Mediaboss Marketing

The supposed implosion of the Affordable Care Acts private insurance markets looks more and more like a manageable, geographically limited problem one that policymakers could fix pretty easily, if only some of them werent trying so hard to undermine the program.

The latest development comes out of Nevada, where until last week 14 counties had no options lined up for the states insurance exchange in 2018. Centene, which already offers policies in parts of Nevada, announced on Tuesday that it would expand next year to offer policies statewide which means roughly 8,000 exchange customers in those 14 counties will have a way to buy the Affordable Care Acts regulated, subsidized policies.

Those thousands of people would have been stuck looking for some other source of insurance had their counties remained bare, with no carriers on the exchange.And because people buying policies through the exchanges dont typically have access to employer-sponsored plans or qualify for government programs, most of those people would have ended up with no coverage at all.

The problem of bare counties has gotten a lot of attention in the last few months. Many insurers have scaled back their presence in the new Obamacare markets, citing their inability to make a profit because they cant attract a stable mix of healthy and sick customers. Republicans have repeatedly said this exodus is a sign of the programs collapse, and a reason to repeal the health care law.

House Speaker Paul Ryan (R-Wis.) once called repeal an act of mercy because, he said, the programs new markets would fall apart without intervention.

But even as most of the big, commercial carriers like Aetna and Cigna have beat a hasty retreat from Obamacare, carriers like Centene have filled in the gaps. At this point, only two countiesnationwide have no carriers lined up for next year. One is in Ohio, the other in Wisconsin. Together they account for roughly 400 customers, and its not too late for those counties to get insurers,too.

That doesnt mean everything is hunky-dory. Centenesbusiness model relies on narrow physician networks to keep premiums down, which isnt what all consumers would prefer. And although the number of truly bare counties has now shrunk to nearly zero, there are still many that only have one insurer. Roughly 40 percent of all counties will have just one exchange insurer in 2018, according to the latest figures from the Department of Health and Human Services.

But even that number is a little misleading, because those counties are disproportionately rural.In other words, not that many people live in them.

This isnt surprising. Rural counties are inherently difficult for insurers to manage, because the low numbers of customers make it difficult to get that ideal mix of healthy and sick enrollees and because the relative paucity of doctors, hospitals and clinics makes it impossible for insurers to play providers off of one another to get lower prices. This was true before the Affordable Care Act was passed.

To put all of this in perspective to show just how many people will really feel the effects of dwindling insurance options, and which parts of the country they call home Harold Pollack, a social scientist at the University of Chicago, and Todd Schuble, a computational scientist there, drew up two maps. They originally posted them at healthinsurance.org and have since adapted them for HuffPost.

One map shows counties with standard geographic borders. The area covered by counties with just one insurer is substantial.

Harold Pollack and Todd Schuble

The second map adjusts county size for population. In it, the portion of the country with just one exchange carrier is smaller, because those rural counties shrink quite a bit.

Harold Pollack and Todd Schuble

One pattern evident in both the original and the population-adjusted maps is where these counties with just one insurer tend to be: in the South and some parts of the interior West.

Partly thats a function of population distribution. Those are the parts of the country with the most rural territory. But partly thats a function of politics.Those are also the parts of the country where conservative Republicans, the ones most opposed to the Affordable Care Act, hold the greatest political sway.

And that almost certainly makes a big difference. The law has tended to work best in places like California and Michigan states where officials have promoted the program and acted swiftly to address problems as they have come up.

ACA marketplaces work well in densely populated liberal areas, Pollack said in his healthinsurance.org article. The marketplaces require more care and feeding to really succeed in Wyoming, Iowa, or Oklahoma. Competition among insurers and providers is pretty thin in these locales.

Nevada is a prime example of this. The exchange has worked well in the metro areas, including Las Vegas. The 14 counties that were at risk of going bare are predominantly rural. One reason they have coverage now is that state officials including Gov.Brian Sandoval, who is a Republican but has also said hes committed to protecting peoples insurance made it their business to attract new carriers

If more state or federal officials were committed to making the law work, they could make inroads as well if not by courting insurers, then by passing new regulations and laws to shore up the laws weak spots.

Theres no shortage of ideas on the table. One possibility would be to create new reinsurance programs, which subsidize the consumers with the most serious medical problems. (Alaska and Minnesota have already done that.) Another possibility would be expansions ofMedicaid,Medicareor thefederal employee health plan, any of which could add insurance options in places that have too few.

Some of these ideas would do more that merely stabilize markets. They would make health care more affordable for the millions who still cant pay for it easily, a problem that even most Obamacare defenders concede the law did not fully solve.

To be successful,policymakers would have to commit to fixing the laws problems. But some key Republicans, including President Donald Trump, seem determined to do the opposite to repeal the law or to undermine it throughsabotage, perhaps bringing about the very kind of crisis they claim is taking place already.

The rest is here:
2 Maps Show The Big Obamacare Crisis Republicans Keep Citing Isn't Actually That Big - HuffPost

Republicans have courted racists for years. Why are they cringing now? Wichita Eagle Yes, last week's violent demonstration by white supremacists in Charlottesville, Virginia, culminating in the death of 32-year-old Heather Heyer, made for a carnival of obscenity as sickening as it was riveting. But the thing is, it did not spring from ... and more »

Excerpt from:
Republicans have courted racists for years. Why are they cringing now? - Wichita Eagle

If Democrats want to assure Donald Trump is a one-term president theres a simple solution register Republican, as appalling as they might sound to lifelong progressives.

Theres no telling if Trump will even make it to the 2020 election. Tony Schwartz the ghostwriter of Trumps Art of the Deal predicts the president will resign by the end of this year. And theres always the possibility of impeachment depending on the outcome of Robert Muellers investigation.

But assuming that Trump is still in office and continuing his assault on American decency, he could be stopped even before the 2020 general election.

No sitting president has received a serious challenge by his own party since Jimmy Carter held off Ted Kennedy in 1980. Four years earlier, incumbent Gerald Ford nearly lost to Ronald Reagan in the primaries.

While Ford and Carter survived inter-party war, they entered the general elections weakened. Both lost re-election and since then the prevailing notion is you dont challenge a sitting president in a primary.

But if Trump runs again he will almost certainly receive Republican challengers. John Kasich, a leading contender, said on Sunday that Republicans are all rooting for Trump to get it together. But Kasich is no fool. He knows that will not happen. Trump is his own worst enemy and hes only going to continue damaging the American psyche. Expect several mainstream Republicans to enter the race. The primaries might seem like a lifetime away but debates will begin two years from now.

Perhaps Republican voters will come to their senses and choose a candidate who at least seems mentally capable of leading the country. Democrats could ensure that happens if enough of them vote in the Republican primary. In closed or semi-closed primary states like Iowa, New Hampshire, Florida and Pennsylvania that means changing their party registration from Democrat to Republican after the 2018 midterm elections.

If enough Democrats made the one-time switch for the primary and they were unified behind the least offensive Republican candidate they could pack enough punch to knock Trump out before the general election. While an inspiring Democrat would be a strong favorite against Trump anyway, Democrats shouldnt assume that Trump is unelectable if he makes it to the general election.

There are a few caveats to this plan. A slew of Democrats from various wings of the party will likely run in their own primaries. So voters who switch to Republican will have no say in the Democratic nominee. Thats a personal decision many Democrats would have to make: is the likelihood of ending Trumps campaign before he even hits the general election worth letting others choose the Democratic nominee? The Democratic Party would fight this strategy, fearful that some wouldnt bother registering back to Democrat after the election.

Theres also the strong possibility that Trump would still run as an independent if he loses the Republican nomination. But that scenario could benefit Democrats. Trump would syphon more votes away from the GOP nominee almost assuring that the Democratic nominee wins the popular vote. But if none of the three candidates were to receive at least 270 electoral votes, the House of Representatives would choose the president. That would still knock Trump out of the running. In that scenario, the next president would come down to which party controls the House after the 2018 midterms. Either way, it wouldnt be Trump.

The third caveat Democrats will have to ponder is whether their strategy could ultimately end with a non-Trump Republican president and if thats the case is it better or worse for the country?

In terms of policy, the Republicans are accomplishing nothing with Trump at the helm. They cant get on the same page and hes been an utter disaster. Its possible that from a policy perspective a Republican party man could do more damage than Trump. The flip side to that is Trump is crushing the countrys moral fiber. Hes pandering to white supremacists. For the good of the country, anything is better than Trump.

Its a lot to digest but at the end of the day Democrats can realistically control Trumps future.

See the original post:
Why Democrats Could Consider Registering Republican To Stop Trump - HuffPost

Like a chubby, orange-haired, 71-year-old version of Edith Piaf, Donald Trump reportedly declared that, after his legendary press conference meltdown on Tuesday, he regrets nothing . And indeed, there did seem to be an unhinged glee in his now notorious performance, reminiscent of Howard Beale in Network, during which he declared, among other things, that there were some very fine people marching with the torch-bearing neo-fascists in Charlottesville.

It was a stark contrast from Monday, when his staff allegedly forced him to choke out a statement that read in part, "Racism is eviland those who cause violence in its name are criminals and thugs, including KKK, neo-Nazis, white supremacists, and other hate groups, that are repugnant to everything we hold dear as Americans." Staring at the teleprompter, he wore the look usually seen on a third grader hauled back to the dime store by his mommy and forced to apologize to the salesclerk for shoplifting.

But no such glum expression crossed his visage the following afternoon, as he decried the loss of toppled Confederate statues, castigated something he called the alt-left, and insisted that there was blame on both sides. We should have been able to gauge his mood even before he crossed the gilded threshold of Trump Tower, since that morning he had already tweeted (and then hastily removed) a cartoon of a train running over a CNN reporter, a particularly tasteful, sensitive contribution to the national debate, given the way in which Heather Heyer was murdered in Charlottesville three days before.

Shell-shocked newscasters (even on Fox! Fox!) expected that this Tuesday debacle, this seeming defense of white supremacy and Neo-Nazism, would be the rhetorical straw that would break the inner circles back, that a red line had been crossed, that a whole gallery of profiles would call out the president and stream out of the West Wing.

We are still waiting for the first staffer to (intentionally) jump off this sinking ship (come on guys, you can do it!). Still, a growing number of Republican lawmakers23 at last counthave critiqued the president by name, the highest-placed among them being Senator Bob Corker, who even appeared to hint that he thinks Trump is nuts, or, as he genteelly put it , that he believes the president has yet to demonstrate stability.

Corker followed a posse of businessmen who took a hike immediately after the Tuesday rant, beginning with Kenneth Frazier, the president of Merck Pharmaceuticals, and swiftly joined by other CEOs. In a K Street version of Youre not breaking up with me! I am breaking up with you first!the president suddenly disbanded the councils on which these fat cats sat.

Wait, so now we kind of like Doug McMillon, the CEO of Walmart? At least this captain of industry said, in a message posted to the stores website: "As we watched the events and the response from President Trump over the weekend, we too felt that he missed a critical opportunity to help bring our country together by unequivocally rejecting the appalling actions of white supremacists." (Can McMillon be a member of this mysterious alt-left?)

Apparently, Anthony Scaramucci is not the only former White House official who doesnt know what off-the-record means: following in the bizarre footsteps of "the Mooch," on Wednesday, White House Chief Strategist Steve Bannon appeared in an odd chat with Robert Kuttner, the co-editor of the American Prospect, openly sneering at the presidents threats against North Korea and alleging that his enemies inside the White House were wetting themselves. Seventy-two hours later, in yet another Friday afternoon massacre, Bannon was dead in the water , apparently defenestrated by Chief of Staff John Kelly and sent scurrying back to the rats nest of Breitbart News . Rumor is that the Commander-in-Chief was also sick of Stevie, convinced that Bannon was a leaker, contributing to his not-a-minute-too-soon downfall. (Wetting? Leaking? What's with these disgusting figures of speech?)

Anyway, according to the erstwhile Chief Strategist, who gave a manic interview to The Weekly Standard a few hours after being axed, "The Trump presidency that we fought for, and won, is over.

From your evil lips to Gods ears, Mr. Bannon.

See the article here:
Which Republicans Will Desert Trump's Sinking Ship First? - Vogue.com

President Trump on Aug. 15 said that theres blame on both sides for the violence that erupted in Charlottesville on Aug. 12. (Bastien Inzaurralde/The Washington Post)

In the aftermath of the white-supremacist rally in Charlottesville, Republican lawmakers and leaders face the most unpalatable set of choices yet in their relationship with President Trump. They are caught between disgust over his failure to unequivocally condemn neo-Nazism, a desire to advance a conservative agenda and fears of rupturing the Trump-GOP coalition ahead of the 2018 elections.

Recent condemnations of the president by Republican lawmakers have been harsher, more frequent and sometimes more personal than in previous moments when Trump went beyond what is considered acceptable behavior. Many GOP leaders are now personally wrestling with the trade-offs of making a cleaner separation with the president, while finding no good options.

To some in the party, the hesitancy to act more boldly in response to Trumps handling of the Charlottesville violence specifically his angry news conference Tuesday falls short of what they believe this moment demands.

At what point does a principled party stand up for its principles? Tom Ridge, a former governor of Pennsylvania and homeland security secretary under President George W. Bush, asked in a midweek interview.

Ridge, a longtime critic of the president, added: You cant be afraid of losing an election because you stood up for what was right. A party of principle requires leadership. But at this time, were kind of rudderless. We need a chorus [of opposition] and we didnt get it. ... And frankly, if we did that, I think most Americans would applaud.

After President Trump's most recent rhetoric about Charlottesville inflamed even more criticism, a handful of GOP lawmakers, including Sens. Bob Corker (R-Tenn.) and Lindsey Graham (R-S.C.), are criticizing Trump directly, while others stay silent. (Jenny Starrs/The Washington Post)

What Ridge is calling for publicly is what some Republicans are asking themselves privately, which is whether a more direct break with the president is either advisable or possible. There are indications of private conversations underway within Republican circles about the presidents behavior and whether, after seven months in office and a new chief of staff who many GOP officials hoped would temper the presidents behavior, there will ever be a change. Many are concluding that the answer is no. The next question is what to do.

Its clear that, as of now, many Republicans lawmakers, leaders and strategists have reached a pair of uncomfortable conclusions. First, whatever they and a majority of the public believe about the repugnancy of the presidents comments, they believe Trump was duly elected as president on the Republican ticket and that he retains a deeply loyal following within the party. They are reluctant to go against that Trump base.

Second, however personally upset they are by Trumps remarks, many lawmakers believe they must maintain a working relationship with the president if they are to accomplish their legislative goals including tax reform and even a health-care overhaul. So far, they have little to show for their work this year and see progress on that agenda as crucial to keeping grass-roots conservatives and Trump loyalists energized ahead of the 2018 elections.

Interviews with Republicans around the country since Charlottesville highlight the dilemma elected officials face. Few were willing to talk about what comes next, even anonymously, and most elected officials and party leaders contacted declined requests for interviews altogether.

Many of these leaders know that in their states, Trump retains considerable support from Republican voters. Among those attending the Iowa State Fair in the past week a place where Trump made waves two years ago when he landed in his personal helicopter at the fairgrounds there appeared to be no significant dampening of support among his followers.

A large banner reading, Stand With Trump hung behind the Iowa Republican Partys booth inside the Varied Industries Building. By Wednesday afternoon, it was covered in signatures, with few spots left for others to add their names. Every few minutes, people would stop by to take photos with a cardboard cutout of the president.

Althea Cole, a member of the state GOP, worked the booth during the week, talking to people who stopped by. Iowans like Trump. Of course, we had the occasional person come up to us and say, How could you? she said Friday.

Notably, Cole said that several people stopped by the GOP booth to inquire about the states two U.S. senators, Charles E. Grassley and Joni Ernst. They want Iowas two senators, they want Iowas federal representatives, to be behind Trump 100percent, she said.

In another Midwestern state, a group of golfers watched Trumps Tuesday news conference from the clubhouse of their country club and vocally expressed their support for him and agreed with his characterization that both sides bore responsibility for the violence that took place in Charlottesville.

A GOP strategist working campaigns in red and purple states said that while support for Trump generally declined slightly since Charlottesville, support rose among his base, after a decline last month because of the failure on health care and revelations about the Russia investigation. This strategist said many Trump supporters applaud the presidents continuing desire to shake up Washington, favor his economic priorities and admire his willingness to speak his mind.

But he said Trump has nonetheless created a longer-term risk. What hes doing thats harmful is hes removing people from the persuadable audience, and thats dangerous, he said. Hes taken an event where he could have added 5percent of people to the persuadable universe and [instead] hes dumped out 10percent of them.

For many Republicans, this has become a look-in-the-mirror moment, a time for taking stock of their own actions, perhaps equal to or even beyond that which took place in the days after the release of the infamous Access Hollywood video in October. This time, the personal criticisms of the president started more slowly but after Tuesday built to a crescendo as the week unfolded.

Sen. Cory Gardner (Colo.), who chairs the National Republican Senatorial Committee, was one of the first to state his displeasure after Trumps Saturday statement, which made no mention of neo-Nazis or white supremacists. He implored the president to call evil by its name. Sen. Ted Cruz (Tex.), who faces reelection next year and who dueled with Trump for the 2016 presidential nomination, was similarly caustic in calling out white supremacists.

On Monday, Trump delivered what many Republicans had hoped to hear Saturday. Reading from a script, he criticized the KKK, neo-Nazis, white supremacists and other hate groups that are repugnant to everything we hold dear. Had he stopped there, he might have avoided what was to follow. But the next afternoon, during an angry news conference at Trump Tower, the president once again sought to blame both sides and defended the neo-Nazi marchers.

That evening, Sen. Marco Rubio (R-Fla.) said the march organizers were 100percent to blame, adding, Mr. President, you cant allow #WhiteSupremacists to share only part of blame. Rep. Patrick J. Tiberi (R-Ohio), accused the president of deflecting attention from the killing of Heather Heyer by a bigoted follower of the white supremacist movement. Former Florida governor Jeb Bush, another 2016 primary rival, tweeted that this was a time for moral clarity. I urge @POTUS to unite the country, not parse the assignment of blame.

On Wednesday, Sen. Tim Scott (R-S.C.) told the Post and Courier in Charleston, S.C., that the presidents moral authority has been complicated by his response to Charlottesville. Saying Trump had tried to draw moral equivalency between the white supremacists and the counterdemonstrators, he told the paper, I think you are either missing four centuries of history in this nation or you are trying to make something what its not.

On Thursday, Sen. Bob Corker (R-Tenn.), chairman of the Foreign Relations Committee, took the criticism another step by questioning the presidents stability and competence. He said that Trump has not shown that he understands the character of this nation and that without that understanding, Our nation is going to go through great peril.

Then, on Friday, Mitt Romney, the GOPs 2012 presidential nominee, posted a lengthy statement on his Facebook page calling on Trump to undertake remedial action in the extreme to atone for remarks that he said, caused racists to rejoice, minorities to weep, and the vast heart of America to mourn. Romney said Trump should address the American people, acknowledge that he was wrong and apologize.

Four magazines the New Yorker, Time, the Economist and Der Spiegel rushed out covers that showed imagery of Trump and some version of a Klansmans hood or a Nazi salute. The Economist declared that Trump had shown himself to be politically inept, morally barren and temperamentally unfit for the office.

The Spectator, a conservative British magazine, echoed part of that sentiment but with a caveat that highlighted the box in which Republican officials find themselves. Yet again, Trump has demonstrated the extent to which he is unsuited to be president, the magazine wrote in an editorial. But yet again we can also see the forces at work that led him to power.

Defenders of the president believe Trumps base will only intensify its anger toward the presidents critics. Saul Anuzis, the former Republican chair in Michigan, said Trump had been goaded by the media into the statements he made Tuesday. I believe there are media folks trying to put him in a position to create forced errors and he does, he said.

He added, I think its an uncomfortable situation [for the party] that unfortunately is not easily walked back because there are a whole lot of people trying to stir it up. Saying he did not believe Trump was a racist or neo-Nazi sympathizer, he said, Weve got a communications issue rather than a political problem [that] is going to be a challenge throughout his presidency.

One strategist said he had just seen the numbers from a survey in a battleground state and that the presidents approval among GOP primary voters stood at a still-impressive 85percent. For elected officials, political survival remains paramount, and they are reluctant to get crosswise with that base.

Elected officeholders have to speak to everyone in their constituency, said the strategist, who, like many, declined to speak on the record so as to offer a candid assessment. Theyre very concerned about the people who will vote for him next time and right now they still [like him].

Another strategist said that, despite the concerns about the president, there are any number of Republicans who consider the party to be in good shape. They say the Republican Partys never been stronger, he said. We have more governors, we have more state legislators, fundraising is great. What are you complaining about?

He added that Republican elected officials either have to feel punished or be punished before they will break significantly with the president. There has to be some sense that there is a price to be paid for this, he said.

A party activist noted that by many traditional metrics, Republicans are strong. Then theres the worst of times, he said. What happened in Charlottesville ... reinforces our biggest problem as a party, which is one word, the perception of intolerance. ... Whether true or not doesnt matter. This reinforced that in a big way.

The internal concerns go well beyond that, however. Party leaders and elected officials more closely tied to the establishment wing of the GOP see a succession of discouraging actions by the president, from his public criticism of Attorney General Jeff Sessions to the firing of former Republican National Committee chairman Reince Priebus as White House chief of staff and especially his attacks on Senate Majority Leader Mitch McConnell (R-Ky.).

What does the party do if it appears as though the president doesnt support the leadership in the party? said a Republican activist, who would not agree to be identified. How does the party run if the person who supposedly runs the party doesnt embrace the party? That is a big question. That is a conversation that is out there right now.

The answer is there is no obvious one, as many Republicans underscored in interviews. Some lawmakers anticipate that individual Republicans will maintain greater distance from the president in public settings and in their rhetoric while focusing more intently on a legislative agenda that remains largely unfulfilled. In essence, that would mean they would begin to chart the partys course without particular regard for Trumps priorities.

Trump has made that easier for congressional Republicans with his attacks on McConnell, which deeply offended McConnells Senate colleagues. His more recent attacks on Sens. Lindsey O. Graham (R-S.C.) and Jeff Flake (R-Ariz.) and earlier ones aimed at Sens. John McCain (R-Ariz.) and Lisa Murkowski (R-Alaska) only add to the impetus to operate more independently.

A Republican strategist who is directly engaged in 2018 politics said progress on the GOP agenda, particularly tax cuts, could help to diminish some of the anguish that has been on display this past week. Cutting middle-class taxes and improving the economy? the strategist said. A lot of people will forgive a lot of sins if that happens.

But he conceded that the weeks events could complicate that path to success. I would be very hesitant to say [Charlottesville] has real meaning six months from now, he added. I think where it hurts the most, its just another thing that makes it harder to get the middle-class tax cut done.

One alternative to charting their own course would be for Republicans collectively to issue a sharper rebuke of the president. But that seems challenging, even in the assessment of Republican detractors of the president.

What does it mean to break with the president? asked William Kristol, editor at large of the conservative Weekly Standard and one of Trumps most vocal critics. Its a pretty big move in effect to go into opposition to a president of your own party. Its a very unnatural mode for an elected congressman or senator.

Another GOP strategist put it bluntly: Im not trying to justify what he said, but theres the practical issue. What youre asking is, do Republicans break with him fundamentally? Hes the president. What are you going to do, impeach for this?

Speaking with reporters Friday morning, Sen. James Lankford (R-Okla.) described the position in which Republican lawmakers find themselves. I have a responsibility to do what I do, he has a responsibility to do what he does, and I dont have the constitutional position to be able to challenge him, he said. Were both in the same party, and so I can push on people within my own party, which I think is entirely appropriate, but the presidents the president, and he can make his own statements.

Ed OKeefe, Mike DeBonis and Karoun Demirjian contributed to this report.

See the rest here:
After Charlottesville, Republicans remain stymied over what to do about Trump - Washington Post