Reports Show More People Insured But No Increase In Patient Volume For Physicians Since January Under Affordable Care Act

The New England Journal of Medicine has reviewed the increase in coverage under the Affordable Care Act and concluded:

Taking all existing coverage expansions together, we estimate that 20 million Americans have gained coverage as of May 1 under the ACA (Figure 3Figure 3Categories of Expanded Health Insurance Coverage under the Affordable Care Act (ACA).). We do not know yet exactly how many of these people were previously uninsured, but it seems certain that many were. Recent national surveys seem to confirm this presumption. The CBO projects that the law will decrease the number of uninsured people by 12 million this year and by 26 million by 2017. Early polling data from Gallup, RAND, and the Urban Institute indicate that the number of uninsured people may have already declined by 5 million to 9 million and that the proportion of U.S. adults lacking insurance has fallen from 18% in the third quarter of 2013 to 13.4% in May 2014.

However, these surveys may underestimate total gains, since some were fielded before the late March enrollment surge and do not include children. With continuing enrollment through individual marketplaces, Medicaid, and SHOP, the numbers of Americans gaining insurance for the first time — or insurance that is better in quality or more affordable than their previous policy — will total in the many tens of millions.

As we look to the future of the coverage provisions of the ACA and their effect on the U.S. health care system, several observations seem justified. First, as the number of individuals benefiting from the law grows, its wholesale repeal will grow less likely, although the law could still be importantly modified in the future.

Second, experience with the ACA will vary enormously among states. Those deciding not to expand Medicaid will benefit far less from the law, and since many of these states have high rates of uninsured residents and lower health status, the ACA may have the paradoxical effect of increasing disparities across regions, even as it reduces disparities between previously insured and uninsured Americans as a whole.17

Third, the sustainability of the coverage expansions will depend to a great extent on the ability to control the overall costs of care in the United States. Otherwise, premiums will become increasingly unaffordable for consumers, employers, and the federal government. Insurers who seek to control those costs through increasingly narrow provider networks across all U.S. insurance markets may ultimately leave Americans less satisfied with their health care. Developing and spreading innovative approaches to health care delivery that provide greater quality at lower cost is the next great challenge facing the nation.

The full article is available to non-subscribers and there is also further discussion at Talking Points Memo.

There has been concern that the increase in number of insured might lead to an increase in number of people seeing physicians despite predictions and early evidence that this would not be a significant problem in most areas. I have seen several reports indicating that doctors generally are not seeing more patients as a result of the Affordable Care Act. The most recent came from Athena Health and the Robert Wood Johnson Foundation. Here is a summary of their findings:

  • Influx in New Patient Volume Not Detected: In the first five months of 2014, a national sample of 14,300 health care providers across the athenahealth network did not see an increase in new patient volume.* Instead, the percentage of total visits with new patients actually dropped slightly compared to the same period in 2013. These findings suggest that an increase in newly insured patients, resulting from the ACA, has yet to have an impact on new patient volume at medical practices.
  • Health Care Reform Widening the Medicaid Gap: In states that are expanding Medicaid coverage under the ACA, the data shows an overall increase in adult (18-64) Medicaid beneficiary patient visits. In expansion states, on average, the percentage of Medicaid-covered patients who are being seen by primary care physicians is rising, with Medicaid patients accounting for 12.3% of care in December of 2013 compared with an increased rate of 15.6% in May 2014. Surgeons and other specialists also show increases. Conversely, states that are not expanding Medicaid coverage have seen Medicaid visits remaining flat. These findings indicate that the implementation of the ACA is widening the gap of the total share of Medicaid patients that doctors in expansion vs. non-expansion states are caring for.
  • No Increase in Chronic Disease Diagnoses Among New Patients: Findings from the first five months of 2014 indicate that established patients have a higher rate of chronic diseases compared with new patients seeking care. When comparing diagnosis rates of chronic conditions from the first five months of 2013 to the first five months of 2014, across both new and established patients, no increase in diagnosis rates of chronic conditions is detected for either population.

It is possible that some of the newly insured are initially going to the Emergency Room and therefore are not picked up as an increase in visits by primary care physicians. In May I reported on a study by the American College of Emergency Physicians which found that 37 percent of ER physicians reported that patient volume had increased slightly, 9 percent reported that it had increased greatly, and 27 percent reported that the number of ER visits had remained the same.

It is also a good finding that the newly insured are not turning out to be sicker than the previously insured. Many insurance companies held off on entering the exchanges last year out of fear that they might wind up with sicker patients, costing them more money. Those which sold coverage have wound up doing well with more insurance companies planning to enter the exchanges to sell coverage for next year. This should help reduce anticipated increases in premiums and give consumers more choice.

Forbes has further discussion of the differences in states which are offering the expanded Medicaid program compared to those which do not.

What’s The Matter With Thomas Frank?

Obama Green Lantern

Thomas Frank has fallen for the Green Lantern view of the presidency, thinking that the president has the power to do anything he wishes. His criticism of Obama:

Why did he do nothing, or next to nothing, about the crazy high price of a college education, the Great Good Thing that he has said, time and again, determines our personal as well as national success? Why didn’t he propose a proper healthcare program instead of the confusing jumble we got? Why not a proper stimulus package? Why didn’t he break up the banks? Or the agribusiness giants, for that matter?

Well, duh, his museum will answer: he couldn’t do any of those things because of the crazy right-wingers running wild in the land. He couldn’t reason with them—their brains don’t work like ours! He couldn’t defeat them at the polls—they’d gerrymandered so many states that they couldn’t be dislodged! What can a high-minded man of principle do when confronted with such a vast span of bigotry and close-mindedness? The answer toward which the Obama museum will steer the visitor is: Nothing.

In point of fact, there were plenty of things Obama’s Democrats could have done that might have put the right out of business once and for all—for example, by responding more aggressively to the Great Recession or by pounding relentlessly on the theme of middle-class economic distress. Acknowledging this possibility, however, has always been difficult for consensus-minded Democrats, and I suspect that in the official recounting of the Obama era, this troublesome possibility will disappear entirely. Instead, the terrifying Right-Wing Other will be cast in bronze at twice life-size, and made the excuse for the Administration’s every last failure of nerve, imagination and foresight. Demonizing the right will also allow the Obama legacy team to present his two electoral victories as ends in themselves, since they kept the White House out of the monster’s grasp—heroic triumphs that were truly worthy of the Nobel Peace Prize. (Which will be dusted off and prominently displayed.)

But bipartisanship as an ideal must also be kept sacred, of course. And so, after visitors to the Obama Library have passed through the Gallery of Drones and the Big Data Command Center, they will be ushered into a maze-like exhibit designed to represent the president’s long, lonely, and ultimately fruitless search for consensus. The Labyrinth of the Grand Bargain, it might be called, and it will teach how the president bravely put the fundamental achievements of his party—Social Security and Medicare—on the bargaining table in exchange for higher taxes and a smaller deficit. This will be described not as a sellout of liberal principle but as a sacred quest for the Holy Grail of Washington: a bipartisan coming-together on “entitlement reform,” which every responsible D.C. professional knows to be the correct way forward.

Frank both ignores the real obstacles which Obama faced and is not very accurate in describing Obama’s record. He forgets that the there was a very good reason that Obama never had a chance to reason with the Republicans–they decided right off the bat that they would oppose anything Obama supported for political reasons. Frank might check out the work of  centrists Norman Ornstein and Thomas Mann on how Republicans are responsible for the current gridlock along with  this Frontline documentary:

On the night of Barack Obama’s inauguration, a group of top GOP luminaries quietly gathered in a Washington steakhouse to lick their wounds and ultimately create the outline of a plan for how to deal with the incoming administration.

“The room was filled. It was a who’s who of ranking members who had at one point been committee chairmen, or in the majority, who now wondered out loud whether they were in the permanent minority,” Frank Luntz, who organized the event, told FRONTLINE.

Among them were Senate power brokers Jim DeMint, Jon Kyl and Tom Coburn, and conservative congressmen Eric Cantor, Kevin McCarthy and Paul Ryan.

After three hours of strategizing, they decided they needed to fight Obama on everything. The new president had no idea what the Republicans were planning.

There were clear institutional limits on Obama in a system where forty Senators could block the majority on anything. The Democrats had sixty votes for a very brief time due to the delays in swearing in Al Franken and later Ted Kennedy’s death.  Even when Obama technically had sixty Senators voting with the Democrats, this included Joe Lieberman and Ben Nelson who would never go for the type of leftist agenda Frank favored.

Obama chose to use his limited political political capital to concentrate on health care reform, passing a comprehensive health reform package after previous presidents from Harry Truman to Bill Clinton were unsuccessful. Ted Kennedy once expressed regret at working with Richard Nixon and instead insisting upon a single-payer system at the time. Similarly Hillary Clinton convinced Bill to threaten to veto anything other than her plan, rejecting a Republican proposal which was very similar to the Affordable Care Act. It would be far better to accept what can be passed and then work to improve it over time.

Sure the Affordable Care Act is a confusing jumble, but that is because it built upon our current system. It would have been better if the system was even more complex and perhaps confusing, including either the public option or Medicare buy-in. Neither could pass because both Lieberman and Nelson opposed them. Obama certainly could have never received sixty votes for a single-payer plan, braking up the banks, or a bigger stimulus.

Beyond Congress, Obama was limited by conservative media bias on economic matters. Obviously Fox was out there spreading lies and attacking anything Obama wanted to do, but the problems weren’t limited to Fox and its viewers. Most of the media is owned by the wealthy, and much of the news, especially on television, is reported by wealthy television stars. They might not share the Republican views on social issues or their opposition to science and reason (leading to the conservative view of  a liberal media) but many of them are quite conservative on economic issues. They were biased towards tax cuts and cutting spending. Media reports on the economy typically stressed the size of the deficit and included the assumption that a reduction in government spending was necessary. Few pointed out the degree to which Republican spending and tax cuts in the Bush years contributed far more to the deficit than Obama’s stimulus spending. The atmosphere was hardly conducive to pushing an even bigger stimulus, regardless of how much more this would have helped the economy recover. He also ignores the degree to which Obama’s stimulus did help bring about economic recovery.

Just as Frank ignores the benefits of Obama’s policies, including the Affordable Care Act and the stimulus, he exaggerates what Obama did not do. No, Obama did not destroy Social Security and Medicare. It is the other party which has been seeking to do that. Offering  Chained CPI in exchange for a grand bargain on the deficit might never have been a good idea, but we can’t blame Obama for making a bad deal when such a deal was never made and we don’t know what he would have held out for before making such an agreement.

Obama’s record has much in it to displease the far left. It is doubtful that any other president would have achieved more than he actually did.

SciFi Weekend: Arrow; The Flash; Agents of SHIELD; Gotham; Doctor Who; Hannibal; Daredevil; True Blood; The Leftovers; The Last Ship; 24; Penny Dreadful

Arrow Oliver Felicity

TV Guide interviewed Andrew Kreisberg about the third season of Arrow:

Can Arrow‘s consummate hero have it all?

The third season of The CW series will dare to answer that question when Oliver Queen (Stephen Amell) attempts to have his cake and eat it too — in this case, that means being a superhero that the residents of Starling City actually respect while also trying to have a personal life. It’s harder than it sounds — something that Ollie will learn fairly quickly into the season.

But Oliver’s love life won’t be the only thing that’s complicated this season, especially since two of his ladies will actually be getting love interests of their own! TVGuide.com tracked down executive producer Andrew Kreisberg to get the scoop on the new season, including a surprising return from the dead, the future for Team Arrow and new villains ahead:

Will there be a time jump when the show returns?
Andrew Kreisberg: 
We’re going to jump the same amount of time that we did last year. It’ll be real time. It’ll be seven or eight months later. For Oliver, things are good. As we like to say, everything is coming up Arrow. Crime is down. At the end of last year, there was victory. A lot of this season is about what happens when you win and how winning isn’t always as easy as it looks.

What does it mean for Oliver now that the city actually accepts him?
Kreisberg: 
In the premiere, Lance (Paul Blackthorne) actually disbands the anti-vigilante task force in his new role as Captain. The Arrow is free to do his thing and it’s different for Oliver. He spent the first two years being hunted and distrusted. Now, he’s starting to feel like he has this under control. And then, of course, as Joss Whedon taught us all, you let your characters have a moment of happiness and then you take it all away from them.

You seemed to be setting the stage for Ra’s al Ghul to be the villain in Season 3. Is he actually the villain? Can you say anything about the new villain?
Kreisberg: 
It’s big. I can say that he’s big and he’s bad. We’re still figuring that stuff out. As far as the Big Bad, there will be Big Bad. Even last year, everybody was a subset of Slade’s (Manu Bennett). Slade was the Big Bad. We will meet other villains along the way, as always. We’ll have recurring villains and new villains we’re starting with this year and people who are coming back from the previous two seasons.

Felicity (Emily Bett Rickards) and Oliver are going on a date in the season premiere. How do you avoid the TV trope that a hero can’t be with the woman he loves just because of his duty?
Kreisberg: 
When you see the premiere and you see how things shake out, you’ll come to a very sympathetic understanding of both of their positions. The premiere last year was a microcosm of what was happening for the whole year. In the same way that the premiere of last season was really about Oliver struggling with whether or not he should be the Arrow, in this season premiere it’s, “Can I have everything I want?” That quest is going to take up his entire year, and hers.

How much of a foil will Ray Palmer (Brandon Routh), Felicity’s new rumored love interest and head of Queen Consolidated, be to Oliver?
Kreisberg: 
A big foil. It’s Season 3, and Season 3 is typically when you add that game-changing character like Buffy did in adding Faith or Everwood did with adding Scott Wolf. First of all, getting Brandon — he couldn’t be nicer, he couldn’t be sweeter. It’s just such a different energy that he’s bringing to the show. A lot of what’s funny about Felicity and Oliver is that he’s so straight and she’s the funny one. With Brandon, you get somebody who’s as tall, square-jawed and handsome as he is [and] he’s a really funny comedian. He and Felicity can have that verbal repartee that we haven’t typically had on the show. As much as the show is getting darker, it’s gotten a lot funnier. It’s just such a different energy. He and Felicity are really cute together.

The second season ended with the Black Canary giving her black jacket to her sister Laurel. This fed speculation that Laurel will become the Black Canary as in the comics. Kreisberg has a good point that she is not ready for this  yet: “As always with all of these things, you can’t just put on a mask and go running around. You’ll get killed. Laurel is still just an attorney. She’s an attorney with a jacket. I think Katie Cassidy fans are going to be very, very excited about her trajectory this year. Laurel is going to have a new love interest this season.” Caity Lotz will be returning for three episodes next season. One of the many good things about Arrow is that there is now a huge supporting cast, and even more characters are to be introduced. This allows them to have a variety of characters for parts of a season as opposed to having exactly the same characters from week to week. There will also be a cross over with The Flash next season in the eighth episode of each show, and Felicity will appear in the fourth episode of The Flash.

There has been contradictory information as to whether The Flash and/or Arrow will cross over with the DC cinematic universe in the manner in which Agents of SHIELD does with Marvel. The latest story is that DC Entertainment Chief Creative Officer Geoff Johns says the television shows and movies will be kept separate. Presumably this will mean that the Flash seen in the Justice League of America movie would be a different character than on the television show. While it would be entertaining to have the television and movie universes combined, there are advantages of keeping them separate. This allows for greater flexibility with the television shows not being confined by the movie universe, avoiding the problems faced by SHIELD most of its first season.

BRETT DALTON

Agents of SHIELD executive producers Jeffrey Bell, Jed Whedon, and Maurissa Tancharoen were interviewed about plans for the second season, now that the show is no longer constrained by waiting for Captain America: The Winter Soldier to reveal HYDRA’s infiltration of SHIELD.

Will there be consequences for Grant Ward for all that he had done last year?

“I would assume so,” Maurissa Tancharoen said. “Let’s put it this way: They’re not gonna just drop him on a farm and let him run wild.” Jed Whedon added. “When last we left him, he was in our custody. What does that mean? You’ll have to see,” Maurissa teased.

What are you specifically excited about for Season 2?

“I think the fact that when we left them, S.H.I.E.L.D. had completely crumbled… so just the idea of Coulson and our team, sort of left with nothing, or limited resources… I think we’ll be rooting for them to rebuild S.H.I.E.L.D.,” Tancharoen said.

“It’s a lot harder to protect the world when you don’t have any resources. Last year we saw how giant and all-consuming S.H.I.E.L.D.’s reach was, and they don’t have that anymore, so it’s much more of a struggle. They’re much more the underdog this year, which we’re really excited about that, and the tone that it sets, and what it does to our characters.” Whedon added.

This “ragtag team” has Maria Hill as a contact and she’s working for Tony Stark. Couldn’t she talk to him to hook them up with some money?

“We hope so! That’d be so cool!” Whedon responded. “Maybe so,” Tancharoen said. “That’s a good question.”

“Tony Stark doesn’t know Coulson’s alive, so it might be really awkward. It’d be weird,” Jeffrey Bell chimed in. “They could set up a Coulson Memorial Fund and channel that into S.H.I.E.L.D.,” he joked.

So with Phil Coulson now being the head of S.H.I.E.L.D., the Avengers still don’t know he’s alive?

“That’s a complicated question. One might assume, but you can’t assume anything, and they have their own movie that exists…” Whedon said, with his brother, of course, directing Avengers 2: Age of Ultron to come out next year.

“At least on screen so far, that hasn’t happened,” Bell said.

Will we be seeing Fitz (Iain de Caestecker) sooner rather than later?

“That’s a good question. When last we left him, we didn’t know exactly what happened to him. We just know he’s alive,” Tancharoen teased.

Gotham

TV Guide has more information on Gotham:

There will be no cape. There will be no cowl. Nevertheless, Fox’s Gotham intends to stay true to the Batman comics that fans have come to know and love over more than seven decades.

Based on DC Comics characters, Gotham explores the origin stories of the Caped Crusader’s eventual ally James Gordon (Benjamin McKenzie), a detective with the Gotham City Police Department, and his battle with the villains who made the city famous.

“What we won’t do is break the canonical iron truths of the mythology,” executive producer Bruno Heller told reporters at the Television Critics Association’s fall previews on Sunday. “It’s not a whole new mythology. But issues of chronology, we will play with in a fun way.”

Instead of Bruce Wayne (David Mazouz) taking center stage in the effort to save Gotham, James Gordon will be the central focus as he fights the ever rampant corruption and crime alongside his partner and mentor Det. Harvey Bullock (Donal Logue). “Gordon is the lynchpin of the show,” Heller explains. “He’s the guy who creates Batman or gives permission for Batman to exist in this world. Gordon will still remain at the central, but it’s very much about [the origin stories of every character], but Gordon is the moral center that you can identify with.”

Though Heller said that Batman won’t appear on the series, he doesn’t believe that will drive the fanboys away. “I don’t think so because the really interesting parts of the stories is the origin stories,” Heller says. “As soon as you’re into the capes and the costumes, it’s less interesting than how the people got there.

“If there is a superhero in this show, it’s Gotham,” he continues. “That’s a larger than life character that’s a central part of the show. To me, heroes are more interesting than superheroes because precisely the difference is superheroes do the impossible, and drama is really about the physically possible. This is about people and people trying to overcome real problems as opposed to trying to learn how to fly.”

But where do Gothamites find hope when the city’s villains of are running free with nary a hero (or the hope of one) to stop them? After all, Bruce Wayne hasn’t even started shaving yet! “That’s the situation that the show is all about,” Heller says. “How do you deal with crime of this level when there are no superheroes? It’s as much about the hope and the struggle that they’re engaged in… It’s about men and women, not about superheroes.”

And those men and women truly will be overrun. Though the first season delves into the rise of the Penguin (Robin Lord Taylor), the series pilot introduces a fair amount of villains for the show to play with, including Catwoman (Camren Bicondova), The Riddler (Cory Michael Smith), Poison Ivy (Clare Foley) and Fish Mooney (Jada Pinkett Smith). “You have to front-load the pilot with the best that you’ve got because that’s the way that you’ve got to open big,” Heller says of introducing so many villains. “As the show rolls on, we’ll be far more … careful with how we roll out the villains and in what way.”

Trailers for the upcoming season of Doctor Who above (one official and one from a fan).

With Laurence Fishburne having a roll on a new show next season, Black-ish, there has been speculation that this might mean that he did not survive the massacre in the second season finale of Hannibal. Fishburne says he is returning, and will do both shows part time. He also says the third season of Hannibal will be very dark–as if the first two seasons were so light and cheerful.

Looking back quickly on some genre shows of the past week, I was happy to see True Blood end some of its weak plot lines and get rid of some of the superfluous characters. This almost gives them yet another fresh start going into the final episodes of the series, and I hope they take advantage of this to end with a better story line.

The_Leftovers_65223

The Leftovers dealt with Christopher Eccleston’s character. As we know that it will not deal with any sort of explanation of what  happened to the missing people, to be successful the show will need to get viewers interested in the characters and how they responded to the other people disappearing. So far they have not done the greatest job of introducing the characters and adequately explaining their motivations. Earlier episodes dealt heavily with the police chief and his family, but it is not clear why his family is so affected considering that nobody in their family disappeared. Entertainment Weekly compared The Leftovers to Battlestar Galactica in the way in which both shows dealt with a loss of a portion of the population. Both the disaster and the manner in which the response were handled was greater on BSG.

While The Leftovers does have that in common with Battlestar Galactica, The Last Ship has far more in common in dealing with a ship of people surviving after mass deaths. It remains more of an action/adventure show than hard science fiction, but remains entertaining summer television.

Under the Dome remains weak (to put it gently), yet somehow remains interesting to watch. The same problems persist with the Dome having powers with no apparent limits but no clear motivations for those using the power. Now it was able to bring a girl who died years ago back to life. Plus Junior’s mother was also confirmed to be alive after her reported suicide.

24: Live Another Day concluded its short season. A shorter season was a plus, but it would have been even better if it ended a few episodes earlier when the main terrorist plot was tied up. In the past, full seasons suffered from the need to move from one plot line to another to keep things going for an entire twenty-four episodes. Now that they were freed from those constraints it would have better to tell one single story well, regardless of how many episodes it took. Then they had to tag on yet another quick story at the end to put Chloe in danger to set up Jack’s fate. The producers of 24 have not yet said whether the show will return. I’m sure that depends upon a lot upon the ratings.

Extant remained interesting in its second episode. I still fear it will turn out to be a network television rehash of old science fiction (and Spielberg)  troupes but I’m willing to give it a chance to prove me wrong.

Penny Dreadful Eva Green

Penny Dreadful ended earlier this month and I should note that after seeing the entire first season that it was well worth watching. The plot was not the strong point but it did excel in creating its characters and a world where fictional characters including Dr. Frankenstein, Dorian Gray, and others interacted. The show had a strong cast including Timothy Dalton, Josh Hartnett, and Billy Piper, but by far the strongest was Eva Green. The actual story such as fights with vampires weren’t terrible significant except as ways to introduce the characters and set up future events. Early episodes showed some violent deaths and, while there were some clues, the probable identity of the killer wasn’t revealed until the finale, undoubtedly influencing the second season. The show also made good use of episodic television, both having continuing stories and using some episodes to reveal character back stories or past events.

James Gardner, star of shows including The Rockford Files and Maverick, died yesterday at 86. Reports from Variety and The New York Times.

Quote of the Day: Gary Hart on Hillary Clinton

“She’s always trying to find the mythical center on controversial issues — and if you do that, someone else is going to take the bouquet for courage.” –Gary Hart on Hillary Clinton being overly cautious. Is it being cautious versus lack of principles beyond getting elected?

Three Reasons Democrats Might Retain Control Of The Senate

Republicans have an excellent chance to gain control of the Senate this year due to a combination of Republican voters traditionally turning out in higher percentages in midterm elections and the need for Democrats to defend several seats in red states. Current projections from most sources give the Republicans a slight edge but there are a few reasons to believe that the Democrats might hold on to one or two more seats than projected, and retain control of the Senate:

1) The power of incumbency:

Democrats must hold onto seats in red states, but they are states that Democrats have won once before, even if in a presidential election year which was more favorable to Democrats. While they don’t have this advantage in 2014, having candidates running as incumbents might increase the chance of winning. Since 2000 Democratic Senate candidates have usually won reelection in the south, despite their states going heavily to the Republicans in presidential elections. Polls are showing that incumbent southern Democrats remain competitive.

2) Women voters:

Republican hostility towards reproductive rights and attempts to restrict access to contraception as well as abortion has many women voters angry, hopefully enough to turn out to vote. The Hobby Lobby decision might also motivate women.

With their Senate majority at stake in November, Democrats and allied groups are now stepping up an aggressive push to woo single women — young and old, highly educated and working class, never married, and divorced or widowed. This week they seized on the ruling by the Supreme Court’s conservative majority, five men, that family-owned corporations do not have to provide birth control in their insurance coverage, to buttress their arguments that Democrats better represent women’s interests.

But the challenge for Democrats is that many single women do not vote, especially in nonpresidential election years like this one. While voting declines across all groups in midterm contests for Congress and lower offices, the drop-off is steepest for minorities and unmarried women. The result is a turnout that is older, whiter and more conservative than in presidential years…

Single women, Democrats say, will determine whether they keep Senate seats in states including Alaska, Colorado, Iowa, Michigan and North Carolina — and with them, their Senate majority — and seize governorships in Florida, Pennsylvania and Wisconsin, among other states.

The party is using advanced data-gathering techniques to identify unmarried women, especially those who have voted in presidential elections but skipped midterms. By mail, online, phone and personal contact, Democrats and their allies are spreading the word about Republicans’ opposition in Washington — and state capitals like Raleigh — to pay equity, minimum wage and college-affordability legislation; abortion and contraception rights; Planned Parenthood; and education spending.

3) Black Southern Voters:

Black southern voters have long voted Democratic, but now might turn out in high enough numbers to influence the results. Republican efforts to prevent them from voting might backfire, motivating more blacks to turn out:

Southern black voters don’t usually play a decisive role in national elections. They were systematically disenfranchised for 100 years after the end of the Civil War. Since the days of Jim Crow, a fairly unified white Southern vote has often determined the outcome of elections.

This November could be different. Nearly five decades after the passage of the Voting Rights Act, black voters in the South are poised to play a pivotal role in this year’s midterm elections. If Democrats win the South and hold the Senate, they will do so because of Southern black voters.

The timing — 50 years after the passage of the Civil Rights Act and 49 years after the passage of the Voting Rights Act — is not entirely coincidental. The trends increasing the clout of black voters reflect a complete cycle of generational replacement in the post-Jim Crow era. White voters who came of age as loyal Democrats have largely died off, while the vast majority of black voters have been able to vote for their entire adult lives — and many have developed the habit of doing so.

This year’s closest contests include North Carolina, Louisiana and Georgia. Black voters will most likely represent more than half of all Democratic voters in Louisiana and Georgia, and nearly half in North Carolina. Arkansas, another state with a large black population, is also among the competitive states…

Democrats lamented low black turnout for decades, but Southern black turnout today rivals or occasionally exceeds that of white voters. That’s in part because black voters, for the first time, have largely been eligible to vote since they turned 18. They have therefore had as many opportunities as their white counterparts to be targeted by campaigns, mobilized by interest groups or motivated by political causes.

Mr. Obama is part of the reason for higher black turnout, which surpassed white turnout nationally in the 2012 presidential election, according to the census. But black turnout had been increasing steadily, even before Mr. Obama sought the presidency. In 1998, unexpectedly high black turnout allowed Democrats to win a handful of contests in the Deep South; in 2002, Ms. Landrieu won a Senate runoff with a surge in black turnout.

The Supreme Court’s decision last year to strike down a central provision of the Voting Rights Act unleashed a wave of new laws with a disparate impact on black voters, including cuts in early voting and photo-identification requirements.

Michigan Democratic Candidates Improving Position In Latest Poll

AP SENATE MICHIGAN PETERS A ELN USA MI

There is good news in the latest EPIC-MRA poll out of Michigan. The biggest race from a national perspective is replacing retiring Senator Carl Levin. In addition to having an impact on control of the Senate, the Republican candidate, Terry Lynn Land, is a Teabagger who so far has come across as only slightly less bat-shit crazy than Michele Bachmann. Democratic candidate Gary Peters (pictured above) leads Land by 9 points, 45 percent to 36 percent.

Republican Governor Rick Snyder is fortunately not an extremist like Land. Many Democrats supported Snyder four years ago in the Republican primary, during a year when it was clear the GOP candidate would win, to prevent more extreme candidates such as Pete Hoekstra from getting the nomination. Snyder has sometimes stood up to the Republican legislature and  might even be tolerable if working with a Democratic legislature. Unfortunately at other times he has given in to the Republicans.

Snyder started out with a big advantage, such as that an incumbent governor has not lost in Michigan since 1990. In May Snyder led his Democratic opponent, Mark Schauer, by nine points. Now the lead has narrowed to three points, with Snyder leading 46 percent to 43 percent. As Schauer is still not well known, it is encouraging that he is making it a close race with a long time to go until November. The results are within the margin of error, and shows Schauer increasing support from the Democratic base and shows independents now breaking towards Schauer.

The Secret To Success In The Senate

warren paul

Congress has a record low approval rating, which perhaps is why the most successful Senators appear to be those who haven’t spent much time there. Barack Obama sure didn’t waste much time in the Senate before successfully running for president. Hillary Clinton is a special case as her time in the Senate is only a small part of her resume, but she didn’t spend very much time there either. The most popular Senator from each party today very well might be a freshman. Both have ignored the old tradition for new Senators to be fairly quiet.

On the Democratic side, Elizabeth Warren has received the most enthusiastic support. There is even a Ready For Warren web site, despite her statements that she has no plans to run for president. She has spoken out the most on economic issues, but is now wading into social issues as well with her comments on the Hobby Lobby case:

I’ll be honest – I cannot believe that we are even having a debate about whether employers can deny women access to birth control. Guys, this is 2014, not 1914 . Most Americans thought this was settled long, long ago. But for some reason, Republicans keep dragging us back here – over and over and over again.

On the Republican side, Rand Paul has generated the most excitement. As his foreign policy views are out of step with those of his party, there are real questions as to whether he has a chance to win a Republican presidential nomination. Gallup found that he falls just slightly behind Mike Huckabee among potential Republican candidates at this time. Aaron Blake looked at other polls to show that Paul is in a strong position to possibly win in both Iowa and New Hampshire, which certainly would give him strong momentum towards winning the nomination. Should Paul manage to win the nomination, a Quinnipiac poll shows that Paul is the strongest Republican candidate against Clinton in Iowa. Of course that might not hold nation wide.

A Huckabee versus Paul race for the Republican nomination would certainly offer a choice of different views. A presidential race between Paul and Warren would do the same, and most likley excite many on both the left and right far more than, say, another campaign between a Bush and a Clinton. Of course a race between Clinton, as opposed to Warren, and Paul is far more likley considering the state of the Democratic race. As I discussed previously, this would lead to a reversal in partisan foreign policy perspective, with the Democrats having the hawk as a candidate. As Peter Beinart pointed out, she sounded more like George Bush than a Democrat on foreign policy on her recent appearance on The Daily Show.

Updates: Digby also questions Clinton’s statement. Politico reports that Warren rallies the base. John Dickerson thinks a Warren run would be a good thing–but primarily to provide a worthy conversation and to “force Clinton to draw clear lines about what she believes, why she’s running, and why her message is something more than ‘It’s my turn.’” I would be more interested in a challenge to Clinton from the left which could actually beat her for the nomination, but that doesn’t look likely.

Liberal Democrats and Libertarian Republicans Working On Common Goals

Republicans have always had a libertarian wing but their influence and willingness to fight for true freedom has varied over time. Far too often Republican talk of freedom turns into the freedom of businesses to ignore necessary regulations or the freedom to impose their social and religious values upon others. Limited government also far too often turns out to mean reducing the authority of the federal government in order to allow state governments to infringe upon the rights of minorities. With true defense of freedom being rare among Republicans in recent years, it was good to see a report from The New York Times that Liberals and Libertarians Find Common Ground in House.

The article lists several areas where some Republicans have crossed the aisle to work with liberal Democrats:

From abortion to electronic privacy to background checks for gun purchases, a strange thing has been happening on the floor of the House as it debates its spending bills for the coming fiscal year: the stirrings of liberalism.

The House on Thursday voted 221 to 200 to approve an amendment by one of its most vocal liberal members, Representative Rosa DeLauro, Democrat of Connecticut, to ban federal contracts for companies that set up sham headquarters in offshore tax havens like Bermuda. Thirty-four Republicans bucked their party to push it to passage.

That was only the most recent stirring of life on the House’s left flank. Democrats have long hoped they could find common cause on at least some issues with the Republican conference’s libertarian wing. That is starting to happen, fueled by rising distrust of government on the right, a willingness of Democrats to defy the Obama administration in some instances and a freewheeling amendment process on appropriations bills.

The article cites examples of liberals and libertarians working together on legislation to increase individual liberty, from medical marijuana to privacy protections:

The tally of left-libertarian legislation is growing, with the House at least on record voting to limit federal law enforcement actions, intelligence efforts and social policy reach. On May 30, 49 Republicans crossed the aisle to approve language barring the federal government from raiding medical marijuana dispensaries.

“Some people are suffering, and if a doctor feels that he needs to prescribe something to alleviate that suffering, it is immoral for this government to get in the way,” said Representative Dana Rohrabacher, Republican of California, once one of the chamber’s most ardent conservatives, now a co-sponsor of the marijuana measure.

The day before, 76 Republicans joined Democrats to add $19.5 million to the federal instant background check system for gun purchases. The House Appropriations Committee has approved an amendment to allow Peace Corps volunteers who become pregnant by rape to have a federally funded abortion and another measure limiting the federal government’s access to private email communications.

“By passing this amendment, the Appropriations Committee is taking a critical step towards ensuring all Americans are protected by the Fourth Amendment — their mail, documents on their desks at home, and now their private emails,” said Representative Kevin Yoder, Republican of Kansas and one of the measure’s authors.

On June 19, the House voted 293 to 123 to prohibit the National Security Agency and C.I.A. from placing “backdoor” surveillance technologies on commercial technology products and to end warrantless collection of Americans’ online activities. That amendment, passed over the White House’s objections with a veto-proof margin, was written by Representative Thomas Massie, Republican of Kentucky and one of the House’s most outspoken libertarians, with the Democratic Representatives Zoe Lofgren, who represents Silicon Valley, and Rush D. Holt of New Jersey, a physicist.

An amendment by Representative Dave Reichert, Republican of Washington, reversed cuts to a Bill Clinton-era program that funds local police forces, a program long on the Republican target list. The liberal Democrat that Republicans love to hate, Representative Alan Grayson of Florida, convinced just enough Republicans to pass an amendment blocking the Justice Department from compelling journalists to divulge confidential sources. Another Democratic amendment clears a legal path for states to cultivate industrial hemp.

To be sure, Republicans note, plenty of amendments have driven spending bills to the right. Just last week, the House voted to block the Obama administration’s efforts to combat climate change on multiple fronts, including one amendment that prohibits any funding for any aspect of the administration’s “climate change agenda.”

Amendments also have passed to end the deferring of deportations of immigrants brought illegally to the country as children, to fund a Justice Department investigation of the Department of Homeland Security’s release of illegal immigrants and to block high-speed rail in California.

But, Mr. Massie said, the libertarian-liberal alliance is real and growing. He said he has been working with Ms. Lofgren on legislation that would repeal a federal law that makes it a felony to unlock a cellphone tied to a particular carrier, even after a contract is expired. Libertarians are also teaming with Democrats to change laws on federal mandatory minimum sentencing.

It would be helpful if left-libertarian goals were a higher priority from the executive branch. Obama had initially raised hopes that he would have governed as more of a left-libertarian, and Obama did receive some libertarian support when initially running for president. While he has been far preferable to George Bush on civil liberties, he has disappointed civil libertarians in areas ranging from continuing many of the Bush surveillance plans (even if seeking reform in some areas) to failing to keep his campaign promises regarding ending federal raids related to medical marijuana. While nothing is a certainty in politics, it looks most likely that Hillary Clinton, who has been to the right of Obama, is likely to win the 2016 nomination. This could leave it up to such a liberal and libertarian coalition in Congress to pursue liberal goals. There is hope for greater emphasis by the Democrats (and possibly some Republicans) on matters of personal freedom in the future as polls show that younger voters are more “determined to protect personal liberties from conservative moral constraint.”

Study Finds Liberal Men Have More Sex

AlterNet reports on a long-term Harvard study of adult development:

Between 1939 and 1944, researchers at Harvard University recruited 268 of the best and brightest members of the student body to participate in a long-term psychological study. The purpose of the Harvard Grant Study—so called for its original funder, chain-store magnate William T. Grant—was to determine which traits best predict a successful life. To track a wide range of factors, including income, physical and mental health, and happy marital and parental relationships, the chosen students (all men, as Harvard wouldn’t become coed until 1977) participated in regular interviews, physical and psychiatric exams, and surveys with researchers. The surviving participants are now in their 90s, making the Grant Study one of the longest-running prospective studies of adult development ever conducted. Triumphs of Experience, a recent book published by George Vaillant, who directed the study for more than three decades, reveals some of the most interesting findings.

Here is the most interesting finding:

Liberals Have More Sex

In one of the oddest discoveries, researchers found that aging liberals had much more active sex lives than their conservative counterparts. Though political ideology had no bearing on overall life satisfaction, the conservative participants ended their sex lives at around age 68 on average, while most liberal men continued having sex regularly well into their 80s. Vaillant was himself puzzled by this, noting that he’d consulted urologists about the findings but “they have no idea why it might be so.”

Yet one more reason conservatives should stop watching Fox, stop listening to right wing talk radio, and stop sending all those ridiculous emails full of right wing talking points. It also might explain why so many Republicans, largely the party of old white men, (or as Matthew Yglesias put it, the cranky oldser party) is so obsessed with interfering with the sex lives of others.

Bill Maher On Republican Zombie Lies About Obamacare

Bill Maher had a rant against all those Republican lies about Obamacare which, despite being repeatedly debunked, are still out there–neither dead or alive, like Dick Cheney. The same is true about all those other lies which Republicans tell, since facts do not matter to them. Video above and transcript (via Daily Kos) follows:

And finally, New Rule: Now that there’s been an uproar over all the neocons who lied about the Iraq War with no consequences, someone must tell me why there isn’t a similar uproar over all the Republicans who lied about Obamacare with no consequences.  (audience applause)  It’s been four years since the bill passed.  Has anybody come across even one death panel?  The next liberal to tell a Republican, “you’re entitled to your own opinion, but not your own facts”, should really just admit they’ve never seen Fox News.  (audience cheering and applause)Now, look, I get it that neither party has a monopoly on lying, and in fact they all do it so often, they’ve invented their own word for it — “I misspoke”.  But how come the rule for one party — the Republican Party — is that when they get caught in a lie, they don’t have to stop telling it?

They said Obamacare would use death panels.  It doesn’t.

They said it was a government takeover, and the insurance industry is making record profits.

They said it covered illegals.  It doesn’t.

They said it was a job killer.  It hasn’t been.

They said there were elves who bake cookies in trees.  Well, almost.  (audience laughter and applause)

Now for sure, Obama also told a lie when he said everybody who likes their health care plan can keep it.  And for about 2% of the population, that did turn out to be false.  The difference is, he stopped saying it!  He stepped up and said, you’re right, my bad, because he understands there’s this thing called observable reality.  (audience applause)

But on the Republican side, observable reality needs more study.  (audience laughter) Which is why their talking points that have been disproven, remain!  Like a guest who’s been asked to leave a party, but does not.

It reminds me of a horror movie where you think you’ve killed the lie, but it won’t stay dead.  Which is why I call them zombie lies.  (thunder crackles and camera shakes)

Ooh, what an effect!  (audience laughter)  Excuse me, I have a weak heart.

Yes, zombie lies.  Remember “fracking doesn’t cause earthquakes”?  Zombie lie!  So stop saying it!

Voter fraud?  We studied it, it’s not an actual problem.  Stop zombie lying about it.

Their entire economic philosophy — cut taxes for the rich, and it trickles down — is a zombie lie!  (audience cheering and applause)

And all these zombie lies are still out there, roaming the countryside, neither alive nor dead.  Like Dick Cheney.  (audience laughter and applause)

Hungry for brains.  Like Dick Cheney.  (audience laughter)

I mean, we think we’ve eradicated one, but it turns out it’s just lying dormant in a cave full of bat blood, like the ebola virus.  Or Dick Cheney.  (audience laughter)

Dick Cheney, who did not even bother in his recent return from the dead to update the lies he told about Iraq the first time.  He’s still out there saying, “Well, Saddam was building a bomb, and he was working with al-Qaeda.”

What??  It’s like when Chuck Berry sings “Sweet Little Sixteen”.  You’re 90, man!

There is no shame in their game.  One week they’re out there saying, “No one will sign up for Obamacare.”

And the next week, “Oh, OK, they signed up?  Sure, OK, but they aren’t paying the premiums.”

“Oh they are?  OK, uh, well, they’re paying, but it’s not the young people.”

“Oh, it is?  It’s the young people?  OK.  Uh, OK, but it only covers you if you’re gay.”  (audience laughter)

You know, you just wanna go, wait, when did we switch over?  What happened to yesterday’s lie?  It’s still out there forever, like a plastic bag in a tree.  But now we’re just using the new one?

Yes, because what they do is they pass a zombie lie down to dumber and dumber people, who believe it more and more.

Hank Paulson may be over the one about climate change being a hoax, but it’s still good enough for Sean Hannity.  Who then gets quoted by Michele Bachmann.  Who forms the intellectual core of the thinking of Victoria Jackson.  And when you think the zombie lie has finally gone to die at the idea hospice of the absolutely stupidest people on Earth, there it is being retweeted by Donald Trump.