Why The Republicans Won Despite Being Wrong On All The Issues

Paul Krugman points out that the Republicans, despite winning the midterm elections on Tuesday, were wrong on everything:

First, there’s economic policy. According to conservative dogma, which denounces any regulation of the sacred pursuit of profit, the financial crisis of 2008 — brought on by runaway financial institutions — shouldn’t have been possible. But Republicans chose not to rethink their views even slightly. They invented an imaginary history in which the government was somehow responsible for the irresponsibility of private lenders, while fighting any and all policies that might limit the damage. In 2009, when an ailing economy desperately needed aid, John Boehner, soon to become the speaker of the House, declared: “It’s time for government to tighten their belts.”

So here we are, with years of experience to examine, and the lessons of that experience couldn’t be clearer. Predictions that deficit spending would lead to soaring interest rates, that easy money would lead to runaway inflation and debase the dollar, have been wrong again and again. Governments that did what Mr. Boehner urged, slashing spending in the face of depressed economies, have presided over Depression-level economic slumps. And the attempts of Republican governors to prove that cutting taxes on the wealthy is a magic growth elixir have failed with flying colors.

In short, the story of conservative economics these past six years and more has been one of intellectual debacle — made worse by the striking inability of many on the right to admit error under any circumstances.

Then there’s health reform, where Republicans were very clear about what was supposed to happen: minimal enrollments, more people losing insurance than gaining it, soaring costs. Reality, so far, has begged to differ, delivering above-predicted sign-ups, a sharp drop in the number of Americans without health insurance, premiums well below expectations, and a sharp slowdown in overall health spending.

And we shouldn’t forget the most important wrongness of all, on climate change. As late as 2008, some Republicans were willing to admit that the problem is real, and even advocate serious policies to limit emissions — Senator John McCain proposed a cap-and-trade system similar to Democratic proposals. But these days the party is dominated by climate denialists, and to some extent by conspiracy theorists who insist that the whole issue is a hoax concocted by a cabal of left-wing scientists. Now these people will be in a position to block action for years to come, quite possibly pushing us past the point of no return.

He then went on to look at why they won, expressing views similar to what I had written about the election earlier in the week:

Part of the answer is that leading Republicans managed to mask their true positions. Perhaps most notably, Senator Mitch McConnell, the incoming majority leader, managed to convey the completely false impression that Kentucky could retain its impressive gains in health coverage even if Obamacare were repealed.

But the biggest secret of the Republican triumph surely lies in the discovery that obstructionism bordering on sabotage is a winning political strategy. From Day 1 of the Obama administration, Mr. McConnell and his colleagues have done everything they could to undermine effective policy, in particular blocking every effort to do the obvious thing — boost infrastructure spending — in a time of low interest rates and high unemployment.

This was, it turned out, bad for America but good for Republicans. Most voters don’t know much about policy details, nor do they understand the legislative process. So all they saw was that the man in the White House wasn’t delivering prosperity — and they punished his party.

This was their strategy, literally beginning on Day 1, if not earlier. A Frontline documentary described what the Republicans planned:

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.

Of course we cannot just criticize the Republicans. The Democrats were at fault when six years later they still had no effective response to this Republican strategy, and were afraid to stand up for their accomplishments. Being right doesn’t do any good politically if they were afraid to explain this to the voters. Democratic candidates ran away from Obama and his policies and then were shocked when the Obama voters didn’t come out to vote for them. As Peter Beinhart wrote, the Democrats cannot keep playing not to lose:

This fall, Democrats ran like they were afraid of losing. Consider the issues that most Democrats think really matter: Climate change, which a United Nations report just warned will have “severe, pervasive and irreversible impacts” across the globe. The expansion of Medicaid, so millions of poor families have health coverage. Our immoral and incoherent immigration system. Our epidemic of gun violence, which produces a mini-Sandy Hook every few weeks. The rigging of America’s political and economic system by the 1 percent.

For the most part, Democratic candidates shied away from these issues because they were too controversial. Instead they stuck to topics that were safe, familiar, and broadly popular: the minimum wage, outsourcing, and the “war on women.” The result, for the most part, was homogenized, inauthentic, forgettable campaigns. Think about the Democrats who ran in contested seats Tuesday night: Grimes, Nunn, Hagan, Pryor, Hagan, Shaheen, Landrieu, Braley, Udall, Begich, Warner. During the entire campaign, did a single one of them have what Joe Klein once called a “Turnip Day moment”—a bold, spontaneous outbreak of genuine conviction? Did a single one unfetter himself or herself from the consultants and take a political risk to support something he or she passionately believed was right?

…We saw the consequences on Tuesday. According to exit polls, voters under 30 constituted only 13 percent of the electorate, down from 19 percent in 2012. In Florida, the Latino share of the electorate dropped from 17 to 13 percent. In North Carolina, the African-American share dropped from 23 to 21 percent.

By positioning himself as a moderate, he may have missed a chance to gin up more enthusiasm within the state’s expanding Democratic base, earning fewer votes in such deep-blue communities as Arlington County and Alexandria than left-of-Warner Gov. Terry McAuliffe (D) did a year ago.

All of it has left some to wonder whether Warner would have won bigger if he had eschewed the middle and embraced the left, and whether the winning path for moderates that Warner forged during his own bid for governor 13 years ago is becoming extinct.

“I think if you look at the returns around the country . . . it raises questions about just how successful the bipartisanship brand really is,” Rep. Gerald E. Connolly (D-Va.) said Tuesday after easily winning a fourth term in Northern Virginia’s 11th Congressional District by talking about women’s rights, immigration reform and climate change — and less about working with Republicans.

Here’s a similar take on what the Democrats did wrong: “They were so focused on independents that they forgot they had a base. They left their base behind. They became Republican-lite.”

That opinion came from Rob Collins, the executive director of the National Republican Senatorial Committee. He also said Democrats “sidelined their best messenger” by running away from Obama, and for not talking about the economy. Republicans might be wrong virtually all the time lately when it comes to governing, but quite often they are smarter than Democrats with regards to politics.

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Republicans Beat Something With Nothing Other Than Negativity And Fear

Ronald Reagan couldn’t save the Senate for the Republicans in his 6th year. While the closeness of the polls left hope until the end, realistically the Democrats were not in a situation to defy history. There were two tends which the Democrats could not overcome. When people are unhappy, they look at the president regardless of who is actually to blame. Running a campaign based upon negativity was a winning formula for Republicans. Democrats were further hampered by the older and whiter electorate in midterm elections as once again large portions of the Democratic base stayed home for a midterm.

Republicans won by avoiding discussion of what they would do in power, beating something (Obama) with nothing. Americans who vote for Republicans to retake control of the Senate out of concern about current problems are as delusional as Russians who want the return of Stalinsim. It makes no sense to trust the party which created the economic downturn with fixing it, and Americans certainly do not want the Republican social or militarist agenda. The party which opposes most government action (other than imposing the agenda of the religious right, foolish military action, or rigging the system to transfer wealth to the ultra-wealthy) is hardly likely to propose real solutions to problems.  Polling on issues generally shows a majority favoring Democratic views but that does not help in elections where Republicans concentrate on distorting the views of their opponents and  hiding their own views.

That said, I am disappointed (as usual) in the Democrats as a political party. Yes, all the fundamentals were against them. So they took the cowardly way out, running away from not only Obama but from principles. If they ran a campaign based upon their accomplishments and the problems with GOP principles they very well still might have lost in this atmosphere, but at least their campaign would have meant something. Plus, considering how close the polls were, just maybe they could have won some more seats.

Of course that isn’t something that can be done in the last few months of a campaign. It requires a change in attitude and behavior of the party every year, acting as if it was a perpetual battle of ideas–as Republicans do even though they run on bad ideas. When Democrats run from their own record and fail to speak out on the issues, they leave themselves wide open to being defined by their opponents.

The Republicans were successful in hiding their most extreme views. They did receive some help from a friendly media in this regard as many of the most extreme statements from Republicans such as  Joni Ernst received too little attention. When Mitch McConnell tried to make his desire to repeal Obamacare more popular by claiming the people of Kentucky would still have their popular exchange, the media concentrated far more on the less important refusal of Alison Lundergan Grimes to say whether she voted for Obama. When liberals spoke out on this, the media did begin to pay more attention to McConnell’s gaffe, showing there is benefit to serious discussion of the issues by liberals. If only Democratic candidates had the courage to do this too.

External events helped the Republicans. Widespread opposition to Congressional Republicans over the threat of a government shutdown of October 2013 was forgotten after the initial failed roll out of the exchanges, even if this was quickly fixed. Republicans gained further by promoting exaggerated fears of ISIS and Ebola.

The Republicans avoided saying what they would do while running, but now will be under closer scrutiny. Republicans decided upon a strategy of opposing everything Obama does, including if he promoted policies previously favored by Republicans, from before he took office. Now that they control Congress, this might no longer be their best strategy. Many Republicans will mistakenly see this election result as a mandate and try to move even further to the right. Some must be intelligent enough to realize that Republican victories with the midterm electorate will not translate into victories with the younger and minority voters who turn out in greater numbers for general elections. While it is hard to see the two parties work together on many of the big issues such as climate change, there might be some pragmatic legislation which both McConnell and Obama could agree on, considering Obama’s long-standing willingness to compromise with Republicans.

McConnell is attempting to portray a more moderate image, but even if this is his personal desire he still has to deal with the far right wing of his own party. He might even find that he cannot pass legislation without Democratic cross over support. It remains to be seen whether McConnell will pass legislation which doesn’t beg for a Democratic filibuster or presidential veto, especially if Tea Party Republicans push through amendments to legislation to attempt to repeal Obamacare or restrict access to contraception. The Tea Party wing is least likely to realize that this election does not signify agreement by American voters with their goals. An example of this was seen with the failure of Personhood measures even in red states. Republicans won midterm elections but their policies remain opposed by a majority of Americans.

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Media Lets Republicans Get Away With Absurd Statements On Obamacare & Other Issues

Republicans have been successful at “playing the refs” with false claims of liberal bias, helping them get away with spreading their misinformation. Liberal blogs and magazines, have commented a lot on Mitch McConnell’s absurd statement in support of the popular and successful Kynect exchange site while attacking Obamacare, which makes Kynect possible. Fact checkers have debunked this claim months ago. However the mainstream media is paying little attention to this–considerably less than the far less significant refusal of Alison Lundergan Grimes to say who she voted for.

Brian Buetler thinks that the media is largely giving McConnell a pass on this due to failing to understand this, and not really liking to discuss policy. He explained, as so many have in the past, why McConnell is both wrong and dishonest:

During the debate, McConnell said he’d be “fine” with it if Kentucky decided to hold on to Kynect if and when Republicans repeal Obamacare. The subtext of Holmes’s tweet is that Kynect would simply become a hub for the kinds of plans that existed in Kentucky before Obamacare. After all, it’s true there was an insurance market (a non-group market) before there was Obamacare. It could follow that McConnell’s proposition is perfectly reasonable.

But there were also websites before there was Kynect. One of those websites is a Kynect-like exchange called ehealthinsurance.com. Yet somehow, before Obamacare and Kynect came along, it wasn’t processing half a million Kentuckyians a year. The uninsurance rate in Kentucky was extremely high and showed no signs of falling on its own.

That’s because prior to Obamacare, the non-group market was dysfunctional. It excluded and priced out the sick and poor. It offered decent plans to young people who posed minimal health risks, but also sold junk policies that left people who believed they were doing the responsible thing exposed to medical bankruptcy.

It took Obamacare (and, thus, Kynect) to transform that market into something that proved inviting to half of Kentucky’s uninsured population almost overnight. Take away Obamacare, and Kynect might still exist as a website. But it’d be about as useful to Kentuckians as ehealthinsurance was prior to last year. Not totally useless, perhaps, but dramatically diminished and completely superfluous.

You need to know all this if, as a political reporter, you’re going to dismiss the McConnell camp’s spin and call him out as clearly as you (presumably) called out Grimes. Likewise, when McConnell implies that Kentucky could simply replicate the ACA’s private insurance expansion and its Medicaid expansion, you need to know that Kentucky probably couldn’tand certainly wouldn’tever do it on its own. McConnell is suggesting that Kentuckians replace a valuable, paid-for federal benefit with one that would impose steep new burdens on the people of the state alone, knowing it’ll never happen.

Once you grasp it all, then it becomes obvious why McConnell’s contradiction is theoretically so dangerous. He isn’t just painting a shiny gloss on a controversial position. He’s exploiting the public’s confusion over it, playing voters for fools by peddling absurdities. Something that can come to define a campaign just as easily as Grimes’ political cowardice might ultimately come to define hers.

This isn’t the only dishonest statement to come from Republicans in recent debates. Tom Cotton, Republican Senate candidate in Arkansas, made an absurd claim that people with pre-existing conditions were better off before the Affordable Care Act. I happened to listen to the debate in Virginia on C-Span, hearing Ed Gillespie make multiple false claims, such as repeating the Republican lie that Medicare is being cut to pay for Obamacare.

Part of the problem is that many in the media sees their job as “objectively” reporting what each side says, regardless of whether one side is saying far more absurd things. The conventional wisdom this year is that Republicans are doing better because there have not been statements such as Todd Akin talking about “legitimate rape,” but in reality Republicans continue to say many totally off the wall things which are being ignored by the media. Paul Waldman discussed absurd statements which Republicans are getting away with this election cycle and concluded:

…in the last few years, there’s a baseline of crazy from the right that the press has simply come to expect and accept, so the latest conspiracy theorizing or far-out idea from a candidate no longer strikes them as exceptional. Sure, there are exceptions: For instance, Republicans Sharron Angle and Christine O’Donnell both saw their candidacies derailed by their crazy or outsized statements. But their utterances were truly, deeply bizarre or comical, so they broke through.

But during this cycle, Republican crazy just hasn’t broken through at all. It’s almost as if the national press has just come to accept as normal the degree to which the GOP has moved dramatically to the right. At this point so many prominent Republicans have said insane things that after a while they go by with barely a notice. This is an era when a prominent Republican governor who wants to be president can muse about the possibility that his state might secede from the union, when the most popular radio host in the country suggests that liberals like Barack Obama want Ebola to come to America to punish us for slavery, and when the President of the United States had to show his birth certificate to prove that he isn’t a foreigner.

So ideological extremism and insane conspiracy theories from the right have been normalized. Which means that when another Republican candidate says something deranged, as long as it doesn’t offend a key swing constituency, reporters don’t think it’s disqualifying. And so it isn’t.

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Republicans Remained Obsessed With The Sexual Activities Of Others

Periodically there is talk from some Republicans about letting up on the culture wars, especially as social issues are alienating Republicans from large segments of the electorate. Unfortunately there are always social conservatives who will react negatively to this:

Conservative activists are launching “an unprecedented campaign” against three Republican candidates — two of whom are out gay men — because of their support for marriage equality and abortion.

The National Organization for Marriage, Family Research Council Action, and CitizenLink “will mount a concerted effort to urge voters to refuse to cast ballots” for Republican House candidates Carl DeMaio in California and Richard Tisei in Massachusetts and Republican Senate candidate Monica Wehby in Oregon, according to a letter sent to Republican congressional and campaign leaders on Thursday.

“We cannot in good conscience urge our members and fellow citizens to support candidates like DeMaio, Tisei or Wehby,” the presidents of the three groups write. “They are wrong on critical, foundational issues of importance to the American people. Worse, as occupants of high office they will secure a platform in the media to advance their flawed ideology and serve as terrible role models for young people who will inevitably be encouraged to emulate them.”

DeMaio and Tisei are the only out LGBT federal candidates from the Republican Party to be appearing on the ballot this fall.

“The Republican Party platform is a ‘statement of who we are and what we believe.’ Thus, the platform supports the truth of marriage as the union of husband and wife, and recognizes the sanctity and dignity of human life,” NOM President Brian S. Brown said in a statement.

Brown called it “extremely disappointing” to see candidates supported “who reject the party’s principled positions on these and other core issues.”

Of the effort to urge people to oppose DeMaio, Tisei, and Wehby, he said, “We cannot sit by when people calling themselves Republicans seek high office while espousing positions that are antithetical to the overwhelming majority of Republicans.”

The letter was sent to House Speaker John Boehner, Senate Minority Leader Mitch McConnell, National Republican Congressional Campaign Committee Chairman Greg Walden, National Republican Senatorial Committee Chairman Jerry Moran, and others in Republican congressional leadership.

In it, the three conservative groups also warned that it is a “grave error” for the party to be supporting “candidates who do not hold core Republican beliefs and, in fact, are working to actively alienate the Republican base.”

In opposing gay marriage, these conservatives are looking at consensual behavior between others which does not affect them and desire to use the power of government to limit the choices of those who do not share their religious views. They also fail to recognize the right of a woman to control her own body.

Social conservative groups have considerable influence in the Republican Party and it will be interesting to see how the Republican establishment respond to this.

Such obsession with the sexual activities of others is not limited to a single faction of the conservative movement. The Heritage Foundation held a conference on the future of liberalism. As would be expected, they hold a very warped view of what liberalism is:

“Give up your economic freedom, give up your political freedom, and you will be rewarded with license,” said Heritage’s David Azerrad, describing the reigning philosophy of the left. “It’s all sex all the time. It’s not just the sex itself—it’s the permission to indulge.”

They totally miss the point. It is not a question of whether we should be promoting more sex, or less sex. Liberals believe government should stay out of the private lives of individuals, and let people make such decisions for themselves.

While they advocate restricting individual liberty and greater intrusion of government in the private lives of individuals, they promote a Bizarro World version of freedom. On social issues, freedom means their freedom to impose their views upon others. Economic freedom means freedom from necessary regulation along with freedom of taxation, but limited to the rich. While they preach keeping government out of economic matters, they actually support using government to rig the system to benefit the ultra-wealthy at the cost of the middle class.

The primary political freedom they support is a right for the rich to spend unlimited amounts of money on elections, failing to recognize that regulation of conduct related to spending on  elections is not the same as restrictions on free speech. While a libertarian argument could certainly be made against restricting spending on political contributions, they hardly show any consistent support of political freedom when they use voter suppression tactics to promote their goals.

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Election Forecasts Now Improving For Democrats To Retain Control Of Senate

Various forecasts for who will control the Senate are now tilting in the direction of the Democrats, with most still agreeing the race is very close, continuing a trend I noted at the beginning of the month. Some of the predictions more favorable to Democrats have been those which concentrate more on polls as opposed to historical trends and other factors. Nate Silver had previously discounted many of the polls, noting both the low number and often poor quality of polls available. Silver is now reconsidering his prediction, decreasing chances for Republicans to take control of the Senate from 65 percent two weeks ago to 55 percent.

Others have even more favorable predictions for Democrats. Electoral-vote.com, based purely on polls, has the race even. The Upshot gives the Republicans a 51 percent chance, essentially a toss up. Election Lab gives the Democrats a 51 percent chance. The Princeton Election Consortium even gives the Democrats a 78 percent chance of retaining control of the Senate.

In changing his prediction, Nate Silver looked at factors such as the Democratic ground game, and believes money might be the most important factor.

Charlie Cook looked at the same factors:

Two things may be keeping Republican strategists up at night: money and the Democratic ground game. Perhaps the biggest untold story of this election is how so many Republican and conservative donors, at least those whose last name isn’t Koch, have kept their checkbooks relatively closed. In many cases, GOP candidates are not enjoying nearly the same financial largesse that existed in 2012, and in some races, they are well behind Democrats. While Republican candidates, national party committees, and super PACs are hardly starving, their Senate and House campaign committees have not been able to keep pace in fundraising with their Democratic counterparts. Their super PACs do not have nearly the funding that they had in 2012 (even allowing for the absence of a presidential race this year). And, in a number of key races, Democratic candidates, party committees, and their allied groups have been on the air significantly more than Republicans. GOP strategists have privately said that if it were not for spending by organizations affiliated with the Koch brothers, they might well be in really bad shape.

Many Republican and conservative donors appear to be somewhat demoralized after 2012. They feel that they were misled about the GOP’s chances in both the presidential and senatorial races that year, and/or their money was not well spent. In short, they are giving less if at all, and it has put Republican candidates in a bind in a number of places.

Another reason things might not turn out for Republicans is if the highly touted Democratic Senate ground game comes together. Clearly the Obama campaign and Democratic allies had a superior voter-identification and get-out-the-vote operation two years ago. Earlier this year, Senate Democrats announced the Bannock Street Project, a $60 million program with the goal of putting in place 4,000 paid workers to use techniques perfected and put to work in 2010 by DSCC Chairman Michael Bennet in his race, and again two years ago by the Obama campaign. While some Republicans have scoffed at the likelihood of Democrats being able to mount such an effort, they concede that the Democratic ground game was superior two years ago. In midterm elections, if Democrats can crank up the turnout among young, female, and minority voters, then their chances of success this year increase.

The GOP might be paying for its divorce from reality when Republicans were predicting victory in 2012 despite all the polling data showing that they were delusional.

Electoral-Vote.com also looks at how Democrats are spending their money more effectively, along with factors such as the culture war issues  now favoring the Democrats and the Republicans big demographic problem–a considerable decrease in the low-information, non-college-educated white males who provide such a large percentage of Republican votes (emphasis mine):

Republicans used to use cultural issues like same-sex marriage and abortion to rev up their supporters and get them to vote. Now the shoe is on the other foot. It is the Democrats who are talking about cultural issues and scaring the voters with them. Not only has same-sex marriage gained enormous popularity in the past five or ten years, but Republican support for limiting birth control (such as in the Hobby Lobby case) is scaring women and driving them to the Democrats. Much of the Republicans’ problem has to do with shifting demographics. In 1980, when Ronald Reagan was first elected, white voters without college degrees made up 65% of the electorate. In 2012, that number was 36%. Ever since Richard Nixon began his Southern strategy, Republicans have been basing their campaigns on getting older white men without college degrees to back them. They still do, but there aren’t enough of them any more and it is beginning to be a real problem, hence the action in many states to limit who can vote (voter ID requirements) and when they can vote (shortening early voting periods). This year in states as diverse as Colorado and North Carolina, Democratic candidates are claiming that the Republicans are out of the mainstream. Such an approach was unthinkable 10 years ago, when it was the Republicans making these claims about the Democrats.

What Democrats in red states are also desperately trying to do is make the race between them and their actual opponent, not between President Obama and their opponent. In a new ad the Democratic candidate for the Senate in Kentucky, Alison Lundergan Grimes, literally says “I’m not Barack Obama” while shooting a gun. Then she shows a photo of her opponent, Sen. Mitch McConnell (R-KY), waving a gun with her saying he doesn’t know how to hold it. The Republicans, in contrast, are running against Obama everywhere. Obama himself is not sitting idly by. In October he will begin serious campaigning, although he may be limited to states where he is relatively popular, such as Colorado, Iowa, and Michigan. And of course he can show up in New York and California any time he wants to in order to raise money for the DSCC.

First Read points to how the gender gap continues to help Democrats.The Washington Examiner looked at how Democratic super PACs have been more effective in their use of advertising money.

The Republican playing field has also been narrowing, with states such as Michigan, and now North Carolina moving firmly in the direction of the Democrats. Having Kansas be unexpectedly in play also makes a huge difference. An election which initially looked highly favorable for Republicans now looks to be even.

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Response To Republican Support For Making Birth Control Pills Available Over The Counter

While Republicans have generally been trying to restrict access to contraception, recently some Republicans have been promoting making oral contraceptives available over the counter without prescription. Many people quickly saw through this. It gives the Republicans a way to claim they are removing a barrier to receiving contraception and avoid situations like the Lobby Hobby case. It also does something else–make contraception less accessible for many women. While the Affordable Car Act requires that contraception be covered without out-of-pocket expense to the woman, many insurance plans do not cover over the counter medications. This is also an incomplete response to the issue as there are many other types of birth control, including forms which many Republicans are attempting to restrict.

The Guttmacher Institute issues a statement regarding this topic (via Talking Points Memo):

Birth Control Pills Should Be Available Over the Counter, But That’s No Substitute for Contraceptive Coverage

September 11, 2014

By Adam Sonfield and Sneha Barot, Guttmacher Institute

In recent weeks, some opponents of the Affordable Care Act’s (ACA) contraceptive coverage guarantee have promoted the idea that oral contraceptive pills should be available to adult women without a prescription. Sens. Kelly Ayotte (R-NH) and Mitch McConnell (R-KY), for example, recently introduced the so-called Preserving Religious Freedom and a Woman’s Access to Contraception Act, a bill that would urge the Food and Drug Administration (FDA) to study whether to make contraceptives over the counter (OTC)—though for adults only.

Making birth control pills available over the counter, if done right, would meaningfully improve access for some groups of women. However, such a change is no substitute for public and private insurance coverage of contraceptives—let alone justification for rolling back coverage of all contraceptive methods and related services for the millions of women who currently have it.

The Policy Behind Over-The Counter Contraception
Making birth control pills available OTC has merit, and the Guttmacher Institute is part of a coalition that has been working toward this goal for years. Leading medical groups have also endorsed such a move, including the American Medical Association and the American Congress of Obstetricians and Gynecologists. By removing the need to obtain a prescription, OTC status would eliminate this potential barrier to contraceptive use and thereby increase access.

This is especially true for uninsured women and those who don’t have time for a doctor’s visit or otherwise can’t readily reach a health care provider. However, if the goal is to truly expand access to contraceptive care—and not just provide cover for undercutting insurance coverage for contraceptives—the case to move birth control pills to OTC status should proceed alongside several other important policies and goals:

Protect contraceptive coverage and full method choice: The ACA requires most private health plans to cover the full range of women’s contraceptive methods and services, without out-of-pocket costs for the patient. This policy eliminates cost as a barrier to women’s ability to choose the method that is best for them at any given point in their lives, an approach that has been proven to make a substantial difference in facilitating access to and use of contraceptive services.

Contrary to what some policymakers and commenters have claimed, giving the pill OTC status would not be an effective substitute for the ACA policy. First, it would do nothing to help women access any contraceptive method other than the pill. This matters, since most women use four or more different contraceptive methods over their lifetime to meet their changing needs. If only the pill were available OTC and contraceptives were no longer covered by insurance, women would face significant new barriers in choosing the method that best suited their needs. Cost is a particularly steep barrier for highly effective methods like the IUD or implant that not only have high upfront expenses, but also require a trained provider for insertion and therefore are not candidates for OTC status.

Even for the pill itself, there is no convincing evidence to suggest that moving it to OTC status would substantially lower out-of-pocket costs to patients, let alone come close to the $0 out-of-pocket cost guaranteed under the ACA policy. Rather, making the pill available OTC, if done at the expense of insurance coverage, would replace one barrier (ease of access) with another (cost). Likewise, greater reliance on Health Savings Accounts or Flexible Spending Accounts, as some opponents of insurance coverage have proposed, would also merely replace full insurance coverage with patient out-of-pocket costs—leaving most privately insured women, particularly low-income women, worse off. Uninsured women on average pay $370 for a full year’s supply of the pill, the equivalent of 51 hours of work at the federal minimum wage of $7.25.

Millions of women already benefit from the ACA’s contraceptive coverage guarantee and these hard-won gains must be protected. Rather than substituting for contraceptive coverage of all methods and related services, OTC status for birth control pills should complement and enhance such coverage.

Strengthen coverage for over-the-counter methods: While the ACA’s preventive care provision specifically requires private health plans to cover certain products with over-the-counter status (including the emergency contraceptive Plan B, folic acid, aspirin to prevent heart disease and tobacco use cessation products), a prescription is needed for these items to be covered—essentially negating the benefits of OTC status. This prescription requirement should be eliminated for any current and future over-the counter contraceptives. Coverage of over-the-counter products without a prescription is already the norm in some state Medicaid programs and in the U.S. military’s Tricare insurance program. Further, ensuring full coverage for over-the-counter contraceptives would prevent “free-riding” by insurance companies that benefit from not having to cover pregnancies that were averted through patient out-of-pocket expenditures.

Ensure equal access for young women: Adolescents and young women, who face greater risk of unintended pregnancy and more barriers to accessing contraception than older women, have among the most to gain from a switch to OTC status. However, recent calls to give birth control pills OTC status as a substitute for contraceptive coverage have specifically excluded minors. That would require women 17 and younger to obtain a prescription, without providing any medical evidence to justify such restrictions. This approach would be harmful to adolescent women and would be counterproductive to helping them avoid unplanned pregnancies and the negative health, social and economic consequences that often follow.

In addition, excluding minors would likely not result in a true over-the-counter status, but instead could put contraceptive pills behind the counter, much as happened when the emergency contraceptive Plan B was first approved for OTC sales. To comply with an age restriction, stores would have to require proof of age via a valid picture ID from any woman who looks young enough to potentially be barred from purchasing birth control pills without a prescription. This would be an added hurdle for millions of women, and it ignores the reality that many young women do not have government-issued forms of photo ID.

Keep politics out of FDA decision making: To switch any drug to OTC status, the typical process involves the drug’s manufacturer submitting an application to the Food and Drug Administration (FDA), which—based on several criteria, including the safety and efficacy profile of the medication—decides whether to grant the request. The evidence is quite strong that providing birth control pills OTC would be safe and effective, including for minors. The FDA process should be driven by the evidence and free from political interference by the administration, Congress and others.

It is troubling but not at all surprising that Senator Ayotte and others who purport to be interested in contraceptive access would preempt the FDA with unfounded calls to bar minors from benefiting from any future OTC status for birth control pills. This echoes the longtime political and legal wrangling over minors’ access to OTC emergency contraceptive pills, despite clear evidence that minors could safely use these products without a prescription.

It is also noteworthy that there are dozens of brands and formulations of birth control pills, most of which would likely have to undergo the lengthy and expensive FDA process to gain OTC status separately. Because formulations of the pill are not medically interchangeable, with some women tolerating specific pills better than others, making one or several versions of the birth control pill available OTC would not benefit all current pill users.

Not A One-Size-Fits-All Policy Solution
Just as birth control methods are not “one size fits all” at any point in a woman’s life, let alone for all of her reproductive years, neither is there a one-size-fits-all policy solution to enhance access to the full range of methods, information and services for women of all ages and income levels, regardless of where they obtain their care. A wide range of approaches is necessary to meaningfully respond to women’s family planning needs in a comprehensive way.

One such approach includes making birth control pills available over-the-counter, if done so without additional costs or barriers to women. Doing so can complement and enhance current efforts to help more women become effective contraceptive users, including the ACA’s significant gains for comprehensive private and public insurance coverage for contraceptive counseling, services and supplies.

If anything, contraceptive coverage should be broadened to cover more women and strengthened to eliminate the prescription requirement for OTC methods that are covered. Other urgent priorities include expanded access to Medicaid, public support for safety-net family planning centers and the Title X national family planning program, comprehensive sex education and the development of new contraceptive technologies.

Truly increasing access to contraceptive care requires a multifaceted approach to meet the needs of all women throughout their reproductive lives. Political talking points will not do it.

This article was originally published on Health Affairs Blog at this link.

Click here for a recent statement from the American Congress of Obstetricians and Gynecologists (ACOG) supporting over-the-counter access to birth control pills as part of a broader dialogue about improving women’s health care as opposed to a political tool.

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Kansas Independent Might Be Key To Control Of Senate

With control of the Senate so close, anything which might alter a race in a state felt to be dominated by one party could have huge ramifications. Sam Wang offers a plausible scenario which could make Kansas competitive:

In national politics, Kansas is considered as Republican as they come: Mitt Romney carried the state in 2012 by twenty-two percentage points, and the last Democratic Presidential candidate to carry Kansas was Lyndon Johnson, in 1964. But this year, the reliability of Sunflower State politics seems to have been upended. With control of the Senate in a tight, uneasy race, Kansas may be a game changer on a national level, thanks to an unusually strong independent candidate.

The Republican incumbent, Pat Roberts, is heartily disliked by Kansas voters: his approval rate is only twenty-seven per cent, even lower than the thirty-three per cent who approve of President Obama’s performance. Roberts, who is in his third term, recently survived a primary challenge by the radiologist Milton Wolf. Dr. Wolf ran under the Tea Party banner and gained attention for posting gruesome X-ray images of gunshot victims on his Facebook page that were accompanied by macabre banter with his friends. Still, Roberts’s margin over Wolf was only forty-eight per cent to forty-one per cent. It seems that Kansas voters will seriously consider just about anyone but Roberts.

Except, maybe, a Democrat. Shawnee County’s district attorney, Chad Taylor, cruised to a relatively easy victory in the state’s Democratic primary, but in recent general-election surveys, Taylor trails Roberts by a median of six percentage points. Kansas has not sent a Democrat to the Senate since Franklin D. Roosevelt was President, and it’s unlikely that it will this year.

The third candidate in the race is the businessman Greg Orman. Orman, who comes from Olathe, a city in the eastern part of the state with about a hundred twenty-five thousand people, has been crisscrossing Kansas by bus, meeting voters and preaching a message of fiscal restraint and social tolerance. A former Democrat, he decried the gridlock and lack of action in Washington, and now declines to identify himself as a member of either major party.

Orman’s formula seems to be working with Kansas voters. Despite the fact that thirty per cent of voters still have not heard of him, a recent Public Policy Polling survey shows that in a one-on-one matchup, Roberts would lose by ten percentage points, forty-three to thirty-three. In contrast, Roberts would survive a one-on-one matchup with Taylor by a margin of four points. So if you’re Roberts, you either want Taylor and Orman to split the vote, or to run against Taylor alone.

This means that, paradoxically, Pat Roberts’s political future may depend on his Democratic opponent staying in the race. And that, in turn, affects the balance of power in the closely contested Senate—by converting a Republican seat into an independent one.

Control of the Senate appears to be so close that one seat could certainly make the difference. It would be ironic if the key race turns out to be in Kansas due to backlash against how far right the Republicans have moved.

The first question is whether the Democratic candidate would really get out of the race and if Orman would really win. Polls show that there is an excellent chance of this happening should Taylor agree to drop out. The Democratic Party has plenty of incentive to offer Chad Taylor a lot in return for agreeing to this, and he certainly might accept a decent offer considering that he is not going to win if he remains in the race.

The next question is whether Orman would then caucus with the Democrats if he won. Chances are better that a former Democrat than a former Republican would do so, but he might also look ahead to having a better chance of holding on to the seat long term in Kansas if he becomes a Republican.

If Orman wins there will be intense pressure from both sides, and it might also impact the leadership of either party. Orman has said that both Harry Reid and Mitch McConnell “have been too partisan for far too long” to gain his vote of confidence. Would members of either party initiate a revolt against their leader if they thought it would mean retaining control?

Update: Taylor drops out of race

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Quote of the Day: Alison Lundergan Grimes on Mitch McConnell

“If Mitch McConnell were a TV show, he would be ‘Mad Men,’ treating women unfairly, stuck in 1968 and ending this season.” --Alison Lundergan Grimes on Mitch McConnell at the Fancy Farm picnic in Kentucky or, as she referred to it, “Senator  McConnell’s retirement party.”

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McConnell Promises Conservatives That Republicans Will Work To Restrict Abortions If They Take Control Of Senate

With control of the Senate up for grabs, The Hill reports on one key reason why it is important for Democrats to get out to vote. Mitch McConnell vows to escalate Republican efforts to restrict reproductive rights and promote further government intrusion in the private lives, and bodies, of women:

Senate Minority Leader Mitch McConnell (R-Ky.) promised Saturday to focus more attention on limiting abortions if Republicans take control of the Senate in November.

Speaking to the National Right to Life Convention in his home state of Kentucky, the Senate’s top Republican suggested Majority Leader Harry Reid (D-Nev.) has blocked the upper-chamber from voting on bills that would limit women’s rights to abortion, according to conservative website Townhall.com.

But McConnell said he would push abortion-limiting legislation to pressure President Obama to take a stand on the issue.

“For six years, the president has been isolated from this growing movement,” McConnell said. “He will be forced to listen to the cause that’s brought us all here this morning. Senate Dems would be forced to take a stand.”

I fear that the Republicans will really do this, as opposed to their empty promises to work to create more jobs when they took control of the House. Undoubtedly Obama will take a stand and veto such legislation.

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Republican Extremism And The Weakness Of Republican Leadership

The victory of David Brat over Eric Cantor was momentarily a cause for celebration, but the long term results might not be so favorable. Norm Ornstein warns that this will lead to further radicalization of the Republican Party:

First, it is clear that this moves the Republican Party even further to the right, in approach, attitude and rhetoric. Even if the overwhelming majority of incumbents, including establishment ones, have won renomination, even if broader Republican public opinion is more establishment conservative than Tea Party radical, all it takes is an example or two of the opposite to get all politicians jumping at their shadows and muttering to themselves, “That could happen to me.”

…American political parties always face a tension between their establishment and ideological wings. On the Republican side, going back more than a hundred years to the Teddy Roosevelt era, that was a struggle between moderate progressives and conservatives.

Now it is different. There are no moderates or progressives in today’s GOP; the fight is between hard-line conservatives who believe in smaller government and radical nihilists who want to blow up the whole thing, who have as much disdain for Republican traditional conservatives as they do for liberals.

In our 2012 book, “It’s Even Worse Than It Looks,” Tom Mann and I described the Republican Party as an “insurgent outlier.” That is even more true today. The energy and driving force in the party, in its House membership, media dominance, caucus and primary electorates and financial backers, is not its conservative wing but its radical side.

Ornstein is probably right that this will pull the Republicans even further to the right, but how far right can they go before even safe Republican districts are at risk? Will Republicans in these districts support any lunatic with an R after his name, or is there a limit? At the moment it appears that Brat should win, but the narrative would certainly change if the victory by such an extremists were to cause the Republicans to lose a safe Republican district.

Yesterday I noted Brat’s views on slashing spending on Medicare, Social Security, and education.  His plan to replace Obmamacare is just as absurd: “We need to also scrap employer-based health insurance, and give those incentives to individuals to carry their own portable health insurance. If we did that, the issue of pre-existing conditions largely goes away.” This makes absolutely no sense as the individual market has been dominated by insurance plans which have been the most abusive at denying coverage to the sick.

Brat’s campaign manager, Zachery Werrell, scrubbed his Facebook page after the victory but Yahoo News took screen shots while the page was still available:

From comparing George Zimmerman’s shooting of unarmed black teenager Trayvon Martin to abortion to calling for the abolition of the Food and Drug Administration and encouraging the adoption of the silver monetary standard, Zachary Werrell – one of just two paid staffers for the upstart campaign of Randolph-Macon College economics professor David Brat – sought in 2012 and 2013 to build a public profile as a socially conservative libertarian voice…

“Can someone who was outraged that George Zimmerman was found not guilty of ‘SOMETHING ANYTHING’ and who is simultaneously pro-choice explain the logical dissonance there? Ie. Why its not ok to kill someone who is banging your head into concrete but its ok to kill someone for simply existing who, through your conscious actions, you brought into the world?” Werrell had written in an Oct. 24, 2013, posting.

The month before, the campaign manager for the likely next congressman for Virginia’s 7th District – since no Democrat has represented that district since 1971 – questioned whether existing state lines were defensible. “Should sections of States be allowed to secede from a State if they feel they are un/underrepresented in the State Government?” Werrell asked. “I say yes. I derive that opinion from our first foundational document – the Declaration of Independence. What say you?”

On Oct. 25, 2013, he called for an end to the regulation of prescription drugs, citing a story from the Ludwig von Mises Institute. “Abolish the FDA!” he wrote.

On Oct. 29 of that year, it was a piece by Fred Reed from Lew Rockwell’s website on the wussification of boys that set him off. “There is a war on boys!” Werrell wrote. “Rough housing, playing soldier, etc, are all punished or medicated away. And we wonder why there is gender inequality in the classroom and in college/attendance/graduation rates.”

The Reed piece called for the end of women teachers in coed or boys’ schools. “It is time to get women out of the schooling of boys,” wrote Fred Reed. “It is way past time. Women in our feminized classrooms are consigning generations of our sons to years of misery and diminished futures.” The piece further argued that “women should not be allowed within fifty feet of a school where boys are taught” and that “Women are totalitarian. Men are happy to let boys be boys and girls be girls. Women want all children to be girls.”

Brat is far more likely than Cantor to make a major gaffe. It will be interesting to see his take on the views of his campaign manager.

If we can fantasize about a Democratic upset in this Congressional district, we might also fantasize about another upset in the general election. Peter Beinart looked at the weakness of the Republican leadership:

Cantor’s boss, John Boehner is, according to Nancy Pelosi, “the weakest speaker in history.” Less than 50 percent of Republicans approve of his performance. Over the last two years, he has repeatedly retreated in the face of opposition from rank-and-file conservatives who treat him with barely disguised disdain. Until the defeat of Cantor, his most likely heir apparent, it was widely assumed that he would soon either step—or be pushed—aside soon.

In the Senate, Minority Leader Mitch McConnell only avoided Cantor’s fate by attaching himself to his Kentucky colleague Rand Paul, whose upstart Senate candidacy McConnell had opposed. Like Boehner, McConnell is treated with striking disrespect in his own caucus.

David Frum wonders whether the Republican leadership will ever fight back:

At some point, Republican leaders must recognize that they have a fight on their hands whether they like it or not. If they refuse to join that fight, they will be devoured anyway. If they surrender, they condemn the whole conservative project in America to the destructive leadership of fanatics (and the cynics who make their living by duping fanatics).

I never thought there was much of a chance of Grimes to beat Mitch McConnell despite being close in the polls but today Political Wire reported that “A new Magellan Strategies (R) poll in Kentucky finds Allison Lundergran Grimes (D) leading Sen. Mitch McConnell (R) by three points in the U.S. Senate race, 49% to 46%.” Perhaps a major reason that Cantor was defeated is general bipartisan disgust with the Republican leadership, and if so this just might extend to knocking out McConnell.

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