Why Corbett might embrace Obamacare: Governor cagey on allegations of illegally kicking thousands off Medicaid
Last month, the U.S. Supreme Court ruled to support the Affordable Care Act's controversial individual mandate to buy health insurance. But the justices also delivered conservative governors more wiggle room to opt out of the law's enormous expansion of healthcare for the poor, declaring it unconstitutional for the federal government to require states to participate in an expanded version of Medicaid as a condition of participating in the entire program.
Some conservative Republicans are vowing to reject that part of the law: Florida Gov. Rick Scott and Texas Gov. Rick Perry quickly announced that their states would not participate. Yet there's a possibility that Republican Gov. Tom Corbett may quietly acquiesce. He's still deciding whether to accept Obamacare's Medicaid expansion, which is set to provide health insurance to a huge chunk of currently ineligible poor people ― estimated at up to 682,880 Pennsylvanians―living under 133 percent of the federal poverty line.
“There is no decision on that, and we are still reviewing the law,” says Department of Public Welfare spokesperson Donna Morgan.
Conservative governors say their states cannot afford the increased cost to the state-federal program, which in Pennsylvania could be a hike of between 1.4 percent and 2.7 percent in state Medicaid spending. The federal government, however, will pick up most of the tab, starting at 100 percent in the first three years of implementation, through 2017, and gradually declining to 90 percent by 2020.
The state House is currently debating state Rep. Matt Baker's highly controversial abortion bill, which women's health advocates have claimed is an anti-abortion "Trojan horse," which might close down every abortion clinic in state because of allegedly unnecessary regulations. It was written in the wake of Kermit Gosnell.
For a good show, watch the state House debate on the bill here.
They are currently discussing amendments to the bill. Sources tell City Paper that one such amendment would change the language in order to make Baker's bill more like one written by Sen. Pat Vance, which women's health advocates have called "way better."
UPDATE: I'll be live-tweeting the debate. Follow along @hollyotterbein!
A judge this morning sentenced Catherine and Herbert Schaible to 10 years probation in the accidental death of their two year old son.
The couple, who are lifelong members of the First Century Gospel Church in northeast Philadelphia, have seven other children. The Schaibles were convicted of involuntary manslaughter andÂ endangering the welfare of a child in December after prosecutors say they failed to take their infant son to a doctor when he showed signs of the flu. Instead they prayed and their son, Kent, soon died of pneumonia.
Several undated sermons on the First Century Gospel Church's website speak directly about the church's opposition to doctors and medicine.
"Our life must be committed to God without compromise, and our will is to be His will in everything," according to one sermon. "That commitment to God means we are to trust God alone for physical healing without the use of medicine, drugs, prescriptions, human remedies, or a doctor."
Senior Common Pleas JudgeÂ Carolyn EngelÂ Temin said "it's obvious a prison sentence is not called for" and that "everything I've heard about you is complimentary with the exception of this incident." She stressed, however, that "religious freedom is trumped by the safety and well-being of the child."
The terms of their probation require the couple to schedule regular in-person meetings with probation officers for two years, followed by three years of regular phone meetings and then five years of non-reporting probation. Part of this sentence requires that the Schaibles schedule regular medical appointments for all their children and release their children's medical records to probation officers.
"I need to give a sentence that's long enough to ensure the kids have adequate healthcare until they turn 18," judge EngelÂ Temin said.
Plenty, it seems. As Holly reported yesterday, Tom Corbett, Republican candidate for governor, has announced that he will join fellow crazypants wingnut AGs from Virginia, Florida and other bastions of insanity in suing to block the health-care reform act President Obama just signed, on account of it being unconstitutional. He's even having a press conference today, at 2:15, to decry socialism or mandates or whatever.
Hopefully, some intrepid Harrisburg reporter will ask him how much taxpayer money he's willing to blow on this epic fail. After all, this one's been pretty well argued, and per usual, the teabaggers have no idea what the fuck they're talking about.
Quoth Jeffrey Toobin:
2. Constitutionality. Various states have threatened to go to court to assert that Congress acted outside its authority in passing the health-care reform bill. Even with a conservative Supreme Court, these challenges seem bound to fail. For decades, the Court has upheld the extensive federal role in health care through such programs as Medicare and Medicaid. This new law is a change in degree, not in kind, and courts will likely stay out of the way.
And Mark A. Hall from Georgetown:
The Constitution permits Congress to legislate a health insurance mandate. Congress can use its Commerce Clause powers or its taxing and spending powers to create such a mandate. Congress can impose a tax on those that do not purchase insurance, or provide tax benefits to those that do purchase insurance. If Congress would like the states to implement an insurance mandate, it can avoid conflicts with the anti-commandeering principle by either preempting state insurance laws or by conditioning federal funds on state compliance. A federal employer mandate for state and local government workers may be subject to a challenge; however, such a challenge is unlikely to be successful. Individual rights challenges under the First Amendments Free Exercise Clause or RFRA are unlikely to succeed, although a federal insurance mandate should include a statement that RFRA does not apply or provide for a religious exemption. Fifth Amendment Due Process and Takings Clause challenges are also unlikely to be successful. The legal analysis presented is likely to endure, as the Supreme Courts current position and approach to interpreting relevant constitutional issues appear to be stable.
In other words, ain't gonna happen. And Corbett probably knows that. But hell, he'll probably raise a boatload of money of this thing, so why should he care about chasing this Republican white whale on your dime.
Attention, fellow denizens of Philadelphia: Socialism is scheduled to begin at 11:15 a.m. eastern standard time. Watch history unfold here, in real time, comrade! [audio:http://stream.citypaper.net/music/soviet-anthem_en.mp3]
Not that we expect that this will go anywhere, but still, check out this buzzkill of an e-mail we just got from Attorney General Tom Corbett (who, keep in mind, may just become Pennsylvania's next governor):
Tom Corbett today said that he will file a lawsuit to protect the citizens of Pennsylvania whose rights will be violated when the health care reform legislation, passed last night by the U.S. House of Representatives, is signed into law by President Obama. Corbett said that he believes the courts will find the health care reform legislation unconstitutional. Corbett said he is discussing legal strategy with attorneys general from Alabama, Florida, South Carolina, Michigan, Texas, Utah, Washington, North Dakota and South Dakota and Virginia.
Take a look at the casually dressed Prez trying to sell the divided public (although not too divided of a crowd here, specifically) on health care reform this morning at Arcadia University.
Or, take a look at editor-in-chief Brian Howard's tweets on the event. (A few highlights: "Obama: GOP sez bring down costs. Obama sez we're bringing down costs duh" and "Ref to 'gov't run health care system' gets big applause.")
Another interesting tidbit: Howard said that neither President Obama nor Gov. Ed Rendell were booed upon entrance to the event, but Mayor Michael Nutter was. I guess a soda tax is more unpopular than pillaging our state's forests?
Keep this in mind if/when you're watching the healthcare summit, and/or the coming budget debates. Conservatives give lip service to cutting costs, lowering taxes, etc.When it comes time to actually choose what to cut, however, the support evaporates (except for "foreign aid," which is an insanely tiny proportion of the federal budget, and "welfare programs").
At last weeks Conservative Political Action Conference, Minnesota Gov. Tim Pawlenty called on the attendees to imitate the wife of Tiger Woods: "We should take a page out of her playbook and take a nine iron and smash the window out of big government in this country."
But theres a problem for Pawlenty and the activists who cheered him: Rank-and-file conservatives actually like big government.
In 2008, the American National Election Study asked a national sample whether federal spending on 12 different programs should be increased, decreased or kept about the same.
As the graph above illustrates, the respondents who identified themselves as "conservative" or "extremely conservative" had little appetite for specific spending cuts.
Very few conservatives said they favored reducing (or cutting out altogether) spending on any program. The least popular program proved to be childcare -- with a grand total of 20 percent of conservatives saying theyd slash it. The most popular is highways; only 6 percent want to cut spending there. Even bugaboos like welfare and foreign aid fare well, attracting the ire of only 15 percent of conservatives. Amazingly, the survey found that, on average, 54 percent of them actually wanted to increase spending.
Joe Sestak on Mass. election, health care, the filibuster, American democracy and the Democratic Party's loathesome leadership: "I won't sacrifice good policy at the altar of bipartisanship."
The thing about Rep. Joe Sestak is, he talks fast. Particularly when he gets worked up. And he was, in fact, worked up. And when he calls your office, without warning, and you have no chance to rig up some sort of recording contraption, you have to scribble down as much as you can, then go back and try to interpret your own chickenscratch/shorthand later. But anyway. I spent about 20 minutes this morning talking with the congressman/senate candidate "call me Joe" about, well, a bunch of things, but all centered around the idea of the Democrats' relative ineffectiveness to get things done, and what he thinks should be done, both short and long term, about the Senate's structural flaws namely, the idea that, despite an 18-seat majority in the upper house, and 78-seat majority in the lower house, and control of the White House, Democrats still have to bend over backwards to accommodate the likes of Joe Lieberman, Ben Nelson, and now, Cosmo centerfold Scott Brown to get a universal health care package through is, for lack of a better word, preposterous.
This is probably the best visual representation of the ridiculousness of the current system I've seen:
But before we get to the interview, take a minute and go read this. I'll wait.
For those of you who don't have an hour or so to reading one of those 8,000-word essays The Atlantic is so famous for, here's the part Sestak wanted me to see when he cited the piece, repeatedly, during our conversation (I'm quoting in more length that I usually would for someone else's work, so please clink the link above and give James Fallows the page view; good journalism and writing should be rewarded):
Every system strives toward durability, but as with human aging, longevity has a cost. The late economist Mancur Olson laid out the consequences of institutional aging in his 1982 book, The Rise and Decline of Nations. Year by year, he said, special-interest groups inevitably take bite after tiny bite out of the total national wealth. They do so through tax breaks, special appropriations, what we now call legislative "earmarks,â and other favors that are all easier to initiate than to cut off. No single nibble is that dramatic or burdensome, but over the decades they threaten to convert any stable democracy into a big, inefficient, favor-ridden state. In 1994, Jonathan Rauch updated Olson's analysis and called this enfeebling pattern "demosclerosis,â in a book of that name. He defined the problem as "government's progressive loss of the ability to adapt,â a process "like hardening of the arteries, which builds up stealthily over many years.â
We are now 200-plus years past Jefferson's wish for permanent revolution and nearly 30 past Olson's warning, with that much more buildup of systemic plaque and of structural distortions, too. When the U.S. Senate was created, the most populous state, Virginia, had 10 times as many people as the least populous, Delaware. Giving them the same two votes in the Senate was part of the intricate compromise over regional, economic, and slave-state/free-state interests that went into the Constitution. Now the most populous state, California, has 69 times as many people as the least populous, Wyoming, yet they have the same two votes in the Senate. A similarly inflexible business organization would still have a major Whale Oil Division; a military unit would be mainly fusiliers and cavalry. No one would propose such a system in a constitution written today, but without a revolution, it's unchangeable. Similarly, since it takes 60 votes in the Senate to break a filibuster on controversial legislation, 41 votes is in effect a blocking minority. States that together hold about 12 percent of the U.S. population can provide that many Senate votes. This converts the Senate from the "saucerâ George Washington called it, in which scalding ideas from the more temperamental House might "cool,â into a deep freeze and a dead weight.
The Senate's then-famous "Gang of Six,â which controlled crucial aspects of last year's proposed health-care legislation, came from states that together held about 3 percent of the total U.S. population; 97 percent of the public lives in states not included in that group. (Just to round this out, more than half of all Americans live in the 10 most populous states which together account for 20 of the Senate's 100 votes.) "The Senate is full of ârotten boroughs,'â said James Galbraith, of the University of Texas, referring to the underpopulated constituencies in Parliament before the British reforms of 1832. "We'd be better off with a House of Lords.â
The decades-long bipartisan conspiracy to gerrymander both state and federal electoral districts doesn't help. More and more legislative seats are "safeâ for one party or the other; fewer and fewer politicians have any reason to appeal to the center or to the other side. In a National Affairs article, "Who Killed California?,â Troy Senik pointed out that 153 state or federal positions in California were at stake in the 2004 election. Not a single one changed party. This was an early and extreme illustration of a national trend.
On rereading Mancur Olson's book now, I was struck by its relative innocence. Thinking as an economist, Olson regarded the worst outcome as an America that was poorer than it could otherwise be. But since the time of his book, the gospel of "adapt or dieâ has spread from West Point to the corporate world (by chance, Olson's Rise and Decline was published within weeks of the hugely influential business book In Search of Excellence ), with the idea that rigid institutions inevitably fail. "I don't think that America's political system is equal to the tasks before us,â Dick Lamm, a former three-term governor of Colorado, told me in Denver. "It is interesting that in 1900 there were very few democracies and now there are a lot, but they're nearly all parliamentary democracies. I'm not sure we picked the right form. Ours is great for distributing benefits but has become weak at facing problems. I know the power of American rejuvenation, but if I had to bet, it would be 60â40 that we're in a cycle of decline.â
What I have been calling "going to hellâ really means a failure to adapt: increasing difficulty in focusing on issues beyond the immediate news cycle, and an increasing gap between the real challenges and opportunities of the time and our attention, resources, and best efforts. Here are symptoms people have mentioned to me:
â¢ In their book on effective government, William Eggers and John O'Leary quote a former deputy mayor of Los Angeles, Michael Keeley, on why the city is out of control. "Think of city government as a big bus,â he told them. "The bus is divided into different sections with different constituencies: labor, the city council, the mayor, interest groups, and contractors. Every seat is equipped with a brake, so lots of people can stop the bus anytime. The problem is that this makes the bus undrivable.â
For that same book, Eggers and O'Leary surveyed members of the National Academy of Public Administration, a counterpart of the National Academy of Sciences for public managers. Sixty-eight percent of those who responded said that the government was "less likely to successfully execute projects than at any time in the past.â
Essentially, the argument here is that the institutions of American polity have grown structurally deficient, as politicians cater to special interests and ignore the public good, a la Olson. You could add to it the increasing polarization and cleavages of the two major parties (one of the best, and newest explanations I've read is here), and the dysfunction and myriad of problems that often come alongside populist movements (this thought-provoking book, by former Chestnut Hill College historian John Lukacs, a self-described reactionary who although I fundamentally disagree with his take on rights and liberties lays out a strong case that populist movements are dangerous and short-sighted; it's certainly a view the Founding Fathers shared) and you've got a recipe for a slow, but uncontrollable, burn. Or maybe not. As the Fallows piece notes, predictions of doom and gloom are part and parcel of the American experience, and hey, we're still here.
But, on the other hand, there's the reality that health care reform, so desperately needed and a central plank of Obama's 2008 campaign you know, the one in which he won some 70 million votes is about to being watered down because the Democrats only control 59 percent of the Senate, and because of an anachronistic rule that has been used and abused by the Republican minority in an unprecedented manner, they know have to beg for scraps from the likes of Mitch McConnell.
Last night, I put my thoughts into an e-mail to Sestak's press office, asking for his take on health care strategy and cloture rules. This morning, the congressman gave me an (unexpected) call. Below, I'm going to reconstruct this conversation to the best of my ability. Sestak's not quite signing on to junking the old Senate rules, but, he says, he's thinking about it, in part because of the Fallows piece, and in part because of the inordinate power the current system allots to egomaniacal dickbags (my words, not his) like Lieberman.
"I've said for a long time, we don't need to reform America. We need to reform the Senate," he says.
The Massachusetts election, he continues, wasn't a rebuke to Democrats or an embrace of Republicans, but rather, "the same evidence that I saw in my 67-county tour [of Pennsylvania] in July. People don't trust Washington." Particularly, he suggests, it's not so-much about policies themselves so much as the nature of the place, an environment where Ben Nelson can secure goodies for his home state in exchange for his vote, or of course he brings this up Arlen Specter's past votes as a Republicans are ignored the second he switches jerseys.
There is, as Sestak sees it, no inherent faith in Congress; consequently, as legislation as necessarily complicated as health care reform becomes bogged down in a morass of giveaways and special favors, this distrust is exacerbated into a sea of populist (and perhaps deserved) anger at the powers that be. And then you get Massachusetts. (It's worth noting, as Sestak does, that the Mass. election was hardly a mandate for Democrats to go slower on health care. In fact, a large majority of Obama voters who pulled the lever for Scott Brown, polling shows, favors the public option.)
In Sestak's words, the problem is, "Washington didn't change." Asked about what he thinks the Dems should do to push HCR now, Sestak offers something of a non-answer: "I would have helped shape the bill at the beginning."
OK, fine. But how should they proceed now? I was talking to Sestak a few minutes after he walked out of the morning Democratic caucus meeting. The consensus? "We have to continue, for the good of working people, to get a health care bill through." That said, he continues in almost the same breath in an echo Obama's comments yesterday, "I don't think we should just jam this thing through."
And what does that mean, exactly? "We should put through a package [that can] get through, we should do that," he says.
To Sestak, that means putting forward the bill's most popular items, and basically daring the Republicans to oppose them: eliminating the insurance companies' anti-trust exemption; prohibiting denial of care based on pre-existing conditions; banning the recision of coverage when insurance companies find out you're sick and don't want to pay; mandating that insurance companies spent 80 percent of premiums on health care; giving small businesses a tax credit. "Principled compromise," he calls it.
But you can't compromise with a brick wall, I reply. They decided long ago to make HCR Obama's "waterloo," thank you Jim DeMint, teabagger emeritus. At this point, I'm not sure what he could propose, short of another round of tax cuts for millionaires, that would garner a single Republican vote. (An anonymous Democratic Senate aide agrees with me: "Imagine we introduce a bill that says health insurance companies can't discriminate based on pre-existing conditions. All that would happen is the insurance industry would pay some firm to do a study that concludes that would cause insurance companies to go out of business, and some GOP senator will go to the floor and say 'See? This is all about forcing single payer.' Throw in some douchebag on TV with a tri-cornered hat and a chalkboard, and you have a unified GOP caucus against any bill that remotely attempts to deal with the health care issue.")
"I would lose my job in a heartbeat to get a health care bill through, in a heartbeat. â¦ If there were just some leaders. A Ted Kennedy could work with a Bush on immigration reform â¦ ."
That means the White House, as well as Congress, Sestak says. And in any event, wishing for bygone eras of cooperation and sanity and strong leadership doesn't make it real, and to be frank, it doesn't really get at my underlying question: How do you pass anything as complex as HCR in a body as dysfunctional as the United States Senate, where you basically need 60 votes to take a bathroom break?
One option, of course, is for the House to pass the Senate's version word for word. If the leadership calls for that, Sestak says, "I will look at it and make a determination. â¦ There are some good things in that bill." This doesn't seem too likely. The liberal blogosphere is, as I write, buzzing with news that Speaker Nancy Pelosi will push portions of HCR through via the budget reconciliation process, which means they can't be filibustered. Republicans would raise holy hell, and David Broder would bitch about bipartisanship, but HCR would pass, easily and strongly and it's not like W. never used reconciliation to pass trillion-dollar tax cuts that exploded the deficit so tough cookies. And, as Sestak points out, this is too important to fail: "I don't think you come to a full stop," he says, though he doesn't think Democrats need to rush, either. In the Philadelphia area, he says, 66 percent of the uninsured are working. "Premiums have doubled. I believe we have to get something through. I will support what we can get through."
In other words, if the Dems go for the Senate bill, he's probably in. If they go for reconciliation, he's in. If they go for his preferred method, the more incremental steps outlined above that have a slight hope for bipartisan votes, he's in. But then he adds, "I won't sacrifice good policy at the altar of bipartisanship. But I do support bipartisanship."
So which is it, I ask. The Dems have, since the Tuesday vote, basically divided themselves into two camps: The damn-the-torpedoes, full-speed-ahead camp, and the let's-slow-down-and-try-for-Republican-votes camp. To which did he belong?
His answer, as fine a point as I can put on it, is whatever works.
But this brings me to the larger point: Americans are disenchanted with Washington because there's the perception that nothing is being done, and what's being done isn't good, and that special interests have all of us over the barrel, and that they're all corrupt and self-absorbed and out of touch. All valid observations, but the big one is this: Americans wanted to change the way DC works, and instead, they get Ben Nelson's favors and Bart Stupak's antiabortion zealotry and Lieberman's seemingly endless ability to string Dems along and Max Baucus' lobbyist girlfriend and the excise tax and no public option and compromise to the point of near-meaninglessness. How would a Senator Sestak go about fixing that?
Much of the American system, he ruminates, is set up to protect minorities. (This is sort of true; although, according to a fascinating history I'm now reading, it was actually set up to protect southern slave plantations at the expense of everyone else.) "I don't want to change it right now," he says. "I want to get over there, and see about it. We need some leadership."
Here he points me to The Atlantic piece above. "Honest to gosh, I thought of you," he says."Maybe, I'm thinking seriously you know the Democrats will [one day] be in the minority I am taken with [Fallow's notion that] the institution of the Senate is the only place that hasn't changed [in 200 years]. I don't think you can just go from 60 to 51. There has to be some balance. Maybe some changes are needed, right? We could be sacrificing good policy for an arcane rule."
The flip side, he says, is that in the House, an abundance of power in vested in the party leaders the Speaker, Majority and Minority leaders, specifically. "I don't want the Senate to be that way. It's less democratic. What's the right mix? That's what I'm going to try to work out."
And before I could ask him if the constant refrain about needing leadership meant that he would support someone other than Harry Reid as Senate Majority Leader assuming Reid survives his re-election bid, which is by no means a given he excused himself for a meeting. Next time.
Oh, and just so you don't think we're biased, I asked one of our correspondents who's in with the Specter campaign to put these same questions to his staff. We'll let you know what he comes back with.
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