Medicaid wounds are still raw in GOP

If the latest fracas between Gov. Jan Brewer and Republican Party operatives is any indication, it's going to be a long, ugly 13 months until the 2014 primary election.

Brewer recently reached out to the right wing of her party in hopes of healing wounds left by the bipartisan passage of Medicaid expansion, saying it's time to put differences aside and unite for the good of the party.

Conservative Republicans responded by sharpening their invective and moving forward with a series of "no confidence" votes against the governor and the 14 GOP lawmakers who backed the governor's expansion plan last month.

Supporters of the new law to broaden health-care coverage for the poor under the federal Affordable Care Act say the legislative precinct committee members represent a small fringe of the GOP and their symbolic votes don't matter.

But at the same time, they warn that, in some districts, working to knock off GOP moderates in the primary could give the seats to Democrats in the general election.

Brewer was concerned enough to send a letter Friday to thousands of precinct committee members across the state who make up the grass-roots political machinery of the GOP, making her case for Medicaid expansion and asking for their support.

"To continue efforts to potentially hurt and intimidate those who stood with me only puts Republicans' chances for electoral success next year back into harm's way," the governor wrote.

"We are allies. It is time to move on, work together for a united front in 2014 and focus on the key issues that face our state, including the economy, quality education and public safety."

Brewer sent a similar missive to GOP officials in March, when they were passing, during legislative-district meetings, harshly worded resolutions that opposed expansion and threatened the political careers of Republican lawmakers who supported it.

At that time, the governor argued that the GOP would be more at risk if it turned down the federal funds that will pay for most of the expansion and kicked their constituents off Medicaid.

But the conservative party loyalists say Brewer and the Republicans who teamed with Democrats to pass expansion have abandoned conservative GOP principles and made matters worse by pushing the bill through in a three-day special session that the governor called without consulting GOP leadership.

"They're elitists who think that what they've done can be forgiven. They're mistaken," Maricopa County GOP Chairman A.J. LaFaro said. "We are not going to be able to defeat all of them, but we will definitely defeat some of them. They are Arizona's 15 most wanted."

So far, GOP executive committees in five legislative districts have approved no-confidence resolutions or resolutions to censure the renegade Republicans and Brewer for supporting Medicaid expansion.

Most also include Rep. Michele Reagan, R-Scottsdale, who voted for expansion once but against it in the end. Another vote is scheduled in Mesa's Legislative District 16 on Thursday.

The votes have no legal impact, but GOP officials hope they will help turn voters against the incumbent lawmakers.

Rep. Heather Carter, R-Cave Creek, was out of town late last month when her Legislative District 15 GOP committee gave her a no-confidence vote.

Carter, who shepherded the expansion bill through the House, said she's proud of her vote but doesn't want to dwell on divisions within the party.

"I don't make decisions based on my political future," she said. "I make decisions based on what's best for my state. If you look back in history, when the Republican Party has done well, they have always provided a big tent."

Veteran Arizona pollster Bruce Merrill said the GOP split over Medicaid is another example of the conservative takeover of the state's GOP machinery.

"It just shows the extent to which the Republican Party is really fractured," said Merrill, a senior research fellow at Arizona State University's Morrison Institute for Public Policy. "The right wing has really taken over the party."

Merrill said the precinct committee members should not be underestimated in their ability to get conservative candidates elected in primaries, when most Arizona races are decided.

They may not represent mainstream Republicans, he said, but they know how to play politics.

"They're a smart, hardworking group of people who understand how the system works," Merrill said. "I reluctantly give them credit. … At the precinct level, they help you win."

Rep. Carl Seel, R-Phoenix, said he's not concerned about whether bouncing moderate Republicans could give Democrats the advantage in some districts.

As he sees it, the moderates, by voting with Democrats to pass Medicaid expansion, already have given Democrats control of the House, where the GOP holds a 34-26 advantage.

"One could make the argument that those nine turncoat Republicans in the state House are now Democrats," Seel said.

"It's not safe for any of them."

Copyright 2013 The Arizona Republic|azcentral.com. All rights reserved.For more information about reprints & permissions, visit our FAQ's. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to letters@usatoday.com. Include name, phone number, city and state for verification. To view our corrections, go to corrections.usatoday.com.

Posted

View the original article here

Will Time Heal Health Care Wounds?

When the Supreme Court declared the Affordable Care Act’s provision for an individual mandate to buy medical insurance constitutional, the majority did so by placing the mandate within Congress’s power to tax rather than under the Commerce clause. While the decision keeps most of the law intact, what does it mean politically? And how will the characterization of the mandate as a tax play among supporters and opponents of the legislation?

Supreme Court rulings on politically prominent issues can have three effects on subsequent attitudes among the public: legitimation, backlash or polarization. As Nathan Persily, Jack Citrin and Patrick Egan show in their 2008 book, “Public Opinion and Constitutional Controversy,” legitimation occurs when public opinion moves in line with the court, as it has over time with regard to the 1954 Brown v. Board of Education school integration decision and to gender equality decisions like Stanton v. Stanton in 1975, which invalidated laws predicated on traditional gender roles that differentiated between men and women in the allocation of government benefits.

Backlash occurs when public opinion moves directly in opposition to the court’s ruling, as when the public shifted, more in favor of school prayer and against flag burning after controversial decisions on those issues. Crucially, under polarization, overall opinion does not shift but different groups move in opposite directions. Examples include the gap in abortion opinion that grew between Protestants and Catholics after Roe v. Wade in 1973 and the difference between liberals and conservatives that widened after the Lawrence v. Texas gay rights decision in 2003.

A look at public opinion during the first few years after the Massachusetts health care reform in 2006 offers some insights into what might happen now at the national level. Although there has not been a legal challenge as dramatic as the suits against the Affordable Care Act, the Commonwealth’s experience does show how public opinion changes with health reform implementation. Of course, the Massachusetts case is different because it is a state-level reform that cannot elicit the objections to federal intervention that the Affordable Care Act. does, and yet the case is informative because the underlying structure of the reform is nearly identical. So what happened? There is evidence of both mild legitimation and pronounced polarization.

Polls by the Harvard School of Public Health in the first years after the law was implemented show that both the health reform overall and the individual mandate became more popular. Support for the Commonwealth’s reform increased from 61 percent in September 2006, shortly after implementation began, to 69 percent two years later, in June 2008. Similarly, support for the individual mandate increased from 52 to 58 percent. Overall support for the reform has dropped and risen since, with the percentage in favor of the mandate falling back to 51 percent. It is not always steady progress.

There is also evidence of sharp partisan polarization over the issue: Democrats became more supportive of the reform and the mandate while Republicans became more opposed, despite the fact that the legislation was signed by a Republican governor (after having passed the Democrat-controlled state legislature). In 2006, Democrats were 12 points more likely than Republicans to support the law (68 to 56 percent). By 2008, that gap had grown to 32 points (76-44).  Similarly, Democrats were 5 points more likely than Republicans to support the individual mandate in 2006 (56 to 51 percent), a gap that grew to 17 points two years later (65 to 48 percent).

Politically we might expect similar polarization at the national level. While increased familiarity and experience with the new legislation may enhance overall support in ways that might elate proponents of the law, implementation also seems to breed antagonism, perhaps precisely because opponents find such success threatening. That the court’s ruling defines the mandate’s penalty as a tax opens up opportunities for damning rhetoric from the reform’s opponents as well. Already we are hearing reminders that candidate Obama promised not to raise taxes on the middle class. As Sarah Palin wrote on Facebook after the court released its decision, “Obama promised the American people this wasn’t a tax and that he’d never raise taxes on anyone making less than $250,000.” Now, she said, we “see that this is the largest tax increase in history.” Glenn Beck’s Web site agreed: “No taxes on the middle class? Lies! Obamacare now Obamatax.”

However, a large group – both in Massachusetts and nationwide – are political Independents, whose opinions are informative because they are one group not constrained by partisanship. Their support for the Massachusetts reform and mandate grew over time, from 60 to 70 percent for the overall reform, from 53 to 58 percent for the individual mandate. With Democrats and Independents constituting a majority of voters nationwide, supporters of the Affordable Care Act may not just celebrate the law’s survival but also have good reason to expect that its popularity will increase — if the law, having made it through the Supreme Court, now also survives the political threat of a Republican repeal effort.

Andrea Louise Campbell is an associate professor of political science at the Massachusetts Institute of Technology. Her April 4 Op-Ed essay, “Down the Insurance Rabbit Hole,” was cited by Justice Ruth Bader Ginsburg in her concurring opinion in the health care decision on Thursday.

View the original article here