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Red States seek to gut the Affordable Care Act and make Blue States more like them.

Red States seek to gut the Affordable Care Act and make Blue States more like them.

In this timely piece from the LA Times we learn about two working mothers, one in California and one in Texas, and their very different health care experiences thanks to the Affordable Care Act’s expansion of Medicaid to low-income adults, or lack thereof, in their states. The California mum (Jenny) whose state enthusiastically embraced the ACA, has health coverage which kicked in last year when she was hospitalized from a severe infection. Texas on the other hand opted out of the Medicaid expansion and the Texan mum’s (Courtney) experience reflects that fact; without health coverage she’s not able to afford asthma inhalers nor dental treatment for a broken molar she received in a domestic dispute. Courtney’s been living on Orajel, she says.

In fact recent research has concluded that the Red States who refused Medicaid expansion suffered a higher mortality rate among near elderly low-income adults compared to states that expanded the program. The result is that the states who opted out likely sustained almost 16,000 avoidable deaths during the period studied. 

The fate of the ACA now rests in the hands of an ideologically extreme right-wing Supreme Court (SCOTUS) in California v Texas stemming from an effort by Texas and 17 other Red States joined now by the Trump administration to overturn the ACA. (The result will not be known until next year). It’s difficult not to see this as anything other than a continuation of an expanding war on Blue States who typically provide their citizens with more and better services. It’s bad enough that Texas and the others demonstrate such a studied unconcern for the health and well-being of their own residents, but it’s truly reprehensible that they’re driven to seriously damage that of low-income people in the rest of America. Apparently, Texas politicians will not rest until Jenny’s experience in California mirrors that of Courtney. Misery really does love company it seems.

And if Republicans win the November election, we can be assured that any chance of a meaningful replacement for the ACA in the event that SCOTUS throws it out will be just as dead as those 16,000 people who died prematurely. Nor should we forget that if the law falls, all who enjoy private health insurance will once again be subject to caps on their coverage, prohibitions on pre-existing conditions and the other means of victimization in the tool bags of the insurance companies. 

All of which is a strong reminder that the sooner we crush the GOP at the ballot box, the better it will be for our collective welfare.

The GOP Has Become a Malevolent Force in American Life

The GOP Has Become a Malevolent Force in American Life

Consider these words written in 2012 by non-partisan political scientists Thomas Mann and Norm Ornstein:

The GOP has become an insurgent outlier in American politics. It is ideologically extreme; scornful of compromise; unmoved by conventional understanding of facts, evidence and science; and dismissive of the legitimacy of its political opposition.

Eight years on things have got demonstrably worse. Republicans continue efforts to repeal the Affordable Care Act both legislatively (in 2017, which failed) or in court as GOP states led by Texas pursue a lawsuit currently pending before the Supreme Court that may see the ACA overturned next spring. The consequences to millions of Americans would be devastating.
This in the face of a virulent pandemic with more millions of Americans losing their jobs and their health care who will likely need the ACA. In the current health crisis, the Republicans’ rush to open up the economy before infection rates have decreased or we have adequate testing and contact tracing capabilities promises to cause thousands of unnecessary deaths – particularly among the elderly.

Meanwhile the GOP’s stubborn and obtuse denial of climate change threatens the future of our children and grandchildren. The depressing litany of destructive policies the GOP has embraced over the years whether its unravelling environmental protections and workplace safety regulations, beating up on the poor in America, suppressing voting rights of minorities to name but a handful, do enormous harm to the American people. The reality is of a political party and conservative movement that rejects the worth and role of government to do good and runs it incompetently to prove its point, while doing everything possible to impede the other party from governing effectively.

In this the GOP is robustly supported by its perpetually angry base, and a right-wing media machine that pushes both to the extremes. Negative partisanship is bipartisan but at least most Democrats get their news from reliable mainstream media as opposed to Republicans who are far more likely to be misinformed thanks to conservative media even on something as critical as the coronavirus. The latest conservative conspiracy theory, for example, is that the COVID-19 death rate is vastly exaggerated, a dangerous illusion that promotes a lethal complacency.

In short, Republican governance at every level is severely hazardous to our health and well being. In the present emergency, a GOP administration first weakened the federal government’s ability to combat a theoretical pandemic then thoroughly botched its response to a real one. And while a pragmatic Democratic House has tried gamely to bring some sanity to the government’s response to the economic and health calamities, it’s an uphill struggle against an ideologically driven, boneheaded GOP majority in the Senate. For example, an obvious need to support states with an infusion of federal funding as their economies tank and their revenues plummet is being blocked by a hatefully partisan GOP leadership that sees it as disproportionately (and erroneously) benefitting Democratic states.

When this catastrophe is finally over, Americans need to have a serious conversation on the future of our democracy in light of the bitter divisions that are unlikely to ameliorate even without the vile and divisive presence of either Trump or Senator “Moscow” Mitch McConnell. I don’t pretend to know the answer but I do know that we can never move forward as a country while this extreme polarization, without parallel in any other democratic nation, persists.

Democrats’ Aim Should Be Universal Coverage – Improving the ACA is the Right Vehicle

Democrats’ Aim Should Be Universal Coverage – Improving the ACA is the Right Vehicle

I get why the liberal wing of the Democratic Party is obsessed with enacting Medicare-for-All as the vehicle to universal coverage. I do. There’s no question that if we got it right, it would be both far more equitable and cost-effective than the present chaotic patchwork of a “system” that we’re currently lumbered with. I was raised in England and I know what a blessing the National Health Service has been, warts and all, in providing first class health care to everyone and without driving any of anybody into bankruptcy.

I also understand only too well the frustration of forever being told that it simply can’t be done, that the odds are stacked against it. How do we know unless we try, right?

Nevertheless, reality must intrude. First, as we have already seen with the few states that have tried to add a public option to their ACA markets that the health care industry will wage total war on any suggestion of even a modest expansion of of a public health care option. And when I say the health industry, we’re talking the insurance companies, the hospital industry, the pharmaceutical industry and much of the medical profession, particularly specialists, surgeons and the hospitals each of whom gain the most from the present lack of price controls on any but Medicare patients, and who will fight tooth and nail to keep it that way. Added to the health industry’s implacable opposition will be the Republican Party and the entire right-wing universe complete with relentless fear mongering and lies. And they will have a powerful issue that lends itself to demagoguery. Socialized medicine! Egads!! The fact that they’ve called the ACA, modest insurance reform at best, the same thing will of course be lost in the din.

Second, a total reform of the entire US health care system, one that dwarfs the enactment of the ACA, will require the support of most Americans, 180 million of whom currently have employer-provided health insurance which most of them believe is just fine, thank you very much. And Democrats would be asking them to give that up and see their taxes increase to boot – a hard sell even though insurance premiums will go away. All of this on the promise that expanding Medicare to include everybody, entirely rationale but something we’ve never tried before, would be better. And then there’s the seniors who are currently well satisfied with their Medicare and will be scared into believing (by you know who – see above) that somehow they will lose much of what they have if their health care is folded into a national scheme for the whole population.

In short it will not merely be an uphill struggle to enact Medicare-for-all but the policy equivalent of free climbing Half Dome in Yosemite National Park and to believe otherwise is delusional.

But there are other ways to universal coverage. In fact there are many models among developed countries that have achieved and did so with a system that incorporates private insurance albeit heavily regulated. Switzerland is one, for example. Check this link to the non-partisan Commonwealth Fund for a thumbnail sketch of the Swiss system and that of other developed nations from whose systems we can draw lessons .

Which brings us to the Affordable Care Act. Like all compromises on huge and complex pieces of legislation, the ACA is manifestly imperfect and in need of substntial improvement, for example by vastly reducing out-of-pocket expenses and greatly expanding the income cut off to receive premium subsidies. Yet the law has significantly increased the number of people with health insurance whilst proving unexpectedly resilient in surviving GOP efforts to repeal it and the Trump administration’s attempts to weaken it. If Democrats win the White House and Congress in 2020, they have an opportunity to undo all the damage of the Trump era and to make the ACA a far bigger success in providing affordable health coverage to a vulnerable population.

As well, Democrats have other costly priorities to address such as climate change and relieving our kids of the huge debt burden of college loans, to name but two. A full throated battle for a single payer health system will suck all the political oxygen out of the air and leave us with little energy to seriously tackle those issues. And that would be a tragedy.

Voting in Republicans to control the Congress and more states is a truly dumb idea.

Voting in Republicans to control the Congress and more states is a truly dumb idea.

In the first two years of his presidency Barak Obama and a Democratic majority in Congress saved the United States auto industry from bankruptcy, enacted a stimulus package that effectively cushioned a collapsing economy and likely prevented another Great Depression, passed the Dodd Frank law to make it much less likely we will suffer another banking meltdown in the future and, last but not least, enacted the Affordable Care Act which is already driving down the rate of medically uninsured Americans and promises to reduce it still further in future years.

In 2010, however, a Republican takeover of the US House of Representatives effectively ended any possibility for further problem solving from the federal government as the GOP House majority, and a filibuster-happy GOP minority in the US Senate, blocked additional efforts to boost the economy and, indeed, sought to do further damage to it by slashing government spending at a time when the private sector was still contracting.

Despite the GOP’s destructive efforts, however, the US economy has improved significantly albeit much more slowly than would have been the case had we enacted another stimulus heavy with infrastructure spending, as Obama and Democrats wanted. In fact, congressional Republicans by their unprecedented obstructionism have behaved as though they wanted the economy to remain in the tank just to score political points.

And they appear to have succeeded. Polls show it is all but certain that the country will vote next Tuesday for full Republican control of the Congress, and an expansion of that party’s control of governorships and state legislatures. Even millennials seem to be deserting Democrats, and lukewarm support from women cannot balance strong support for the GOP among (white) men. In short things appear pretty bleak.

But it would be useful to know what policies embraced by Republicans have won the support of the electorate in this election cycle.

Is it the Republican desire to unravel environmental laws and rules such as those to reduce carbon emissions from coal-fired plants or to drastically expand drilling for oil and gas on public lands and off-shore? Is it their enthusiasm for slashing food aid and other crucial support for America’s poorest citizens?

Or perhaps it is the GOP’s oft-stated intention to repeal the Affordable Care Act and strip 10 million Americans of their newly acquired health coverage that appeals to the electorate? But there again, maybe it’s the party’s economic agenda to cut taxes on corporations and the wealthy while blocking any move to increase the minimum wage that attracts voters?

Many believe the 2014 midterm elections don’t matter but I disagree and here’s just one example from The New Republic  to illustrate why.  To summarize, if the conservative and somewhat erratic GOP governor of Maine is defeated, 70,000 low-income residents of the state stand to gain health insurance through the ACA’s Medicaid expansion. If he‘s re-elected, they don’t. That’s pretty simple but the lives of real people who struggle every day will be affected.

In 2010 a wave of GOP state-level victories led directly, as in Maine, to a denial of health care coverage for millions of Americans. Let’s not make the same mistake in 2014.

All elections matter so get off your duff; make the right choice and VOTE on November 4th!

High price paid by states that did not expand Medicaid under Obamacare

High price paid by states that did not expand Medicaid under Obamacare

There has been no shortage of good news about the beneficial effects of the Affordable Care Act, particularly for those states that embraced it; and on the overall reduction in the percentage of uninsured adults in the country.

However, research by the Urban Institute also highlights the steep price paid by states that fought it tooth and nail, notably in the South.

For example, as of June 2014, 49% of the remaining uninsured adults in the United States live in the South, up from 41.5% before the act took effect in September 2013. Furthermore, almost 61% of uninsured adults reside in states that did not expand Medicaid under the ACA compared to less than 50% before the ACA.

And the bad news doesn’t stop there. The Urban Institute has quantified the billions in federal money lost by (mostly Red) states that rejected expanded Medicaid, as explained in this piece from Jonathan Cohn in the New Republic, again based on research by the Urban Institute. The excuse offered by Republican governors that they are simply being fiscally responsible is exposed for the nonsense it is by the map in Cohn’s piece.

Georgia, for example, saves $2.5 billion in what it would have spent to expand Medicaid over the course of a decade, but stands to lose $33.5 billion in federal funds, more than ten times as much. And of course it does nothing for the 20.2 % of Georgia adults who are still uninsured; in fact and as lamented in this piece from The Atlanta Journal-Constitution, the state now has the third highest rate of uninsured behind the perennial champs, Texas and Mississippi.

Talk about cutting off your nose to spite your face!

The economic boom in Texas is no vindication of conservative governance.

The economic boom in Texas is no vindication of conservative governance.

In a recent blog piece in The New York Times, Nobel-prize winning economist and liberal columnist Paul Krugman recounted an effort by Stephen Moore, a conservative economist with the Heritage Foundation, to demonstrate that tax slashing (Red) states have outperformed high tax (Blue) states in job and overall economic growth. It transpired that Moore had evidently been piqued by a column Krugman had written earlier about Kansas GOP Governor Sam Brownback’s disastrous tax-cutting binge which has left the state with a huge deficit while doing next to nothing to grow the economy.

The problem was that the most specific claims in Moore’s article, which appeared in the Kansas City Star, were inaccurate and completely misleading. The Bureau of Labor Statistics data he cited which he said were for the last five years were actually from an earlier period starting just before the last Great Recession. These skewed the numbers to the point of uselessness. Moore claimed he made a “mistake”.  I believe him, but thousands wouldn’t.

Of course we shouldn’t be surprised because ideological blinkering long ago supplanted truth and facts in the alternate universe occupied by most conservatives – even ones with PhDs. And as Krugman says in his piece, comparing states is, in any case, an inexact science given stark differences in key areas such as the price of housing.

But for me it raised a more fundamental question. After all Texas has been extolled as an example of successful conservative governance not only by Moore in his dodgy article, but in a June issue of The Economist a far more credible source. But is it enough to measure success, particularly as it relates to whether a state is well governed, by the number of jobs produced in a given period (one driven, at least in part, by the oil and gas industries) or its economic growth rate? Certainly by these measurements Texas is flourishing; but when viewed against what many consider are other key metrics, such as the economic well-being of its lower-income residents, not so much.

Poverty-USA ranks Texas 40th among states. And in its report on child well-being, the Annie E Casey Foundation  ranks Texas 43rd overall, this in a country which as a whole ranks near the bottom among rich countries. Out of 16 measurements of economic, educational, health, and family/community well-being examined by AECF, Texas only managed to beat the national average in 4 of them. Its efforts in the areas of health and family/community support were particularly dismal.

Finally, this table from the Kaiser Family Foundation shows that the income threshold for adults with children to be eligible for Medicaid is an eye-popping $3,736 for a family of three, placing it only behind Alabama as the stingiest of states. Even Mississippi is more generous (albeit not by much).

And the disparities between states like Texas and their Blue State peers are only likely to grow. This is especially so when it comes to health as the rate of uninsured likely continues to drop significantly in states that fully embraced the Affordable Care Act, while staying the same or decreasing only marginally in Texas and other states that have fought it tooth and nail.

I don’t expect any sense from an ideologue such as Stephen Moore but The Economist should be ashamed of itself for mistaking Texas for a well governed state.

It’s nice to be able to brag about economic growth but what good is it if an ideologically blinkered and uncaring government does little to use the generated wealth to improve the lot of its neediest residents?

Rep Paul Ryan’s plan for poor Americans deserves a raspberry.

Rep Paul Ryan’s plan for poor Americans deserves a raspberry.

Over at Vox.com, Ezra Klein has written a trenchant analysis of GOP Rep. Paul Ryan’s “plan” to address poverty in America. While giving Ryan credit for some good ideas such as expanding the Earned Income Tax Credit and sentencing reform, Klein, not unexpectedly, identifies several serious problems.

Let’s start with the inconvenient fact that Ryan’s own budget plans don’t fit with his poverty proposals

Ryan’s budgets and his poverty plan aren’t merely different. They’re flatly contradictory. They cannot be implemented in the same universe at the same time. His budget, for instance, cuts deep into the funding stream that powers the Earned Income Tax Credit. His poverty plan sharply increases spending on the Earned Income Tax Credit. His budget cuts deep into food stamps and other income-support programs. His poverty plan holds their spending constant.

So what’s going on? As Klein states, the centerpiece is to combine 11 poverty programs, including food aid, into a block grant to the states, the “Opportunity Grant”. However as he and Bob Greenstein of the Center on Budget and Policy Priorities, whom he quotes, explain

One of the 11 programs included in the Opportunity Grant is not like the others: food stamps, which is structured as an entitlement program, and so responds to rises in need automatically.

“It’s really important right now that if there’s a recession and you lose your job and need food stamps you can get them,” says Greenstein. “You are immediately eligible. You’re not on a waiting list.” Ryan’s Opportunity Grant would end the role food stamps play as an automatic stabilizer during recessions.

Ryan is working off of the welfare reform model here: this is more or less what the federal government did to the welfare program (or TANF) in 1996. But that just goes to prove the point: welfare’s role as an automatic stabilizer has been gutted by the reforms. The welfare reforms were successful at cutting welfare rolls — not at making welfare better at helping the poor, particularly during recessions.

This graph from the Center on Budget and Policy Priorities tells the tale. When welfare reform passed, during a boom economy, the program was helping 68 out of every 100 families with children in poverty. Thirteen years later, during the deepest recession since the Great Depression, it was helping fewer than 30 of every 100 families with children in poverty.

And of course, if food aid loses its entitlement status it can be more easily cut

Ryan’s poverty plan can be seen either as an effort to move the Republican Party forward on poverty or as a Trojan Horse-like effort to achieve his budget’s goals by other means. “The food stamp block grant proposal in his last budget had $135 billion in cuts,” says Greenstein “It was dead on arrival. If the strategy in this plan is to remove the program’s entitlement status, convert it to block grants and, over the decades, let the funding erode — well, that is a much cleverer and more sophisticated strategy to get to the same goal.”

And there is little doubt that less money overall will be spent on the poor

“When you make a block grant this broad and sweeping to states it is virtually inevitable some of the block grant dollars will replace current state dollars,” says Greenstein, “and so the total amount of money going to poor people goes down. It’s not that you’re directly using the federal dollars for a highway or a tax cut. You use the federal dollars for services to poor people. But maybe for every $3 states take from food stamps and put into services, they reduce state funding for those services by $1 and take that dollar and use it somewhere else in the budget.

“This is not hypothetical. It happened on a large scale in the Temporary Assistance for Needy Families block grant. And it’s well known that it’s almost impossible to stop this from happening. People thought about it in the TANF block grant. They wrote into the law maintenance-of-effort clauses to try to prevent it. And they weren’t effective. It’s just almost impossible to stop.”

Furthermore, Ryan’s faith in states to do better by the poor is hardly validated by experience, as we see from the refusal of 24 primarily GOP-led states to accept the Medicaid expansion under the Affordable Care Act.

The heart of Ryan’s plan is essentially to wash the federal government’s hands of America’s poor and leave it to states, whose own records of effective management of poverty programs are uneven at best. In so doing, he opens the door to future pernicious cuts in programs to help the poorest Americans.

Ryan’s poverty plan, like his budget, deserves a big, fat raspberry.

US healthcare system ranks last again. Obamacare will raise its future rankings.

US healthcare system ranks last again. Obamacare will raise its future rankings.

A recent study by the Commonwealth Fund ranking healthcare systems in eleven advanced countries found the United States in last place. And while we languished at the bottom the study, which ranked healthcare delivery on such metrics as quality of care, access, efficiency and healthy outcomes, rated the United Kingdom at number one (take that, Fox News know-nothings). Just to add insult to injury, the UK spends $3,405 per capita on health (second lowest behind New Zealand) while we spend a whopping $8,508, the most of any in the study by a country mile.

Unsurprisingly, we fared poorest in categories associated with access and equity thanks to our lack of universal insurance coverage, and in efficiency where we are burdened with such deficiencies as excessive insurance company administrative overhead, medical duplication and overuse of emergency room treatment.

We also performed the worst in healthy outcomes as measured by infant mortality, healthy life expectancy, and mortality amenable to medical care (i.e. unnecessary or avoidable deaths).

As if this study wasn’t bad enough, we also have the International Federation of Health Plans 2013 Comparative Price Report which annually measures the cost of medical procedures and drugs among selected countries. Guess who regularly emerges as the most expensive? Even Switzerland (where a hamburger meal can cost $50) is way cheaper. As Ezra Klein noted about the iFHP 2012 price report in the Washington Post:

This is the fundamental fact of American health care: We pay much, much more than other countries do for the exact same things. For a detailed explanation of why, see this article. But this post isn’t about the why. It’s about the prices, and the graphs.

One note: Prices in the United States are expressed as a range. There’s a reason for that. In other countries, prices are set centrally and most everyone, no matter their region or insurance arrangement, pays pretty close to the same amount. In the United States, each insurer negotiates its own prices, and different insurers end up paying wildly different amounts.

So the US healthcare system is definitely ailing. But relief may be at hand. In noting the results of the Commonwealth Fund report, a New York Times  editorial states:

The poor results for the United States reflect the high cost of its medical care and the absence of  universal health insurance, a situation being addressed by the Affordable Care Act. The federal law is already increasing the number of Americans with health coverage and will substantially cut the number of uninsured in coming years. Other advanced nations are far ahead in the game because they have long had universal health coverage and promoted strong ties between patients and doctors.

Already the ACA’s beneficial effects on the rate of uninsured are being felt, particularly in states that embraced it wholeheartedly, as this piece about Minnesota from Jonathan Cohn in the New Republic shows.

So, despite the best efforts of Republicans to keep us mired in a rotten system that is inefficient, inequitable, prohibitively expensive, and too often lacking in overall effectiveness, there is hope that the future will be significantly brighter for American healthcare, thanks to Obamacare.

The case for Obamacare just keeps getting stronger.

The case for Obamacare just keeps getting stronger.

Two recent news items lend strong support to the notion that the Affordable Care Act will be a very significant benefit to the country going forward.

First, Sarah Kliff at Vox reports on recent evidence that the percentage of uninsured Americans is at its lowest rate since before the economic meltdown in 2008. The decrease in the uninsured is particularly strong among lower income Americans who were a particular focus of the law:

The gains of insurance coverage have been especially large among lower-income Americans – the people who qualify for Medicaid or insurance subsidies under the Affordable Care Act. There’s been a 5.2 percentage-point drop in the uninsured rate, for Americans who have a household income lower than $36,000 since the end of 2013.

Second, Jonathan Cohn in The New Republic has a piece on a newly published study in the Annals of Internal Medicine by highly regarded researchers showing that the overall mortality rate in Massachusetts fell significantly following the introduction of the state’s health care law (“Romneycare”), the one on which Obamacare is largely based.

This last is important for several reasons, not least because conservative opponents of the ACA have gleefully cited a different study, of Oregon Medicaid recipients, which seemed to show that having medical insurance did not equate to better health outcomes.

Cohn explains that for the Massachusetts study, the researchers

….obtained figures on mortality and, better still, they were able to isolate causes of mortality “amenable to health care.” In other words, they were able to get data on cancers, various cardiac problems, and other conditions that, with better medical care, people should be more likely to survive. Then they compared how the people in Massachusetts fared relative to groups of people from around New England, who were similar in almost every meaningful way—age, income, and so on—except that they lived in states where similar expansions of health insurance were not underway.

The results were clear. In those other places, outside of Massachusetts, the death rate from “amenable” causes went down by only a little bit and the overall death rate actually increased a tad. But in Massachusetts, deaths overall and deaths from “amenable” causes both went down—significantly. The authors calculated that, for every 830 people who got insurance in Massachusetts, about one person avoided a premature death.

The Massachusetts study covered a broader population than did the Oregon Medicaid research and a longer period. And the greatest improvement came, unsurprisingly, in counties where there were more low-income and uninsured adults. The researchers also examined whether factors other than expanded insurance could conceivably account for the decrease in mortality but concluded they could not.

Some caution is necessary. Certainly this is only one study in one state. But as Cohn puts it

The findings from a Massachusetts are consistent with a long line of similar, previous work. In the 1990s, for example, economists Janet Currie and Jonathan Gruber found that expanded eligibility for Medicaid led to lower infant mortality and fewer low birthweight babies.  “More work is clearly needed,” says Gruber, an MIT professor who was an architect of both the Massachusetts and federal health reforms, “but we should basically be back to our presumption that health insurance improves health.”

Conservatives continue to be in denial about Obamacare and to insist on dire predictions of the ill that will befall us if we do not repeal it. The decreasing percentage of uninsured in America and the Massachusetts study showing the benefits of health insurance, however, seriously undermine that narrative.

Nebraska US Senate Candidate Ben Sasse hates Obamacare – We know because his daughters tell us so.

Nebraska US Senate Candidate Ben Sasse hates Obamacare – We know because his daughters tell us so.

Midland University President Ben Sasse, who is running for the US Senate in the Nebraska Republican primary this month, uses his daughters; 10-year-old Alex and 12-year-old Corrie, in a political ad that expresses how much he despises the Affordable Care Act.

Alex: “He does not like ObamaCare. He’s read it and he realizes how bad it is, and he wants to find a way to, um, destroy it and rebuild something that’s successful”.

Corrie: “He despises it. When people say bad things about him, he tries to ignore it, and we always pray for the opposing candidates at breakfast”.

Alex: “My Dad wants to go there as the outsider and he wants to fix Washington”.

Corrie: “Can I put in now that I want a horse very badly”?

Awwww…. isn’t that cute? She supports her father in his quest to destroy ObamaCare, and prays with him at breakfast for God’s help to defeat his political enemies. But she wants a horse, so it’s all good!

Actually it’s a pretty creepy ad. He enlists his little girls to go negative because it would seem unbecoming of a University president to say he despises the Affordable Care Act and wants to destroy it. Best to leave the attack ads to the kids.

I suppose he could star in an ad that explains how he would “rebuild something that’s successful”, but he can’t. Just like all the other Republicans who hate Obamacare, he is stuck with the law because it was their idea to begin with.

The Republicans left with any brains at all know that the only way a free-market based system designed to cover everyone, including those with pre-existing conditions, can work is to get healthy people to pay into the pool. To do that there must be a mandate and, since some people are poor, they need help paying the premiums. If you take away any of the three most important features of the law: coverage for everyone, a requirement for everyone to have insurance, and subsidies for those who can’t afford to pay the premiums – the whole thing falls apart.

The Republican Party has had years to propose an alternative solution, but so far we’ve heard nothing tangible. We’ve only heard that they want to keep the parts they like and get rid of the parts they don’t like.

So tell us Mr. Sasse, after you destroy ObamaCare how will you successfully rebuild it? What will be better about it and will it be affordable?