Final 2014 Midterm Election Predictions

The final Fix Senate rankings are here    The Washington Post

With a little under a week to go before Election Day, it is time to make last-minute predictions once again.

You can see my earlier predictions from January here, and from October here.

Overall, the trends have moved slightly, but not significantly, toward Republicans. The generic poll numbers have not significantly moved, but the enthusiasm gap steadily has increased, as the GOP is relatively excited to come out and voice their displeasure at the polls.

GOVERNORS

I didn’t spend a lot of time on the Governor’s races in my previous post, and won’t do so here either, other than to make quick predictions on a few key races. In the races not mentioned, I expect the incumbent/heavily favored to win.

Alaska: Walker (I), in close race.

Colorado: Hickenlooper (D) anb Beauprez are going neck-and-neck; I was ready to call it for Hickenlooper a few days ago, but right now…I wouldn’t bet a nickel on either side. True tossup. Guess? Republicans pull it out.

Connecticut: Polls are tied; my gut says Foley (R) ousts Gov. Malloy.

Florida: I have no idea; really. I would not be surpised to see a recount.

Georgia: Deal (R), but less than 50%, so heads to runoff.

Illinois: Polling all over the place; low confidence, but I think Rauner (R) pulls it out.

Kansas: Another true tossup; gut tells me Brownback (R) wins, though deserves to lose.

Maine: LePage (R), by the skin of his teeth.

Massachusetts: Baker (R); a stunning turn of events.

Michigan: Snyder (R)

New Hampshire: Hassan (D), in a race closer than predicted.

Rhode Island: Fung (R) has run a great race, but I predict he loses to Raimondo.

Wisconsin: Walker (R), but closer than predicted.

HOUSE

In my earlier post, I predicted a gain of 5-8 House seats. The polls have shifted recently, with several Democrat incumbents now in tough races, as both parties rush to pour money into these districts. That is good news overall for Republicans, who could steal a few seats that were considered safe by Democrats, including several in the completely blue region of the North East. Polls in states like New York are showing GOP surges late…that is a sign of good things.

PREDICTION: Gain of 8-12 House seats, up from 5-8 earlier this month.

SENATE

All the real fun is still with the Senate.

The Senate prediction models (538, NY Times Upshot, Washington Post, Realclearpolitics, Huffington Post, Wang,Larry Sabato, and the new AoSHQDD) have slightly moved toward Republicans in the past month, including Dr. Wang’s site, which had heavily favored Democrats last go around.

The short term shift of polls toward Democrats died a quick death, with most of the polls trending toward the GOP over the past several weeks. In that last week before election day, we have seen several polling units show last-minute surges for Republicans. That has solidified some of the ratings changes below:

1. ARKANSAS

Arkansas has trended GOP over the past several months, and Tom Cotton should be considered the heavy favorite. This race looks very close to being over.

RATING: Likely GOP.

2. NORTH CAROLINA

This race is sitting with a razor-thin margin. Kay Hagan has had a lead for months, but that has been slowly, but steadily, narrowing. Several polls show the race tightening or even at the moment. If momentum matters, Tillis will pull it out. As it were, I still have to give a light edge to Hagan, based on her long-term lead. One caveat though: Hagan has polled consistently in the low 40s for the entire campaign; in the RealClearPolitics average, no incumbent has ever won re-election with a rating below 45% going into election day. Hagan will try to become the first.

RATING: Slight Democrat lean.

3. LOUISIANA

This race is likely heading for a runoff in December. Cassidy is trailing slightly in the three-way race for next week, but in head-to-head with Sen. Landrieu, shows a solid lead. He is likely to win the race in December.

RATING: Likely GOP in runoff.

4. Alaska

Alaska is notoriously hard to poll, because of its sparse population. But there has been some decent polling there in recent weeks, and the news is not good for Democrats. Dan Sullivan has opened a small, but persistent, lead over Democrat Senator Mark Begich.

RATING: Leans GOP

5. Iowa

Iowa was considered the ‘firewall’ for Senate Democrats’ hopes to hold the Senate, along with Colorado (see below). Bruce Braley was a unanimous choice as a strong candidate to hold the seat. However, conservative Joni Ernst has run a strong campaign, attacking Braley on both policy and personal issues. Surprisingly, Ernst appears to have the tiniest amount of momentum at this point.

This is another race that a late GOP surge makes me a believer.

RATING: Leans GOP.

6. Colorado.

Along with Iowa, this was considered the Democrat firewall to hold the Senate. Cory Gardner has disrupted that strategy. Gardner is a solid candidate, who has run a clean campaign against incumbent Sen. Mark Udall. Udall has led for most of the year, but recently Gardner has taken a slight, but consistent, lead. Udall has had several hiccups of late, but he still has a lot of money and a strong ground game.

Like Iowa, we are seeing a GOP surge late…and that should take Gardner over the top.

RATING: Leans GOP.

7. New Hampshire

Honestly…I did not think we would be talking about New Hampshire at this point. Sen. Jeanne Shaheen is a relatively popular Senator, with no major scandals. Fmr. Sen. Scott Brown is a relative usurper, moving from Massachusetts just earlier this year. But key issues, including foreign policy, have made this race competitive. Shaheen still holds a steady lead though, and I presume she will pull it out.

RATING: Leans Democrat.

8. Michigan

Of all the races for the GOP, this is by far the most disappointing. I openly advocated for Terri Lynn Land, but she has run a horrendous campaign, where her messaging has been off, her campaigning has been lackadaisical, and she has allowed herself to become mired in silly controversies time and again. Unlike every other Republican on this list, she has actually outspent her opponent, to little or no avail. Gary Peters is not a good candidate, but in a blue state, you don’t have to be a good Democrat candidate to beat a mediocre Republican.

RATING: Solid Democrat.

9. Kansas

This is a race nobody can honestly predict. All the fundamentals should mean Sen. Pat Roberts wins re-election. The polls are not great in this race, but like Sean Trende has said on Twitter, until I see solid evidence, you have to bet on Roberts.

The GOP has ridden to Roberts’ rescue in the last few weeks. And former Sen. Bob Dole pulled out all the stops. My guess is, by the skin of their teeth, that will be enough.

RATING: Leans Republican.

10. Georgia

Georgia wasn’t listed in my last prediction…because I never seriously considered it in play. However, just to show the flux in polling, a surge for Nunn gave her a tiny lead during the interim. Perdue’s polling appears to have rebounded, and he seems to have a small lead. This race looks like it is going to a runoff, but once there, Perdue will very likely comfortably win. However, Perdue has surged enough in recent days, he is achingly close to avoiding a runoff all together by reaching the 50% mark.

RATING: Leans Republican.

PREDICTION: I think the last two weeks have slightly shifted the electorate. Where as some races were true tossups at that time, like Iowa and Colorado, those races now appear to be leaning Republican, if not out right over. For example, the Des Moines Register poll, often considered the premier poll in the state of Iowa, gives Joni Ernst a outside-the-margin-of-error lead of 7 points, and calls the race over. That would have been an unthinkable claim at the beginning of the month.

I think Republicans are going to be very, very disappointed in races in New Hampshire and North Carolina. In New Hampshire, Scott Brown has run an excellent insurgent campaign, very much like this win in 2010 in Massachusetts. However, the GOP was a little late in coming to his aid, and he will probably lose by a point or two.

In North Carolina, Thom Tillis had run a terrible campaign through out the summer. He disastrously remained in the North Carolina state legislature, which not only gave him bad press, but allowed Kay Hagan to pound him on the campaign trail for months. Tillis has done a nice job in recent weeks, both on the trail and in the debates. I think he is going to fall just short though.

When all is said and done, I predict the GOP takes 8 seats, to get to a 53 seat majority in the United States Senate.

OVERALL:

In recent days, a lot of political pundits are already setting up the ‘expectations’ game for both political parties. The Washington Post said the GOP will need a ‘reality check’ after winning. Nate Cohn in the New York Times is that the success in the midterms tells us little about the electorate for 2016.

In general, that is true. The midterm elections really have no significant bearing on what will happen in a Presidential elections. We have to look no further than 1986 Democrat Party victory, after which George H.W. Bush shellacked Michael Dukakis; or 2010, when the GOP had a wave election, only to be overcome by Barack Obama once again in 2012.

Victories this year, mostly in states favorable to the GOP, doesn’t really prognosticate for future victories.

This comes with a couple caveats however. Note how far the GOP has come since just JANUARY. See my predictions from January here, which aligned nicely with those of other pundits throughout the blogosphere. Democrats expected to hold both Colorado and Iowa, with Ken Buck thought to be the expected candidate in the former, and nobody giving Joni Ernst a chance in the latter. New Hampshire was not supposed to really be in play. North Carolina was the one race where Democrats can be happy with their plans.

In short, pundits are moving the bar greatly in these last few weeks. Simply put, virtually nobody predicted the GOP would take both Iowa and Colorado, both blue-leaning states in the era of Obama. And many, if not most, prognosticators thought Democrats would gain seats in the House, or at worst, stay even; instead, the Democrats are guaranteed to lose House seats, and some of those seats may be in relatively ‘safe’ Democrat districts.

The repercussions for 2016 and beyond simply cannot be predicted right now. But the short answer is this: the GOP looks like it is doing their job: elevating their ground game, recruiting strong candidates, and then running relatively err0r-free campagins. The Democrats, on the other hand, tried to depend on past victories in the ground game, recruited some poor to terrible candidates, and have run campaigns full of gaffes and mistakes.

Whether this is a true ‘wave’ election is a matter of opinion. But there is no doubt, this is going to be a solid victory for Republicans, who now have to look forward both on policy and 2016 to make this election matter.

This was cross posted at Neoavatara

Primary Race 2014: Kansas

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Much like Kentucky, which I wrote about yesterday, Kansas is not a primary race I thought of nor wanted to be talking about.

Incumbent Senator Pat Roberts is seeking his fourth term.  He has been a steadfast conservative by all accounts, though a fixture among the Republican establishment.  His re-election should have been a cakewalk.

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However, Roberts has stumbled into a controversy of his own making.  It was recently discovered he lists as his voting address the home of two longtime political supporters who rent out a room to the senator.

Roberts’ campaign has handled the entire story badly.  The Senator himself told the New York Times that he stays with the couple when in the area. “I have full access to the recliner.”

His campaign then promised to release, in detail, the evidence behind Roberts current living status.  After several days, they changed their mind, and stated they would not comment any further on the story.

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Into this mess enters Milton Wolf, M.D.  What is Dr. Wolf’s primary claim to fame?  He is the second cousin of our current President, Barack Obama.  Wolf has been a vocal opponent of the Affordable Care Act from the very beginning, and has been a Tea Party activist for years.

Nobody had seriously given Wolf a chance at upsetting the steadfast Roberts, but the new controversy could tip the tables enough to make the race interesting.  Most conservative groups had stayed out of the race until now, and the few that had voiced any opinion had come out in support of the incumbent.

Wolf is hitting Roberts hard on the residency status, basically accusing Roberts of being a Virginian in fact. Several early radio ads show that Wolf will try to discredit Roberts as quickly as possible.

Is this contest seriously in question?  I remain skeptical, but clearly Roberts has provided Wolf with an opening.  I have a soft spot for Wolf, who is a radiologist like myself.  He will have to make the most of Roberts’ stumble to make this a race worth watching.

 

Primary Races 2014: Kentucky

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This, honestly, is not a discussion we should be having.

Minority Leader Mitch McConnell is an icon in Kentucky. He is a 5 term Senator in a red state. He will raise more money than virtually any other Republican in this cycle.  He has every major Kentucky GOP member behind him.

And yet…this is still an open question.

The problem for McConnnell is his likely Democrat challenger, Alison Lundergan Grimes, Secretary of State of Kentucky.  She has family lineage, Democrat support, and a cash reserve all of her own.

Even worse…she is running even with McConnell in early polling.

Into this dynamic enters Matt Bevin.  A businessman, he believes McConnell has betrayed the conservative wing of the party.  As such, he has the support of virtually every Tea Party and Conservative action group, including the Madison Project, the Senate Conservative Fund, and radio personalities Mark Levin and Glenn Beck.

Questions of Bevin’s conservative credentials came to light this week, as evidence showed that Bevin supported the TARP rescue program in late 2008.  That said, this is likely a small bump in the road for Bevin, and likely doesn’t change his prospects at all.

I am not a big fan of challenging GOP stalwarts that are relatively conservative.  McConnell is flawed, but unlike many of the RINOs of the past, his departures from conservatism largely are because of his leadership position more than his true beliefs.

That said, McConnell is a relatively weak candidate in a state the GOP should and must hold to have a reasonable chance of taking the Senate.  If McConnell’s poll numbers stagnate or drop further, conservatives in the state have to take a serious look at the alternatives.

Primary Races 2014: Nebraska

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Next in our series of primary races: Nebraska, a seat being vacated by the retirement of Mike Johanns.

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Ben Sasse is considered the leading candidate to win the nomination.  Sasse is the President of Midland University.  He has a series of prominent endorsements, including the Senate Conservatives Fund, Club for Growth and prominent GOP leaders such as Tom Coburn and Paul Ryan.

 

He has been steadfastly conservative, opposing Obamacare among other things, though was criticized for his support of Medicare Part D.

The other major candidate is former State Treasurer Shane Osborn.  Osborn actually has a significant history:  he was the pilot at the Hainan Island incident.  On April 1, 2001, Osborn was piloting an EP-3E airplane with a 23 member crew about 70 miles (110 km) away from the Chinese border when it collided with a Chinese fighter jet.

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As Treasurer, Osborn focused on increased transparency for the state administration.  He also put extensive effort into returning private property from the hands of government.

Freedomworks has endorsed Osborn, which sets the major conservative groups against each other in this race.

The other candidates, who are considered longshots, include Sid Dinsdale, President of Pinnacle Bank, Clifton Johnson, and attorney Bart McLeay.

 

Election 2014: Senate

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From Center for Poltics, UVA

The 2014 midterm provides many possibilities, and many conundrums for conservatives. After squandering several ideal potential Senate race victories in 2012, most notably in Missouri and Indiana, Republicans face a relatively favorable landscape in this cycle.  However, that by no means implies that taking the Senate majority will be an easy task.

States that are foregone conclusions:

Safe Republican Seats:  Alabama, Idaho, Kansas, Maine, Mississippi, Nebraska*, Oklahoma, South Carolina (both Senators), Tennessee, Texas, Wyoming.

Safe Democrat Seats: Iowa*, Massachusetts, New Jersey, New Mexico, Oregon, Rhode Island

* denotes seats where the incumbent is retiring. 

Races Up For Grabs:

Alaska:   Mark Begich was lucky to win his seat 6 years ago.  If not for a late prosecutorial action against former Senator Ted Stevens, Begich would never have won the seat in the first place. The best thing going for Begich is the competitive Republican primary, where Lieutenant Governor  Mead Treadwell, 2010 nominee Joe Miller (a Tea Party candidate), and State Natural Resources Commissioner Dan Sullivan will all challenge each other in a heated primary.  Miller ran a very poor race last time, and his strength this time is dubious.  Treadwell is the candidate that is most likely to unite the GOP.  The key point in this race will be Begich’s defense of his Obamacare vote, which will be a recurring meme in this piece.

Prediction:  Slight Democrat lean, because of the GOP primary fight.

Arkansas:  Mark Pryor is among the weakest incumbents, and has consistently trailed Republican Rep. Tom Cotton for months.  Pryor is actively running away from Obamacare now, although advertisement money is pounding him on the issue.

Prediction:  Republican lean.

Colorado:  Mark Udall seems like he was on course for a smooth re-election campaign a year ago; that is no longer the case.  A mix of Obamacare, along with resurgent gun rights movement in the state, have moved his seat into a tossup.  2010 Sen nominee Ken Buck, Ex-state House Majority Leader Amy Stephens, State Sen. Owen Hill, State Sen. Randy Baumgardner, Businessman Mark Aspiri, and Businessman Jaime McMillan all are considering primary challenges.  Buck is the most well-known name, but he ran a poor campaign in his Senatorial loss last time.  This is a primary that will be hotly contested by the GOP and the Tea Party.

Prediction:  Democrat lean.

Georgia:  With the retirement of Saxby Chambliss, and without a clear obvious successor, Democrats hope to steal this seat with Michelle Nunn, the daughter of long-time Democrat Senator Sam Nunn.  Even with money and name recognition, that will be a hard slog.   Ex-Sec. of State Karen Handel, Rep. Jack Kingston, Rep. Phil Gingrey, Rep. Paul Broun, Businessman David Perdue are just a few of the Republicans challenging for the seat.

Prediction:  Republican lean.

Iowa:  Iowa should be a much competitive race for Republicans this cycle, with the retirement of Tom Harkin.  However, a primary race with no clear big name limits the GOP chances against Democrat Rep. Bruce Bailey.

Prediction:  Democrat lean.

Kentucky: Mitch McConnell is the Wiley E. Coyote of Republican politics.  Tea party hates him, he has been challenged multiple times, but he somehow always pulls through.  That is the most likely result here against well-financed Democrat Sec. of State Allison Lundergran Grimes.

Prediction:  Republican lean.

Louisiana:  Mary Landrieu is in trouble.  But we hear this during every re-election cycle and she still manages to pull through.  Is Obamacare the albatross that finally weighs her down too much?  A strong GOP field is led by Rep. Bill Cassidy, Ret. Air Force Col. Rob Maness, and State Rep. Paul Hollis.

Prediction:  Tossup.

Michigan:  This is a race that should be an easy lay-up for Democrats.   Carl Levin has held this seat for decades, and Republicans have not been a significant factor in Senate or Presidential races here for decades.  But former Secretary of State Terri Lynn Land has won statewide races here before, and is well-financed, and Rep. Gary Peters, her Democrat opponent, is not exactly a household name.

Prediction:  Tossup.

Montana:  With Sen. Baucus’s retirement, this should be an easy pickup for Republicans.  But considering 2012 where Republicans lost three seats that they should easily have picked up, nothing should be considered easy.  This is a wide open primary race on both sides of the aisle.

Prediction:  Republican lean.

North Carolina:  Kay Hagan is in big trouble.  She trails all of her GOP challengers, and these are not well-known Republicans running. She is running away from Obama and Obamacare as fast as her feet will take her, but it is not likely enough.

Prediction:  Republican lean.

New Hampshire:  Jeanne Shaheen should be a cakewalk for re-election, but Obamacare is dragging down her favorables.  With former Massachusetts Senator Scott Brown ready to jump in the race, he will make it at least somewhat interesting.

Prediction:  Democrat lean.

Virginia:  Similar to New Hampshire above.  Mark Warner should be walking easily to re-election, but well-known insider Ed Gillespie will be able to raise money and is high-profile enough to make the race interesting.

Prediction:  Democrat lean.

This is just the earliest look at the Senate races.  In the short run, what will be most important is the primary races, choosing the most competent conservative to challenge in the general election.

Early next week, I will have a primer on which primary races we should watch, and candidates to keep an eye on.

 

 

What Really Worries Democrats About Obamacare

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Ignore the media, and the liberal spin.  There is one simple political reality:  Democrats across the board are extremely worried about the Affordable Care Act, and its effect on the 2014 elections.

I have quite a few connections to staffers and other behind-the-scenes people in the Democrat Party.  Talking to them, there is a consensus: they are in trouble.

Some of them fully believe that Barack Obama, Kathleen Sebelius and the rest of the President’s administration can right the ship, and some make the Obamacare system functional enough to please the public.

Most, however, don’t believe anything of the sort.

There is a reason for this:  for all the bluster and hot air about the Obamacare website debacle, that is the least of the worries for liberal supporters of the health insurance reform plan.  In fact, the failure of the website may actually be hiding some of the more pernicious aspects to the health care law.

So here is a timeline of the largest hurdles  the supporters of Obamacare face over the next twelve months:

 

November through December 2013

The enrollment numbers for the first month were terrible, and that is unlikely to dramatically change any time soon.  Initial numbers stated the total enrollment nationwide for October was a meager 50,000 or so.  That is less than 1/10th of 1% of the total necessary to keep the system sustainable.

Obamacare defenders will try to spin that the tens of thousands added on to the Medicaid system as a sign of success, but even people not familiar with the ACA understand it is easy to give away free stuff; It is another thing entirely to get Americans to pay their hard-earned money into the system, when that system may not provide them any great benefit in the near term.

The website functionality is going to be an ongoing challenge as well. President Obama and HHS Secretary Kathleen Sebelius both promised that the website would be working by the end of November.  That now appears to be another ‘incorrect promise’ and frankly, most IT experts I talk to would be surprised if the system is up and running before February.

Website Security will be an issue as this process continues as well. Consumer Reports and others already warned Americans that they should wait until major fixes in the security loopholes were corrected. On 11/19/13, there was testimony that the website places user data at “critical risk” despite recent government assurances it is safe to use.   Several security experts have predicted a large-scale breach in security. Imagine millions of Social Security numbers, credit card numbers, along with IRS tax data and health data being breached.

Amazingly, the entire ACA Payment system also has to be built, after three years.  There is no system at present to transfer funds from the Federal government to the states or to insurers.  And even more shocking? On November 18th, the head of the IT for the ACA admitted that at least 30% of the ENTIRE IT INFRASTRUCTURE still needed to be constructed.

To compound matters, the system also has a nonfunctional subsidy calculator.  What does this mean?  Right now, they are only estimating individuals expected subsidies.  However, if the estimate is incorrect and over estimates your subsidy, you could be liable for hundreds or thousands of dollars more in premiums next year.  This would be problematic in the best of situations.

To compound this problem, the administration is trying to shunt customers to private insurance websites, as a ‘work around’ for  the broken Federal exchange.  The problem is, it is technically against the law for purchases outside of the exchanges to receive federal subsidies.  What happens if a legal entanglement results in those subsidies to be ultimately rejected?  Customers could be in for a real disaster if they agree to purchase insurance, only to find they are not eligible for subsidies.

 

January through June 2014

The first problem is one I have already written about:  Obama will have to break his promise that If you like your doctor, you can keep your doctor.  This promise could never have held true in the market that Obamacare creates, because as predicted, many of the policies purposefully eliminate expensive and elite institutions.

I personally have been booted off of several health care plans because of a cancer center I work at.  I know many doctors stating similar experiences at elite institutions such as Memorial Sloan-Kettering Cancer Center, Mayo Clinic, Cleveland Clinic, and other prestigious institutions. The most famous case was a cancer patient in California who wrote an editorial in the Wall Street Journal, and who could no longer see her oncologists and other treating physicians, because the California exchange had no policies that would include all of her physicians.

The next major debacle will be the surprise of high deductible payments. The majority of the policies being sold are the cheaper ones on the exchanges; the so-called Bronze and Silver plans.  The average yearly deductible, after paying your premium for these policies, is around $5,000.  There is a high degree of variability, but on average these are high deductible plans.  What will happen the first time there is a sick child, and a $5,000 deductible stands between that poor family and a life saving procedure?

One interesting twist will be the use of Obamacare Navigators.  This was a program the administration started to ‘guide’ customers through the process.  Sounds great.  Except for one problem:  many of the Navigators were not appropriately screened, and there has already been a fair amount of fraud in this group of government workers. Undercover videos of Navigators telling customers to defraud the government have already surfaced, and I am sure you will see dozens of those as time goes on.

 

July through September 2014

This is actually when the rubber meets the road.  By this point, no matter how incompetent the administration’s IT experts are, virtually everyone that wants to have insurance should have insurance.  The website problems, even if they still persist, should no longer be relevant.

The first question that will arise is how many people chose to pay the penalty?  For many of the lowest income persons, a penalty of $95 was all that was required to opt out; with the high expense of many plans, a fair number of people will choose this option.

More important is the ratio of healthy individuals compared to sick ones in the exchanges.  For the exchanges to survive, they require a very high ratio of healthy people buying in, in order to subsidize the rest of the population.  Recent data from Kentucky (supposedly a liberal success story) shows that the ratio of healthy to sick is closer to 1:4 than the close to parity required for financial sustainability.

What happens if this does not occur?  Insurers will enter the oft talked about ‘death spiral’.  They will be required to raise their future premiums in 2015, because the cohort of patients in their insurance pools are less healthy, and thus, more expensive to treat.  The death spiral occurs as young, healthy persons realize that the increased costs of their insurance is not worth it, and opt out…further increasing the ratio of sick persons in the insurance pools, and further increasing costs.  This is the scenario that most scares Obamacare proponents.

The irony of all this is this presumes that the individual mandate  is not delayed.  Right now, the Upton and Landrieu bills sit in Congress, and Obama has announced his executive order to ‘fix’ the problem of policy cancellations.  The more delay of the individual mandate, either by legal methods or presidential signature, the more likely it is that insurers will have costlier insurance pools that will drive up premium costs moving forward.

The next problem is how this huge new population of insured patients will be treated by a system that is already overburdened.  A doctor shortage very well could arise.  Something similar, but to a lesser scale, occurred during Romneycare’s implementation in Massachusetts.  Massachusetts was more prepared than most states, as it has the highest ratio of doctors to patients in the country.  Even then, access to physicians, especially specialists, was restricted substantially.  Now imagine the states with low doctor to patient ratios, and you can imagine the complications that could arise.

That doesn’t even take into consideration that many physicians are likely to opt out to the largest expanding health care insurance program in the country:  Medicaid.  Already in states like New York, about a third of doctors have opted out.  Many physicians, especially those tied to hospitals, cannot opt out.  But this decrease in available primary physicians to handle this huge new number of Medicaid patients (who are among the sickest and poorest patients around) could be a disaster, and there is no short term solution to this problem.

 

October through December 2014

This is where all the real excitement occurs.  Let us assume some how, some way, Democrats have survived the year without any major catastrophes, and are holding their head above water as the midterm elections come.  There are several huge hurdles still remaining.

The first, and largest by far, will be the kicking in of the employer mandate. Remember that this mandate was supposed to occur this year; however, because of the completely broken and unworkable system, Obama delayed it (outside of legal bounds no less).  But the employer mandate is the crux of the entire system; the majority of Americans get their insurance through their employer, and insuring this mandate is vital to that majority.

The problem arises in the fact that in the same way that millions are losing their private insurance plans today, even a greater number of employees are likely to either lose their plans or see drastic changes next year.  This was predicted by the Department of Health and Human Services as far back as 2010.  Now is when that change kicks in.

Furthermore, millions of small business owners will have to decide whether to pay for insurance, or send their employees into the exchanges; the same exchanges that are so far struggling to handle the volume and load.

For employers that are going to continue their insurance plans, another problem: they will likely get notices from insurance companies that the plans they currently purchased no longer exist.  Sound familiar?  And insurers will, under Federal law, have to do that a minimum of 60 days before cancellation, meaning…the beginning of November, at the very latest.

And, remember the ‘death spiral’ we discussed above?  If insurers face that hurdle, they are likely to raise rates across the board.  Here is the biggest problem of all: for all the talk about these changes affecting only the people on the exchanges, if and when a ‘death spiral’ or anything like it occurs, costs will rise for everyone.  That means increased premiums for businesses, which will likely be passed on directly to employees.  Some employers will also likely choose the easy option, which is shifting their employees to the exchanges.

And all this will be announced just weeks before the election.

 

After all of this, you begin to understand why those that truly understand the steps necessary in the next year to implement the full-scale of the Affordable Care Act are worried.  Right now, we are seeing the tip of the iceberg: gross incompetence in establishing a website for entry into this behemoth government monstrosity.

But once you enter this behemoth, you start to understand that there are numerous interweaving and interconnected cogs that will need to work relatively smoothly, or the system as a whole will flounder.

That doesn’t even tell the political story.  Every week, if not daily, there will be a story about individuals who are being harmed by the ACA.  Those stories will drown out any of the positive stories, because we know that ultimately the media highlights the negative.  As stated above, when a child or young mother is denied life saving treatment because of restrictions placed upon them by Obamacare, who takes the blame?

Liberals are trying to circle the wagons, to keep sustainable political support for the plan, in the hopes that the Obama Administration can fix the problems in short order.  But as you can see above, there is no simple fix.  Many of the ‘problems’ with Obamacare are inherent to the system that Democrats devised.  These were intended results.  How do you fix the plan, when it is the intent of the plan that is the problem in the first place.

So batten down the hatches, America…it is going to be a bumpy ride.

 

Obama’s Redemption?

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Conservatives love to despise Barack Obama.  The first reason is because he was a neophyte with little experience that rose to the top leadership position in the world, mostly riding his media status.  Second, because he is arrogant and espouses his moral superiority, even when being a hypocrite about it.  Third, because his own analysis of his leadership skills is woefully incorrect.

On most of the grand issues of the day, Mr. Obama has taken the wrong path. He could have built a stimulus program in early 2009 that actually promoted job growth.  He could have pushed Democrats to build a health care plan that reduced and restrained costs instead of increasing them.  And then for the last two years, he could have pushed tax reform and entitlement changes instead of reverting to the classic tax and spend mantra that has haunted liberals for decades.

But he has always taken a pass.

Last week proves hope springs eternal.  Mr. Obama invited a group of Republican Senators to dinner to talk about how to move forward in his final four years as an American President.  And according to reports, Obama was more open and honest than he has been in the past.

Despite liberal whining about how much Barack Obama has had to endure from Republicans, the reality is he has never faced an opponent greater than himself.  Obama’s primary problem through out his Presidency is the inability to tell everyone, including his own party, to ‘Go to hell’, and simply lead on an issue.

Leadership, true leadership, begets public support.  See Rand Paul’s crusade on civil rights and drones last week, ironically occurring the same time as Obama’s dinner round table with the GOP.  This wasn’t an issue that the media, Republicans or Democrats for the most part cared about.  But the public did care.  There is a growing unease of the every expanding power of the President when it comes to such things as drones.  Paul simply was willing to take a stand, even if he knew there was no path to victory in his endeavor.

Obama has never done that.  Can you think of a stand Obama took that was not cautious, thought out, and strategically positioned in such a way that Obama could either back down or blame someone else for its failure?

During his dinner with the GOP, Obama seemed reluctant to lead on the issues, again.  From Peggy Noonan, from an unnamed Senator at the meeting:

Senator No. 1: When pressed on the question, the president seemed to step back. “His idea of a process is, ‘You guys figure it out and work with my staff, and if you need me call me.’ But in the end, unless the president really gets engaged and forces meeting after meeting, I don’t see how you get past the logjam.”

…or this…

Senator No. 2: “At the end I mentioned, ‘Share [with us] how you see this going forward.’ ” Here the president “got hazy. . . . I told him this will never work without adult supervision from the White House. I don’t think he comprehends that this is part of getting something done.”

Senator No. 2 said he planned to “press” the president in coming days “to lead, to exert authority.”

Obama, at this moment, has a chance to lead.  What does he honestly have to lose?  He was a solid victory for re-election, is the undisputed leader of his party, with Democrats (even if they disagree with him) willing to go to the mat for him.  He will never face election again, and the only thing remaining in his future his his legacy, which at the moment, is mixed.

But is the President willing to use that political capital?  The above quotes lead you to believe the answer is ‘No’.  A report from the Politico states more than half of the Democrats in Congress oppose any changes to Social Security, Medicare and Medicaid, which is fiscally insane.  Another quote from Noonan’s article:

At certain points in the conversation the president, according to the senator, said that even if he wanted to agree with the Republicans on certain specific questions there would be a rebellion in his own party: “He said that a few times. But that’s an abdication. You have to lead! You have to educate as only a president can with a bully pulpit, you have to bring your party along.”

Tuesday was the first time that I can remember that President Obama speaking to his liberal caucus, and telling them hard truths. Obama met with Senate Democrats, and was up front for the need for entitlement reform.  He stated his need to exchange entitlement cuts for more taxes.  We can debate the numbers and the actual specifics, but for Obama to tell liberals they will have fundamental changes to entitlement programs is some what of a breakthrough.

A tremendous amount of opposition to this kind of plan exists among the liberal base, and I am not sure that the President realizes what kind of fight he is in with his own party if he is honest about achieving these goals.  And of course, from our side, we conservatives have a huge trust deficit with this President, after 5 years of having the football pulled out from under us, Charlie Brown-style.  Mr. Obama will have to be forthright and honest through out the process to build enough respect and faith to get such a big deal done.

I have long said this is not an intellectual barrier for the President, but a psychological one.  Barack Obama has long been a cautious person, unwilling to take public stands that reflect poorly on his character or his public persona. Maybe this is what comes from being America’s greatest African American politician; maybe it is a reflection of African American society today to avoid risk.  I don’t know.  But I know that reality exists for this man.

So ultimately, Mr. Obama could lead.  He could get a grand bargain of tax reform, entitlement recalculation, and budgetary changes that could put the country on a long term path of fiscal sanity and economic prosperity.  It would mean he would have to compromise with the GOP and push back against liberals in his own party.  Ironically, I seem to believe the latter is much harder for this President than the former.

This was cross posted at Neoavatara

A Positive Few Weeks For The GOP

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It has been an inglorious few months for the Republican brand.  Everything that could go wrong has, and the momentum politically has been all in the direction of the President and his allies.

The past couple weeks however marked the first time since the election that is not the case.

It began, predictably, with gun control.  I predicted long ago that the gun control fight would be a political road bump that the Democrats would not pleased by.  Last week saw the first inkling of that reality.  Mr. Obama released his presidential orders (of which, all that can be said is they were of no real consequence, either to defenders of the 2nd amendment or prohibitionists).  He then followed with his legislative plan for Congress.  This week Senator Feinstein released her plan to the public as well.

And that was largely responded to with a big ‘thud’.

What is glorious about the gun control debate for Republicans is that this is a fight that will be fought completely on the Democrat side.  For the most part, Republicans will vote against any assault weapons ban.  They may be willing to look at background checks, the so-called ‘gun show loophole’, and other fringe items.  But the prohibitionist wing of the Democrat Party demand a Brady-like assault ban.

To have any chance of getting this through, they need to be able to get it through the Senate.  Even if somehow they can get around filibuster rules, it is uncertain whether they can get 51 votes needed to pass the measure.  At least 10 Democrats (including 7 from red states running for re-election in 2014) have signaled distaste for the ban.  And of course, they don’t want to be holding the bag if the House GOP vote against it.

Boehner, in a moment of great wisdom, refused to take a stand on the issue…thus leaving the onus on Senate Democrats.  That is precarious position for them.  First, they refused to overturn the filibuster rules, which means on top of having to take unpopular votes, they need several Republicans to side with them.  And with momentum in the media and in polls significantly slowing for gun control, time is running out.

The GOP had little to do with the gun control debate, but had to a lot to do with the shift in the debate on the debt ceiling and the sequester.  This week, they made public a plan to give a short term extension to the debt ceiling, but promised progress only if the Senate held up their legally bound duties and passed a budget.

Again, this is a situation where the GOP has now shifted the responsibility, to some extent, to Democrats. The fight over the artificial debt ceiling was a defensive posture for the GOP, and not they were ever going to win.  However, we see the first rays of light that this posture may pay dividends.  From the Washington Post‘s editorial board, lauding the move:

Mr. Obama must distinguish between the Republicans’ unreasonable positions and their reasonable ones. Refusing to consider tax increases and holding the debt ceiling hostage were examples of the former; both have now been significantly modified, if not abandoned.

Insisting on serious reforms to entitlement programs, however, was the GOP’s reasonable demand, one the Republicans have not abandoned. This presents Mr. Obama with a choice: He can continue driving a hard bargain, in both political and policy terms. That would presumably entail refusing to deal on entitlements until the Republicans capitulate with regard to the sequester and a partial government shutdown on March 27.

Or the president could act on his past promises to tackle entitlements and engage in good faith with Republicans now, so that they have no further reason to exploit the sequester or threaten a shutdown. In that regard, a reference Friday by the White House to purported GOP plans for “drastic cuts in Medicare” was not an encouraging development. There is still plenty of time for Mr. Obama and Mr. Reid to show that they are willing to treat the GOP’s change in position as an opportunity to address the country’s long-term fiscal needs, rather than their party’s short-term political ones.

This is the first times in months that I can remember a major liberal publication taking any GOP argument’s side in the debate.  Surely, others like the New York Times will pull a ‘Pelosi’, and argue that any discussion of a normally passed budget and proper appropriations process is, in her words, ‘ludicrous’. But most common sense people have been arguing for this for at least four years.  The budgetary system is broken.  Yes, Republicans played a part in it.  But now, the Republicans are willing to fix their mistakes; are the Democrats?  I think it is doubtful, but this places the responsibility for failure back on the shoulders of Harry Reid and Barack Obama, squarely where they belong.
The last shift may be the most important, in the long term.  Sen. Marco Rubio finally released major portions of his long awaited immigration plan.  Rubio’s plan would allow illegal aliens to get a pathway to a green card and citizenship, but unlike Obama, would not allow them to ‘jump the line’, as it were, and demand they enter the normal naturalization process with all those that have followed the law and applied for entry in the United States in the proper way.
Rubio’s position was quickly supported by Paul Ryan and others, and likely allows the GOP a workable way forward in the immigration debate.  Rubio’s position is actually much more logical and a stronger position than that of Obama, which would give preference to illegals over those that followed the law; a policy which I believe the public would find abhorrent.
Whether the far right would accept this, or would still call it ‘amnesty’ is up for debate, and also there still needs to be a discussion about how to shore up border security.  However, for the first time since President Bush suggested immigration reform in 2005, we are in a position of discussing policies, instead of simply playing a defensive posture going forward.
The path for the Republican Party is quite clear in these three examples.  We must first accept the reality that we do not, in any real way, control Washington. Second, although the above is the case, we must still provide policy solutions to the problems at hand, and more specifically, show why Democrats positions are either untenable or simply ludicrous.
There are of course many potholes on the way for the GOP.  And a comeback, politically speaking, is a long way off.  But the seeds of how to get the Republican party moving in the right direction is here…if we look hard enough and accept it.
This was cross posted at Neoavatara