Public Policy Final Test

Improving the ACA

-Problems include insufficient subsidies and sicker pool of people increasing premium costs -Purchase of insurance across state lines -Health Savings Accounts -High risk pools -Medicaid

Expanding Coverage

-Public and private sectors -Existing and new initiatives -Insurance regulations, individual mandate, medicaid expansion, insurance exchanges -Court decisions

Hobby Lobby Case

-Questioning preventive care vs. religious rights -Individual religious rights are protected by federal legislation, RFRA (Religious Freedom Restoration Act) -Private companies have some religious rights as individuals -Companies have religious objection to certain preventive services under ACA -Court found that some companies can circumvent the requirement

Repeal and Replace

-Republican led Congress has voted at least 60 times to disband Obamacare before 2017 -While the House passed a repeal and replace bill in May 2017, the Senate, despite at least 5 tries, were unable to agree on legislation -With Trump's election, Republicans have both houses of Congress and the White House -One of President Trump's first acts was to issue an E.O. addressing the ACA

Democratic Option: Universal Care

-Single Player --> Medicare for all --> Leadership may not support this approach -But as a minority party, democrats can support this without discussing details -Flip side of GOP repeal and replace of ACA when Obama was President -Bernie Sanders' success in presidential campaign gave him a strong platform for more progressive and radical policies

Lenses

-Social (Dynamic conditions about how people live and interact) -Economic (regulations in the market and taxes) -Political (ideological differences and compromises) -Governing (institutions, federalism, separation of powers) -Cultural/ Religious (Values; morality (judgments and beliefs)

Immigrant

-Someone who chooses to resettle to another country -United States has a legall process for that immigrant to seek legal residency and eventually citizenship

Refugee

-Someone who has ben forced to flee his or her home country -Can apply for asylum in the United States, a process that could take years -Applicants have to prove that if they return to their home country, they'll be inured because of their race, religion, nationality, membership, in a particular social group or their political opinion

Alabama Senate Race 2017

-Special election for replacement Jeff Sessions who was Senator for Alabama and is not Attorney General -Roy Moore v. Doug Jones -Strong showing from African American community-- stronger than white vote -Alabama has relatively strict Voter ID laws -"The country is going to be poorer if we only care about voter suppression when it affects the outcome"

VRA Section 4

-States requiring pre clearance must seek approval of DoJ before changing any election laws or procedures -These states often had a history of discriminatory voting practices -Preclearance needed/ Formula Provisions: Use of test or device or "moral character" test -<50% of voting age persons registered OR <50% persons voting in NOVEMBER 1964 -VRA reauthorized in 1970, changing the "relevant date" from 1964 to November 1968 -1975: Coverage formula was extended again, and the relevant date was changed to November 1972 -Provided a "bailout" for areas covered for pre clearance, consisting of a number of criteria the state had to achieve to be released from section 5 or earning their way off the pre clearance list -Goes hand in hand with section 5

Controlling Costs

-Taxes on higher income individuals and insurance plans -Tax on certain other health care related items like medical equipment -Changes in provision of medical care... hospital mergers --> Accountable Care Organizations -Streamlining Medicare --> Antifraud, value based payments, increasing "transparency" -Individuals saved from increased competition on exchanges

Whitford v. Gill (Partisan Gerrymandering)

-The Supreme Court has ben tolerant of partisan gerrymandering and in the past has been split over whether to take an active role -A federal court in Wisconsin ruled in November 2016 that the state's Republican controlled legislature had discriminated against Democratic voters -What makes this case different is that it included a "test" to help determine if the state did impose, through its redistricting process, a burden or restriction on the rights of certain voters -"Efficiency Gap" measures the effects of packing and cracking. Every voter packed into a district above the threshold needed to elect a candidate from his/ her party creates a "surplus" vote. Additionally, someone who votes for a candidate who is unable to win is a "lost" vote. Surplus and lost votes are considered wasted votes. The efficiency gap measures the difference between the wasted votes of the 2 parties in an election divided by the total number of votes cast -Federal Court in Wisconsin acknowledged the efficiency gap, but only as one of several theories supporting its findings that GOP leadership had a discriminatory intent; that the plan had a discriminatory effect and that the state had no legitimate reason for drawing the districts that way

Homeland Security Act

Created the Department of Homeland Security, which included Customs and Border Patrol, ICE, and U.S. Citizenship and Immigration Services

Federalism and Immigration

Justices focused on power of federal government to set immigration policy and pre-empt state policies that infringe on that power

Immigration Reform and Control Act

Legalized undocumented immigrants, mainly from Latin America, who met certain standards

Voting Rights Act

-Law passed in 1965 to prohibit discrimination in voting nationally -Relied on 14th and 15th Amendments-- Constitutional protections -Created special enforcement provisions for those areas of the country deemed more likely to continue with discriminatory practices

VRA Reauthorizations

-1970: Vote for 18 year olds, and section 5 extension by 5 years -1975: Protections against language discrimination and extended section 5 and required bilingual voting material -1982: Extended pre clearance provision (section 5) for 25 years -2006: Section 5 extended for 25 years and extension was for interpreters/ materials in different languaages

Arizona Law

-2010 law requiring immigrants to carry documentation and giving police the right to check documents if they stopped a suspect for other issues -State crime to live in AZ undocumented with specific penalties -Allowed to arrest people without a warrant -State officials can only report violations to federal authorities, not institute any penalties -"Papers Please" provision okay, allows police to check immigration status during routine stops and lets police stop those believed to be undocumented

Benefits of Expanding Coverage

-4 coverage levels, covers varying % of medical expenses -All states must have an exchange.. set up by either the state or, if they refuse, federal government steps in and sets up exchange -Essential Benefits Requirement: Plans must include a package of items and services from 10 categories

Trump's 3rd Executive Order

-90 day suspension on entry of nationals from 7 countries (Iraq, Syria, Iran, Libya, Somalia, Sudan, and Yemen) -DHS and Department of State can allow entry on a case by case basis -120 suspension of refugees, and the admission for the full 2017 cannot exceed 50,000 -Sept. 2017: Administration included Chad, North Korea and Venezuela in their list and removed Sudan -Some countries have a blanket ban on all visas while others allow very limited visas -The Justice Department argues that the President does have the authority to ban travelers from certain countries and that the Constitution and Acts of Congress confer on the President broad authority to suspend or restrict the entry of aliens when he deems it in the Nation's interest

DACA

-Apply the idea of conflict -Through Obama's Executive Order and Trump getting rid of Obama's executive order -Through the Senate and the House -Checks and balances is President v. Congress

Federalism and Healthcare

-Bipartisan Governors generally oppose the Republican plans -Phase out of Medicaid expansion could hurt state budgets and threaten coverage for millions -Governors generally support a plan that would stabilize insurance markets

Trump's 1st Executive Order

-Border Security and Immigration Enforcement Improvement -Increase by 5,000 border control agents -Funding is unclear

Sanctuary State

-California -Allows federal agents to interview people in custody and state and local agencies can participate in joint-task forces

VRA Section 2

-Can only be used to challenge existing laws (or events occurring after the fact of implementation) -DoJ has begun using Section 2 to challenge some of the new voting laws -Harder to challenge a law with section 2, which prohibits discriminatory voting practices -Section 2 can be used AFTER THE FACT -Justice Department/ Plaintiffs do not have to prove that the initiative had a discriminatory intent but that its result would deny protected groups an opportunity to participate in political processes -Prohibits drawing election districts in a way that improperly dilutes minority voting power on federal, state, county, or local levels (dilution/ gerrymandering) -Important in redistricting as state/ local officials may create districts that fairly reflect minority voting strength, or may dismantle districts providing minority representation

Implications of Shelby

-Changes in racism -Decision emphasized that an updated Section 4 does NOT make discrimination against voters legal all of a sudden, but it allows all states to make changes to voting laws free from federal oversight by lifting key barrier to ensure new laws treat all fairly -Section 5 originally put more burden on the states and allowed federal government more intervention/ power an gave the government opportunity to stop harmful practices BEFORE they could be implemented -Section 2 cases can still be filed but it is tougher for the government to prove discriminatory actions AFTER the fact, and these cases are often focused one redistricting -SECTION 5 ISSUES OFTEN DEALT WITH PRACTICAL APPLICATIONS SUCH AS POLLING PLACE LOCATIONS, VOTING HOURS, VOTER ID, ETC.

Family Unification

-Changes occur in 1965 (Great Society) -From quotas to family reunification and skill focus, including seasonal labor discussions

Voting Rights Act of 1965

-Congress had determined that the existing federal anti-discrimination laws were not sufficient to overcome the resistance by state officials to enforcement of the 15th Amendment -Most important sections are 2, 4 and 5 -Prohibits the use of literacy tests (Sec.4c); poll taxes (Sec. 10a), and sets out guidelines for federal examiners

"Progressive and Conservative Freedom" (Framing and Healthcare)

-Conservative views, individual focus -Nanny state of health care= freedoms taken away by government -Big government = wasteful, communistic and socialism -Marketplace = vehicle for citizens to pursue individual goals -Conservative view of imposition of government and loss of choice in health care as a loss of freedom -"Conservative media was effective in evoking fear that government would take away freedom of Americans to choose life or death" -Free market, punctuated by profits, is threat to common good -Must ensure freedom of political processes -"Conservatives have learned far better than liberals how to take advantage of the links between emotion and rationality" -The progressive commentators have spent time contesting frames created by the conservative media rather than proactively creating their own frames of the health care debate -Liberal/ Progressive: Views and community focus

Framing ("Undocumented" vs. "Illegal")

-Conservatives: Lawbreakers and fearsome, government must protect society from these INDIVIDUALS, and they are criminals and must maintain law and order -Progressives: Abused by society, "Papers please" show government overreach in civil rights (racial profiling), and they are humans and need protection from profiling in society -Progressives spend time contesting conservative frames rather than coming up with their own

Cooper v. Haris (Racial Gerrymandering)

-Court ruled in May 2017 that North Carolina legislature relied heavily on racial considerations in redrawing districts -Lawmakers are required to consider race when drawing legislative lines so people of color can elect candidates of their choice -These racial considerations cannot be the MAIN factor when redistricting -North Carolina argued that their efforts were partisan in protecting their majorities, not an attempt to diminish the impact of minority voters -State legislators note the challenge in finding the appropriate balance -In this case, the Court cited "packing" voters into the 2 districts into question

Trump Commission on Voter Fraud

-Created by Executive Order in May 2017 -Purpose: To investigate voter fraud in the 2016 election -Requested data from each state on registered voters -Information requested included names, addresses, partial social security numbers, military status, and other information -Majority of states refused to comply, with some providing only limited information such as names and addresses -Concern over what is going to be done with that person's information

Federal Initiatives

-Creation of NIH (1880s) -FDA (1906) -CDC (1946) -National Health Insurance considered by many Presidents, including FDR and Truman -Medicare and Medicaid (1965) -Nixon (1970s) signs HMO Act and Title X -1988: Medicare Catastrophic -1990s: Clinton tries but fails to pass healthcare reform -1996: HIPPA (makes it easier to carry insurance when changing jobs -2000: SCHIP -2003: Medicare Part D (implemented in 2006) -2010: Patient Protection and Affordable Care Act

Enhanced Border Security and Visa Entry Reform Act of 2002

-Dealt with data sharing and upgrading electronic documents

Trump Initiative: New Rule and Funding Cuts

-Draft rule to come out early 2018 allowing "bare bones" policies -Counters the idea of Essential benefits, allowing some "short term" plans to offer fewer benefits for lower costs -Outreach funds cut; administration refuses to allow funding to educate people regarding ACA and to help new enrollees

Ways to Evaluate Policy

-Effectiveness: Reaching state goals and objective -Efficiency: Bang for your buck -Equity: Who reaps the benefits? Who pays the costs? -Ethics: "Normative" or broad issues; includes questions lime the size of government, individual rights, and public's health

Trump's 2nd Executive Order

-Enhancing Public Safety in the Interior of the United States -Prioritizes deportation of undocumented immigrants convicted or charged with crimes -Added 10,000 border officers through ICE -Federal dollars can be withheld from "sanctuary cities" -Creation of Office for Victims of Crimes Committed by Removable Aliens -Sanctuary Cities

DREAM Act

-Executive order of 2012 -Legislation to block deportation of certain undocumented immigrants -Lived here at least 5 years, here before age 16, no criminal record, less than 30 years old -Allowed young illegals to present certain documentation and be able to stay in the United States and work toward citizenship -Can work and get a drivers license

Goals of the ACA

-Expanding coverage -Cost controls

VRA of 2014

-Expands ability of courts to address pre-clearance "remedies" -Looks at prior 15 years, and if a state has had 5 voting rights violations, they are subject to pre-clearance -Bill expands government power (DoJ and Courts)

Economic Concerns

-Expenditure to support immigrants -Supporting border security -Different costs per state -Immigrants= decreased wages

DAPA (Deferred Action for Parents)

-Extend deferred action to parents of United States citizens or lawful permanent residents and allow them work permits -Part of Obama's 2014 Executive Order

Supreme Court Challenge ACA Part II (Medicaid Expansion)

-Fed. gov. cannot force states to expand Medicaid programs by withholding funding -Moving forward, states can participate and receive funding or refuse to expand and forgo new funds -La requires states to expand Medicaid programs to include those up to 133% above poverty -The federal government will pick up the full cost of this expansion to the states for 3 years -After that, states will be required to contribute (10%)

Supreme Court Challenges Part 4 (Subsidies)

-Federal exchange subsidies questioned Hill v. Burwell -The ACA mentioned only "state" exchanges, yet Congress couldn't force refusal of states to set up exchanges -Court found that the intent of the law was to have exchanges in all states, regardless of state or federally set up -May 2016: Federal judge ruled that the administration did not have the authority to fund "cost sharing" subsidies for low income people at 250% of poverty -These subsidies are separate from the other subsidy that is available to those at 400% of poverty -These subsidies were authorized by ACA but not funded by Congress -These are the funds now being questioned -Judge said only Congress can appropriate money but put a hold on decision during appeal process -Cost sharing subsidies help with copays and deductibles

Medicaid

-Federal/ state program -Must qualify -State policies differ -Innovations on state level -ACA Medicaid money -MEDICAID IS TRADITIONALLY LOOKED AT FOR HELPING THE VERY POOR OR DISABLED

Problems with the ACA

-Fewer options of individuals as insurers leave the exchanges and premiums have increased, in some places over 100% while others have seen single digit increases. Varies geographically -Insurer exists and rising premiums are related. The number of enrollees and their health care needs are often not what insurers expected -In some places, Obamacare marketplace plans attracted more older people than initially thought-- thus more costly population -Where there is a larger proportion of sick, costly consumers and not enough people with modest health needs, health care costs outstrip premium revenue -Premium increases can further discourage customers, especially healthy ones, from enrolling

Trump's 3rd Executive Order ACA

-Followed up with a rule allowing employers to opt out of birth control mandate due to RELIGIOUS or MORAL objections -Broadened ideas from Hobby Lobby case-- not limited to certain types of companies

Separation of Powers

-Governing power is shared among the three branches of government -Judicial, legislative, and executive

Shelby v. Holder (Facts)

-In 2006, a city in Shelby County, AL, enacted a redistricting plan without receiving preclearance. The sole African American councilman lost his seat -To comply with Section 5, they redrew their districts and had another election where the councilman won back his seat -Shelby County challenged the constitutionality of Section 5 by arguing that Congress had exceeded its authority in reauthorizing it in 2006 as there was no longer a need for the pre clearance "remedy" -Supreme Court reversed and invalidated the Section 4 formula which determined which areas were covered by the act since it was based on old data -Encouraged Congress to take action to update the formula

Court Decisions

-Individual Mandate -Medicaid expansion -Contraception (Parts I and II) -Subsidies (Parts I and II)

Trump's 2nd Executive Order on ACA

-Issue new rules -Allow small employers/ other groups to come together to create "association health plans" -Sell at lower costs and only covered by more general federal regulations, not state regulations -Can purchase across state lines and provides less required services

Sanctuary Cities

-Jurisdictions that do not generally cooperate with federal immigration enforcement -In late November, a federal judge blocked Trump's E.O. denying funds to so-called sanctuary cities -Lawsuit filed by San Francisco and Santa Clara County as a violation of the 10th Amendment and the 5th Amendment's separation of powers clause -The Constitution gives Congress spending powers not the President -Federal funds cannot be used in a coercive way

Green Card

-Known as a permanent resident card -Gives the holder permanent residence in the United States -Can legally live and work in the United States and can travel in and out of the country more freely -First step toward U.S. citizenship, as one must generally secure a Green Card before applying for naturalization

Changing Demographics

-Latinos to become majority -Increased political power

Supreme Court Challenge ACA Part I (Individual Mandate 2012)

-Mandate is lynchpin of reform and is viewed as TAX or PENALTY -Congress has the power to tax and Court said "...increasing taxes on those who have certain amount of income but choose to go without insurance" -Dissenters believed health care is regulated under the Commerce Clause... Congress can control regulation but NOT force individuals to engage in it -Congress has the authority to tax people if they do not purchase insurance

Gerrymandering

-Manipulation of district boundaries to gain partisan advantage -Racial gerrymandering and partisan gerrymandering -Geography: people tend to live in areas where others are similar to themselves (self-segregate) -"Voting with your feet" or people tend to sort into ideological enclaves -Democrats tend to cluster in and near cities -Republicans may be more equally spread throughout a state

American Health Care Act (AHCA) House Bill

-Medicaid Funding: Block grant or set amount per beneficiary, state choice... and Expansion funding set to be reduced -Flexibility for states to opt out of Essential Benefits -Insurers: Flexibility with preexisting condition requirement but must have high risk pool of funding to help spread risk -Individual mandate is repealed -States have access to a federal pool of funds to use for flexible reasons (subsidize premiums, pre-existing condition support, mental health benefits)

Issue Framing

-Occurs when different presentations of an issue generates different reactions among those who are exposed to that issue -Through framing, communications seek to establish a dominate definition or construction of an issue -Frames influence opinion by suggesting which of many possibly conflicting considerations should predominate

Trump's 1st Executive Order ACA

-One of the first EO's issued -Seeks "prompt repeal of ACA" -Agencies may "loosely interpret regulations" -Gives states more flexibility -Flexible enforcement of individual mandate -Seeks to "minimize financial burden" on individuals, insurers, etc. -President and Congress may have different proposals

History (Federalism)

-Original voting controlled by states -Limited to property holding white men -15th Amendment specifically addressed voting and was aimed at the states -14th Amendment said that states must read all citizens equally -Indirect impediments such as literacy tests and poll taxes -"Grandfather Clauses" allowed whites to bypass prohibitions if they could show their grandfathers had voted -Women committed from 14th and 15th amendment coverage but secured right to vote with 19th amendment (1920) -Blacks continued to face restrictions, in practice, to free voting due to poll taxes, literacy tests, intimidation and violence

State Actions- Ramifications post Shelby

-Over the past 3 years, 30 states sought to impose voter restrictions often due to to voter fraud concerns -Predominantly in the form of photo IDs, curbs on early voting either by mail, in person or extended voting dos, limiting same day voter registration as well as redistricting maps -Many former preclarance states are moving forward, especially TX and NC -Oregon was the first state to automatically register eligible citizens who request or renew a driver's license through the DMC -One of the few states to move forward on voter registration, including all mail voting, on line registration and pre-registration for 17 year olds

Role of the Big 5 (Oppose Republican Plan)

-PRACTITIONERS (Doctors, Hospitals): Loss of insured patients, especially inner city and teaching hospitals stand to lose funding also -INSURERS: Uncertainty in changing regulations; impact on Medicare and Medicaid; loss of people who can afford insurance -ADVOCATES: Groups like American Cancer Society, American Public Health Association -PUBLIC

Expand DACA (Deferment Action for Childhood Arrivals)

-Part of Obama's Executive Order in 2014 -Cover more young people who arrived here as children

Trump's Immigration Pillars

-Path to citizenship for Dreamers -Immediate funding for border wall -End to visa lottery system -End to family based or chain migration

Expanding Coverage and Insurance Regulations

-People cannot be denied coverage due to pre-existing conditions -Benefits cannot be capped -No gender rating -Young adults to 26 can stay on their parents' policies -Individual mandate: All Americans need health insurance or will pay a fine -Insurance works by spreading the risk-- all people need insurance, sick and healthy, to keep costs down -2017: Payments on behalf of patients who cannot afford premiums to insurance companies-- cost sharing subsidies being challenged

Health Care in the U.S.

-Predominantly employer based insurance -Hybrid System: Private coverage through insurance via employers PLUS some government run systems -States also provide certain levels of care (varies from state to state) -High cost and unequal access -Federal programs are MEDICARE and MEDICAID -Health care authority is diffused rather than concentrated -Shared by all levels of government

VRA Section 5

-Was used to stop a potentially discriminatory action from going into effect as a law could not be enacted until the DoJ approved it (pre clearance) or blocked it) -Prohibits "covered" jurisdictions from changing their voting laws without getting pre clearance from either the Justice Department (Attorney General) or a 3-judge panel of the D.C. District Court -Covers only certain areas -Must prove that proposed voting change doesn't deny or abridge the right to vote on account of race, color, or membership in language minority group -To be used to PREVENT discriminatory practices from happening

Chain Migration (Family Sponsorship)

-When green card holders can sponsor spouses or unmarried children for permanent residence -Citizens can petition for residence for their parents, siblings, and married adult children

Policy Output

Action taken by the government to pursue goals

Cracking

Breaking up a community into several districts, none on which has the group as a majority

PATRIOT Act

Broadened terrorism grounds for excluding people from entering the U.S. and increased monitoring of international students

Packing

Concentrating a community in a few districts so votes are concentrated in majority areas

Policy Outcome

Effect that actions have on society

Nativism

Fear of foreigners

Chinese Exclusion Act

First Anti-Immigration Law

Medicare

Part A: Hospital Care (funded by employee and individual contributions) Part B: Doctor Care (Funded by individual contributions and taxes) Part C: Managed Care Option Part D: Prescription Drug Coverage (Expanded under the ACA)

Federalism

Relationship between federal government and each state

National Origin Quotas

Restricted South and Eastern Europeans, as well as others

Is America a "Nation of Immigrants?" Immigration Agency Says No.

a. Change in mission statement i. Framing -- use of words matters b. Chain Migration (Family Sponsorship) i. When green card holders can sponsor spouses or unmarried children for permanent residence ii. Citizens can petition for residence for their parents, siblings, and married adult children c. Numerical limits exist for family based migration each year d. Depending upon the country, the wait could be 10 years or more e. Green Card i. Known as a permanent resident card ii. Gives the holder permanent residence in the United States iii. Can legally live and work in the United States 1) Can also travel in and out of the country more freely iv. First step toward U.S. citizenship as one must generally secure a Green Card before applying for naturalization

"Progressive and Conservative Freedom..."

a. Conservative Views, Individual Focus b. Nanny state of health care = freedoms taken away by government c. Big government = wasteful, communistic and socialism d. Marketplace = vehicle for citizens to pursue individual goals e. Conservative view of imposition of government and loss of choice in health care as a loss of freedom f. "Conservative media was effective in evoking fear that government would take away freedom of Americans to choose life or death" g. Free market, punctuated by profits, is threat to common good h. Must ensure freedom of political processes i. "Conservatives heave learned far better than liberals how to take advantage of the links between emotion and rationality" j. The progressive commentators spent time contesting frames created by the conservative media rather than proactively creating their own frames of the health care debate k. Liberal/ Progressive i. Views ii. Community Focus

Progressive and Conservative Framing: Immigration

a. Framing of policy issues help to structure people's worldviews b. Conservatives: Frame Undocumented As... i. Lawbreakers, fearsome ii. Government must protect society from these individuals iii. Criminals, must maintain law and order c. Progressives: Frame Undocumented As... i. Abused by society 1) "Papers please" show government overreach in civil rights a) AKA racial profiling ii. Humans, need protection from profiling in society d. Conservatives use emotion and charged language e. Progressives use sarcasm, humor, facts, deconstruction i. Progressives spent time contesting conservative frames rather than coming up with their own f. Are cable programs in competition with social movements in the framing process? i. Sometimes cable hosts create the frame, other times they build on concepts from social movements 1) Goes both ways