interviews
After the Polls Close
by John Fortier
October 19, 2020
This interview with John Fortier, Director of Bipartisan Policy Center’s Democracy Project, was conducted and condensed by franknews.
Why do we have an Electoral College?
Our election system is really much more of a states’ issue than people realize. We vote differently in different states, and the Electoral College really is the mechanism by which we vote through the states.
Who makes up the Electoral College? Who are our electors?
Sometimes people think of the Electoral College as a point system — if you win a state, you get some amount of points — but, really, when you vote, you are electing a slate of electors.
Slates of electors — one Republican, one Democrat — are nominated or elected by the parties in each state. On election day, the public votes for one of those slates.
The vote on November 3rd typically results in an Electoral College majority. There is a second election in December amongst electors, but it is not widely discussed or covered, mostly, because it doesn’t matter. Electors are loyal to their parties and typically vote as expected. The new Congress then votes to validate the Electoral College votes on January 6th, and by January 20th we reach inauguration. Usually, there are not any great hiccups in the process.
Does that change if it is a close election?
Even in a close election, we don’t think too much about the Electoral College. However, there are a few things that have happened in the past that could happen again.
First, there can be “faithless electors” — electors who vote against the popular vote of their state. Electors, for the most part, have the ability to act freely, and some people worry that they could tip a very close election if a few electors were to change their votes at the last minute — they could move the total for a candidate from 270 to 268, for example. However, in the past, faithless votes tend to be protest votes that do not really amount to anything.
Recently, a number of states have passed strict laws that bind their electors to the popular vote of their state. Previously, laws asked that electors be bound and, in some cases, imposed small fines on faithless electors, but there were no severe constraints. In the 15 States that now have this power, electors will be replaced if they vote the wrong way.
I wasn't sure if that was going to pass constitutional muster, but The Supreme Court upheld it this summer. The Supreme Court actually, in their footnote, hinted at the idea that the only case where this would cause additional hiccups is in the scenario that a candidate unexpectedly drops out, dies, or, for one reason or another, is not on the ticket. Which, of course, is something that has been in the conversation over the last couple of weeks with the president having Covid.
Another thing that can happen is the bargaining amongst the electors. In the 1968 election, George Wallace, a third-party candidate, won states and won electoral votes. Amongst the Nixon and the Humphrey electors, there was some discussion about coming together to exclude the Wallace electors. They didn’t want the election thrown into the House of Representatives, which is what happens if the Electoral College is tied.
But these are sort of odd situations, and these aren't the issues that keep me up at night.
What would you consider to be the more pressing concerns with the Electoral College during this election cycle?
I think the more realistic scenario that we could see is something like what started to happen in 2000 or what happened in 1876. In both cases, because the state race was so tight, there was a real question as to which slate of electors, the Republican slate or the Democratic slate, should be appointed.
In Florida 2000, if Al Gore were to pull ahead in the recount, would a second slate of electors need to be appointed? Eventually the Supreme Court stepped in and halted the recount in Florida, and the Republican slate of electors was appointed. But, imagine a scenario where the dispute is not resolved.
There are cases where two slates of electors may be appointed, and there is no set way to resolve that conflict.
Eventually, the dispute will end up in Congress’ hands, but it is not clear in The Constitution how Congress is supposed to decide. After 1876, when multiple slates of electors were actually sent in, Congress passed the Electoral Count Act to try to address how to approach that sort of scenario, but, I would say, it still is ambiguous.
It is also important to note that though we do have popular elections in every state, popular elections are not guaranteed by The Constitution.
Early on in our democracy, many state legislatures would directly appoint state electors. If you had a Republican legislature, you would appoint a Republican slate of electors. While this faded out after the Civil War, an argument — a controversial argument — was made by the Florida legislature in 2000. The Republican legislature felt that Democratic attorney generals were unfairly favoring the recount for Gore, so they wanted to step in and send the slate of electors to Washington themselves.
If I wanted to think of disaster scenarios — this is the sort of case that would be the disaster scenario. This is where there is the least amount of clarity in the election mechanisms after November 3rd. This is where parties could really seriously disagree, and this is where we have no third arbitrator to decide between the two of them. The parties would have to work it out on their own.
Are there deadlines that are important to know in the electoral process?
The president’s term ends on January 20th at noon.
Despite conversations about postponing the election, it would be incredibly hard to do. The deadline is in The Constitution.
If the election is not resolved by the inauguration, if it is still with the House of Representatives, then perhaps we have to go to the line of succession. But January the 20th at noon is when a new president has to take office.
There are two other dates that might matter. They're both in law, not in The Constitution, so theoretically they could be moved. There is the meeting of the electors, which is on December 14th this year. There is also the “safe harbor” deadline which is 6 days before the meeting of the electors, which is set by law to try and aid in the counting by ensuring no interference from Congress if the counting is complete by the set deadline. This date was highlighted by The Supreme Court in Bush v. Gore, and was one of the reasons they stopped the recount.
Recently, it seems there have been a lot of claims that the electoral process is undemocratic, and a push to move us towards a national popular vote. Do you think the Electoral College is still a democratic system?
The Electoral College has never been particularly popular in the modern era. Many people think that we should have a national popular vote — it is a more natural line of thought. And if we were to start from scratch now, maybe we would instill a national popular vote.
But is the Electoral College system undemocratic? I guess that I am not fully convinced of that.
We are a country of states. And though a few times there has been a difference between who wins the Electoral College and who wins the popular vote, it still is very unlikely to happen.
The proposal for a national vote, as it stands, is a halfway house, because it is really hard to amend The Constitution. States can appoint electors directly based on whatever criterion they want, and so the idea would be to appoint electors based on national popular, rather than the states' vote. But, there are some issues with that. What happens if the election is really close? You can’t really recount a national election, you can only recount the states. You would also have to make sure that all the states are uniform in their elections. And maybe that's a good thing, maybe people would like that. But maybe when we get down to the nitty-gritty and people will say, "Well, we really liked the way we vote in Alaska, it's good for us, or we like the way we vote in Oregon."
It is hard for a party to be on the losing end of this system twice within 16 years, and perhaps once more again, but I think there are reasons to be cautious about changing the system.
interviews
The Cost of Care
by Sara Collins
September 23, 2020
This interview with Sara Collins, vice president for health care coverage and access at The Commonwealth Fund, was conducted and condensed by franknews.
Sara | I lead the healthcare coverage and access program at the Commonwealth Fund. I also lead the tracking health system performance initiative, which is a research initiative that tracks state by state performance on a variety of measures.
We just released a report on health insurance coverage in the United States based on a survey we do every other year. In addition to looking at how many people were insured, we created a metric to examine how many people are underinsured. We define underinsured as those whose out-of-pocket costs are equal to 10% or more of their income, 5% if they have lower-incomes, or if their deductible is 5% or more of their income. Our goal is to look at how many people are exposed to high out-of-pocket costs relative to their incomes. How many people are insured all year, but have such high out-of-pocket costs and deductibles as a share of their income that they are effectively uninsured?
frank | Can you lay out the landscape of your findings regarding healthcare and affordability?
In our biennial survey that we have conducted since 2001, we asked working-age adults if they have had difficulty paying their medical bills. Over time, we have seen growth in the share of people who had any problem in paying their medical bills. That includes those who are not able to pay their medical bills, those who were contacted by a collection agency for unpaid medical bills, or those who have to change their way of life in order to pay the bills or were paying off medical debts over time.
Since we started, there has been a gradual trend upward in the share of people reporting any one of those problems. It peaked at about 41% in 2012, and then as more people got health insurance with the passage of the Affordable Care Act, we saw a slight decline. But the percentage of people never really fell that much.
The rates are the highest among people who are uninsured or were uninsured anytime over the past year. About half the people who were underinsured reported problems paying their medical bills.
What sort of long term implications do these medical bills have?
This has implications for the rest of people's lives. In our survey we asked if they were having other financial problems because of medical bills, including using up all their savings, receiving a low credit rating, taking out credit card debt, or being unable to pay for basic necessities.
We can see that there are significant lingering financial implications for those with medical bills.
What explains the increase you have been seeing over the last decade?
Over the last decade, people's incomes haven't grown very much, but their out-of-pocket cost exposure has grown and their deductibles have grown.
If you are getting coverage through an employer, which is where half of the working-age population gets their benefits, in most years the cost of your premiums is rising. Premiums are driven by health care costs. People are having to contribute more towards their premiums, and they are seeing increases in the amount they have to pay out of pocket in copays when they get healthcare. And incomes are not rising very quickly as people make wage concessions to receive their healthcare.
Why are premium costs so high? Does it accurately reflect the cost of providing assistance on the part of providers?
In private insurance, much of the growth we are seeing in premiums comes from growth in the prices that are paid to hospitals and other providers. Prices vary significantly across the country. There's no consistent pattern. Provider prices generally have very little relationship to the actual cost of healthcare. They're determined by local market conditions.
Providers that have a lot of leverage in markets are able to increase their prices. In other product markets, the cost of production drives the price of a good, but healthcare is different.
Why don't we see that significant of a fall with ACA?
The ACA made critical changes in the individual market. It made sure that people were able to get a plan, and that those with preexisting conditions were able to get a plan. The subsidies from the ACA were also important in enabling people with lower incomes to get coverage.
But the trend in private coverage, the trend of rising premiums and wage stagnation, has continued, and that affects individual markets too. It covers people but still exposes many people to high out of pocket costs. Deductibles are taking up a larger percentage of people's income.
What sort of healthcare reform could drive lower costs?
The primary value of both a public option and a single-payer approach is the ability to leverage down the primary drivers of healthcare costs.
And think about what I mentioned about what's driving premiums -- and that is the prices that providers are paid in commercial insurance. A public option provides the federal government with some leverage to negotiate those prices down close to Medicare prices. The cost of covering everyone could be lower with a public option or with a Medicare for all approach.
How do costs and the threat of debt affect people's willingness to seek care?
On the same survey, we asked a set of questions about delaying care because of cost. About 56% of people who were uninsured anytime answered yes, and about 43% of people who were underinsured answered yes.
Out of pocket costs are leading people to make decisions that are not in the best interests of their health. It's a significant issue and the pandemic has shone a bright light on the dangers of having high out of pocket costs that lead people to decide against getting the care they need to stay healthy.