincts in primarily Black and brown neighborhoods. Similarly, Georgia’s entire voter suppression law would be subject to preclearance, as would any new action taken under that law — such as a decision by state-level Republicans to take over local election boards in Atlanta, or to use their control of local election administration to shut down polling locations in Black communities.
The premise of ShelbyCounty was that it was unfair to single out the particular jurisdictions that were previously subject to preclearance because those jurisdictions no longer engaged in the kind of “‘pervasive,’ ‘flagrant,’ ‘widespread,’ and ‘rampant’ discrimination” that characterized the Jim Crow era. As Roberts wrote for the Court in Shelby County, “there is no denying … that the conditions that originally justified [preclearance] no longer characterize voting in the covered jurisdictions.”
Perhaps. But, as Justice Ruth Bader Ginsburg famously wrote in dissent, the fully operational Voting Rights Act was one of the primary reasons Jim Crow voter suppression waned in the latter part of the 20th century. “Throwing out preclearance when it has worked and is continuing to work to stop discriminatory changes,” Ginsburg clapped back at Roberts, “is like throwing away your umbrella in a rainstorm because you are not getting wet.”
Ginsburg’s warning now seems prescient, as many of the same states that were once subject to preclearance are now racing to enact laws disenfranchising voters.
It’s going to get worse
Decisions like Crawford and Shelby County were handed down when the relatively moderate conservative Justice Kennedy held the balance of power on the Supreme Court, when Justice Ginsburg was still alive, and when Amy Coney Barrett was still an obscure law professor at Notre Dame. Now that Kennedy and Ginsburg are no longer around, the Court’s new majority is likely to make significant new incursions on the right to vote.
The Supreme Court heard a case in March, for example, that could potentially dismantle what remains of the Voting Rights Act. Although several of the justices seemed disinclined at oral argument to eliminate all of the nation’s safeguards against racist election laws in one fell swoop, this case is still likely to weaken the Voting Rights Act even further, opening the door to more voter suppression laws.
The conservative justices, meanwhile, are pushing a radical doctrine that would give state legislatures an unprecedented new power to enact new election laws — even if those laws are vetoed by the governor or struck down by the state’s courts. As Justice Neil Gorsuch described this doctrine, “the Constitution provides that state legislatures — not federal judges, not state judges, not state governors, not other state officials — bear primary responsibility for setting election rules.”
It’s unclear whether the Court will implement this doctrine or how far it will go in doing so. Of the six conservative justices, only four currently endorse Gorsuch’s approach. Roberts has backed it in the past, but he stepped away from that view in an opinion last October. This means that the decision likely comes down to the recently confirmed Justice Barrett, who has not been on the Court long enough to reveal whether she agrees with Gorsuch.
If taken to its logical extreme, Gorsuch’s proposed rule could skew elections even further toward the Republican Party. It could potentially allow gerrymandered state legislatures in states like Wisconsin, Michigan, and Pennsylvania to draw congressional maps that will lock Democrats out of power — and then to enact these maps into law even if the states’ Democratic governors attempt to veto the maps. Gorsuch’s approach might also prohibit state supreme courts from enforcing state constitutional provisions that protect voting rights or prohibit gerrymandering.
The Supreme Court, in other words, is signaling that it is not inclined to protect voting rights — and that it may even be inclined to further dismantle existing rules that protect our democracy. Republican state lawmakers are as capable of reading these signals as anyone else. And so it should come as no surprise that we are seeing the kinds of voter suppression bills that we are now seeing in places like Georgia, Florida, Texas, and Arizona.
Virginia Republicans’ messy, Trumpy race to pick a nominee for governor -
State Sen. Amanda Chase, seen here at a 2020 open-carry protest in Virginia, is one of the most explicitly pro-Trump candidates now running to be Republicans’ gubernatorial nominee in Virginia. | Eze Amos/Getty Images
The Republicans running for governor in Virginia signal a lot about the future of the GOP.
GALAX, Virginia — Republican gubernatorial candidate Kirk Cox was several minutes into a wonky election security answer at a diner when January 6 came up again.
Did President Joe Biden win the election? Cox avoided directly answering the question at this recent event, though he had previously acknowledged that reality, the one GOP frontrunner willing to do so.
Instead, he refocused on proposals like voter ID requirements, which are popular with lots of voters. But now, Lin, a Trump supporter who had posed the Biden question, had another one. She wanted to know whether he agreed with the Virginia Senate censuring one of its members, Amanda Chase, after she called the people who stormed the US Capitol that day in January “patriots.”
Did Cox support the “freedom of speech” of Chase, now one of Cox’s competitors for the Republican nomination?
“I’m very much for freedom of speech,” Cox answered.
“So you were against [the censure vote]?” asked Lin, who supports Chase in the race. “I don’t want to put words in your mouth, but I need a ‘yes’ or a ‘no.’”
This narrow line on the 2020 election and cancel culture is one Republicans have had to dance along for months in courting voters before Saturday’s Virginia GOP gubernatorial convention.
The GOP has had a tough go of it statewide in the past few years in Virginia, with demographic changes helping push the state to become reliably Democratic. The party’s response — running further and further to the right — has only exacerbated the problem. But Virginia might not be lost to the right kind of Republican. At least not yet.
Republicans will choose their nominee in an “unassembled convention”; nearly 54,000 Republicans who successfully applied to be a delegate will be able to cast ranked-choice ballots at 39 drive-up locations around Virginia. It’s a process that has had more than a fewbumps along the way, including Chase alleging the party chose a convention over a primary to prevent her from becoming the nominee. It could also take several days to know the results — candidates have already sown doubt about the race.
“It’s going to make the Iowa caucuses look like a well-oiled machine,” a Democratic operative said, with a touch of hopeful glee.
The candidates represent a few ways the GOP could go in Virginia
Virginia last chose a Republican in a statewide election in 2009. Since then, the GOP has run candidates that its own insiders say don’t appeal to the state’s growing suburban population. They’re going to have to make inroads back into those communities to have a hope of winning, says Miles Coleman, associate editor of Sabato’s Crystal Ball at the Center for Politics.
“I always look at, in the 2016 primaries, places where candidates like John Kasich and Marco Rubio did well against Trump: Those are the areas that have moved more toward the Democrats since — places like Loudoun County, Hanover County, Chesterfield County,” Coleman said. “Maybe those voters are still open to the right type of Republican after voting for Hillary [Clinton] and Biden.”
But can they do that while turning out the 44 percent of the state that went for Trump?
The mix of contenders has been revealing.
Chase, the self-described “Trump in heels,” has dominated headlines in national media, saying things like the Derek Chauvin verdict made her “sick” because she worried about how cops would feel about it. And she’s popular with the base, at least according to a February poll and a more recent one conducted by Democrats.
Businessman and former lieutenant governor hopeful Pete Snyder is nearly as Trumpy, railing against the “woke” liberal establishment and highlighting endorsements from figures like Ken Cuccinelli and Sheriff David Clarke.
Meanwhile, newcomer and former private equity group executive Glenn Youngkin has surged to the top of some recentstraw polls by running a well-funded campaign that ticks all the conservative culture war boxes but alsotalks about appealing to “Trump Republicans, libertarians, and Democrats” to win in November.
Cox, a delegate in the Virginia House and formerly the body’s speaker, remains the establishment favorite. He touts his know-how on implementing conservative policies, telling Vox, “it’s very important to have the experience to know how to run the state and to make good decisions.”
But regardless of how candidates are positioning themselves, there are certain issues that keep coming up on the trail: support for law enforcement, the eradication of “critical race theory” from schools, and election integrity, to name a few.
And for some voters, like Heather, who attended Cox’s event in Galax, the last on that list is most important — or, more specifically, it’s the question of whether Joe Biden won the 2020 election that matters most.
“That’s a huge one,” she said. “That’s first and foremost for this election or any election.”
Virginia Republicans want to stay competitive — and keep conservatives on board
Here’s what it looks like: There are seven candidates running for the Republican gubernatorial nomination, with four in real contention (Youngkin, Chase, Cox, and Snyder). All of them tout their traditional conservative bona fides — being pro-Second Amendment, anti-abortion, pro-business, and the like. Many of them rail against Covid-related closures, praising Florida Gov. Ron DeSantis for keeping schools and businesses open throughout the pandemic.
“All across Virginia on day one, we are going to get every single school open — five days a week, every single week, with a real, live, breathing teacher in every classroom,” Snyder told a crowd at a brewery in Wytheville last weekend. “And folks, getting the schools open is only the beginning. We need to break the backs of this special interest monopoly of the teachers’ unions and bring real change to our schools.”
Closing message for #VAGOV candidate Pete Snyder (R), all on education. If he’s nominated at this Saturday’s convention, expect the message to continue into the general…https://t.co/WN1YxoIRA6
Given the country’s rate of vaccination, decreased community spread, and reopening, those pandemic issues might not be as relevant come November — or in 2022 and beyond. Trump, though, still will be.
At Snyder’s event, an emcee opened the afternoon by asking, “How many of you wish Donald Trump was president right now?” and a one-time Trump operator told the crowd they had to get to work to “defeat the socialists,” who “might even be worse than socialists, they’re bordering on communists.”
Youngkin, for his part, makes sure to note in his stump speech that he’s won praise from Trump, but he was also willing to criticize the former president’s tone as “a bit harsh” at a campaign event in northern Virginia.
Loyalty to Trump isn’t the key thing, argues Peter Doran, a former think tank CEO and one of the other three candidates recognized by the state party. (The others are former Roanoke Sheriff Octavia Johnson and retired Army Col. Sergio de la Peña.)
“Most Virginia Republicans are painted as these big hard-right, hard-conservative voters who only care about Donald Trump. That’s not true,” Doran said. “They care about their job. They care about what’s happening to their kids in this past year, and their education. And they care very deeply about the Republican Party’s failure to win over the past decade.”
Wilma, a mother of four and delegate in the convention, agreed, saying the GOP’s future relies on getting young people to understand conservative values like small government, constitutional rights, and concern about the deficit.
“My kids all look at the stimulus — it might be nice to get that money, that cash,” she said. “But eventually they know in the long run, they’re the generation that’s going to have to pay it back.”
The culture wars have consumed the GOP
Still, it’s no longer enough to tick the “fiscal conservative,” “Christian,” “gun owner,” and “anti-abortion” boxes. There are new ones on the list — keywords of the culture war issues the former president helped animate.
Take “critical race theory,” which Chase says is part of the reason she decided to homeschool her children.
As Vox’s Fabiola Cineas explained, “critical race theory is a framework for grappling with racial power and white supremacy in America.” But it’s also become a catch-all term for what the Trump administration thought was an effort to “indoctrinate” American students and workers with “divisive and harmful sex- and race-based ideologies”:
“They’ve lumped everything together: critical race theory, the 1619 project, whiteness studies, talking about white privilege,” Kimberlé Crenshaw, a founding critical race theorist and UCLA and Columbia University law professor, told Vox. “What they have in common is they are discourses that refuse to participate in the lie that America has triumphantly overcome its racist history, that everything is behind us. None of these projects accept that it’s all behind us.”
It’s not just Chase using the term frequently: Almost all the candidates make sure to highlight their opposition to it; six have signed a pledge opposing critical race theory. As journalist Dave Weigel pointed out on Twitter, Youngkin went so far as to upload multiple video clips of him criticizing it.
One of the front-runners in the #VAGov GOP primary uploaded four videos in 24 hours about his opposition to critical race theory. pic.twitter.com/RjSuGf3Enx
Trump’s impact, though, is perhaps most evident in the obsession with election security.
On one hand, Amanda Chase’s stance on the 2020 election sets her apart from the rest of the party — so much so that she, her supporters, and some outsiders claim the state party chose a convention rather than a primary to mitigate the risk of her ending up at the top of their ticket.
But none of the candidates can distance themselves too far from Trump’s lies and doubt-sowing about the 2020 election. They need only look to the US House to see the consequences of doing so.
This is the key here. Cheney is responding to massive movement across the party to validate 1/6, led by, but by no means limited, to Trump. She’s not the one forcing this conversation, what annoys her colleagues is she won’t ignore it. https://t.co/t6QzdKQTkn
Neither Youngkin nor Snyder will say Biden’s presidency is legitimate. Cox appears willing to do so (at least when he’s not at a diner in southwest Virginia).
And everyone has plans to improve election integrity. Youngkin promotes his “election security task force,” one plank of which is updating voter rolls monthly. He and Cox talk about making the state election commission nonpartisan. Snyder wants to “make Virginia No. 1 in ballot integrity.”
They’re all fairly anodyne-sounding proposals, but talking about things like that is a requirement for securing the nomination, says Stephen Farnsworth, a political scientist at the University of Mary Washington.
“While they may not support what happened on January 6, they do want to offer a position that shows some sympathy to the position of Trump supporters,” Farnsworth said.
That doesn’t necessarily mean the rhetoric will dog them during the general election — Youngkin’s spokesperson said they believe election security isn’t a partisan issue, “it’s a democracy issue.”
And “Kirk Cox is an example of a candidate who accepts Biden as a legitimate president but nevertheless speaks in ways that gives some solace to Trump supporters,” Farnsworth pointed out, adding it’s likely that “voters in November will not be dramatically impacted by what’s said in May.”
Still, the insistence on making America’s elections more secure helps perpetuate a world in which seven out of 10 Republican voters still say — per a recent CNN poll — that Biden didn’t win enough votes to be president.
Questioning election integrity is coming home to roost
And the continued questioning of elections has applied even to their own party’s choices. Some of those choices, admittedly, merit scrutiny from candidates extolling the importance of signatures on absentee ballots. But it also led Youngkin, Cox, and Chase to write to the party, demanding it not use “untested and unproven software that creates uncertainty, lacks openness and transparency, and is inconsistent with our calls as a party for safe and secure elections.”
Now, every ranked-choice ballot will be counted by hand, at a ballroom at the Richmond Marriott, race by race. Chair Rich Anderson detailed to the Virginia Scope’s Brandon Jarvis the lengths the Republican Party of Virginia is going to try to instill confidence in the process:
Each ballot “will be seen by several eyes at the same time” to guard against transposition of numbers.
An out-of-state independent oversight team will be present.
Each candidate can have two representatives in the counting room, a party spokesperson told Vox. And Anderson said they can “be pretty much right up on the ballots, and eyes on them,” because he wants “them to feel comfortable with the process, to understand it, and have confidence in the final outcomes.”
The news media can be on site to report, and Anderson says he’ll provide regular updates on social media as well.
They’ve also set aside money to livestream the counting process, because, Anderson said, “I just don’t want to repeat what was done in different places around the country where people were concerned about it being an opaque process.”
That’s left “no room” for any conspiracy theories about the counting to crop up, says John March, the state party communications director. Even so, there are bound to be some dissidents, and if it takes days, Coleman says he can “see the conspiracy theories now.”
“When you have a multi-candidate field in a multi-round election,” Farnsworth said, “the only sound bet is expecting that the party won’t get together and sing ‘kumbaya’ when this is all over.”
Do these Republicans even have a shot in a general election?
Virginia, once home to the capital of the Confederacy, has moved left enough in presidential races that on election night in 2020, the forecast group Decision Desk called it for Joe Biden right as polls closed. Trump ended up with just 44 percent of the vote here, Biden with 54.
But the GOP argues the state is not lost to them just yet.
In recent decades, Virginia had a peevish streak, electing a governor from the opposite party that just won the White House. The candidate to break that trend was former Gov. Terry McAuliffe — who’s running again this year.
And March points to the “unprecedented” level of interest in the convention as a sign of what’s to come: “54,000 people are getting involved on the grassroots level. … You don’t really see that, and that just shows how excited Virginia Republicans are.”
Without Trump on the ballot this year, there might be an opening — a slim one for the governorship, but a bigger one to flip competitive state House districts.The person Republicans choose on Saturday will matter a lot.
“One thing I do think that could bode well for them is even though he lost, in 2017 Ed Gillespie got more votes than any previous Republican nominee for governor,” Coleman pointed out. “So maybe if Youngkin or whoever else can get that type of Gillespie turnout, which is definitely a question mark, and Democrats can’t get that anti-Trump turnout, maybe it’s going to be closer.”
Even so, it’s going to be an uphill battle for the GOP to narrow margins in some areas, let alone retake them. Take Chesterfield County, which Republicans easily won for decades. In 2020, it went for Biden by more than 6 percentage points.
“Going forward,” Coleman says, “this may be the last potential cycle where the Republicans could win a county like Chesterfield, and that may not even be enough — it may be necessary but not sufficient.”
Democrats seem to think it won’t be.
“We’re ready for a fight; we expect a fight. We expect a tough race,” said David Turner, the communications director for the Democratic Governors Association. “But what I would say is you can’t report accurately on the state of Virginia without acknowledging there’s pre-Trump and there’s post-Trump, and we’re still post-Trump.”
Why Democrats’ ambitions for health care are shrinking rapidly -
President Joe Biden seems to be scaling down his health care ambitions as he runs into the problem of how to pay for them. | Melina Mara/Pool/AFP via Getty Images
The Biden agenda has run into the hardest roadblock in health care: How do you pay for it?
As Joe Biden closed in on the Democratic Party’s nomination, with only Bernie Sanders still running against him, part of his pitch was that he knew how he’d pay for his proposals.
“The fact of the matter is, everything I call for I pay for,” Biden said in his final debate with Sanders on March 15, 2020.
But in practice, an $800 billion plan may be almost as politically daunting as a $32 trillion one.
“It’s still a monumental lift,” Kim Monk, who follows Congress for investment clients at Capital Alpha Partners, told me.
And that is forcing Biden to aim lower still.
Right now, in his proposed American Families Plan, Biden is asking Congress for $200 billion to expand the Affordable Care Act’s subsidies for health insurance premiums. The expansion already passed in the American Rescue Plan but expires after two years; the new proposal would make them permanent. The public option is nowhere to be found.
Meanwhile, the payment plan Biden proposed during his campaign and in his debate with Sanders — an increased tax on capital gains — will probably be used to pay for other parts of the Biden agenda, while a $450 billion savings proposal, favored by most Democrats in Congress, that would allow Medicare to directly negotiate drug prices with pharmaceutical companies was also left out of the Families Plan. Congressional Democrats were urging Biden to include the drug price idea and use the savings to pay for coverage expansions, such as lowering Medicare’s eligibility age.
It’s hard not to see one as related to the other. Biden’s plans for expanding health coverage — earlier Medicare eligibility, a public option — were modest compared to Sanders’s. But their fate, even as Biden proposes trillions in other new spending, shows that health care programs still have to pass a difficult test: They need to at least partially pay for themselves.
For decades, the norm has been that when Congress wants to pass a new expansion of health coverage, it will find the money to pay for at least some of that expansion from the health care industry, whether in the form of new taxes or spending cuts. Health care funds health care.
But that creates a huge political problem: The health care industry can block new reforms not by opposing the reforms themselves but by campaigning against the cuts or taxes used to pay for them. Doctors, hospitals, and health care companies retain a lot of influence in Congress; every congressional district has a hospital, as lobbyists happily point out.
So even as their ambitions for health care grow, as demonstrated by Biden’s embrace of the public option, Democrats find themselves caught in this trap.
Biden’s health care proposals still cost a lot of money — and that money has to come from somewhere
Nobody knows for sure why Biden dropped the Medicare negotiations proposal from the American Families Plan, even as he called for lawmakers to pass it this year on a bipartisan basis — an unlikely prospect — in his first address to Congress. The reporting has been circumspect.
But we do know the pharma industry has a massive war chest, refilled every year by member fees, and has promised to deploy it if any major drug pricing reform started moving through Congress. Drug manufacturers also enjoy their best public approval in years after delivering Covid-19 vaccines in record time.
“Why go after the very industry that basically is our lifeline out of the pandemic?” Monk said.
This is how the trap closes: When health care must pay for health care, the health care industry must take a hit in order to cover more people. That is something the industry’s immense lobbying apparatus usually wants to stop, and given its influence in the halls of Congress and in the White House, that can make anybody’s health care plan — whether it costs $800 billion or $32 trillion — a nonstarter.
Biden avoided this problem with the initial two-year expansion of the ACA subsidies in the American Rescue Plan by mostly not paying for it. But even in this age of deficit doves, the $200 billion to make that expansion, or any other major health care expansion, permanent would need to be paid for. That presents a massive political problem, even for Biden’s more modest (compared with Sanders’s) proposals.
“It was quite easy to get the health care industry on board for temporarily increasing ACA premium help without any budgetary offset to pay for it, as was the case in the American Rescue Plan,” said Larry Levitt, executive vice president for the Kaiser Family Foundation. Levitt framed that bill’s health care provisions as “all winners, no losers.”
“As soon as there starts being pressure to pay for health care enhancements,” he continued, “it becomes a zero-sum game with losers as well as winners.”
If Democrats are serious about expanding public programs, they can’t count on the health care industry as allies
The health care industry can be persuaded that the trade-off is worth it. It’s happened before.
The platonic ideal of this framework is the ACA itself, the 2010 law Biden says he wants to build on with this subsidy expansion and (eventually) a public option. About 80 percent of the ACA was covered by spending cuts (for Medicare payments to providers, for example) or new taxes (various new levies on pharma and health insurers and medical devices) targeted to the industry.
The industry bought into the law and didn’t oppose its passage. It took the deal that is at the heart of this long-held tradition: The coverage expansion would mean more paying customers. It might take a trim in payment rates or on new taxes, but it’d make up for it with more volume. And, as it turned out, more than 20 million people were covered by the law.
But the industry may not be willing to make the same kind of bargain with Biden because his proposals don’t have the same appeal. The Medicare expansion is opposed by many hospitals and doctors — Medicare pays lower rates than private health insurers; more people on Medicare means less reimbursement for them.
The industry opposes the public option, which would presumably set rates lower than private insurance so it could charge cheaper premiums, for the same reason. Considering more than half of America’s uninsured already qualify for Medicaid or the ACA, the public option is less a device for expanding coverage than a way to drive down health care costs. And that is exactly why the health care industry would fight fiercely to stop it.
The Biden administration still can, and has, taken steps to expand health coverage. An additional 4 million people qualify for ACA subsidies since Biden signed the American Rescue Plan into law. Nearly 1 million people have signed up for insurance during a special open enrollment period Biden started shortly after taking office.
The administration is also bound by the rules and politics of the Senate. A public option may not be permissible under the “budget reconciliation” rules that allowed Democrats to move some legislation without any Republican votes. Some moderate Senate Democrats may be less enthused about the public option or even a Medicare expansion than some of their peers who are more progressive.
But America still has the highest uninsured rate in the developed world and the highest health care costs. So long as the health care industry wields a veto pen over any plan that would cut into its profits to address those problems, little is going to change.
Democrats will have to find a way to escape this trap.
From The Hindu: Sports
IPL suspension shows game’s vulnerability, World T20 could be postponed or shifted: Ian Chappell - Chappell recalled a few incidents that led to the disruption of the game in the past.
MI’s foreign recruits reached their destinations safely, says franchise - A total of 14 foreign players and support of MI have left India after the cash-rich tournament had come to a halt on May 4.
Bumrah can take 400 Test scalps, he’s “so different” than any bowler I’ve seen, says Curtly Ambrose - Bumrah, who made his Test debut in 2018, has snapped 83 wickets in just 19 Tests at an impressive average of 22.10
Two ATK Mohun Bagan players test COVID-19 positive ahead of AFC Cup match - Under the AFC protocols, competing players will have to have COVID-19 negative reports two days before departure from their home base.
Maldives’ sports minister alleges breach of COVID-19 protocols by Bengaluru FC - Maldives is hosting the play-off match and all the Group D matches as the AFC wanted single venues in view of the COVID-19 pandemic.
From The Hindu: National News
10% quota in Devaswom boards to stay - Confusion prevails over legal validity after apex court verdict in Maratha case
Role of private doctors crucial in fight against COVID-19: Maharashtra CM - Uddhav Thackeray said family doctors should focus on patients in home isolation so that if required, they can be shifted to hospitals timely.
Defence Ministry orders Armed Forces Medical Services to recruit 400 retired medical officers of AMC, SSC - India has been badly hit by the second wave of coronavirus infections and hospitals in several States are reeling under shortage of health workers, vaccines, oxygen, drugs and beds
VSSC gets ready to help with COVID care - The centre develops three mechanical ventilator models and a portable medical oxygen concentrator
Local bodies collaborates to build oxygen cylinder plant for Kasaragod - Kasaragod is one of the two districts in Kerala which do not have an oxygen plant
From BBC: Europe
Covid: Macron calls on US to drop vaccine export bans - The French president spoke out after the US backed a proposal to waive patents on Covid-19 vaccines.
Sophie Scholl: Student who resisted Hitler and inspires Germany - Germany marks the 100th anniversary of the birth of Sophie Scholl, who was killed defying the Nazis.
Neanderthal remains unearthed in Italian cave - Researchers believe the nine unlucky individuals may have been hunted and killed by hyenas.
German call to ban ‘Jewish star’ at Covid demos - The anti-Semitism commissioner urges officials to stop protesters “relativising” the Holocaust.
European Super League: Real Madrid, Barcelona & Juventus defend plans in face of Uefa ‘threat’ - Real Madrid, Barcelona and Juventus defend their plans for a European Super League in the face of “threats” from Uefa.
From Ars Technica
Why Amy Klobuchar just wrote 600 pages on antitrust - “Monopolies tend to have a lot of control, not just over consumers, but also over politics.” - link
Review: The role-playing game’s afoot in charming black comedy Murder Bury Win - It’s not an instant classic like Clue, but it’s fun, very solid indie fare. - link
Rivian’s electric truck features include air compressor and AC outlets - It’s got storage compartments galore, plus an extending truck bed. - link
Apple brass discussed disclosing 128-million iPhone hack, then decided not to - Emails entered into Epic Games lawsuit show execs contradicting Apple talking points. - link
It began as an AI-fueled dungeon game. Then it got much darker - AI algorithm created disturbing stories, including sex scenes involving children. - link
From Jokes Subreddit
I always take 40 or 50 lighters with me in a bag… -
Not because I’ll need them, but you can always use a lighter bag when hiking.
And I make sure it’s not an odd number so that way it’s even lighter.
Dr. Mike had sex with one of his patients and felt guilty all day long. No matter how much he tried to forget about it, he just couldn’t. -
The guilt and sense of betrayal were overwhelming. But every once in a while he’d hear an internal, reassuring voice in his head that said: “Mike, don’t worry about it. You aren’t the first medical practitioner to sleep with one of your patients, and you won’t be the last. And you’re single. Just let it go, Mike.”
But invariably another voice in his head would bring him back to reality, whispering:
What’s wrong with you Mike, you’re a veterinarian.
