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Cross-posted at The Makeshift Academic

In breaking news, the Montana House of Representatives passed a Medicaid Expansion Bill to a final reading by a 54-46 vote yesterday.

The expansion called the Health and Economic Livelihood Partnership Act (HELP Act), is a slightly  amended version of Senate Bill 405, which was approved in that chamber on March 30 by a 28-21 vote.  The amended House version, slated for final approval today, is almost certain to pass the Senate next week, after which Democratic Governor Steve Bullock will be extremely likely to sign the HELP Act into law.

The bill is slightly different from a traditional Medicaid expansion in that it will require some beneficiaries to pay co-pays; and has a job search component. However, as Section 6 of the bill notes, those co-pays will not exceed caps and regulations established by law.  The job-search component (Section 14) also appears to not eligibility for the program and only asks the state labor and industry department to partner with the state health department to match up HELP beneficiaries with potential job openings.

This should get through the Federal Department of Health and Human Services with few problems.

In both chambers, a moderate Republican sponsored the bill. In the House, Democrats managed to get the bill out of a hostile committee that had bottled up both it and Bullock's expansion proposal this year by using a legislative stratagem called the "Silver Bullet," under a gentleman's agreement during this session that each party gets to move six bills of their choice that have been blocked in committee on to the House floor for a straight-majority vote.  Eleven Republicans helped the 41 Democrats in the chamber get the bill on the floor, while 13 GOPers joined the Democrats to advance the bill to final passage.

There are four things about this that are great news:

1. Poor Democratic Representative Tom Jacobson will finally get to forget about his accidental vote that killed expansion in 2013.
2. These guys spent a lot of money on an astroturf campaign that is going to fail.
3. 29 states now will have expanded Medicaid coverage.
4. Best of all,  27,000 to 45,000 people are going to get access to health insurance.


(Cross-posted at The Makeshift Academic)

Much of the focus in the Senate right now is justifiably on the GOP majority's slow-walking Loretta Lynch's confirmation vote for attorney general on the Senate floor.  

But what's getting a lot less attention is the predictable lack of traction that President Obama's judicial nominations are getting.

The Senate has not confirmed a single judicial appointment this year in three months of work.

Contrast that with the first three months of 2014, the Democratic majority confirmed three circuit court judges and 16 district court judges.

In the first three months  of 2007, the incoming Democratic majority confirmed two of George Bush's circuit court nominees and 13 district court nominees.

Four rather uncontroversial district court nominations are waiting for a floor vote --three in Texas and one in Utah -- all which easily cleared the Judiciary committee in February. They'll get through the Senate eventually, but somehow I don't think Mitch McConnell has them as a priority.

Just another reminder that elections matter.


(Cross-posted at The Makeshift Academic)

Newly minted Oregon Governor Kate Brown kicked her administration off with a bang on March 16 by signing a motor-voter bill on steroids into law.

The law is good policy and will remove some considerable hurdles to voting for a large number of people. However, it does leave out potential voters and may not in itself increase voter turnout all that much.

The bill makes voting registration automatic for any eligible potential voter existing in the Oregon State Department of Motor Vehicles database. This feature goes far beyond federal requirements, which simply make it mandatory to allow residents to register to vote when they get a license. According to Reuters, the bill could expand registration by 300,000 voters – an increase of about 13.7 percent over the most recent voter roll.  

That’s good news and brings Oregon’s policies much more in line with most other industrialized democracies, which automatically register voters whenever they move. Coincidentally, most of those countries traditionally have had higher turnout than the United States. Better yet is that these policies will automatically keep track of people who tend to move around a lot and who have their registration fall through the cracks, like younger people – particularly students – and working families.

But the law doesn’t cover everyone. People without driver’s licenses (who often will not be in the DMV’s files) won’t get tracked; and those individuals tend to be disproportionately poor and/or people of color as we know from the battles over voter ID in numerous states.

Additionally, political science strongly suggests that easing barriers to voter registration doesn’t necessarily increase voter turnout.  Candidates and parties still have to give people a reason to vote and actively work to effectively mobilize and get them to the polls.

So raise two-and-a-half cheers for Oregon making it easier to participate in the democratic process. Now progressives just have to make it worth the new voters’ time to actually, you know, vote.


(Cross-posted at The Makeshift Academic)

On March 15, American Federation of Teachers President Randi Weingarten published an Op-ed in the Huffington Post contrasting the recent economic performance of two very similar upper Midwestern states that have chosen drastically different governments: Minnesota and Wisconsin.

But what we often forget is that Minnesota came perilously close to following Wisconsin to the dark side.

We know the policy story. Wisconsin has been under unified Republican control since the 2010 elections. Governor Scott Walker has spearheaded a hard-right push in state politics: crushing public sector unions, signing “Right-to-Work” legislation that will cripple private sector unions, cutting taxes for the wealthy, stiffing Obamacare's Medicaid expansion, gutting funding for public schools and universities, centralizing power in the governor’s offense, gutting environmental protection, killing useful transportation projects…. Sigh… frankly, to go into detail and finding links is just too depressing. Go read Charlie Pierce so at least you can laugh along with the despair. As Weingarten and others have noted, though, Wisconsin hasn’t performed that well in economic growth or jobs growth.

Minnesota, on the other hand as Weingarten argues, elected Democrat (technically Democrat-Farmer-Labor) Mark Dayton to the Governor’s chair in 2010. Dayton raised taxes on the wealthy, invested in public schools, worked with organized labor and aggressively implemented the Affordable Care Act. The state has performed much better on the economic front than Wisconsin, and indeed the U.S. at large.

But that critical 2010 election actually looked pretty similar in the two states. In an electoral disaster, Democrats lost majorities in both houses of the Minnesota State Legislature, turning an 87-47 majority in the House into a 72-62 minority. A 46-21 Senate supermajority became a 37-30 minority. In Wisconsin, narrow Democratic majorities became a medium-sized 19-14 Republican majority in the Senate and a 58-41 majority in the Assembly.

The Minnesota legislature was interested in many of the same things that Walker wanted – after a budget standoff with Dayton in 2011, they tried to push a “Right-to-Work” law through in a constitutional referendum in 2012, though it failed to make the ballot.

The difference was in the Governor’s Race. Walker beat Democrat Tom Barrett in a clear though reasonably close election by 120,000 votes out of about 2.2 million cast (52.3 percent to 46.5 percent). Dayton, in contrast, barely squeaked by conservative Republican Tom Emmer by an 8,730 vote plurality out of 2.1 million cast (43.6 percent to 43.2 percent).

Maybe it was Dayton’s higher name-recognition as a former Senator; maybe it was the fact that the incumbent in Minnesota was a Republican and not a Democrat. But whatever the reason, those 8,730 votes put Minnesota progressives in position to block the attacks on labor and public services that took place in Wisconsin. And they left them in position to push a progressive agenda when Democrats managed to take back both chambers of the state legislature in 2012.  

Let that be a bit more motivation to knock on one more door, make one more phone call and give $10 more in the next state election.


Cross posted at The Makeshift Academic

With the results of the 2014 elections, the pace of Medicaid expansion has become frustratingly slow for progressives.  However, the overall picture has two very important positive points for those seeking to provide universal health care in this country. First, despite meeting several setbacks and roadblocks recently, the expansion continues to grind ahead –excruciatingly slowly, but ahead all the same -- to new states. Second, recent developments in Arizona and Arkansas suggest that a state’s expansion may be durable even in states that get taken over by hard-right governments.

On the first point, Indiana joined the parade of Conservative states expanding Medicaid under a waiver in January. Pennsylvania, under its new Democratic Governor Tom Wolfe, has thrown out the complicated waiver plan submitted by outgoing governor Tom Corbett and is replacing it with a traditional expansion more congenial to beneficiaries (elections matter). Frustrating setbacks have happened in Tennessee and Wyoming, when legislative committees defeated plans negotiated by their governors to expand Medicaid, at the behest of an Americans for Prosperity pressure campaign. However, Utah and Montana are still considering their own plans – and Kansas(!) of all places looks like it may join soon too. Vox, as usual, has the snappy summary.

The second point is more interesting and, for now, just as encouraging. In 2013, Arkansas had negotiated an expansion with waivers under Democratic Governor Mike Beebe to mollify the Republican-controlled legislature. However, it looked like the plan might not survive new Republican Governor Asa Hutchinson and a much larger and more conservative Republican majority elected in 2014. But Hutchinson got behind the program with a few tweaks and convinced the legislature to approve it for another two years while forming a committee to seek a new waiver in 2017.  

In Arizona, the situation appears more ambivalent. Outgoing Republican governor Jan Brewer choose to expand Medicaid in 2012 over howls of protest from conservatives in her legislature. Incoming Governor Doug Ducey has suggested he’s against the expansion, while conservatives made gains in the Arizona statehouse in 2014. Medicaid expansion looked doomed.

But an in-depth examination of legislation Ducey just signed trying to curtail the expansion is instructive. The legislation consists of two Republican pet rocks: attaching work requirements to Medicaid recipients, and limiting beneficiaries to five years total of receiving Medicaid before throwing them off the program. It’s an ugly bill. But notice that the law doesn’t eliminate the expansion, it only attempts to modify it with issues a GOP legislator could plausibly defend as “common-sense reforms” to their tea-party constituents. More importantly, any of these changes would have to be negotiated with the Federal Department of Health and Human Services.

At least for the next two years, those negotiations are going to go like this:

ARIZONA: “We want you to give us a waiver to create work requirements for beneficiaries and throw them out of Medicaid after five years” (hands over proposal).

HHS SECRETARY BURWELL: “Would it annoy you if I did this?” (Folds proposal into paper airplane and tosses it back at Arizona’s forehead)

The bill binds Arizona state officials to go back to the Feds every year and beg for the waiver.  Those conversations are going to go like this:

ARIZONA: “We want you to give us a Medicaid waiver to…”

BURWELL: (Takes proposal. Blows nose on proposal. Crumples it up and hands it back.)

What we have here is Politics 101: it allows Arizona Republicans to both whine loudly about how horrible the federal government is, while looking like they are doing something to fight the dastardly Obamacare Medicaid expansion by writing sternly worded letters. They also get to quietly take advantage of all its benefits (including federal funding) that will remain at least as long as a Democrat controls the White House.

So at first glance, at least, the Medicaid expansion is looking surprisingly resilient, even in its infancy. Despite the poor results of the 2014 elections, the expansion continues to meander forward in several states. Better yet, every state that takes the expansion may have quite a hard time getting rid of it. This stickiness is good news for justice and for hundreds of thousands of people who get access to health care.


Crossposted at The Makeshift Academic

On January 30, Ezra Klein posted an insightful Vox piece about one of the great ironies of the Affordable Care Act.  After a lot of thought of my own, however, I don’t think it’s much of an irony at all.

Klein’s analysis noted that the original ACA – supported heavily by Democrats – featured a massive redistribution of wealth from Blue States to Red States.  The people helped by Obamacare’s Medicaid expansion and exchange subsidies were disproportionately concentrated in the states of the ex-Confederacy that had low-wage economies with skimpy existing Medicaid programs. (An old joke in Mississippi claims that you have to be legally dead to qualify).

The irony that Klein points out has been that Republicans are fighting tooth and nail to turn the ACA into a program that drains money from Red States and transfers it to Blue States. When the Supreme Court held that the Medicaid Expansion had to be optional for states, many states dominated by Republicans declined the expansion while Blue States snapped it up, shifting the benefits flow from Red States to Blue States If the Supremes decide the case of King vs. Burwell in favor of the forces of darkness, it will declare subsidies on exchange marketplaces illegal – but only in the states on the federal exchange, which of course are disproportionately Red States. As a result, higher earners in Texas will be sending their increased Medicare taxes to poor and working-class people in states like New York and California while their own states lose out.

It’s an interesting puzzle, but I think it can be explained quite easily – at least on the liberal side of the equation – by changing our unit of analysis. Klein looks at states, but I think it makes more sense to look at people to explain this paradox. On some issues, perhaps it makes sense to look at issues as state vs. state.  If a major manufacturer decides to leave one state and move to a second, for example then pretty clearly the second state is better off relative to the first. Politicians will act accordingly and line up state against state.  

But the motivating purpose behind the Affordable Care Act wasn’t about New York vs. Texas, it was about 48 million people in the United States who didn’t have health insurance. Ohio Senator Sherrod Brown didn’t refuse to take federal health insurance because Florida got more Medicaid dollars than Ohio, but rather in solidarity with millions of Floridians and Ohioans who didn’t have access to health care at all. If Mississippi took $14.5 billion in federal money over the next decade to expand Medicaid, I wouldn’t be mad that that money wasn’t going to Pennsylvania, my latest state of residence; I’d be celebrating because 169,000 of my fellow citizens got access to health care.

On the flip side, the logic is perhaps more difficult to explain for a Red State GOP governor like Rick Perry or Mississippi’s Phil Bryant. There’s the potential that they just don’t understand it. Perry recently suggested that millions of Texans liked not having insurance, which may represent a weak dodge or actual ignorance of reality. But there’s also the possibility it’s about people for them too – specifically “those people” who are poor and likely have a darker hue of skin and are viewed as undeserving of federal benefits. Politicians used to be able to wrangle earmarks and pork for their state , which reduces the role of ideology, but ideological sorting and polarization has been getting stronger over the last 40 years. As a result, politicians who rely on bringing home federal dollars to get votes find themselves facing tough primaries, like the one Thad Cochran barely survived in Mississippi in 2014.

We can solve Klein’s puzzle then by re-imagining the pieces. It’ not about cash flows to states, it’s about people – and whether a state official’s ideological blinkers permit those without access to health care to be seen as human beings deserving of compassion or dignity.


(Cross-posted at the Makeshift Academic)

The dust has cleared on a brouhaha surrounding a proposed minimum wage hike in Michigan.

The good guys (mostly) won – thanks to grassroots organizing, massive public pressure and some skilled negotiating behind closed doors. It was an incomplete victory, but it was a victory all the same – most low-wage workers in Michigan are getting a 25 percent pay increase over the next three years to $9.25.

The story starts at Raise Michigan, a grassroots organization that put together a petition drive in February to put a proposal before the legislature to amend the minimum wage to raise the wage. If the legislature didn’t pass it, it would go before voters in November.  It’s a similar gambit that anti-choice organizations used to circumvent Gov. Rick Snyder’s veto of legislation that excluded abortion coverage from Michigan’s health insurance exchange last summer.

The idea was to raise the wage for most workers from $7.40 to $10.10 an hour over three years from, 2015 to 2017, and then index future increases to inflation. As importantly, the petition would also raise the minimum of tipped workers from the current unconscionable $2.65 an hour by 85 cents a year until it reached parity with the rest of the work force.

Of course, the usual suspects in business and the restaurant industry cried bloody murder about how giving low wage workers a raise to non-poverty income levels would wreck the economy.  But the legislature’s Republican majority was in a pickle – if they defeated the measure in the ledge, then it would go on the ballot – where minimum wage increases tend to fare quite well.

In response, Senate majority leader Randy Richardville (the dude who drove me to blog in the first place) reasoned that if the minimum wage law was repealed, then technically an initiative amending the law would be out of order.

Follow me below the fold for how that particular evil gambit actually turned into a productive set of negotiations and a legislative victory for progressives in a GOP-dominated environment.

Continue Reading
(Cross posted at the Makeshift Academic)

There’s been a lot of frustration among Progressives over Republican senators continuing to block Obama judicial picks in committee thanks to the blue slip system. The latest manifestation of the frustration comes with Michael Boggs, a Republican-backed candidate nominated as part of a deal to fill several slots on federal bench in Georgia (In return for nominating Boggs and two other district appointments, Georgia’s Republican Senators agreed to allow the nomination of Jill Pryor to move forward for the 11th Circuit Court seat and Leigh Martin May for a district judge seat.)

Progressives' frustration is understandable – as a state judge and legislator Boggs has defended voter identification laws, displaying the Confederate flag and opposed gay rights. However, Democrats should also keep their eyes on the forest through the trees: with the elimination of the filibuster for most executive nominations last November, judicial confirmations have drastically increased.

How much?  In 2014, the Senate has confirmed 40 judges thus far – 33 in the district courts and seven in the appellate courts. During the first five years of Obama’s presidency, the previous high number of judges confirmed through the end of May was 24 (in 2011 and 2012).  That translates into an increase of 67 percent in the number of judicial confirmations. Oh – and we’ve still got another week of Senate business to go in May.

In addition, the vacancy rate is also starting to decline noticeably on the federal bench.  At the beginning of December, just after the Senate eliminated the filibuster, there were 86 vacancies on the district and circuit courts. That number increased on February 1 to 96 openings – likely because GOP obstruction forced Obama to resubmit every nomination, forcing a fresh round of committee hearings. However, by the beginning of March, the number of vacancies was beginning to fall and has continued to decline ever since. By May 20, the number of vacancies had declined to 67, a decrease of 30 percent from its February high (See figure above).

Again, this happening doesn’t mean that everything is rosy.  In some states dominated by conservatives, the process is slow (like in Georgia) or seems entirely hopeless, like in Texas (though the Fifth Circuit court picked up Texan Greg Costa yesterday).  

And would some one give Jennifer Prescod May-Parker of North Carolina a commission already?

However, even in some conservative states there has been progress. Four nominees from Florida have cleared committeeand await final confirmation after months of obstruction from Senator Marco Rubio. More importantly, Arizona has a functioning district court for the first time in several years as six  nominees received confirmation last week – including Rosemary Marquez, who was first nominated in 2011 and blocked by Arizona's senatorial delegation, and Diane Humetewa, the first Native American woman to become a federal judge.

Progressives are right to be frustrated by continuing blocking of some nominations.  however, we should keep it in the back of our minds that nominations are flowing much more quickly now than they were a year ago.


(Cross posted at the Makeshift Academic)

With the filibuster dead for most executive appointments, Senate Majority Leader Harry Reid has stepped on the gas for judicial appointments this spring.  As of May 2, the body had confirmed four circuit court judges and 24 district court judges in 2014 – a veritable consentapalooza.

But for all the progress on nominations, the character of the federal bench is changing more slowly than it appears on the surface. This is because many judges who retire from their court don’t fully step down. Rather, when they take senior status, they still hear some cases.

How big of a stamp can these semi-retired judges make? Sometimes a profound one, depending how the draw affects the composition of a three-judge panel at the circuit court level -- one step below the Supreme Court.

Take for example the recent infamous case Hobby Lobby vs. Sebelius currently before the Supreme Court – in which a corporation claims to have religious rights to evade the contraception mandate in the Affordable Care Act. The opinion at DC Circuit was authored by noted fire-breathing conservative circuit justice Janice Rodgers Brown. However, the other judge that joined the opinion was A. Raymond Randolph – a George H.W. Bush appointee who took senior status in 2008. (For that matter, the dissenting justice was Harry Edwards, a Carter appointee who took senior status in 2005)

Semi-active senior judges also boast impressive numbers.

With the confirmations of Michelle Friedland and Nancy Moritz (Moritz is up on Monday) , Democratic appointees will hold 80 judge ships on the circuit courts and GOP appointees hold 74, with 14 vacancies.  

However, there are 91 active judges with senior status – 55 appointed by Republican presidents and 36 by Democrats. Throwing them into the mix leaves us with 129 Republican appointees and 116 appointed by Democrats – quite a shift.

This comparison is a bit misleading – most of those senior judges don’t hear as many cases so the GOP advantage is overstated considerably. (Senior judges hear about 15 percent of all cases across the court system.) Nor do senior-status judges sit on en-banc cases at the appellate level in which the entire court hears a case and often overturns the decision of a smaller three-judge panel.

However, the presence of senior judges is currently working to slow the pace of progressive judicial decisions, which is all the more reason to keep aggressively confirming judges.


(Cross posted at the Makeshift Academic)

Later today, the Senate is going to vote to confirm Michelle T. Friedland to be a judge on the Ninth Circuit Court. You can read up on her here – she’s pretty darn impressive in both competence and politics.

Oh, and by the way, the Senate will also appoint David Weill as the administrator of the Wages and Hours Division for the Department of Labor -- you know, the people who stop low-wage workers from getting ripped off by their employers.

You probably haven’t read much of anything about either nomination. These appointments seem entirely unremarkable and ordinary. Frankly, they should be, it’s a routine part of making government function. And in the post-filibuster world, routine nominations, judicial and otherwise actually seem to be proceeding fairly smoothly for the first time in five years.

During the first four months of 2014, the Senate has confirmed 20 judicial nominations – the most of any of the first four months of any calendar year of the Obama administration. On average, Majority Leader Harry Reid seems to be confirming either one appeal court nominee or four district judges per week the Senate has been in session this year.

Things aren’t perfect.  In some cases Republicans are still blocking qualified nominees in committee through the blue slip system– like North Carolina’s Jennifer Prescod May-Parker. In other cases, Republicans aren’t providing any input on nominees at all – like in Texas while the state’s federal bench languishes, as Houston's ever-handy Charles Kuffner has pointed out. And in some cases, they are driving a hard line – insisting on having Obama nominate a large number of their nominees in exchange for seating a few of his, like in the Northern District of Georgia -- a deal that has irked the state's civil rights community.

Even the Friedland nomination should have been voted on before the Senate left town for the Easter recess on April 10, but Republicans insisted upon using their allotted 15 hours of debate to slow down the nomination (though none of them actually planned to debate).

However, overall the nominees are both flowing in a more orderly manner through the confirmation process.  There are currently 50 judicial nominations awaiting action in the Senate (eight appeals and 42 district). Thirty-one of those have moved through the judiciary committee and are awaiting final confirmation.

Among those 31 include several  nominees from Arizona and South Carolina, who had been languishing for months in committee.

Once those are confirmed (hopefully by August) that will leave Obama with 50 appellate appointments and 214 district appointments – roughly on track to match George W. Bush’s total number of appointments.

Overall then, move to end the filibuster for most executive appointments seems to have been a good one.

Continue Reading

(Cross Posted at The Makeshift Academic)

Since the Supreme Court made the Affordable Care Act’s Medicaid Expansion optional, many state legislatures and governors; well at least many of them dominated by Republicans, have loudly declaimed that they will not accept the expansion.

 Proponents of the expansion – meaning those of us who understand public policy and/or have a soul – have been bitterly disappointed in the states which are preventing millions of people from getting access to health insurance.

 But let’s have a bit of historical perspective here.  The original Medicaid was a voluntary program as well and it took a bit of time for the states to get their act together. When federal matching funds became available in January of 1966, a grand total of six states had programs set up, as this Kaiser Foundation brief shows (see page 6). By the end of the year, 26 states had signed up.

Coincidentally, when New Hampshire expands its Medicaid program in July, 26 states will have signed up for the expansion (plus DC).

For the original program, 37 states had jumped on board by the end of 1967, 41 by the end of 1968 and 48 by Jan. 1 1970. (Alaska joined in 1972 and Arizona finally dragged itself into the program in 1982)

The point is that we tend to forget that it took more than a decade for all states to get into the Medicaid program. The beauty (sarcasm alert) of American federalism is that instead of merely having to get things enacted through an inefficient national legislature and executive, we often have to get them enacted through 50 inefficient regional legislatures and executives as well. Give it some time – often  states will see what’s working in other states and try to pick up on programs (or free money) that work. The Children's Health Insurance Program is another example -- it took three years for all 50 states to get on board after the federal government created the program in 1998.

This analysis doesn’t necessarily mean that the ACA’s Medicaid expansion will be picked up as quickly – political parties weren’t as polarized in the late 1960s as they are today, which means that opposition to the latest expansion may be more entrenched, even when the results are crystal clear.  And in any case, delays to extending the program will result in thousands of unnecessary deaths.

However, we shouldn't despair -- Medicaid wasn't built in a day; so there's no reason to expect the expansion to become universal in a year either. The important thing is to keep grinding forward and organizing to gain political power to make states do the right thing for their residents.


Cross-posted at The Makeshift Academic

It's been lost over the general noise of the debate surrounding the recent close of the enrollment period for the health exchanges, but on March 27, New Hampshire quietly became the 26th state to accept the Medicaid expansion.

New Hampshire --split between a Democratic governor and lower house on one hand, and a GOP-controlled upper house on the other -- negotiated an interesting path to expansion, as Ann Marie Marciarille over at her highly informative Missouri State of Mind blog discusses.

States seeking a modified Medicaid waive have generally tried to work the waiver out first then implement the program. For states that got a late start or that faced GOP-induced delays to considerations -- Pennsylvania and Michigan come to mind -- this has led to the delay in the start-up. Of course, this has led to frustrating delays in getting needy people health insurance and left federal money on the table (since the Feds pay for 100 percent of the expansion until 2017.)

New Hampshire reversed that strategy by jumping into the Medicaid pool now while attempting to negotiate a waiver over the next year to 18 months to reach an Arkansas- or Iowa-style program in which individuals between 100 percent and 138 percent of the poverty line will get steered into purchasing subsidized plans available on the state exchange.

The law also contains a stipulation that program will sunset at the end of 2016 (when the federal match is reduced from 100 percent to 95 percent) unless the legislature votes to renew it.

Of course, it's a bit frustrating that New Hampshire simply didn't accept the expansion straight-up, but it's a good thing that they decided to start up the program now and dicker about the details later.

Most importantly over the short term, 50,000 people are going to get access to health insurance -- and by extension, health care -- that they didn't have before.  After all, that's the point of the Affordable Care Act, right?

It's also a milestone of sorts now that more that half of the states are in the expanded Medicaid program. Of the 26, five are under split control (New York, Nevada, New Hampshire, Arkansas and Iowa) and four are under complete GOP control (Michigan, Ohio, North Dakota and Arizona). The Medicaid expansion isn't just a program for dirty hippies and effete coastal elites any more.

The current state of play in the states regarding Medicaid expansion can be found at the ever-useful Kaiser Foundation.

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