Michigan ex-pat in Brooklyn, web nerd, banjo novice, loves food, mildly abrasive
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Making Sense of the Spicer's Tale


Let's review a few key points.

1: Fast Not Slow. Spicer said that President Trump first heard about Flynn's deceptions on January 26th, after Acting Attorney General Sally Yates informed the White House Counsel about it. Spicer says there was a slow erosion of trust which led over almost three weeks to Flynn's ouster on February 13th. This makes no sense at all. Flynn appears to have maintained all his access to the center of the national security process right up until the day he was fired. Mere hours before his ouster top administration officials were still saying he had the full confidence of the President. And the White House had no replacement at the ready when Flynn was fired. These and many other reasons point overwhelmingly to the conclusion that Flynn's firing was a sudden decision, triggered by leaks which confirmed both his deceptions (2/9) and the DOJ warning (2/13).

2: No Mention of the President. Spicer awkwardly asserted a few key claims - that President Trump did not authorize the sanctions conversation with the Russian Ambassador and that he did not know about it until the DOJ warning. These were not categorical denials. But Spicer found his way to denying them. But throughout, Spicer conspicuously did not say that the Flynn misled the President. This is not an accident. It's a key to the story. It simply makes no sense and most likely means the President knew what had happened all along.

3. Trump Knew It Was Okay. Spicer repeatedly stated that President Trump "instinctively" knew that what Flynn had done was okay and that Trump's chief lawyer later confirmed this. (Spicer used the term "instinctively" at least three times.) No one thinks this was okay. Whether it violated any statutes is highly uncertain. It's not okay. If it were, why would Flynn have lied about it repeatedly? This is a highly odd statement which seems to allow for the President to acknowledge later either knowing about or authorizing the conversation.

4: And Trump Was Definitely Right. The consistent theme of Spicer's argument was that there was no legal or substantive problem with what Flynn did. Indeed, the President "instinctively" knew it was okay. The only issue was that Flynn misled the Vice President and others. In other words, there's no "Russia" issue here at all, simply an internal White House issue of the President losing confidence in the honesty of a key staffer. This is demonstrably not true. The need to insist it is strongly suggests that others in the White House, namely the President, is implicated in the Russia issue. Otherwise, it would make political sense and be eminently fair to toss Flynn to the wolves.

5. Desperate Not Serious. Handling a White House briefing in this climate would be a challenge for anyone. But Spicer is palpably not up to the challenge. This was clear in awkward pauses, pained attempts at humor, etc. But he made a number of claims that were clearly pre-planned. The most glaring instance of this was blaming the Department of Justice for not informing the White House soon enough. This isn't just ridiculous. It's not simply a typically Trumpian effort to shift blame, often in nonsensical ways. It shows panic and desperation.

Everything about this story suggests that the White House has many secrets to hide and little of the time to prepare, the competence to execute or the cooperation of the President to hide them effectively.

The story makes no sense. That's because it's not true. They didn't even have enough time to concoct a tight cover story.

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39 days ago
Brooklyn, NY
40 days ago
New York, NY
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Are Cities Too Small or Too Big?

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The Electoral College’s bias against American cities has spurred some liberal commentators to suggest that left-leaning urbanites should venture out of their coastal bubble cities and head toward the smaller cities and metros of the heartland and the Sunbelt, where their votes could make much more of a difference.

Another way of saying it is that our big, successful cities are already too large (not just too liberal) and the nation would be better off, and better balanced politically, if educated and talented people spread out across the country.

But others contend our cities are not big enough. A growing chorus of economists argue that out-of-date zoning and building codes create artificial limits on our biggest and most productive cities, driving up housing costs, and making inequality even worse—at a substantial trillon-dollar-plus cost to the economy as a whole.

A recent National Bureau of Economic Research working paper by economists David Albouy, Kristian Behrens, Frédéric Robert-Nicoud, and Nathan Seegert frames the issue in terms of a simple question: What is the optimal distribution of U.S. cities?

You can think of this in terms of two sets of trade-offs. Cities generate costs and benefits. Larger and denser cities benefit us by generating innovation and improving productivity, but they can also be plagued by costs—such as congestion, crime, pollution, and disease.

Then there is the trade-off between individual versus social benefits. Left to their own devices, people might choose to form and occupy a bunch of small cities geared to their own individual needs and desires. In other words: suburbs. When this happens, individuals do not pay the full cost for inefficient development of lots of small places.

The dotted lines demonstrate the benefit to large and small cities when they constrain their population growth to maximize private gain. The solid curve shows an increased social average benefit when all cities increase their population and consolidate. (Albouy et. al)

The study finds that large American cities might in fact be undersized by as much as a third. Furthermore, we may have up to two times as many cities as we need, causing up to half the U.S. urban population to live in places that are too small.

Three types of cities

The authors paint three broad scenarios for the distribution of American cities and the people who call them home. The table below outlines the different possibilities for cities, which play out in wildly different ways.

The first is what they call “optimal,” where cities essentially make optimal use of the best locations, extracting the most amount of benefit for the most amount of people with the least amount of cost.

The second is based on “free mobility,” where individual households make the decisions that best suit them.

And the third reflects “local politics,” where city sizes reflect local policies and regulations—for example where land use regulations artificially limit the size of cities.

Additional models consider whether the economies of cities have higher agglomeration, higher congestion, or whether there is more or less heterogeneity in how the land in a hypothetical city can or cannot be used.

(Albouy et al.)

On the extremes, the study finds, we could end up with as few as nine giant cities, each housing 50 million people, or 20,000 small cities with between 3,000 and 58,500 residents.

The study generates a wide swath of best- and worst-case scenarios. As a baseline, the authors note that under the “optimal” scenario we would end up with 100 cities that range between 230,000 and 30.5 million people in size; “free mobility” would mean roughly 400 cities of between 25,000 and 15 million people; and “local politics” gives us a whopping 17,500 cities between 13,300 and 58,500 residents.

For simplicity’s sake, take look at the baseline estimates at the bottom left corner of the table. The optimal scenario creates an average benefit of $28,977 per person and costs $22,200 per person across cities. The free mobility scenario creates a similar output of $27,002 benefits per person to $21,960 per person. The local politics scenario creates only $19,649 per person and costs of $18,148 per person. NIMBYism is expensive.

The upshot of this exercise: We probably have too many cities. People may want to live in smaller towns and those who live in urban neighborhoods may want to protect themselves against certain kinds of growth or density, but doing so brings substantial costs to the economy as a whole. This does not mean that everyone needs to congregate in a big dense city like Manhattan.

Behind this thought experiment is a serious consideration: How should we live? Creating a denser and more efficient distribution of cities cannot happen overnight, but this theoretical framework should help steer wonky discussions about zoning, land use, and development toward a more lofty territory.

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47 days ago
"NIMBYism is expensive."
Brooklyn, NY
46 days ago
I live in a town of a little less than 30K residents, very close to a city of a little over 2.3M residents. I hate it here and will move to a much less densely-populated area as soon as I can. I can't imagine what kinds of policies would have to exist to make me move into an even denser area. I think it would have to be coercive, perhaps even threatening my existence.
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The Information War Has Begun


Yesterday, Steve Bannon clearly articulated what many people have felt and known for quite some time when he told journalists, “You’re the opposition party. Not the Democratic Party… The media’s the opposition party.” This builds on earlier remarks by Trump, who said, “I have a running war with the media.”

Journalists have covered this with their “objective” voice as though it was another news story in the crazy first week of WTF moments. Many of those who value the media have looked at this with wide eyes, struggling to assess which of the many news stories they should be more horrified by. Far too few are getting the point:

The news media have become a pawn in a big chess game of an information war. 

News agencies, long trained to focus on reporting information and maintaining a conceptual model of standards, are ill-equipped to understand that they may have a role in this war, that their actions and decisions are shaping the way the war plays out.

When Kellyanne Conway argued that they were operating with “alternative facts,” the media mocked her. They tried to dismiss her comment that the media has a 14% approval rating by fact-correcting this to point out that this was only a Gallup poll concerning the media’s approval rating among Republicans. But they missed her greater point: there’s no cost to the administration to be helpful to the media because the people the Trump Administration cares about don’t trust the media anyhow.

CC-BY-NC-ND 2.0-licensed photo by Mark Deckers.

How many years did it take for the US military to learn that waging war with tribal networks couldn’t be fought with traditional military strategies? How long will it take for the news media to wake up and recognize that they’re being played? And how long after that will it take for editors and publishers to start evolving their strategies?

As I wrote in “Hacking the Attention Economy,” manipulating the media for profit, ideology, and lulz has evolved over time. The strategies that hackers, hoaxers, and haters have taken have become more sophisticated. The campaigns have gotten more intense. And now many of the actors most set on undermining institutionalized information intermediaries are in the most powerful office in the land. They are waging war on the media and the media doesn’t know what to do other than to report on it.

We’ve built an information ecosystem where information can fly through social networks (both technical and personal). Folks keep looking to the architects of technical networks to solve the problem. I’m confident that these companies can do a lot to curb some of the groups who have capitalized on what’s happening to seek financial gain. But the battles over ideology and attention are going to be far trickier. What’s at stake isn’t “fake news.” What’s at stake is the increasing capacity of those committed to a form of isolationist and hate-driven tribalism that has been around for a very long time. They have evolved with the information landscape, becoming sophisticated in leveraging whatever tools are available to achieve power, status, and attention. And those seeking a progressive and inclusive agenda, those seeking to combat tribalism to form a more perfect union —  they haven’t kept up.

The information war has begun. Normative approaches to challenging the system will not work. What will it take for news media to wake up? What will it take for progressives to start developing skills to fight back?

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49 days ago
Brooklyn, NY
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The Beginning of the Trump Years

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And for this one I’ll use the Q&A format I’d used in some earlier pieces about the incoming Trump administration.

I knew you’d be back!

Yes, fine. Let’s get to it.

How do you feel about Trump taking office on Friday?

I’m sort of relieved.


Look, we’ve known this day was coming for two and a half months and in all the time people have maintained a certain level of freakout I’ve ultimately found wearying. I’m pretty much like: He’s going to be president? Fine, let’s get to it, because this waiting shit is boring the fuck out of me. I mean, we’re gonna fight, yeah? Then let’s fight, already.

What do you think will happen?

To the extent that the Trump administration has a strategy at all, which is honestly an open question, I think it will be a hundred-day dash to gut the infrastructure of government in the hopes of overwhelming everyone who would complain — a sort of Gish Gallop of bad governance, if you will.

Will it work?

It might! I think a lot of people opposed to the Trump administration are still in oh shit oh shit oh shit mode, as opposed to fuck you, let’s do this thing mode. Trump and his agglomerated assemblage of assholes are hoping the left (which in this case would include large swaths of the middle) are still shell-shocked and/or content to be a circular firing squad rather than focusing fire on them. On the other hand, those marches on Saturday are a very nice declaration of intent, and people certainly seem to be burning up their congresspeople’s phones. So we’ll see.

Be that as it may, Trump will be president and his administration will basically get to make all the opening moves. That’s what happens when you win the presidency. No matter what, some damage will be done. People are going to have to push back against that damage, not move forward with other things.

And how do you feel about that?

I mean, it is what it is. Trump won the presidency. He’s an incompetent. There’s nothing to be done about that now, so we have to get on with keeping the damage to a bare minimum. I don’t feel good about that, but I don’t feel bad about making the decision that for the next few years, some portion of my life will be spent loudly opposing bad governance and pissant authoritarianism. In fact, I feel just fine about that. I would be ashamed to do otherwise.

What would you say to the people who are still in oh shit oh shit oh shit mode? 

Leaving aside the folks who are genuinely depressed and focusing on the ones who are just merely wringing their hands at this point: Time to get over that shit now. I think there’s still a bit of a “somebody do something” mentality, in which the hand-wringers are somewhat passively hoping someone else will solve this problem.

Thing is: There is no someone else. No one is coming to save us from Trump and his merry band of egregious nincompoops. If there is saving to be done, it comes from us, or not at all. Be the “someone else” you want to see in this world. Because otherwise you’re leaving it to the horde of racists and bigots following in Trump’s wake. And that’s not acceptable.

At the very least, if you can’t get out of oh shit oh shit oh shit mode, then make goddamn sure you’re not making things harder for the people who are stepping up. I think it’s time to realize that we’re in a “perfect is the enemy of good” situation.

What do you mean?

Well, for example, right about now there are a lot of politically and socially conservative folks who are aghast at the fact of a Trump presidency and who recognize that he represents a clear danger to the Republic. What do I think about these conservatives, who I might otherwise have almost no political overlap with? I think: Hello, ally. In this fight and in this moment they and I have a common goal — making sure our system of governance isn’t completely tubed by an insecure vulgarian — and I’m okay with focusing on that goal right now. After that’s done, then we can get back to yelling at each other on every other topic. Heck, we can yell at each other while we focus on our common goal! They are important topics. But holding the line against Trump is more important.

Hello I am a Trump supporter!


Isn’t it possible that Trump could be a good president and bring back jobs and make people happy and be popular?

Sure, although bluntly there’s nothing he’s done since the election that indicates that. Yelling at businesses on Twitter isn’t ultimately likely to be a viable domestic strategy, and so far his foreign strategy is to goatse himself so that Vladimir Putin can slide his arm up to the pits and operate Trump’s mouth with his hand. Likewise his cabinet choices don’t inspire confidence; they largely either don’t seem to understand what job they’re up for, or they seem to approach the positions like they were corporate raiders, or both. Meanwhile, the GOP congress is beavering away at their plan to punt millions off of medical insurance immediately, and make it more difficult for everyone else to keep the insurance they have.

But, hey, as a member of the 1% at least I will get a big fat tax cut! Thanks, guys!

Now, Trump does seem to have a rudimentary jobs plan, which calls for building out the country’s infrastructure, and you know what? I think creating jobs by fixing our crumbling roads and bridges and such is a very fine idea, in principle. I don’t suspect that Trump’s version of it at the moment is that great — by all indications it’s mostly a call to the trough for corporations — but I will allow that a massive jobs bill, suitably tuned, could put him in good stead with the average voter.

Will this make him a good president? Not likely, unless other aspects of his administration (and his personality) changed greatly. But I’m not going to deny there are ways he can be popular, which for him might be enough.

So do you really think Trump is a puppet of Vladimir Putin?

No, if we’re talking like a Russian version of a Manchurian Candidate, or a captive of salacious pee videos. But do I think Russia (under Putin’s orders) went all in to attempt to influence the election, and Putin, who is manifestly smarter and more manipulative than Trump, is happy to flatter the incoming president and maneuver him in such away that Trump’s own predilections, in terms of personality and temperament, serve his needs. Trump is being used by Putin, certainly. And I also think it’s likely that Trump’s own self-interest, which includes lots of Russian money flowing through his properties and accounts, is inclining him toward Russia and Putin.

Note well this is bad enough — in my opinion we have an incoming president who seems prepared to severely hobble our alliances because of his own personal financial interests, and has picked for his cabinet several people with similar issues. The technical term for such a situation is “a real shitshow.”

Is it treason? Meeeeeeeeeeeeeeeeh, I don’t think so? But I wouldn’t be terribly surprised if eventually it becomes the core of an impeachment proceeding.

(Update: And then there’s this, which if anything comes of it, does not look great for Trump.)

Hello I am not a Trump supporter!


How do I oppose him? 

That’s up to you. For myself, I’m planning to give a whole lot of money (possibly from that tax cut I will now almost certainly get) to organizations that will gum up the works for the Trump administration and/or help to protect people who his administration will put at risk (pretty much anyone who is not a well-off straight white person), and do a lot of writing, because rumor is, I have an audience. There are other things I’m considering as well.

For other folks, aside from giving money, calling representatives and protesting and volunteering and voting for fuck’s sake and making sure everyone you know is registered and votes too all help. One suggestion I’d offer people is not to spread yourself too thin — per above I think the Trump administration is going to make pushes into all sorts of areas: Free speech, women’s health, public education, minority voting, LGBT+ rights and so on. They want you to be dazed and thinking there’s too much to focus on. Pick one as your main focus and drill down on it, hard. Others will take up the other categories. Help them when you can but push hard on the one area you know and care most about. If enough people do that, everything will get covered and energy won’t dissipate. It’s going to be a long four years. Best to keep focus.

Okay, seriously, what do you think is going to happen in the next four years?

I have no idea. But I know a couple of things. One, where I stand, and with whom. It’s not with racists and bigots and the people who would hurt the lives of others just for a goddamned tax cut. I don’t believe every Trump voter intended to enable racists and bigots and the greedy (even if that’s what they ended up doing), and I think in time some of them will regret their vote. At this point, I’ll take regret over a double-down, and welcome them when and if that happens. And in the meantime, I’m happy with where I’m standing.

Two, you know what, if I’m going to resist for the next four years, I’m gonna have fun doing it. I mean, come on: Thumping on racists and bigots and greedy assholes, and shoving sticks into the spokes of their shitty little plans? That’s holy work, that is, and I’m going to enjoy every minute of it. Opposing Trump and his pals is serious business, but I think if you can approach the work with some joy, it will help. I’m going to take pleasure in sticking up for my country. I hope you will, too.

So let’s get to it.

(P.S.: Today I’ve also written about the end of the Obama years, here.)

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66 days ago
Brooklyn, NY
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What Betsy DeVos Didn't Say About School Choice

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Tuesday’s Senate confirmation hearing of Betsy DeVos, packed with reporters, surrogates, and congressional staff, was more heated than any Department of Education hearing in recent memory. DeVos made headlines for her evasive answers about political contributions made by her family’s foundation, her failures to denounce gun bans in schools (citing the threat of “potential grizzly bears”), and her shaky grasp of federal education in general.

But one topic never came up: American schools’ deeply entrenched racial segregation.

This lack of discussion of civil rights issues at the hearing was glaring, but it may be in line with DeVos’ advocacy of school vouchers and other school choice programs in her home state of Michigan. As Kimberly Quick, a policy associate at the Century Foundation, notes, “Both historically and currently, voucher programs have served as a means for wealthier and white families to flee an increasingly diverse public school system, moving into largely unaccountable private schools that can exclude students based on a number of factors.”

And an increasing body of research suggests these concerns should not be isolated to vouchers, but to school choice programs of all kinds: Nationwide, school choice programs, such as charter schools and open enrollment options, have pushed more low-income minority students into even more racially segregated schools.

A 2010 study from the UCLA Civil Rights Project, for example, examined data from 40 states, the District of Columbia, and several dozen metropolitan areas. It found that 70 percent of black charter school students attended schools with 90 to 100 percent minority populations—double the percentage of intensely segregated black students in traditional public schools.

This increased segregation did not only apply to black students. The study also found that higher percentages of charter school students of every race attended more 50-to-100 percent minority student schools or 90-to-100 percent minority student schools than did their same-race peers in traditional public schools.

Other state-based studies in North Carolina, Pennsylvania, and Texas have also found that charter schools are deepening segregation, though a few city-based studies have shown contradictory results. Less academic literature exists on the impact of vouchers on school segregation.

“Research shows that free-market school choice, without diversity as a stated goal of a program, tends to exacerbate segregation and inequality in schools,” says Halley Potter, a former charter school teacher and co-author of A Smarter Charter: Finding What Works for Charter Schools and Public Education. “The expansion of vouchers is particularly worrisome because of many private schools’ ability to pick and choose students based on academics, behavior, or even religion or sexuality.”

But charter school advocates observe that DeVos, or any Education Secretary, would have a limited ability to affect these forces. In a statement, Vanessa Descalzi of the National Alliance for Public Charter Schools points out that “[c]harter schools are public schools and therefore, subject to the same federal requirements on integration as all other public schools. The Every Student Succeeds Act ensures important decisions about education, including the expansion and oversight of charter schools, remain firmly in the hands of states—the Secretary of Education has surprisingly little influence in those matters.”

To show how school choice may be exacerbating school segregation, CityLab mapped charter school data from two communities—the Twin Cities of Minneapolis and St. Paul, Minnesota, and Charlotte, North Carolina—that were once lauded for their desegregation efforts.

Taking enrollment 2014-2015 data from the greater Twin Cities region’s charter schools, provided by the Institute on Metropolitan Opportunity, and underlaying it with the 2014 Census data, it becomes clear that these charter schools are recreating the neighborhood segregation patterns that previous desegregation efforts successfully counteracted.

Scrolling over the charter schools located in the intensely white outer ring suburbs of the map, you can see their student populations are also nearly all white. In majority non-white urban areas, the charter schools feature almost completely non-white populations. These charter schools are far less integrated than their peer public schools.

According to Will Stancil, an attorney and researcher at ‎the Institute on Metropolitan Opportunity at the University of Minnesota, as of the 2014-2015 school year, nearly 70 percent of students of color at charter schools in the Twin Cities were in completely segregated environments, compared to less than 20 percent at traditional schools. “The people that school choice doesn’t reach are those whose parents are overwhelmed, who have no time to shop around,” he says. “Of course, those are the kids we should be helping, but in a consumer-oriented system you will never cater to them.”

The story is similar in North Carolina, where researchers in 2015 found that most white parents prefer sending their kids to schools that are no more than twenty percent black—and they use charter schools to make this choice. In grades 4-8, for example, Duke University researchers found that over the last fifteen years, North Carolina’s public school population became 11 percent less white (down to 53 percent), while its charter school population grew more white (up to 62.2 percent).

Mapping 2015 charter school data in the greater Charlotte area, you can see how these parent choices play out. Schools with student populations that are almost completely black (and sometimes Hispanic) cluster in the largely black urban core. Those in the inner-ring and outer-ring suburbs feature majority or almost exclusively white student populations. (Note:  UNC Charlotte sociology professor Roslyn Mickelson provided CityLab with this data, but could not confirm whether Charlotte-area charter schools themselves are measurably more segregated than nearby public schools).

Eve Ewing, a doctoral candidate at the Harvard Graduate School of Education, argues such stratification is built into the design of many school choice programs. "The notion of ‘choice’ suggests that all options are on the table for all parents,” says Ewing, ”but when resources like transportation, childcare, and information access are unequally distributed, the choices on the table are in fact very constrained."

The Twin Cities and Charlotte examples also suggest that deregulated school operators, not just parents, may be helping drive the disparities in parents’ access to choices. In Minnesota, charter schools are not required by state law to take any action to reduce segregation. Similarly, North Carolina state law allows families to choose any charter in the state, as long as they can provide their own transportation. It can be far more difficult for non-affluent families to send their kids to charter schools in the wealthier parts of town: In the greater Charlotte-area charter schools mapped above, for example, only four of the twenty-one majority white and Asian charter schools provided free transportation, whereas seven of the fifteen majority black and Latino charter schools did so.

Some policy experts say school choice programs must take active steps to ensure they do not engineer district-level segregation. “In order for school choice to promote integration, diversity must be built into the design of the program,” says Potter. She points to Cambridge, Massachusetts, where “students are assigned to schools based on their families' ranked choices,” she says, and a system is in place to “make sure that all schools roughly reflect the diversity of the district.”

Such initiatives, civil rights advocates argue, do not appear to play a big role in Betsy DeVos’ extremely deregulated vision of school choice.

“We don’t have a problem with charter schools, but we do have a problem with massive segregation,” says Yusef Mgeni, vice-president of the St. Paul NAACP and a former school administrator. “Public schools take anyone who walks off the sidewalk, but charters here will say, ‘We would love to take your child in, but he’s just not a good fit.’ DeVos has said her priorities are charters, vouchers, and choice … so people here are fastening their seat belts. We will be in for a rough ride.”

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66 days ago
Brooklyn, NY
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The Michigan counties most vulnerable if Obamacare is repealed

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Hundreds of thousands of state residents would likely be affected by a repeal of the Affordable Care Act, including those in counties that went hard for the law’s critic-in-chief, President-Elect Donald Trump, according to a Bridge Magazine analysis of government data.

The implications of an immediate repeal of the ACA could be felt by nearly 1-in-10 Michigan residents, and as much as 13 percent of the population in places as different from one another as the Detroit-area and rural Emmet County.

Consider: In Wayne County, dominated by Democratic-heavy Detroit, 12.7 percent of county residents receive health care through a combination of ACA enrollment or Medicaid expansion. In Cheboygan County, at the top of the mitt, where Trump trounced Democratic nominee Hillary Clinton by a 2-to-1 margin, 13.1 percent of residents depend on ACA coverage or Medicaid expansion.

If the Republican-led Congress, with a likeminded president, also change the way that traditional Medicaid is funded, as many as two million Michiganders could be impacted by Washington’s dramatic health-care changes, enrollment data show.

Impact of ACA repeal in Michigan

Congress is considering repeal of the Affordable Care Act and major changes to Medicaid. Nearly a million people in Michigan get their health coverage through the ACA or Medicaid expansion, helping cut in half the percent of people who don’t have health insurance. Click or tap on a county or congressional district to see how many people are covered by Medicaid expansion and the ACA.

By county

By congressional district*

*Estimates based on county-wide numbers. Some counties are split among two or more congressional districts.
Source: State and federal health data on Medicaid and the ACA enrollment.

Trump is pushing Congress to immediately repeal “Obamacare” and congressional leaders have already begun taking votes to dismantle President Obama’s signature domestic legislative achievement.

It remains unclear whether Congress can agree on a plan to replace it immediately or at some point in the future. That uncertainty could leave many Michiganders facing the prospect of losing their health coverage, at least temporarily.

Bridge asked the state’s congressional delegation whether and how the ACA should be changed or repealed. Republicans, who hold 9 of the state’s 14 congressional seats, generally indicated they would move quickly to dump the law though, notably, no Republican spelled out whether they are willing to ditch Obamacare without a concrete plan to replace it.

MORE COVERAGE: Repeal Obamacare? Michigan delegation split…and a bit vague

“The president’s health-care law has led to double-digit premium increases, rising deductibles, and dwindling choices for consumers,” said one, Rep. Tim Walberg, R-Tipton, in a statement. “Obamacare is collapsing and families who are hurting need relief. To fix this broken system, we need to repeal Obamacare and have a stable transition to patient-centered health care solutions that give families more choices and lower costs.”

Rep. Tim Walberg, R-Tipton, says he favors Obamacare’s repeal and a move toward a system that’s less expensive and with more options for families.

Rep. Tim Walberg, R-Tipton, says he favors Obamacare’s repeal and a move toward a system that’s less expensive and with more options for families.

Half the state’s delegation – four Republicans and three Democrats – responded to questions posed by Bridge this week. Both U.S. Senators, Democrats Gary Peters and Debbie Stabenow, defended the ACA and, like others in their party, said they do not favor repeal but largely agree that the ACA can be improved, though they too weren’t terribly specific on how.

“The Affordable Care Act must be preserved. The evidence of its benefits are clear in our state,” Rep. Sandy Levin, D-Royal Oak, said in statement. “The protections in the law are also vital so that no one can be denied coverage because of a pre-existing condition or women are not charged more for their care.”

Republican congressmen Fred Upton of St. Joseph, Mike Bishop of Rochester and Paul Mitchell of Dryden sent general answers that criticized the ACA but offered no specific plans on how best to repeal, replace or change any elements of it.

Dems: Repeal not the answer

Since the ACA went into effect in 2013, the percentage of state residents without health insurance fell from 11 percent to 6.1 percent, according to U.S. Census data from 2015. It’s likely even lower today though, as Republicans are quick to note, premiums for ACA-bought policies continue to rise.

“The Affordable Care Act is not perfect but it has provided a significant benefit to working families across Michigan,” Rep. Debbie Dingell, D-Dearborn, said in response to Bridge’s inquiry. “We cannot afford to go backwards, and I will be fighting tooth and nail to protect the health care coverage” of those receiving coverage through the ACA.

More than 630,000 people were added to the state’s Medicaid rolls since early 2014, when the Michigan Legislature voted to expand coverage for the poor. The ACA offered additional federal funding to states to cover those making up $33,000 for a family of four or $16,000 for a single person. (The limit for traditional Medicaid is just below $25,000 for a family of four and $12,000 for an individual.)

Rep. Debbie Dingell, D-Dearborn, says she will fight “tooth and nail” to maintain ACA coverage for her constituents

Rep. Debbie Dingell, D-Dearborn, says she will fight “tooth and nail” to maintain ACA coverage for her constituents

The plan, approved by the Michigan Legislature with the vast majority of Democratic legislators and a minority of Republicans, went into effect in early 2014 and has seen hundreds of thousands sign up across the state. In many northern Michigan counties, the expansion doubled the number of people eligible for Medicaid.

Then, beginning in 2014, residents were able to buy private health insurance through the federal exchanges. As of late last year, more than 345,000 Michigan residents were covered by ACA-bought policies.

To ACA supporters, the number of beneficiaries – nearly a million across the state – should give Congress pause before it makes major changes to a program that benefits so many in Michigan and across the country.

“One would hope that the congressional delegation is responsive to its constituents,” said Marianne Udow-Phillips, director of the Center for Healthcare Research & Transformation, a nonpartisan health care research center based at the University of Michigan.

Benefits from…somewhere

Udow-Phillips, a former director of the Michigan Department of Human Services, acknowledged that the ACA has problems, including premium increases averaging nearly 17 percent, and needs to be amended. But she said it might get more support if more of its beneficiaries were aware of who they are. She said some who benefit from Medicaid expansion don’t know that they are benefitting from “Obamacare” in part because Michigan calls its expansion program Healthy Michigan” with no mention of Medicaid or the ACA.

“A lot of people didn’t realize they got coverage because of the Affordable Care Act,” she said. “Communication around this law has been terrible by advocates for the law.”

Indeed, news stories have appeared around the country indicating that some recipients don’t know the coverage they now have is a result of the ACA.

“I guess we really didn’t think about that, that he was going to cancel that or change that or take it away. I guess I always just thought that it would be there,” Debbie Mills, a Trump voter in Kentucky, told Vox. “I was thinking that once it was made into a law that it could not be changed, but I guess it can? Yes?”

The Senate took the first steps toward repeal this week, voting 51-48 to use the budget process to begin defunding the law. However, no plan to replace it has emerged, although individual pieces of a potential new health-care structure have been talked about for years. Republicans in charge of writing legislation to defund the ACA say no final decisions have been made, despite a Jan. 27 action deadline set by the incoming administration.

A vote for change

In Michigan, some counties with the highest Medicaid expansion and ACA usage gave Trump some of his largest victory margins (he won the state by just over 10,000 votes).

In Oscoda County, between Grayling and Lake Huron in northern Michigan, more than a quarter of residents get Medicaid – traditional or through the expansion – or bought a policy through the ACA. It’s one of the highest rates in the state. So too is the support it gave Trump, who received 70 percent of the county vote; Trump performed better in only two other Michigan counties.

Conversely, urban areas like Wayne County, where more than 30 percent of residents get Medicaid (traditional or through expansion) or bought an ACA policy, went for Democratic nominee Hillary Clinton in big numbers. She promised to preserve the ACA.

Charles Gaba, a Bloomfield Hills web developer, began collecting and disseminating data on the ACA in 2013 and has become a reliable source for ACA data to both the media and politicians. He estimates that two-thirds of those who bought a private policy through the ACA and all of those who are on the Healthy Michigan plan could be directly affected by repeal.

And that doesn’t count roughly one million state residents who benefit from traditional Medicaid coverage, which could also see substantial changes. Georgia Republican Rep. Tom Price, Trump’s pick as secretary of health and human services, has advocated turning Medicaid into a block grant program similar to welfare, which would send money to the states while giving them greater flexibility on how to spend it.

Those plans make some advocates for the poor nervous, in part because of how states, including Michigan, have historically handled other block grant programs. Bridge wrote last year about how some block grant money for the poor ended up funding scholarships at private colleges in the state for more affluent students.

Change is coming

For critics of the ACA, Trump’s election has created an opportunity to focus on those who’ve been harmed because their premiums rose sharply, their insurance shifted to higher deductibles, or they lost job opportunities because of high insurance costs.

“It’s very easy when you talk about the possibility of repeal that you’ll be able to identify and swing a camera and find some people who would lose their coverage. It’s true and unfortunate. (But) right now the existence of the law has some very serious negative effects on a lot of people,” said Robert Graboyes, a senior research fellow focusing on health care at the Mercatus Center, a market-oriented research center at George Mason University in Virginia.

Noting that the plan has been far more expensive than expected, Graboyes said he is hopeful the ACA’s successor will tackle cost.

If regulatory controls on new drugs and treatments are altered, pharmaceutical costs could fall, he said. If hospitals are allowed to compete more, other costs could come down. He said savings from a “market approach” could pay for the health care coverage of millions. Instead, he said even Republican solutions are focused largely on how bills are paid – through insurance – rather than how those bills are comprised.

“And as long as all we talk about is insurance and the demand side we’re not going to get out of it,” Graboyes said. “But I’m confident that ultimately we will. To some extent we don’t have a choice.”

No clear proposal has emerged from the Republicans on what they plan to do. Price hasn’t been confirmed yet and Trump isn’t inaugurated until Jan. 20. Until they do or until a bill gets enough support in Congress, what happens next is almost anyone’s guess.

“I think it’s very, very hard to know at this point exactly what they’re going to propose,” Udow-Phillips said. “I don’t think they know what they’re going to propose yet.”

The post The Michigan counties most vulnerable if Obamacare is repealed appeared first on Bridge Michigan.

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