Bizarro GOP Plan: Cut Health Spending to Pay for an Unpopular War

Our most recent book is The Comeback: The 2024 Elections and American Politics. The second Trump administration has been full of ominous developments -- now including a war in the Middle East.

In early February, a YouGov poll found majorities of Americans supported increasing government spending on veterans (74%), Social Security (69%), Medicare (67%), aid to the poor (64%), Medicaid (59%), and the environment (52%).   Only 34% wanted to increase defense spending -- that that was before the Iran war, which is unpopular.  Last week, Pew found 61% disapproved of Trump's handling of the war, and 59% said that US made the wrong decision to use military force in Iran.

In that light, the House GOP's spending plans sound politically insane.  Peter Sullivan at Axios:

Republicans are considering reductions in federal health spending to help pay for a budget bill containing as much as $200 billion to fund the Iran war and immigration enforcement.

Why it matters: New efforts to rein in health programs are sure to be controversial and open the GOP up to election-year attacks that they're cutting health care to pay for an unpopular war.

Driving the news: Top House Republicans are looking at health care offsets addressing fraud in federal programs, as they did during last year's debate over the budget law that made deep cuts to federal Medicaid spending and imposed first-time work requirements.

Moses Supposes Erroneously

Our new book is The Comeback: The 2024 Elections and American Politics. It includes a chapter on congressional and state elections. Trump was a liability for Republicans in the 2025 off-year elections. He could be a bigger liability in the 2026 midterm -- and not just because of his low approval ratings.

Congressional Republicans are in a tough spot. On the one hand, anything bearing Obama's name is toxic to GOP activists. On the other hand, the general public now favors the Affordable Care Act by nearly a two-to-one margin. And about half of those who receive ACA premium subsidies are either self-employed or work for a small business — exactly the kind of voters that marginal Republicans need in a general election.

Emily Brooks at The Hill:

Speaker Mike Johnson (R-La.) on Wednesday insisted that he has not lost control of the lower chamber of Congress in the wake of four Republican moderates mounting a major rebellion by joining with Democrats to force a vote on extending expiring ObamaCare subsidies.

“I have not lost control of the House, no,” Johnson said when asked about his grip on the chamber following the GOP rebellion.

“We have the smallest majority in U.S. history. These are not normal times,” Johnson said. “There are processes and procedures in the house that are less frequently used when there are larger majorities.”

His comments came shortly after four Republican moderates in swing districts — Reps. Brian Fitzpatrick (Pa.), Mike Lawler (N.Y.), Rob Bresnahan (Pa.) and Ryan Mackenzie (Pa.) — signed a petition led by House Minority Leader Hakeem Jeffries (D-N.Y.) to extend the expiring enhanced ObamaCare subsidies for three years. That brought the petition to 218 signatures, enough to force a vote on the matter.

That, in turn, came after negotiations between moderates and GOP leaders on a compromise amendment vote to extend the subsidies as part of a separate House GOP health care bill fell apart over the weekend and on Tuesday.

ACA Subsidies

Our new book is The Comeback: The 2024 Elections and American Politics. It includes a chapter on congressional and state elections.  Trump was a liability for Republicans in the 2025 off-year elections.  He could be a bigger liability in the 2026 midterm -- and not just because of his low approval ratings.

Congressional Republicans are in a tough spot.  On the one hand, anything bearing Obama's name is toxic to GOP activists. On the other hand, the general public now favors the Affordable Care Act by nearly a two-to-one margin. And about half of those who receive ACA premium subsidies are either self-employed or work for a small business — exactly the kind of voters that marginal Republicans need in a general election. 

Robert Jimison at NYT:

Representative Jen Kiggans, Republican of Virginia, once called for eliminating the Affordable Care Act.

Representative Mike Lawler, Republican of New York, has repeatedly called it “a disaster.”

But the two are part of a small group of G.O.P. members of Congress — most of them facing tough re-election races next year in competitive districts — who have broken with their party to push for a temporary extension of a crucial piece of the law: subsidies, currently slated to expire at the end of the year, to help Americans afford their premiums.

Their eagerness to vote for an extension, which was Democrats’ main demand in the weekslong government shutdown fight, underscores how entrenched the health care law has become, even among Republicans who once fought to kill it. And it helps explain why President Trump, who has long railed against the law, commonly called Obamacare, is said to be weighing such a move as he and his party toil to address affordability issues that could be a major liability for them going into the midterm elections.

Letting the subsidies lapse would put a heavy financial burden on millions of voters just as the G.O.P. is grasping to keep control of Congress.

People Support ACA Subsidies

Our new book is The Comeback: The 2024 Elections and American Politics. It includes a chapter on congressional and state elections.  In shutdown negotiations, Republicans refused to extend ACA subsidies, though Thune promised a Senate vote.  The issue is very likely to help Democrats.

KFF:

[P]ublic support remains high for extending the enhanced ACA tax credits set to expire at the end of the year, with three quarters (74%) of the public in favor of extending them, a new KFF Health Tracking Poll finds.

The expiring tax credits are a central issue in the ongoing Congressional budget standoff, as Democrats want the tax credits extended as part of a budget deal while Republicans want to reopen the government before negotiating over an extension. Without the enhanced tax credits, ACA Marketplace enrollees who benefit from them would on average have to pay more than twice as much out of pocket in premiums next year.

...

Other findings include:

• Among those who want the tax credits extended, most say that either Congressional Republicans (38%) or President Trump (37%) would deserve most of the blame if they weren’t extended. Fewer say Congressional Democrats (23%) would deserve most of the blame.
• About half (47%) of the public correctly says that undocumented immigrants are not eligible to buy ACA marketplace coverage. About one in seven (14%) incorrectly say that they are eligible to buy marketplace coverage, while the rest are not certain. Similar shares of Republicans and Democrats know the correct answer.

Shutdown, Obamacare, and the Debt

Our new book is The Comeback: The 2024 Elections and American Politics. The first year of the second Trump administration  has been full of ominous developments.  Americans are noticing.

Chris Stirwalt at The Hill:

Two big data points in the headlines this week: 1) The average cost of a family health insurance plan will be $27,000 for coverage next year and 2) The federal debt grew faster than any time other than the pandemic and surpassed $38 trillion Wednesday.

...

Democrats have already won the shutdown. Whether it ends today or on Nov. 1, when the open enrollment period for health insurance begins in most places, the shutdown will have dramatically increased the pressure on Republicans over rising health costs. The GOP has already agreed to extend enhanced ObamaCare subsidies, but is insisting the vote will come after the government is reopened, not as a condition for reopening it.

...

Which is all a long way of saying that in that way, Democrats have already won the shutdown. Whether it ends today or on Nov. 1, when the open enrollment period for health insurance begins in most places, the shutdown will have dramatically increased the pressure on Republicans over rising health costs. The GOP has already agreed to extend enhanced ObamaCare subsidies, but is insisting the vote will come after the government is reopened, not as a condition for reopening it.

Either way, when they do, Republicans will be acceding to Democrats’ demands to have the government provide more subsidies to offset the consequences of a cost spiral that itself is partly caused by … subsidies.

So Washington’s response to those two big new numbers this week will most assuredly make them both worse.

Trump Doing Unpopular Things

Our new book is The Comeback: The 2024 Elections and American Politics. The first year of the second Trump administration  has been full of ominous developments.  Americans are noticing.

PRRI:

A new national survey released today by Public Religion Research Institute (PRRI) in partnership with the Brookings Institution reveals Americans’ responses to the unprecedented actions taken so far by President Donald Trump during his second presidential term. The survey — the 16th annual American Values Survey — also examines Americans’ concerns about the economy and how democracy is working, what it means to be “truly American,” and opposition to building internment camps for undocumented immigrants and allowing ICE agents to mask their identity.

Majorities of Americans say that the Trump administration cuts in federal funding for health care (60%) and universities and research institutions (55%), the implementation of new tariffs (54%), and the increase in funding for Immigration and Customs Enforcement (ICE) (52%) have gone too far. Across all areas, independents hold views more aligned with Democrats. For example, most Democrats (90%) and independents (67%) say that cuts in federal funding for programs such as Medicaid, Medicare, and the Affordable Care Act have gone too far, compared with only 25% of Republicans

Sarah Fortinsky at The Hill:

A majority of Americans said in a new poll they disapprove of President Trump’s plans to demolish part of the East Wing in the White House to make room for his $250 million ballroom.

In the YouGov America poll, released on Wednesday, 53 percent of Americans said they strongly or somewhat disapprove “of the decision to demolish part of the East Wing of the White House as part of the renovations,” while 24 percent approved and 24 percent said they are unsure.

Jason Lange at Reuters:

More than half of Americans, including about three in 10 Republicans, believe President Donald Trump is using federal law enforcement to go after his enemies, according to a new Reuters/Ipsos poll that also found growing concern about U.S. political divisions nine months into his second term in office.

Some 55% of poll respondents in the six-day poll, which closed on Monday, agreed with a statement that the Republican president is using law enforcement to target his enemies, while 26% disagreed and the rest were unsure or did not respond. Some 85% of the poll respondents who identified themselves as Democrats agreed, as did 29% of the Republican poll takers.

 

ACA subsidies: The Ship Has Sailed, and Is Sinking

Our new book is The Comeback: The 2024 Elections and American Politics. It includes a chapter on congressional and state elections. The looming expiration of ACA subsidies could affect the 2026 midterm.

 Robert King and Kelly Hooper at Politico:

State insurance officials are warning that the longer Congress waits to extend enhanced Affordable Care Act subsidies, which help low- and middle-income people afford premiums, the more difficult it will be to update rates before consumers start shopping for 2026 coverage on Nov. 1.

As a result, they said, some enrollees — particularly young and healthy people — could be frightened off by the higher rates and drop coverage, even if the rates can be adjusted later. This would further undermine Obamacare by worsening the risk pool, driving up ACA costs even more.


The dire warnings come as no deal on the subsidies is in sight, stretching the government shutdown into a third week.

“The ship has sailed,” said Ingrid Ulrey, CEO of the Washington State Health Benefit Exchange. “Congress missed the opportunity to make this decision early enough for us to reset our markets for open enrollment, and to make it clean and easy for people to come in and see premiums that include the savings from the enhanced level of premium tax credits.”

Consumers are likely to see, on average, double-digit premium increases in 2026 plan offerings, according to an analysis from health policy research firm KFF. The hikes reflect rates insurers have filed under the assumption that the subsidies will expire at the end of the year and other factors such as increasing health costs.

 Benjamin Guggenheim, Jordain Carney and Meredith Lee Hill at Politico:

The ongoing debate over soon-to-expire Affordable Care Act insurance subsidies has reopened an old wound for Republicans: What should they do about the health care law they have railed against for more than a decade but has now taken root with their own constituents?

While some GOP hard-liners are again embracing repeal-and-replace rhetoric, the scars from the party’s failed attempt to undo the ACA in 2017 have left a broader swath of Republicans extremely wary of trying to rip out the law — even as they continue to criticize it.

...

But Democrats are already seizing on the repeal talk in some corners of the GOP, with Sen. Patty Murray of Washington comparing it to the cataclysmic sinking of the Titanic.

“It is bad enough so many of them can see the iceberg coming and are saying, ‘Ah, we’ll worry about that after the ship goes down.’ But we’ve also got Republicans saying that you wish this ship had sunk earlier,” Murray, the Senate’s top Democratic appropriator, told reporters. She was referring to the GOP’s refusal to extend the Obamacare subsidies before Nov. 1, at which point notices will go out alerting enrollees to massive premium hikes.

Obamacare Politics

Our new book is The Comeback: The 2024 Elections and American Politics. It includes a chapter on congressional and state elections.

Elena Shao and Margot Sanger-Katz at NYT:

More than 23 million Americans are currently enrolled in Obamacare plans, and nearly all of them will face higher health care costs next year if extra federal funding for subsidies expires, as scheduled, on Dec. 31.

Democrats in Congress are withholding their votes on a government spending bill to demand that Republicans extend these subsidies, which lower the cost of insurance for people who buy their own health care coverage in marketplaces established by the Affordable Care Act. Since Congress introduced the extra funding in 2021, enrollment has doubled.

These Americans live nearly everywhere in the country, but their numbers are especially concentrated in a handful of red states whose governments have declined to expand Medicaid programs to cover poor, childless adults.

Fifty-seven percent of people with this type of insurance live in Republican congressional districts.

Trump's War on Knowledge

Our forthcoming book is The Comeback: The 2024 Elections and American Politics. The second Trump administration is off to an ominous start.

Adam Serwer at The Atlantic:

The administration is threatening colleges and universities with the loss of federal funding if they do not submit to its demands, or even if they do. The engines of American scientific inquiry and ingenuity, such as the National Science Foundation and the National Institutes of Health, are under sustained attack. Historical institutions such as the Smithsonian and artistic ones like the Kennedy Center are being converted into homes for MAGA ideology rather than historical fact and free expression. Libraries are losing funding, government-employed scientists are being dismissed from their jobs, educators are being cowed into silence, and researchers are being warned not to broach forbidden subjects. Entire databases of public-health information collected over decades are at risk of vanishing. Any facts that contradict the gospel of Trumpism are treated as heretical.
...
By destroying knowledge, Trumpists seek to make the country more amenable to their political domination, and to prevent meaningful democratic checks on their behavior. Their victory, though, would do much more than that. It would annihilate some of the most effective systems for aggregating, accumulating, and applying human knowledge that have ever existed. Without those systems, America could find itself plunged into a new Dark Age.

Petula Dvorak at WP:

Huge volumes, bound in the timeless, red buckram linen of legacy books, are historians’ gold — and crucial to the nation’s understanding of how U.S. foreign policy is made.

There is a dispatch from Japan to President Abraham Lincoln’s administration describing the “bloody affair” of July 1861, the “daring and murderous attacks” by samurai warriors on British diplomats stationed in Edo, now known as Tokyo.

There is the top-secret report that pushed President Harry S. Truman to authorize covert actions in peacetime in 1947 to counter the “vicious psychological efforts” by the Soviet Union.

And then there’s the telegram handed over at 12:15 p.m. on April 18, 1961, from Soviet premier Nikita Khrushchev to President John F. Kennedy hours after the disastrous Bay of Pigs invasion in Cuba, warning that the action endangers peace “for the whole world. … It is a secret to no one that the armed bands invading this country were trained, equipped and armed in the United States of America.”

An advisory committee of diverse historians helps ensure that the record of America’s history — especially classified and covert actions — remains unbiased, transparent and thorough.

President Donald Trump just fired all of the members of the committee.

These advisers help oversee the exhaustive publication series called the Foreign Relations of the United States — or the FRUS, as insiders call it — and lawmakers rely on it daily. It is available to the public in major libraries and online.

The volume began in 1861, when Congress demanded a full account of Lincoln’s foreign policy during the Civil War. More than 450 volumes have been printed since

Medicaid Messaging

Our forthcoming book is The Comeback: The 2024 Elections and American Politics.

Hans Nichols at Axios:

The short-term funding bill only deals with discretionary spending and won't affect spending levels for Social Security, Medicare, and Medicaid, according to GOP leadership aides.But in the GOP's separate budget reconciliation package, lawmakers have instructed the Energy and Commerce Committee to cut some $880 billion, which will be very difficult to do if they don't touch Medicaid.

The bottom line: It was unclear if Friday's Democratic demands on Medicaid apply to the CR or the bigger tax and spending package that has yet to fully take shape. But both House leaders are signaling to their rank-and-file that they expect party loyalty on next week's vote.

Dr. N. Adam Brown at MedPage Today:

Medicaid serves lower-income adults, children, pregnant women, and people with disabilities, as well as dually-enrolled Medicare-Medicaid older adults. Despite the talking point that people on Medicaid "don't work," 92% of adults under 65 who are on Medicaid and don't receive other social security benefits work full or part-time.

While 80 million Americans are insured through Medicaid, many people don't think of themselves as "on Medicaid" -- even when they are.

Why? Because Medicaid is not branded as Medicaid in most states. If you tell a patient in South Carolina they might lose Medicaid, their eyes may glaze over. Tell them Healthy Connections is at risk? You have their attention. In Tennessee, Medicaid is TennCare and in Ohio it is the Buckeye Health Plan. In Florida, Medicaid sounds like an orange juice brand: Simply Healthcare. (Seriously, it feels like that moniker should have an exclamation point behind it.)

Adding to the confusion, many states offer Medicaid coverage contracted through private companies. These types of plans are state-funded, private insurance-branded programs (called managed care organizations) often featuring actual private insurance logos, a fact that further distances them from their federally funded origin. No wonder Tennesseans shrug when we talk about Medicaid recipients. They don't think, or even know, they are one. And if they do not know the issue applies to them, they may be less likely to oppose cuts.

In every state, we need to call Medicaid by its real name.
...

This is why healthcare advocates need to translate the impact of cuts at the individual, family, and community level. Instead of saying "Republicans want to reduce Medicaid by $880 billion" try, "If Republicans' Medicaid plans come to fruition, you could lose your Buckeye Health Plan health insurance." Or try explaining how these cuts could erode their child's access to care. Nearly half of U.S. children rely on Medicaid and 40% of all births are covered by Medicaid. Cutting the program would destabilize pediatric practices, many of which already operate on thin margins. If parents think they already have to wait too long to get a well-child visit, just wait until these cuts take effect.

Health and the Deficit

Our forthcoming book is The Comeback: The 2024 Elections and American Politics. It notes that neither candidate talked a lot about specific deficit reduction plans.


Meredith Lee Hill at Politico:

House Republicans in competitive districts warned GOP leaders Thursday: We could lose our seats if you gut Obamacare to pay for a massive border, energy and tax bill.

A group of about a dozen centrist Republicans delivered the message in a meeting with GOP Whip Tom Emmer (R-Minn.) and other senior lawmakers, according to four Republicans familiar with the meeting who were granted anonymity to speak frankly. GOP members are already concerned that they’re poised to lose their trifecta and a swath of seats in the 2026 midterms — they worry GOP efforts to pare back the Affordable Care Act could pour fuel on the fire.

Hans Nichols at Axios:

GOP tax writers are gathering support for creative ways to make the price tag $0 for extending Trump's 2017 tax cuts.

Why it matters: The procedural and budgetary gambit will free Republicans from the burden of finding the $4 trillion in spending cuts. But deficit hawks, including member of the House Freedom Caucus, haven't completely signed off on the novel approach.

Zoom in: Scott Bessent, Trump's nominee for Treasury secretary, has privately indicated to senators that he's sympathetic to their view that the cost of extending the 2017 tax cuts should be zero, according to people familiar with the matter.

By the numbers: Under a "current law baseline," extending Trump's personal and estate tax cuts will cost $4 trillion over 10 years.The tax cuts expire at the end of 2025, and the Congressional Budget Office has to score how much revenue the Treasury will miss if Congress passes it for another 10 years.

But what if Congress runs the numbers from a different starting point, and considers "current policy"?

Current policy has the tax cuts in place (at least until the end of the year). Among friends, say Republicans, what if we use current policy as the baseline? Then extending the tax cuts will cost … zero.

Roots of Rural Resentment

In Defying the Odds, we talk about the social and economic divides that enabled Trump to enter the White House. In Divided We Stand, we discuss how these divides played out in 2020.  

Democrats have paid a steep price for their withdrawal from rural America.

Lloyd Green at The Guardian:

The fact is, residents of Republican-run states are more than 20% more likely to join the military and after Iraq and the great recession, the disconnect between white rural America and coastal and cognitive elites swiftly became a chasm.

In 2016, parts of the US that felt the effects of the 9/11 wars more as reality than abstract moved to the Republican column. According to Douglas Kriner of Boston University and Francis Shen of the University of Minnesota, “Wisconsin, Pennsylvania, and Michigan could very well have been winners for [Hillary] Clinton if their war casualties were lower.”

Wisconsin is the 20th-most rural state. A quarter of Michigan is rural. Pennsylvania has been characterized as Philadelphia in the east, Pittsburgh in the west and Alabama in the middle. As Trump prepares for his rematch with Joe Biden, all three states are toss-ups.

Schaller and Waldman also downplay the impact in rural areas of Democratic messaging on hot-button issues such as crime. It’s no longer just “the economy, stupid”. Culture wars pack an outsized punch. Outside New England, white rural Democrats are a relative rarity.

Inexplicably, Schaller and Waldman do not examine the case of Jon Tester, the three-term Democratic senator from deep-red, highly rural Montana who faces a stern fight to keep his seat this year. In 2020, in the aftermath of widespread protests for racial justice after the murder of George Floyd, a Black man, by a white Minneapolis officer, but also rioting and looting, Tester criticized his party.

See state data on the cost of post-9/11 wars. 

From CDC:

Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Rates of drug overdose deaths are rising in rural areas, surpassing rates in urban areas. Although the percentage of people reporting illicit drug use is lower in rural areas, the effects of use appear to be higher. The percentage of people with drug use disorders among those reporting past-year illicit drug use in rural areas was similar to that in urban areas.

Most overdose deaths occurred in homes, where rescue efforts may fall to relatives who have limited knowledge of or access to naloxone and overdose follow-up care. Understanding differences in illicit drug use, illicit drug use disorders, and drug overdose deaths in urban and rural areas can help public health professionals to identify, monitor, and prioritize responses

The GOP and Ideas

Our recent book is titled Divided We Stand: The 2020 Elections and American Politics.  Among other things, it discusses the state of the parties. The state of the GOP is not good. 

Among other things, it has failed at developing and articulating policy ideas.

Gladden Pappin at American Affairs:

[With] voters not motivated by the top-line branding, the ability of realignment policy to mature into a governing approach is thwarted. On this score, much of the Republican Party has been plagued by well-intentioned half steps that are difficult to translate into a com­pelling national message. The Republican Study Committee is one such example. After several years of heightened discussion around the need for fiscally generous policies to support the American family, the RSC released its “Family Policy Agenda” in September of 2022. Any move­ments in the direction of robust family policy are praiseworthy. But as the political scientist Darel Paul has observed, the RSC’s agenda “is largely another collection of more savings accounts, more tax cuts, more privatization, more work incentives and less regulation.”7 With abortion now a motivating left-wing issue, the Republican Party knows on some level that it must become a pro-family party. Filtered through the GOP’s typical policy levers, though, the result is often halting and insufficient.

For the inside track of policy change to harness the outside track of voter interest, policies have to be translated into simple and compelling messages. At the overall level of voter messaging, however, the Republican Party has made few shifts. Seeking a message for addressing persis­tent inflation in the country, the GOP settled on blaming Biden and the Democrats’ “reckless spending”—a phrase it hammered in advertisements throughout 2022. Among voters concerned about inflation, 47 percent cited the cost of groceries as their chief concern. These voters tilted Republican by a twelve-point margin. Yet 25 percent of the electorate despaired above all of price increases in health care, prescription drugs, housing, childcare, and miscellaneous other purchases. These voters voted overwhelmingly for the Democratic Party—by twenty-four to forty-one points, depending on the issue. A message of decreased government spending makes working-class voters more rather than less afraid of the increasing costs of goods. Among voters overall, 53 percent hold the view that “government should do more to solve problems,” whereas only 46 percent judge that government does “too many things better left to businesses and individuals.” Here again, getting to 51 percent in states that count will require Republicans to modulate its messaging—not losing government-skeptical voters but governing in a tangibly conservative way. Yet two months before the election, the Heritage Foundation’s new president was once again out promoting the message, “Government is not the solution, but the obstacle, to our flourishing.”8

Republicans Hoist White Flag on Obamacare

Our most recent book is titled Divided We Stand: The 2020 Elections and American Politics.  Among other things, it discusses state and congressional elections. 

Sahil Kapur at NBC: 

Republicans are abandoning their long crusade to repeal the Affordable Care Act, making the 2022 election the first in more than a decade that won’t be fought over whether to protect or undo President Barack Obama’s signature achievement.

The diminished appetite for repeal means the law — which has extended health care coverage to millions of people and survived numerous near-death experiences in Congress and the courts — now appears safer than ever.

With slightly more than a month before the next election, Republicans in Congress and on the campaign trail aren’t making an issue of Obamacare. None of the Republican Senate nominees running in eight key battleground states have called for unwinding the ACA on their campaign websites, according to an NBC News review. The candidates scarcely mention the 2010 law or health insurance policy in general. And in interviews on Capitol Hill, key GOP lawmakers said the desire for repeal has faded.

CA Dems Drop Single Payer, Depriving GOP of an Issue

Our new book is titled Divided We Stand: The 2020 Elections and American Politics.  Among other things, it discusses state elections.

The absence of exciting California state races could depress turnout in 2022, which in turn could have consequences in elections for the House.

State Democrats just dodged an issue that could have motivated GOP turnout.

 Alexei Koseff at CalMatters:

Despite, or perhaps because of, an aggressive last-minute push by progressive activists ahead of a crucial deadline, legislation to create a government-run universal health care system in California died Monday without coming up for a vote.

The single-payer measure, Assembly Bill 1400, was the latest attempt to deliver on a longtime priority of Democratic Party faithful to get private insurers and profit margins out of health care. Because it was introduced last year, when it stalled without receiving a single hearing, it needed to pass the Assembly by Monday to continue through the legislative process.

But even the threat of losing the party’s endorsement in the upcoming election cycle was not enough to persuade the Assembly’s Democratic supermajority to advance the bill for further consideration, effectively killing the effort for another year.

After several tense hours Monday afternoon, during which a scramble of meetings took place just off the Assembly floor, Assemblymember Ash Kalra, the San Jose Democrat carrying AB 1400, announced that he would not bring up the measure for a vote.

...”

Republicans were eager to make it into an election issue this year. Though Kalra’s bill was largely conceptual, with a separate measure introduced to address the financing, they attacked it as a massive tax hike on Californians. (Kalra proposed a series of taxes on businesses and high-earning households to fund the single-payer system, estimated by legislative analysts to cost between $314 billion and $391 billion annually.) A 4,000-page petition signed by voters who opposed AB 1400 sat in the back of the chamber on Monday for Assembly Republican Leader Marie Waldron of Escondido to use as a prop in a floor debate that never happened.

Delta Is Killing GOP Voters

 Our new book is titled Divided We Stand: The 2020 Elections and American Politics.  Among other things, it discusses the politics of COVID.

Predictable and predicted: the anti-vax and anti-mask movements are resulting in illness and death.

On August 10, Eleanor Clift wrote at The Daily Beast:

DeSantis was elected governor in 2018 with a margin of victory of just 0.4 percent, or 32,000 votes. Florida’s official COVID death count is now 39,695, a chilling reminder about the public health impact of DeSantis’ policies, and the fact that politics is about addition, not subtraction.

Christopher Ingraham at The Why Axis:

It’s well-known, by this point, that the Delta variant is currently hitting Republican states and counties the hardest. In the South especially, vaccination rates are low and mask use has typically been spotty, resulting in skyrocketing case and hospitalization numbers in several states.

But the picture on mortality has been less clear. Deaths lag behind hospitalizations, so the former have been slower to rise than the latter. Covid treatment has also improved since the early days of the pandemic, boosting patients’ odds of survival. And senior citizens, the group most vulnerable to the virus, have high rates of vaccination relative to other age groups.

But several months into the Delta wave and the data are clear: over the past month, people living in the most staunchly Republican counties have been three times more likely to die of Covid than those living in Democratic strongholds. While the disease doesn’t make political distinctions, Republican attitudes, conspiracy theories and policy failures have created conditions in which the Delta variant can thrive.

New on the Why Axis: August mortality data show how GOP Covid policy is killing GOP voters pic.twitter.com/QlYllzCtUL

— Christopher Ingraham (@_cingraham) August 31, 2021

GOP Vaccine Hesitancy

 Our new book is titled Divided We Stand: The 2020 Elections and American Politics.  Among other things, it discusses the politics of COVID.

 Caitlin Owens at Axios:

Driving the news: Nearly half of Republican men — 49% — say they won't choose to be vaccinated if a vaccine is available to them, according to a recent NPR/PBS NewsHour/Marist survey.

• Among those who said they supported Trump in 2020, 47% said they wouldn't choose to be vaccinated.
• In contrast, 6% of Democratic men and 10% of Biden supporters said they wouldn't get the shot.
• 25% of Black respondents, 28% of white respondents and 37% of Latino respondents said the same.

What they're saying: NIAID Director Anthony Fauci yesterday told "Fox News Sunday" that "it would make all the difference in the world" if former President Trump urged his supporters to take the coronavirus vaccine, Axios' Orion Rummler reports.

• "I'm very surprised that the high percentage of Republicans say they don't want to get vaccinated," Fauci said. "I don't understand where that's coming from. This is not a political issue. This is a public health issue."
• Georgia Gov. Brian Kemp said on Friday that the state is seeing vaccine hesitancy among white Republicans, and said partnerships between pharmacies and churches or civic clubs will be important, CNN's Kaitlan Collins reports.

...

Go deeper: 25% of House not vaccinated as some members refuse to get shot

SCOTUS, ACA, and the Senate

 In Defying the Odds, we discuss congressional elections as well as the presidential race. In 2020, Senate Democrats are trying to leverage the Supreme Court fight and Obamacare.

Let's be clear: A vote by any Senator for Judge Barrett is a vote to take away health care and eliminate pre-existing condition protections for millions of Americans.

Democrats are fighting for Americans’ health care. pic.twitter.com/VDcJD2m4zW

— Senate Democrats (@SenateDems) October 1, 2020

Shane Goldmacher and Jeremy W. Peters at NYT:

For much of 2020, Al Gross’s Senate campaign in Alaska has proceeded as something of an afterthought for most Democrats, a distant contest that was off the radar in terms of determining control of the U.S. Senate. After all, Mr. Gross is not even technically running as a Democrat, an affiliation that might doom him in a conservative state.

But in the hours after Justice Ruth Bader Ginsburg’s death on Friday, Dr. Gross’s campaign as an independent saw an infusion of attention and cash that could reshape the race: Nearly $3 million has poured into his coffers — about as much total money as the campaign had in the bank at the end of July.

“Within 15 minutes of the sad news, you saw truly organic movement,” said David Keith, who is managing Dr. Gross’s bid to oust Senator Dan Sullivan, a Republican.

From Alaska to Maine to North and South Carolina, Democratic strategists working on Senate campaigns described a spontaneous outpouring of donations the likes of which they had never seen, allowing Democrats the financial freedom to broaden the map of pickup opportunities, or press their financial advantage in top battlegrounds already saturated with advertising.

Justine Coleman at The Hill:

Democrats have raised more than $300 million in small-dollar donations for candidates and progressive causes since Justice Ruth Bader Ginsburg’s death, an ActBlue spokesperson told The Hill on Monday.

ActBlue had already announced that Democratic candidates had received more than $91 million in 28 hours after the Supreme Court announced Ginsburg’s death on Sept. 18.

Swing Left, a Democratic group that aims to flip the Senate to Democratic control, told The Hill that it has raised more than $2.6 million for Senate candidates and more than $1.7 million for state legislative races since Ginsburg's passing.

ACB and ACA

In Defying the Odds, we discuss the health care issue in the 2016 campaign.  the 2019 update includes a chapter on the 2018 midterms.  As we explain, loss aversion made Obamacare a liability for Democrats at the time of its passage: voters worried about losing health benefits that they already had.  But by 2018, the roles had reversed.  Obamacare was now the status quo, and the GOP was threatening to take it away.  The issue now strongly favors the Democrats.

Gregory Krieg at CNN:

Democrats on Saturday night launched their case against federal Judge Amy Coney Barrett, President Donald Trump's Supreme Court nominee, saying support for her confirmation was equivalent to a vote to end the Affordable Care Act.

In a rush of statements following Barrett's Rose Garden introduction, top Democrats put the fate of the law -- and its popular protections for patients with pre-existing conditions -- front and center. They also made frequent reference to the coronavirus pandemic, and the chaos that could arise from stripping health insurance options from millions of Americans in its midst.

From the Democratic presidential ticket on down, criticism of Barrett repeatedly circled back to what has been a political winner for the party: health care -- and the backlash to Republican efforts to dismantle the ACA, former President Barack Obama's signature policy achievement.

And Trump walked right into it:

Obamacare will be replaced with a MUCH better, and FAR cheaper, alternative if it is terminated in the Supreme Court. Would be a big WIN for the USA!

— Donald J. Trump (@realDonaldTrump) September 27, 2020

So did Senator Mike Lee:

For all the talk of Dems needing to watch what they're saying, Mike Lee is likely to feature in a Dem campaign ad. https://t.co/jXXMZd1XrV

— Drew Savicki (@SenhorRaposa) September 27, 2020

Drug Gift Cards

In Defying the Odds, we discuss the 2016 campaign. The 2019 update includes a chapter on the 2018 midterms. The 2020 race, the subject of our next book, is well underway.  Trump is weaponizing the federal government for his political benefit. He is lagging badly with seniors, so he is trying to buy their votes.

Lev Facher and Nicholas Florko at STAT:

President Trump on Thursday pledged to send $200 prescription drug coupons to 33 million Medicare beneficiaries “in the coming weeks,” a political ploy to curry favor with seniors who view drug prices as a priority.

Trump’s promise comes less than six weeks before Election Day, and represents the latest step in his administration’s (and his campaign’s) efforts to amass health care talking points, even if their actions do little to save Americans money.

The administration is getting its authority to ship the coupons from a Medicare demonstration program, a White House spokesman told STAT in a statement. The nearly $7 billion required to send the coupons, he said, would come from savings from Trump’s “most favored nations” drug pricing proposal. That regulation has also not yet been implemented — meaning the Trump administration is effectively pledging to spend $6.6 billion in savings that do not currently exist. The cards, he said, would be “actual discount cards for prescription drug copays.”

So @realDonaldTrump is promising seniors a $200 drug gift card. He has a serious case of Nixon Envy. In fall 1972, Nixon included this notice with Social Security checks. Big difference, though: it was a notice of an actual law. h/t @EdwardTufte pic.twitter.com/8oeoP1ieN9

— Jack Pitney (@jpitney) September 25, 2020