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Washington Readies a Repeal of Obamacare

Posted by NYPIRG on December 26, 2016 at 9:00 am
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After years of railing against the Affordable Care Act, also known as Obamacare, Congressional opponents and the President-elect are now poised to eliminate it. Since its passage six years ago, opponents have argued to “repeal and replace” the law, but that has turned out to be merely a slogan, devoid of substance.

Opponents have no agreement on their plan to replace the ACA.

As imperfect as it is, the ACA did make major strides toward the goal of universal health coverage.  Nearly 20 million Americans have health insurance because of the ACA, according to the Department of Health and Human Services. That includes about 10 million people who gained coverage through the expansion of Medicaid and another 10 million who buy insurance on the Obamacare exchanges or are young adults covered through their parents’ insurance.  Here in New York, federal data show that the uninsured rate has fallen by 40 percent since the Affordable Care Act (ACA) was enacted in 2010.  There are now over 3 million New Yorkers who obtain their coverage through programs provided under the ACA.

In addition, the number of people who have trouble paying their medical bills has plummeted in the last five years as more people have gained health insurance through the Affordable Care Act and gotten jobs as the economy has improved.

report from the National Center for Health Statistics showed that the number of people whose families are struggling to pay medical bills dropped by 13 million, or one-fifth of the total, in the last five years.  That’s good news; one of the biggest reasons why people go into bankruptcy is due to unpaid medical bills.  The more coverage there is, the less likely such bankruptcies will occur.

That’s not to say that the law has been a complete success.  There are still millions without health insurance, residing primarily in the South and the Southwest. Those people tend to be poor and live in Republican-leaning states, where opposition to the ACA has been highest.

Moreover, the ACA – which was based upon a law originally designed in the Massachusetts – has run into structural problems.  Some health insurance companies are pulling out due to their purported inability to make enough money to cover the law’s costs and others are sharply raising prices.   In New York City, for example, rates for a benchmark plan could go up by an average of 16 percent.  Thus, without changes, unless the marketplaces stabilize, the drop in the uninsured rate could have stalled or even reversed.

Fixes were needed, but now the Congress and the President-elect will radically change the program.

In addition, the new Congressional leadership reportedly will be seeking to overhaul the nation’s Medicare program – the health insurance for those over the age of 65.  And they are planning changes to the nation’s Medicaid program, which provides coverage for the poor.

Ironically, the Medicare changes under discussion could transform that program into something that looks more like the Affordable Care Act, a program that supplies a defined set of benefits and would offer subsidies for participants to purchase health care directly from insurance companies. There is also discussion to raise the Medicare eligibility age to rise to 67.

Any changes to Medicare and the health care law would be far-reaching, affecting some 55 million American seniors.

Despite the massive uncertainties and the potential enormous impacts, the Congress may send to President Trump a “repeal” bill in January that lays out at least a two-year timeline for changing the law.

While Washington cavalierly debates health coverage for tens of millions of Americans, the changes could have real impacts in New York.  If the feds cut back on its support for the Medicaid program, how will the state make up the difference?  If the ACA is fully repealed how will hospitals and other providers care for New Yorkers lacking health insurance?

After years of complaining about the federal law opponents now have a choice – replace the law with something better, or get rid of coverage for millions of Americans.

New York’s Electoral College Delegates Vote for President

Posted by NYPIRG on December 19, 2016 at 1:57 pm
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This week, delegates to the Electoral College will cast their votes for President of the United States.  This Monday, New York’s delegates will vote at the state Capitol in Albany.

Under the U.S. Constitution this is the election that really matters.  Delegates are chosen by the states and each state gets a total number of delegates that equals of the sum of its members of the House of Representatives plus its two members of the U.S. Senate.

Historically, those delegates have voted for President based on how the relevant state’s population voted – if candidate X won the popular vote in a state, then the delegates from that state voted for that candidate.  In all but two states (Maine and Nebraska), the system is based on “winner take all,” meaning that New York’s 29 delegates all vote for the winner of the Presidential vote of our state.

Given that smaller population states are entitled to Congressional representation of two U.S. Senators and at least one member of the House, the Electoral College system can give disproportionate power to those smaller states.  The result of this system is that in this election the state of Vermont cast about 320,000 votes, and thus each of its three electors represent roughly 107,000 voters.  However, New York cast approximately 7.5 million votes for 29 Electoral College delegates, thus representing roughly 260,000 voters per delegate – more than twice the per delegate population as Vermont.

Why the Electoral College?  The Electoral College was created for two reasons. The first purpose was to create a buffer between population and the selection of a President.  In the Federalist Papers, historians believe that the founders wanted the electors to be able to insure that only a qualified person becomes President. They believed that with the Electoral College no one candidate would be able to manipulate the citizenry. It would act as a check on an electorate that might be duped.

The second reason was that the federal government, and its chief executive, were created by the states.  Thus, the Electoral College was one of several compromises made to ensure that the smaller states would agree to the constitution.

The impact of the Electoral College is usually pro forma.  But this Presidential election is different; the expected winner of the Electoral College vote was the loser of the popular vote.  And a big loser to boot.

Mrs. Clinton received nearly 3 million more votes that her opponent Donald Trump.  Purely in terms of popular votes, Mrs. Clinton’s performance would put her in the top half of the winners of other Presidential elections.  Of course, the nation’s population has grown over time, but her margin of victory in the popular vote exceeded that of Presidents Carter in 1976 and Nixon in 1968, among others.

But she is the projected loser in the Electoral College delegate vote – and by a lot.  As a result, she will join the list of five candidates who won the popular vote, but did not become President.

This is also the second time in recent years that the winner of the popular vote did not become President (the other being the 2000 election).

As a result, there is a growing national discussion over the relevance of the Electoral College system.  As a practical matter, since virtually all of the delegates follow the popular vote within their states, why have an Electoral College?  Other than the constitution’s requirement, there really is no reason in the 21st Century to have one.

To change the system would require an amendment to the constitution, which is extremely difficult, but there are plans that should be considered.

One change could be that the power of the smaller states be maintained by merely continuing the current practice and apportion the states’ “votes” based on the rules of each state.  The constitution does not mandate a “winner take all system,” so states could change that if they wished – liked Maine and Nebraska already have done. Such a system may not change the outcome of this election, but it would eliminate the ceremony of the Electoral College process, one which made more sense in a “horse and buggy age,” not in our 21st Century society.

Another change could be to just rely on the popular vote total.  That would be a more fundamental change and one which would overrule the decisions of the founders, but one which is certainly defensible in a democracy.

Coupled with the power of big money to influencing elections, the patchwork system of voting rights which seems increasingly designed to deter people from voting, a debate over the future of the Electoral College is one that should start now.

The Trump Administration Takes Shape

Posted by NYPIRG on December 12, 2016 at 11:33 am
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President-elect Donald Trump has been revealing his proposed leadership team for the new Administration set to take office next month.  According to media reports, it appears that his nominee for Secretary of State will be the head of oil-giant ExxonMobil, Rex Tillerson.  Of course, we do not know if in fact Mr. Tillerson will be the nominee, but the leaks of his nomination will undoubtedly trigger controversy.

Being the head of one of the world’s largest and most profitable corporations offers possible advantages in the Department of State.  Despite no experience in diplomacy, Mr. Tillerson has traveled widely and likely has an extensive network of global contacts, including those at the highest levels of foreign governments. In addition, having run a behemoth corporation, managing the Department of State with its far-flung global activities should be something Mr. Tillerson is familiar with.

Like any other wealthy corporate executive, however, there will be appropriate questions raised that should force Mr. Tillerson to explain how he plans to address the inevitable conflicts of interest arising from his personal financial investments, as well as the corporate interests of ExxonMobil.

But the Tillerson nomination raises a unique question: How does he explain the decades of ExxonMobil’s strategies of attacking global efforts to combat climate change – changes in the earth’s climate that are largely the result of the burning of greenhouse gases?

In recent media reports, it has been revealed that Exxon’s scientists had been sounding the alarm within the company over the heating up of the planet and that oil and gas were key ingredients of that warming.  Those scientists were at the cutting edge of research and had discovered the connections between the burning of coal, oil and gas and global warming.

Those scientists were clamoring for action – not only for the sake of the environment, but for the sake of the company as well.  They claimed, correctly, that as the planet heated up there would be more regulatory actions to reduce the use of fossil fuels.  Those individuals wanted Exxon to get ahead of the policy curve.

Exxon’s reaction was to essentially shut down their science and double down of the use of fossil fuels – all the while hammering away that there was no such thing.

The company hired legions of advocates to muddy the waters and attack those who were advocating for actions to minimize the damage from climate change.  They even funded “front groups” to make their case so that the public would be deceived into thinking that these groups were truly independent.

And it worked, decades later there is little evidence that the United States will seriously address the issue, despite the overwhelming evidence that the world is on a soon-to-be irreversible trajectory toward runaway global warming.

If that happens, tens of millions of people – most of whom live in societies that have played virtually no role in the warming of the planet – will face misery, disease, and incredible hardship.

Mr. Tillerson has worked at ExxonMobil for over 4 decades, during the time of the company’s internal, and world’s external, debates over climate change.  While he may not have been the architect of ExxonMobil’s strategies, he has defended them, often aggressively.

If he is the nominee of the new President, he will have questions to answer: How he will handle his conflicts of interest, his relations with other nations’ leaders, and how does he justify his company’s use of its enormous wealth to essentially snuff out an effort to avert a global disaster? A disaster that for decades Exxon’s scientists had predicted would come – climate changes that would profoundly, and disastrously, affect the planet.

Albany Considers a Special Session

Posted by NYPIRG on December 5, 2016 at 1:26 pm
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The talk of a special legislative session heated up last week.  State legislators – particularly those in the Assembly – were still smarting from the governor’s moves to kill their long-awaited pay increase.  In 2015, the governor and the legislature created a pay commission to establish whether lawmakers – and top ranking members of the executive branch – should get a pay hike, and if so how much.

There hadn’t been a pay increase for lawmakers since 1999 and they assumed that this commission would approve one.  Billed at the time as an independent commission, it turned out to be anything but that.  The governor’s appointees apparently took direction from him and killed the pay increase proposal after the governor stated his opposition, unless lawmakers agreed to ethics reforms.

Last week, the governor unveiled a new package of changes that he wanted, tying it to a pay increase.

If state lawmakers return for a special legislative session this month, the governor not only wants additional ethics changes, he wants financing for a new hate-crime task force and reforms for the state and New York City university systems.

The governor also proposed two amendments to the state’s Constitution that would create a full-time legislature with four-year terms and set term limits for officials that hold statewide posts.

The legislature reacted with hostility, essentially saying that the governor’s linkage of these items to a pass raise was the equivalent of legislative extortion.  And they have a point, it has happened before.

The last time a pay raise was approved; then-Governor Pataki tied pay increases to policies that established charter schools, a budget reform measure and a dairy farm mandate.

Depending how you feel on those issues, of course, may determine whether you think it was a good idea for Governor Pataki to extract them as the price of a pay hike.  But is it right?

The point of the commission was to stop the legislative stick up process and instead try to depoliticize salaries.  Unfortunately for New Yorkers, neither the governor nor the legislative leaders were ever serious about setting up an independent pay commission.  What they really wanted was a pay increase – for both the legislative and executive branches – without them having to take a public position or take a tough vote.

Ironically, playing games with the commission has come back to bite lawmakers.  Whatever they agreed to in order to get the commission was now given away for free and the legislature now faces a governor determined to extract even more.

What should happen?

No one should go nearly two decades without a pay raise.  While New York legislators are currently the third highest paid in the nation, California is number one and pays its lawmakers $100,000.

Should New York lawmakers be the highest paid after essentially failing to deliver real corruption busting ethics reforms?  Absolutely not.

The governor and the legislature should create a real independent compensation commission, not filled with their allies, but with individuals who have no skin in the game – other than the public’s best interests.

Should the legislature capitulate to the governor in order to get a pay hike?  I say no.  Some of the governor’s plans – such as changing the state constitution to allow lawmakers to run for office less frequently, deserves a real public debate – not a rush job.

But let’s get a real independent commission.  And the governor and lawmakers should really tackle the culture of corruption at the state Capitol.