Healthcare, Elections

ACA Provisions: Medicaid expansion

Subsidizes state-level expansion of Medicaid programs to a broader population; states receive federal matching funds tied to actual spending on eligible enrollees (not a lump sum)

ACA Provisions: ACA Marketplaces

• Available to anyone who is a lawful resident of the U.S.

• Subsidies are available for incomes between 100% and 400% of federal poverty level

• American Rescue Plan and Inflation Reduction Act expanded subsidies above 400% of federal poverty level if premium would exceed 8.5% of your income

• *Subject of debate during federal government shutdown

• Basically it fills in the gap for what your employer doesn’t

Requirements for the Medicaid Expansion $$: Permitted use of funds

• Medical services for newly eligible adults

• Managed care capitation payments to plans covering the expansion population

  • Fixed amount of money is paid per enrollee to a managed care organization (private health insurance company that contracts with a state’s Medicaid Program) to provide all covered services to that person

• Administrative costs directly tied to running the expansion program (computer system, outreach, etc)

• Optional wraparound benefits subject to federal approval (e.g.: enhanced behavioral health)

Section 1115 Waivers

Allow for limited flexibility in Medicaid expansion, but funds must be used to support Medicaid-covered populations and services; Can use these $$ to experiment with expansion dollars (e.g.: work requirements, health savings accounts)

E.g.: Arkansas used expansion funds for private insurance (private option)

How is Section 1115 enforced?

States must submit quarterly and annual reports to the Centers for Medicare and Medicaid Services

How do you define accountability in local government?

Acting in constituents interest, knowing what they’re doing

Challenges with an accountable local government

Who should have the most voice?

• People who don’t know anything about local politics?

• Who are planning on living in the community for a year vs people planning to stay longer

• People using public services

What does national politics do to local politics?

National issues start filtering down to local politics.

Ex: Trump endorsing a NY mayoral candidate (not usual)

Nationalization of local politics

For residents to hold officials accountable, we have to vote for officials based on policies they can control

What can local leaders control?

Police, bike lanes, money on housing spent

Why are local officials bringing up national/international issues?

Identity politics? (indirect way of signaling which groups interests you’re looking to defend), policing of protests, city contracts

Turnout differences in off cycle elections

• low turnout b/c most people don’t care

• most people only care about president election

• much more likely to see homeowners and people over 65

• senior homeowners are overrepresented in every city