December 18, 2009
WHY TALKS WITH NELSON GO POORLY.... To hear Sen. Ben Nelson (D-Neb.) put it, if even a small number of American women are able to get indirect subsidies for their reproductive choices, he'll have to kill health care reform. But as of yesterday, Nelson has other concerns, too.
Sounding suspiciously like someone who's read a few too many Republican talking points, Nelson added that a Medicaid expansion would "create an underfunded federal mandate for the state of Nebraska."
Alec MacGillis reports today that Nelson has it backwards -- under proposed Medicaid expansion, his home state stands to do very well.
As it now stands, states and the federal government share the cost of Medicaid on a scale based on their wealth, with richer states paying half and poorer states paying a quarter or less. Nebraska pays 40 percent. States have widely varying levels of eligibility for their residents.
Under the legislation, much of the extension of coverage would be accomplished by raising the threshold for Medicaid eligibility to a uniform level across the country -- to 133 percent of the poverty level in the Senate bill, and 150 percent of the poverty level in the House bill.
To keep this expansion from burdening already-strapped state governments, the bills call for the federal government to pick up nearly the entire cost of covering newly eligible people -- 91 percent of the cost in the House bill, and even more of it in the Senate bill.
The Senate bill would have the federal government cover all newly eligible people until 2016, at which point its share would begin to decline, to 92.8 percent by 2019 in the case of Nebraska. These terms would cover the first 10 years of the bill, then be revisited.
John Holahan of the Urban Institute told MacGillis states Nebraska "have to come up with the extra money, so you can view it as a burden, but on the other hand, a ton of federal dollars are coming in to pay for these people, so it's an economic gain in that sense. This is a really ridiculous thing for anybody to complain about... The bottom line is, Nebraska comes out great on this."
In the larger sense, the problem is not just that Nelson is a conservative Democrat, resisting a progressive policy goal. It's also the fact that Nelson has developed a reputation for ignoring substantive policy details. This makes it extremely difficult to explore compromise solutions with him -- Nelson tends not to understand what other senators are offering. When he raises a concern that troubles him, Nelson hears the explanation of why that concern isn't really a problem, but doesn't really believe it because he doesn't really understand it.
This is a classic example. Nelson probably heard a Republican tell him Nebraska would be hurt by Medicaid expansion. He believed it. When he raised the point with proponents, Nelson didn't understand that Nebraska would benefit from the Medicaid changes.
For what it's worth, Nelson huddled privately with Senate Majority Leader Harry Reid (D-Nev.) earlier today. After their meeting, Nelson told reporters, "Hopefully we're making progress. As I said, there's always a lot of room which you have to have between the bid and the ask, and we're seeing if we can close the gap."
—Steve Benen 4:00 PM
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That could very well be another seldomly considered problem with our government; not only are we hyper-polarized along party lines making governing very difficult, we have the added problem of a distinctly less formidable brain trust than in previous generations when it comes to our elected officials.
And they just so happen to come from certain states... hmmm...
Posted by: citizen_pain on December 18, 2009 at 4:12 PM | PERMALINK
Simple solution - as a compromise, offer to have the bill changed to read exactly what it already does to address his concerns.
Posted by: Memekiller on December 18, 2009 at 4:12 PM | PERMALINK
In other words, he's dumb.
Posted by: Needles on December 18, 2009 at 4:12 PM | PERMALINK
So the esteemed Senator Nelson is either dishonest, dumb, incompetent, lazy, or all of the above?
Posted by: ckelly on December 18, 2009 at 4:19 PM | PERMALINK
Empowering Mr. Ugly Face
Well you can say this about the super-majority requirement: It sure has empowered a handful of old scabs from small states to throw hissy fits and receive hospitality service with a smile...
Posted by: koreyel on December 18, 2009 at 4:20 PM | PERMALINK
In other words, his understanding of the contents of the bill comes from Fox News or some other equally dubious outlet. I guess he doesn't have a paid staff, or if he does, they are all dolts who fell off the Nebraska turnip truck just yesterday.
Posted by: Ron Byers on December 18, 2009 at 4:20 PM | PERMALINK
What's that? Nelson is threatening to kill a bill that will SAVE PEOPLE'S LIVES and his stated reasons are factually erroneous -- nay, moronic -- on their face?
Cue the outrage and derision from Joe Klein, Ron Brownstein, and Chris Mattews!
Posted by: square1 on December 18, 2009 at 4:20 PM | PERMALINK
When does a sergeant laugh at a joke?
Right away.
The captain laughs the next day -- when he understands it.
The major laughs a couple of days later -- when someone explains it to him.
The colonel never laughs, because he neither understands it, nor allows anyone to explain it to him.
You're positing that Nelson is either a major or a colonel, when it comes to health insurance reform. Me, I'd go for a simpler solution: it pays him better to oppose it, with an added incentive of basking in the limelight.
Posted by: exlibra on December 18, 2009 at 4:27 PM | PERMALINK
Incidentally, one of the reasons that I have so little patience with the "liberals are scuttling the bill!" hysteria is that it is SO OBVIOUS that this bill is going to pass. The corporations have gotten an absurdly favorable deal already. There is no reason to concede anything.
From Nelson: "Hopefully we're making progress. As I said, there's always a lot of room which you have to have between the bid and the ask, and we're seeing if we can close the gap."
Good God, people, does Nelson have to hit you over the head? At the end of the day, he's voting for the God damned bill (or not filibustering it anyway). He just wants to extract as much blood as possible.
Posted by: square1 on December 18, 2009 at 4:32 PM | PERMALINK
But progressives should still signal that they support whatever bill comes out of this "process" no matter how bad, right?
Steve, as long as progressives keep rolling over we'll keep getting rolled. It's time for our side to make noise. That's the only way to get the White House's attention. They desperately need to pass a bill, which they can do with 60 votes as long as progressives keep bending over and saying "Thank you (Joe, Ben, Blanche, etc.), may I have another?" The moment a single progressive stands up and says they're willing to use the same tactics as Holy Joe and his ilk to block the bill, the ONLY choice will be reconciliation, a process where we need only 50 votes (+ Biden) and can get a really good bill that will be easy to reconcile with the House.
Why do you and other "reasonable" liberals keep acting like Joe and Ben's game is the only game in town. If we get off the sidelines, we can dictate the rules of the game instead of them.
The bill as it currently stands is bad policy and horrible politics. The Republicans must be licking their chops waiting to run against this huge giveaway to insurance companies at taxpayer and customer expense!
Posted by: Jim in Chicago on December 18, 2009 at 4:58 PM | PERMALINK
Remember Nelson's appearance on Rachel Maddow during the stimulus fight (I give him credit for showing up)? He was incoherent. Remember, Nelson the originator of "war bonds for Afghanistan so we don't add to the budget deficit?"
I don't think he's dumb exactly, I bet his SATs were OK, but he's just like GW Bush. He went into politics because it's easy, and the voters don't give a damn if you're what you're talking about if you use the right buzzwords.
Stop using your brain for a decade or two, it gets rusty.
Posted by: JMG on December 18, 2009 at 5:00 PM | PERMALINK
The stuff about Nelson is hardly surprising; the stuff about Medicaid, I think, gets to the heart of why this reform bill is problematic: it does very little to solve the basic problem with Medicaid, which is 50 state programs with widely varying degrees of coverage and generally not great results. Both the House and the Senate used their respective increases in coverage, such as they are, to basically mask raising costs in the bill. It's effectively cheaper to shunt poor people into Medicaid rather than subsidize, say their ability to purchase other insurance, but that's because other insurance would provide more coverage, and better reimbursement to docs.
And the other mechanism for hiding the cost of the bill is, as noted, that sliding scale of federal funding - when most states are struggling to meet their current side of Medicaid funding, this new plan would add more to their budgets. That money will have to come from somewhere, which means problematic attempts, in many states to raise state and local taxes to rearrange funds. California, as the big example, is in its financial mess partly because of this very problem.
The real solution here has always been to federalize Medicaid, end the highly flawed "block grant" programs (a Reagan era move, one might recall, to reduce spending on welfare), fix reimbursement rates and get decent coverage for all poor people and not some hodgepodge safety nets with tons of holes (it's not at all clear that single working age adults in poverty, for instance, will be able to get coverage under this in every state. Many states don't offer that now). It's just one of the examples of ways that progressives, by obsessively focusing on a "public option" missed the boat on working to reform the already existing "public option" foisted on the poor, which desperately needs it. And I'm sure we'll hear about how this is "at least a first step" and such... but there's absolutely no energy or pressure to fix healthcare for poor people. None. And that's not likely to change, whether this bill passes or not.
Posted by: weboy on December 18, 2009 at 5:16 PM | PERMALINK
Hmmm...Who does this portrayal of Nelson remind me of? Oh yea, that's right! Chiat's description of Liebermann.
Those two were made for each other.
Posted by: kindness on December 18, 2009 at 5:27 PM | PERMALINK
The Republican who talked to Senator Nelson was Nebraska Governor Hiney Man, who extracts his information straight out of the first part of his name. By the way, Hiney Man probably plans on running for Nelson's seat, and he published a scary scenario yesterday about the horrible consequences of providing Nebraskans with health care.
Posted by: NE skeptic on December 18, 2009 at 6:05 PM | PERMALINK
Shorter version: Nelson is a lying piece of shit.
Posted by: km on December 18, 2009 at 6:21 PM | PERMALINK
So why is the WH complaining about "the leftists" acting badly?
Senator Nelson is teaching all of us how to act and get the red carpet treatment.
Posted by: Glen on December 18, 2009 at 6:52 PM | PERMALINK
Nebraska has a population about about 1.8M people... slightly more than half the population of Chicago, less than a quarter of the people who live in the Chicago metro area.
Leaving aside the issue of fairness, we have simple probability to deal with. The chance that a smart, wise, caring, canny and politically able person will live in Nebraska and become a US Senator is less than the chance that such a person will live in Chicago and become Mayor.
Posted by: larry birnbaum on December 18, 2009 at 7:55 PM | PERMALINK
This is very disturbing to me.
Posted by: Brian Douglas on March 9, 2010 at 9:22 PM | PERMALINK