Medicaid Reform, Security Sweeps and a Dead Body: CPAC 2017

From the last Morning Jolt of the week:

Medicaid Reform, Security Sweeps and a Dead Body: CPAC 2017

“Sir, you just walked through a crime scene, I’m going to need to see your ID.”

That’s how my Thursday at the Conservative Political Action Conference began; how was your day? Apparently someone jumped from the top floor of a parking garage about one block away from the Gaylord convention center. The streets had been blocked off with yellow crime scene tape and perpendicularly parked police cars, so I had walked through the garage of the Wyndam hotel to get around the blocked-off area. Apparently the entire block had been ruled a crime scene, so the polite, professional officers needed everyone to hand over their driver’s licenses and log the information.

Word from the police is that the jumper was an employee of a nearby business, and the act is not believed to be related to the conference. But it was an odd, macabre start to what should be one of the happiest CPACs ever. After all, there’s a Republican president, GOP control of the House and Senate, a terrific Supreme Court nominee in the batter’s box, a slew of GOP governors  and state legislatures, giving a leg up in the redistricting after 2020. The weather was unbelievably warm and enjoyable for late February. Literally and figuratively, the sun is shining on the conservative movement.

For all of the thermonuclear reactions in the press, the just-barely-started Trump administration hasn’t really had an un-fixable mistake yet. Yes, the rollout of the executive order on immigration and refugees was a mess from start to finish, but the administration has the option of a mulligan and they’re taking it. (In retrospect, don’t even bother trying to enact a controversial change without your own attorney general in place to defend it legally.)

The markets continue a record run, although that can’t continue forever.

Strategists at Goldman put the mood of the market this way: “We are approaching peak optimism.” They forecast the S&P 500 will hit a high in the next month or so but end the year lower than where it is now as investors push back expectations for the timing of the tax cuts.

I did hear a little bit of grumbling about how slowly the process of repeal and replacing Obamacare is going, and someone assert, “the Republicans just don’t want to do it, they just don’t want to listen to us.” I don’t think it’s so simple as a lack of will.

I had a chance to briefly interview Wisconsin governor Scott Walker yesterday, and he’s leading a small working group of governors trying to help Congressional Republicans figure out how to handle the Medicaid expansion aspect of Obamacare. In the 31 states that chose to expand the eligibility for the health program that is jointly run by the federal and state governments, about 10.7 million people are now covered by Medicaid that otherwise wouldn’t be covered. If you just repeal that, then those 10 million need something new.

Ironically, some states are buying into the Medicaid expansion just as Republicans start talking about replacing it. In Kansas, the state House just voted to expand eligibility, 81-44. It might through the state Senate, but governor Sam Brownback says the idea is akin to “airlifting onto the Titanic.” Maine just decided that in November of this year, they’ll vote on a referendum to expand eligibility.

Sen. Lisa Murkowski of Alaska already said she won’t vote to repeal the expanded eligibility, citing improved health care for about 27,000 Alaskans.

It’s not surprising that what Walker likes best is the version in Wisconsin – where Medicaid eligibility wasn’t expanded, everyone at or under the poverty line was covered, and everyone above it was moved to private plans.

Wisconsin offers a “Premium Tax Credit” to households with incomes up to 4 times the federal poverty level – this was up to $94,200 for a family of four in 2013 – and who are ineligible for Medicaid or don’t have an affordable employer’s plan. “If the individual or family chooses a less expensive plan, the PTC will cover more of their premium costs. If the individual or family chooses a more expensive plan, the PTC will cover less of their premium costs (but the individual or family will have lower co-pays and deductibles).”

Some might grumble that this is taking away Obamacare-era subsidies for purchasing insurance and replacing them with Trumpcare (or whatever the replacement is called) tax credits for purchasing insurance. But Walker seems pretty convinced that this is better if it is part of an overall emphasis of getting people into the workforce:

“When governors are given the ability to really reform Medicaid and our other assistance programs, when I say it’s the same or better, I mean we help somebody get into the workforce. Now they’ve got an employer-based plan, or they’re making enough to be able to afford the co-pays or the premiums on that. They’re better off than they were before. The government just giving them something, even in the form of a subsidy, isn’t necessarily good for them. We can find a better alterative. It doesn’t mean we’re giving you more money, but rather we’re giving you more ability to earn and live a better life.”

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