Author: craigcrawford

By Cathleen Decker, Los Angeles Times:

Among Republicans, the race shifts onto ground dominated by more secular New Englanders after weeks of appeals to Iowa’s evangelical voters. A New Hampshire race that days ago appeared destined to define which of a quartet of establishment Republicans would rise to challenge Donald Trump will offer instead a battle between two young senators, Iowa winner Ted Cruz and third-place finisher Marco Rubio, for that mantle.

On the Democratic side, Hillary Clinton only barely escaped a second straight embarrassment at the hands of an upstart movement candidate by effectively tying with Vermont Sen. Bernie Sanders. Now she must fight him on his home turf of New England.

That is dangerous territory for Clinton politically, raising the specter that she will emerge from the first two contests with no clear victory. But Clinton will also reinhabit the underdog role that she used to great effect in her come-from-behind primary win here over Barack Obama in 2008.

Hillary Clinton must now trash Bernie Sanders and risk losing his voters in November. Good luck with that.

If I have learned anything in the past year it is that Iowa is a complete joke. There was a time way back in 1976 when I went there to campaign for Jimmy Carter as a college kid that I believed in Iowa as an honest broker and screening committee for our presidential politics. But in the decades since it has become a casino unworthy of the media hype the state has so jealously protected. The time has come for ending this madness. Margins of a few hundred or thousand in a universe only slightly largely than a major league football stadium, in a state so unrepresentative of our nation at large, deciding winners and losers for a population of 300 million? Party hacks bought off with chump change? Roads built to nowhere by presidential administrations owing Iowa their power? Federal expenditures per capita at the top of the food chain? This state is now running a scam on our country that the most scandalous infomercials on cable television wouldn’t dare to present. Its bizarre rules, especially those in the Democratic Party denying secret ballots and banning minority candidates, ought to invalidate Iowa’s oversized influence. Iowa no longer deserves this.

A growing problem in rural America is the growing distances its citizens must travel for health care, thanks to years of hospital and clinic closures as large companies buy and consolidate facilities in rural areas. But also because insurance companies don’t include nearby facilities in their networks. And federal regulators are institutionalizing this trend.

Carol Miller, a community organizer in New Mexico, comprehensively writes about this issue in The Daily Yonder, focusing on the chart below showing how federal regulators propose to allow insurers to discriminate against rural populations and still participate in the markets set up by the Affordable Care Act.

One of the worst things about this table is that it exists and is in the public realm. I am extremely concerned that it might dangerously take on a life of its own. Remember, that just as the Health Professions Shortage Area designation was originally created for use by a single program, there are now are more than 20 programs using it. The standards proposed in this table need to go away and never be used by any program. The goal needs to be access to care for people living in rural and CEAC communities [counties with a population density of less than 10 per square mile], not distances and travel times that will guarantee not only worse access, but also worse health.

source: Centers for Medicare and Medicaid Services, Dept. of Health and Human Services