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Why Kansas can't replicate Maine's Medicaid expansion vote

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People in Kansas who have been pushing to expand KanCare under the Affordable Care Act no doubt took notice Tuesday night when Maine became the first state in the union to settle that issue by popular vote, bypassing a Republican governor who has vetoed such a measure at least five times in the last six years.

After all, a 2016 "Kansas Speaks poll" conducted by Fort Hays State University showed pretty solid majorities in favor of extending the joint state-federal health care program to an estimated 150,000 people who could become eligible if Kansas took advantage of the federal law.

Similar efforts are also underway in conservative states like Utah and Idaho to get Medicaid expansion initiatives on their state ballots.

So naturally the question arises, is there a way to get a Medicaid expansion proposal onto a state ballot in Kansas?

The short answer to that question is no.

The process used in Maine and other states falls under the general heading of "initiatives and referendums," two methods by which citizens can initiate legislation or constitutional amendments by petition, bypassing the regular legislative process.

Supporters of Medicaid expansion celebrate their victory, Tuesday, Nov. 7, 2017, in Portland, Maine. Maine voters say they want to join 31 other states in expanding Medicaid under the Affordable Care Act, the signature health bill of former President Barack Obama. (AP Photo/Robert F. Bukaty)

Supporters of Medicaid expansion celebrate their victory, Tuesday, Nov. 7, 2017, in Portland, Maine. Maine voters say they want to join 31 other states in expanding Medicaid under the Affordable Care Act, the signature health bill of former President Barack Obama. (AP Photo/Robert F. Bukaty)

Although those processes have been allowed in some New England towns since time immemorial, in most other places they are a byproduct of the Progressive movement of the late 19th and early 20th centuries. The idea was to put real political power directly in the hands of the people so that whenever legislatures or governors became too intransigent or too corrupt, "the people" could take matters into their own hands.

For whatever reason, though, despite the fact that Kansas was steeped in the Populist movement throughout the 1890s, initiatives and referendums were one part of the movement that just never took hold here.

The last governor who even tried to push through a constitutional amendment allowing initiatives and referendums was Democrat Joan Finney in the early 1990s, but that went nowhere fast.

In modern times, some states that allow initiatives and referendums have learned to regret it, in part because "the people" who try to use that process to their advantage tend to be the same well-heeled special interest groups who stalk the halls of statehouses but who use the public vote process when traditional legislative efforts are unsuccessful.

The general public, it turns out, is sometimes much more pliable and persuadable than legislative committees, which have the power to hold hearings, summon witnesses and compel the production of documents when debating complex issues.

Comments

Clark Coan 1 month ago

"In modern times, some states that allow initiatives and referendums have learned to regret it, in part because "the people" who try to use that process to their advantage tend to be the same well-heeled special interest groups who stalk the halls of statehouses but who use the public vote process when traditional legislative efforts are unsuccessful."

Not really true: There are far more progressive initiatives that are approved by voters than those pushed by corporations.

Dave Lee 1 month ago

the people want it. but those in power who have their unyielding ideological beliefs. deny the people what they want. cause they know better.

Steve Hicks 1 month ago

Might it be time to re-examine the basic premise of American democracy; that "the people" collectively will, more often than otherwise, make wise and good decisions ?

Michael Kort 1 month ago

Well,...... I know who I don't trust to run things and it is the very people who run things in Topeka.......the Legislature, the Governor and our "Missing In Action Figure SOS", who has spent a fortune to enlarge his own office staff, to only catch how many old senile republican voters who double voted in two states ?

Things were so $ unplanned ( or planed $ based on pure fantasy ), that they had to do a retroactive tax increase in the middle of this tax year, to unscrew their best made tax plans that they just couldn't seem to let go of, until absolutely forced at the last moment .

If you want to fault the people of this state, go and fault those who voted for our State Leadership ( for demi gods made in their own sick images ) or go and fault the people who simply stayed home and didn't vote......because their best creation is a governincial Frankenstein, that can't handle anything except for creating disaster for our citizens .

When things get this bad maybe public initiatives should be reconsidered unless we shall wisely deside to wait for the tooth fairy or Santa to fix it .

Ken Lassman 1 month ago

So folks need to keep this in mind when electing the next governor and their state senators and representatives: "exactly what is your stand on Medicaid expansion, and will you support /sign bills that allows it?" It's that simple: if the only way to change this is through legislative approval and executive signature, then lets make sure those folks are going to support it when their position comes up for election.

Steve Hicks 1 month ago

But, Michael and Ken, don't your suggestions only work for the good of our society when the majority of "the people" is wise, and well-intentioned ?

In the past, my view of Americans' character has been very Jeffersonian: and Jefferson's ideas of self-government work quite well for the kind of people he believed we were (and may have actually been) in his time.

Should we continue to put our faith in that view of American character today ?

If not, isn't Jeffersonian self-government more harmful that beneficial when it's an expression of the will of fools and egotists ?

Ken Lassman 1 month ago

If a majority of Kansans support Medicaid expansion and if their elected officials are stopping it from happening, then it should become a topic for the election, regardless of the party or whether Kansas voters meet your Jeffersonian criteria. If a representative slice of Kansans get out and vote, then it will give politicians pause to resist the expansion plain and simple. So while it's nice to ponder about the "character" of the contemporary American voter, I think it is even more important to make sure we are getting out the vote and making it more of a vested interest for citizens to fulfill their civic duty to cast their ballot. Having topics like this circulating helps do just that.

Steve Hicks 1 month ago

Let's try it this way, Ken:

if the majority of voters are too dull, or self-deluded, or easily-manipulated, to perceive what is truly in their OWN best interest...much less what is beneficial for our country and people as a whole...

(and I'm sure you realize this is not just a rhetorical question, since we've seen it happen in Kansas, and in America...)

how is it any kind of solution to "get out the vote," if doing so increases the vote to do what's wrong and harmful ?

See the problem ?

Ken Lassman 1 month ago

You are talking in broad theoretical terms, Steve; I'm talking about the reality as much as we can tell that the majority of Kansans DO favor Medicaid expansion. From the article:

"After all, a 2016 "Kansas Speaks poll" conducted by Fort Hays State University showed pretty solid majorities in favor of extending the joint state-federal health care program to an estimated 150,000 people who could become eligible if Kansas took advantage of the federal law."

I looked it up in the cited poll and a full 62% either favor or strongly favor Medicaid expansion. So in this case, if Medicaid expansion is a major issue in the election, increasing the vote will INCREASE the chances of Medicaid expansion, since the overall vote will be representative of the overall population, which favors the expansion.

I'm pretty dubious of the "too much democracy" view of poo pooing electoral participation. It seems to me we've seen plenty of elections swung the wrong way by voter suppression and lower voter turnout, leaving the organized minority with the ability to do what's wrong and harmful. I'd like to take my chances with 80-90% turnout on a regular basis after living with 20-70% turnout most if not all of my life.

Steve Hicks 1 month ago

What you say is true, as far as it goes, Ken.

But even if voter suppression, the flood of dark money, and professional "opinion"-manipulators were removed from the process: even if our democratic political process directly and perfectly expressed "the will of the people"...

clearly very many of the majority who wanted Medicaid expansion are also members of the majority who wanted Brownback, and Trump. I'm not convinced that every one of those overlap votes can be credited to profound stupidity.

But if voters honestly "will" to have Medicaid, and at the same time "will" to have Brownback and Trump running government, it should at least tell us the will of "the people" is inconsistent, or erratic, or unstable.

I'll ask again: is it time to re-examine our unquestioning faith in "the will of the people" ?

It may be a theoretical question: but it's the theory our real-life politics is built on. We can keep patching cracks in the wall as they appear: but doesn't there come a time we should check to see if the foundation is broken ?

Calvin Anders 1 month ago

Steve, I think that the conclusion that the electorate cannot be trusted even if the corruption and perversion of the current campaign finance system is reformed is an assumption without sufficient evidence. The manipulation of voters in the current system is so egregious and pervasive that I contend it is virtually impossible to predict whether voters would begin to act in their own informed self interest after a few election cycles of fairly run publicly financed elections. I would like to think the results would be very positive. And I strongly believe we should try that before trying any of this "foundation is broken" nonsense.

Steve Hicks 4 weeks, 1 day ago

I'd agree we should try to fix the system that's in place. And I too would like to think the results would be positive, in the relative terms of that system.

But ultimately our system is based on and determined by "the people," and only really works right if "the people" are wise and altruistic. Communism too would have worked well by and for those kind of people. It's not a "system" that's the question, or that's the answer, if human beings are any part of its operation.

Maybe you don't consider that human beings are of different and constantly-changing character and motives; every individual, and much moreso "the people" in aggregate. Or that "the people" in aggregate don't therefore often act inconsistently and erratically. Or that the political behavior of "the people" is therefore often unstable and self-destructive.

If not, and if you don't find the examples I gave convincing...what can I say ? Look around you.

Maybe the ultimate nonsense is believing anything sound and permanent can be built on an unstable foundation. "The will of the people" is an unstable foundation.

Ken Lassman 4 weeks, 1 day ago

But Steve, you can't just brush off those who either had their votes suppressed or just didn't bother to vote as inconsequential. According to the US Elections Project, there were 231 million people eligible to vote in 2016, and only 138 million voted, with Trump receiving almost 63 million and Clinton almost 66 million. That means that Trump was elected with slightly over 27 percent of the eligible voters voting for him. I say that when 40 percent of eligible voters don't participate, the problem is primarily a minority imposing its will on the people, and not a problem of the tyranny of the majority that you are trying to paint.

Steve Hicks 4 weeks ago

Not "brushing off" any of the numbers you cite, and not painting anything as tyranny. Obviously the outcome of the election did not represent the straight vote-total "will of the people." And obviously, the country would be a lot better off if a sane person had been elected.

But I think you miss my point.

Acting on "the will of (the majority of) the people" is as good an idea on which to base government, as any that human beings have come up with to date. It has some major problems.

The Founding Fathers realized that, and hedged "government by the people" around with safeguards (the Electoral College, for example): and checks and balances built-in to the operation of the peoples' government. Those corrective mechanisms have some major problems. (2016 wasn't the first time, for example, that the Electoral College subverted the "majority rule" principle.)

I'm asking how long we keep putting patches on our patches to the operative theory ? Maybe the "best-yet" theory isn't the real best.

We won't find out, one way or the other, until we ask the question. My point is it may be time to ask the question.

Ken Lassman 4 weeks ago

I appreciate your honing your concerns, Steve. It helps me better understand your concerns. But I'm still at a loss why you think that the safeguards provided in our Constitution would be inadequate for maintaining adequate checks and balances for our representative democracy if 95% of the eligible electorate were participating in elections instead of 60%, and exactly how such high voter participation would not solve most if not all of the issues we are currently experiencing. Can you elaborate on this?

Of course there is a chance that the larger voter turnout would result in a similar split in votes resulting in different outcomes between electoral and popular votes like we've been seeing of late. But the numbers that I've seen do not seem to indicate that this would be very likely. If it did, then I think a much stronger case could be made for electoral reform such as doing away with the Electoral College and a less politicized way to draw congressional district boundaries.

So my question to you, Steve is: what exactly are you proposing? And if you are not worried about the "tyranny of the majority," what exactly is your concern and what is your proposal for addressing that concern?

Steve Hicks 3 weeks, 6 days ago

That's exactly the question I'd like to see the many honest and intelligent people in our country, who love (i.e., want the best for) our country, asking. If we don't ask it, we tacitly assent to the country continuing broken.

Personally, I don't believe we can put our faith in human beings (as electorate, or as rulers), or any system human beings come up with and operate. The only other form of government that leaves (which I'm also convinced is the only infallibly GOOD one) is what Jesus called "the Kingdom of God." So I think we have to start with the realistic view of ourselves (as human beings), that no system we come up with can possibly be infallible.

In the only-relatively "better" or "worse" systems of government that human beings are capable of, I think we have to be realistic too that we can't ultimately put our faith in human beings for GOOD government. The Founding Fathers showed that realism, hedging around the parts that "the people," and the human rulers they chose, played in the operation of government.

Obviously any SYSTEM that elevates ill-intentioned, self-serving fools and criminals to positions of power needs drastic re-working. But it seems wise to follow the founders' lead and think realistically about the people who operate it: what kind of people are raised to positions of power in a system, and what kind of people put them there.

I'm a believer in the principle of Proverbs 15, that in a multitude of counselors there is wisdom. America still has a "multitude" of honest, intelligent people who love (want the BEST for) this country. Those are the people we need to hear some wisdom from. So I'm glad you're thinking about the question too, and hope more people will.

I ask the question because I don't have a definite idea of anything I'd consider THE answer: and doubt there is one, in human terms. But we can clearly do (relatively) better than what we currently have.

But the "multitude" of honest and well-intentioned people from whom we could hear some wisdom probably isn't the "majority" of the electorate (whether 60% or 90% of people vote). That seems the misplaced faith that has played a large part in creating the current problem. So I think we have to ask the right question, knowing "majority rule" is not the right answer (or even a relatively-good answer) for eliciting the collective beneficial wisdom of our fellow citizens.

Ken Lassman 3 weeks, 6 days ago

Humans governing humans has always been a bit of a roller coaster, and no society has ben even close to a perfect record over time, with virtually all of them eventually collapsing and other attempts rising from the ashes of their failures. The key I think is to be able to recover from slip-ups and assaults from those who place personal gain above the gain of the society at large. These kinds of challenges are as inevitable as the sun rising in the east, but all in all I think a representational democracy, warts and all, has proven to be about as good as it can get at least for our country. Personally, I would rather take my chances with a society that tries to include everyone's voices and while the "honest and well intentioned people" thing sounds good on paper, the best way to ensure that that happens is to include as many as possible in our society to being active participants. Creating litmus tests, making it harder to participate and other efforts to get to the ideal governing body has pretty much always been counterproductive. The Halberstam book "The Best and the Brightest" chronicling the slide into the disastrous Vietnam debacle comes to mind when folks start talking that way. I prefer the term "more perfect union" used by our founding fathers to describe the gradual but steady process of self correcting that our form of governing is founded on.

Steve Hicks 3 weeks, 5 days ago

I'd heartily agree with almost all those thoughts, Ken.

And you make a very good point that even "the best and the brightest" can produce disasters.

The Constitution originally left it up to the states to decide who were "the best people" in society to run government (as voters, and as elected officials). Most Founding Fathers' states enacted their belief that only free white male property-owners over 21 could be trusted to vote or to govern.

We've changed our views. The "states' rights" people themselves made states the enemies of people's rights, so MOST of us now realize the federal government has a rightful interest in who can vote, and rightful power to say who cannot be DENIED the vote. The 15th, 19th, 24th and 26th Amendments removed almost all the states' original restrictions. As a nation, we believe that age, gender, race, and economic status are invalid ways to determine "the best people" to operate our government.

And as you point out, Halberstam's book shows that a high I.Q. and excellent education don't, by themselves, help people to make the best decisions for our country.

We're probably ahead to have eliminated some false measures of who are "the best people," and to have learned intelligence is not sufficient.

I'd like to see a "public-service" requirement for voting, with an optional public-service program open to any citizen. Anyone who wanted could CHOOSE 2 years of minimum-wage public-service in the military or other government service-agencies (environmental, social, public health, etc.)

Only veterans of public-service would be eligible to vote or hold office (or for student-loans, FHA mortgages, etc.) All voters and office-holders would know what life is like for America's lowest socio-economic strata; and all would be people who'd put their own "skin in the game" of our society's and our government's operation.

(Even spoiled New York rich boys could choose a few years of public-service. If they chose instead to spend those years making shady real-estate fortunes, fine: but they'd be excluded, by their own CHOICE, from having any voice in making decisions for our country.)

I'd certainly agree with you that "no society has ben even close to a perfect record." Human beings are at best hugely flawed: at worst, stupid, utterly self-deceived and self-absorbed, and evil. We see today, better than ever before, that government by the worst is harmful, and destructive to our country.

I'd suggest the best kind of governing can only come from the best kind of our people; and that the best kind of our people are those who demonstrate a love for their fellow-citizens and country. A formal program linking voting-rights to public-service might show who they are, better than our current system.

Ken Lassman 3 weeks, 4 days ago

I like your idea of more public service for citizens to participate in; I doubt that it can be tied to voter registration requirements, but maybe additional incentives could be developed to provide the average citizen or citizen-to-be an opportunity to see how our society works and how others with different lives from your own live, survive and thrive. The trick would be to design these so they would actually accomplish these goals and not be a waste of time for the participants. But isn't that always the case?

If well designed, maybe it could become part of the school curriculum, and maybe a "public service" deduction on your taxes, or a prerequisite for applying for public office, among other options. This would be in addition to public service that private groups already do, such as services provided through religious groups, fraternal organizations, clubs and groups connected to work. The way I figure it, the more opportunities to help others will result in a better understand the fact that the more you are exposed to people who are less privileged than you, the better you will think of them when discussing policies that affect them.

So it sounds like we are in agreement about many things, Steve.

Richard Heckler 1 month ago

Medicaid Expansion which once was the norm until the ALEC privatization scam was introduced to the nation.

ALEC will provide dollars and misinformation against allowing taxpayers the opportunity to rightfully access their medicaid.

ALEC is an economic terrorist organization that has declared war on the middle class as well as many many services that are supported with tax dollars. ALEC does not give a hoot about excellent customer service BUT certainly wants OUR tax dollars in their bank accounts.

Richard Heckler 1 month ago

99% of republican voters have been getting duped by extreme conservatives they have been voting into office. These extreme conservatives are not fiscal conservatives nor fiscally responsible.

They are narrowed minded conservatives who spend big to win elections .... elections that have been leaving 99% of republicans with fewer rights and less money in their bank accounts.

Like it or not we old school republicans need to stop voting the republican ticket because ultra conservatives took over our party through unethical methods. Big reckless spending and monster lies. Conservative Democrats are DINO’s.

Voting Moderate Democrats, Progressive Democrats and Green Party into office are the few practical yet fiscal responsible options. Moderate republicans are hard to find because ALEC dollars have no use for moderate fiscal repsonsible republicans

Moderate Republicans, democrats and Green party thinkers will be subject to voter suppression tactics until the last minute every election day

WINNING TOGETHER === We are millions of people taking action against the war machine, for the environment, for our wallets, ourselves, our children through our right to petition backed with signatures!
https://credoaction.com

The latest tax dollar escapade is a scam on the middle class and a tax dollar money hole to boot. Supply Side Economics is a fraud. Read more: http://business.time.com/2012/08/09/arthur-laffers-anti-stimulus-curve-ball-is-a-foul/#ixzz2OG2JKGYS

WHAT’S WRONG WITH THE NOT GOP? To serial liars like Donald Trump, nothing poses a greater threat than the cold, hard truth. They win elections by preying on people who are not equipped with the information they need to make informed, reasoned decisions. Don’t let yourself be one of those people!

Bill Moyers on the Secretive Corporate-Legislative Body Writing Our Laws http://www.democracynow.org/2012/9/27/the_united_states_of_alec_bill

Dorothy Hoyt-Reed 1 month ago

The question is do you believe that health care is a right or a privilege. And the question is, if most Americans believe it to be a right, shouldn't that rule the day, whether or not there are referendums or a representative? But the sad thing is that voters often vote against their own interests, because of lies and attack ads. Or people don't vote at all. So we end up with representatives who don't really work for their constituents; they work for whomever "donated" the most money. "Donate" in quotes, because it's really a bribe.

Jeremy Smith 4 weeks, 1 day ago

So we should all be entitled to healthcare because it is a right. Therefore, you believe the government should fit the bill since it is a right. If that is your argument then why are you not going on a crusade to end water bills and give free water to every home?

Ken Lassman 4 weeks, 1 day ago

Who said water should be free? Who said health care should be free? If you don't believe in the Affordable Healthcare Act and expanded Medicaid services, do you also think it should be legal to turn people away at the emergency room if they can't pay? Because we will be going back to lots of folks doing just that like it was before ACA and they weren't paying anything for that service because it is illegal to turn those folks away. I suppose you're for repealing that free service too?

Dorothy Hoyt-Reed 4 weeks ago

We aren't talking about free health care here. Fortunately the city provides us with water and we pay for the costs. If a private company provided that water, you would have to tack on their profits and cost us a lot more. The same with health care. The private insurance companies have allowed health care costs rise, because, yes, they have to make a profit. And they have to keep making more profit; it can't be the same profit every year. Same with drug companies.

So, Jeremy, if you would get sick and not have any insurance, would you just sit at home and die? Would you allow that to happen to others? Is health care really only for the rich? Conservatives are the most heartless, inhumane people I have ever met. And sadly, some of them would come begging for help if they got cancer, even though they would kick others to the curb. Why do you hate poor people so much? Why do you think you are so much better and superior to them?

Billy Blanks 4 weeks, 1 day ago

Healthcare cannot be a right. Our rights do not and cannot require the government to give us resources. If we define rights in that way other citizens might need to be compelled to provide healthcare, clearly violating their actual rights.

Ken Lassman 4 weeks ago

So do you also believe that Social Security violates our rights?

Brad Avery 4 weeks ago

Health care is a right in every Western country on the planet. Why not here?

Richard Heckler 4 weeks ago

Medicaid is a federal program. KanCare is a privatization scam that ALEC conservatives have pulled on the people. Yes for big profits some of which find their way into conservative campaign cookie jars. Health Care dollars going into campaign cookie jars no matter by which funnel should be illegal.

Medicaid is a federal program. Why then are people in Kansas denied access?

Bill Moyers on the Secretive Corporate-Legislative Body Writing Our Laws http://www.democracynow.org/2012/9/27/the_united_states_of_alec_bill

Richard Heckler 4 weeks ago

99% of republican voters have been getting duped by extreme conservatives they have been voting into office. These extreme conservatives are not fiscal conservatives nor fiscally responsible. They are NOT Republican.

They are narrowed minded conservatives who spend big to win elections .... elections that have been leaving 99% of republicans with fewer rights and less money in their bank accounts.

Like it or not we old school republicans need to stop voting the republican ticket because ultra conservatives took over our party through unethical methods. Big reckless spending and monster lies. Conservative Democrats are DINO’s.

Voting Moderate Republicans, Moderate Democrats, Progressive Democrats and Green Party into office are the few practical yet fiscal responsible options.

Moderate republicans are hard to find because obscene amounts of ALEC campaign dollars have no use for moderate fiscal repsonsible republicans.

Moderate Republicans, democrats and Green party thinkers will be subject to voter suppression tactics until the last minute every election day.

WINNING TOGETHER === We are millions of people taking action against the war machine, for the environment, for our wallets, ourselves, our children through our right to petition backed with signatures!
https://credoaction.com

Deborah Snyder 4 weeks ago

What none of the comments so far have addressed is how our state legislature and, worse yet, our executive branches of government have hijacked not just public input, but public examination of the legislative process over the last two decades.

Kansas is one of the darkest states in the union for open meetings, recorded votes, KORA requests and financial accountability, PERIOD.

Everyone who lives in this state needs to read the exposé (starting today!) in the Kansas City Star about their cities, their counties and their state governments have done to make this state over into a dictatorship... that's right, a dictionary's description of governance without oversight or accountability... run by individuals who can hide their votes, their meetings' minutes, and their lobbyists from public scrutiny.

The exposé runs this week, and into thecnext

Deborah Snyder 4 weeks ago

...note that even Douglas County is guilty of dark government practices... (that both democrats and republicans are heavily invested in keeping their legislative votes a secret) until they were challenged.

And, before anyone declares nothing can be done to change this situation, note that FOUR PEOPLE were able to change committee practices of not taking Minutes to start doing so... by state law!

Read the KC STAR Exposé this week, then come back to start a better conversation other than finger-pointing or anecdotal evidence of how everyone would regret having public initiatives or petitions, okay?!?

Ken Lassman 3 weeks, 6 days ago

I think that transparency in governing is probably as important to a vital democracy as full participation by the electorate. Thanks for the heads-up on the series; I hope these issues become one of the main topics in any upcoming election.

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