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The Growing Blue State Advantage

August 26, 2013

These are heady days for red state propagandists. After years of leading the nation in poverty, low incomes, poor working conditions, dismal educational performance, awful health care systems, shocking teen birth rates, sky-high divorce rates, bloody gun violence and just about every other measure of social dysfunction, Republican-dominated states finally have some good news to crow about. While Chicago and Philadelphia schools are in crisis and Detroit is in bankruptcy, energy-rich Texas and the Dakotas lead the nation in job creation. Meanwhile, continued population growth in the south and west is changing America's regional balance of economic and political power.
Despite those developments, the cheerleaders for the "Red State Model" shouldn't start popping the champagne bottles any time soon. Because when it comes to realizing Americans' unalienable rights to life, liberty and the pursuit of happiness, the United States is on the verge of a new birth of freedom. And as it turns out, the revolution in access to health care, the freedom to marry and the protection of reproductive rights is underway precisely where Democrats perform best. Thanks in large part to Republican politics and policies, the blue state quality of life of advantage is growing once again.

Of course, you'd never know that from the op-ed pages where the conservative commentariat is publishing its paeans to the GOP policies in the 31 Republican-controlled states. While supply-side fabulist Arthur Laffer and sidekick Stephen Moore boasted about "The Red State Path to Prosperity," Joel Kotkin argued in "America's Red State Growth Corridors" that "low-tax, energy-rich regions in the heartland charge ahead as economies on both coasts sing the blues." Last December, Fox News regular Fred Barnes offered a poster-child for the GOP's future, suggesting "North Carolina as the Blueprint for a Red-State Resurgence."
But less than a year later, Governor Pat McGrory's "Carolina Comeback" is looking more like the "Carolina Blowback." While his draconian restrictions of voting rights in the Tar Heel state may well mean the GOP is "positioned to be the dominant party in North Carolina for at least a decade if not beyond," McGrory's harsh abortion curbs, steep cuts to education funding and lowest-in-the-nation unemployment benefits coupled with the state ban on same sex marriage is rapidly erasing North Carolina's image as the South's social and economic innovator. Now, as Al Hunt explained, "North Carolina is channeling Alabama and South Carolina."

To critics, this conservative agenda -- much of it orchestrated by Art Pope, the governor's budget director and the multimillionaire retailer who is the Tar Heel State equivalent of the Koch brothers -- threatens the state's legacy.
"We're turning back everything that made us different from other Southern states," said Jim Goodmon, the chairman of CBC New Media Group LLC and owner of the Durham Bulls Minor League baseball team. "With this shift, economic development is broken."
Ronnie Bryant, the chief executive officer of the Charlotte Regional Partnership, the area's top economic development recruiter, recently complained to the Charlotte Observer that all the efforts of recent years to promote Charlotte as a business center "have been negated in the last few weeks."
He said business leaders elsewhere are asking: "What the hell are you guys doing?"

What the hell, indeed. Last month, the New York Times described just some of the damage from the GOPnado now devastating North Carolina:

The state has the fifth-highest unemployment rate in the country, and many Republicans insulted workers by blaming their joblessness on generous benefits. In fact, though, North Carolina is the only state that has lost long-term federal benefits, because it did not want to pay back $2.5 billion it owed to Washington for the program. The State Chamber of Commerce argued that cutting weekly benefits would be better than forcing businesses to pay more in taxes to pay off the debt, and lawmakers blindly went along, dropping out of the federal program.
At the same time, the state is also making it harder for future generations of workers to get jobs, cutting back sharply on spending for public schools. Though North Carolina has been growing rapidly, it is spending less on schools now than it did in 2007, ranking 46th in the nation in per-capita education dollars. Teacher pay is falling, 10,000 prekindergarten slots are scheduled to be removed, and even services to disabled children are being chopped.

Oh, and one other thing. Because Republicans refused to either accept Obamacare's expansion of Medicaid or set up their state health care exchange, almost 500,000 North Carolinians will needlessly remain without health insurance in 2014. Sadly, they will have plenty of company in the states now led by the GOP.
From the beginning, the debate over what became the Affordable Care Act has largely overlooked what should have been its defining irony: health care is worst where Republicans poll best. It's not just that the solidly Republican South has the unhealthiest residents and the lowest levels of insurance coverage. Tallying up the ranks of the uninsured actually understates the magnitude of the unfolding health care horror story in Red State America, as the Commonwealth Fund's most recent state health care scorecard revealed. That analysis, which measured performance in providing health care access, prevention and treatment, avoidable hospital use, equity across income levels, and healthy lives for residents, found that nine of the top 10 performing states voted for Barack Obama in 2008 and 2012. In contrast, four of the bottom five (including Arkansas, Mississippi, Oklahoma and Louisiana) and 15 of the last 20 backed Mitt Romney. (That at least is an improvement from the 2007 data, in which all 10 cellar dwellers had voted for George W. Bush three years earlier.)
But instead of acting to narrow that yawning blue state/red state health care gap, Republicans in Congress and the states are making it worse. A year from now, millions of people in states like Texas, Florida and North Carolina will see their friends and relatives in places like Oregon, New York and Colorado with health insurance coverage they themselves lack.
There is no mystery as to why red state denizens will have to have to pay more for fewer hew health insurance choices, assuming they can get it at all. Responsibility can be placed at the feet of the Republicans governors and legislatures in the 26 GOP-controlled states who out of pure political spite rejected Obamacare's expansion of Medicaid. As things now stand, an estimated 11.5 million people nationwide will needlessly be denied health insurance. Among them will be roughly 1.9 million in Texas, 1 million in Florida, 600,000 in Georgia, 300,000 in Louisiana and 182,000 in Wisconsin.

That's why Republican Governors in Virginia, Pennsylvania and Ohio even at this late date may sign on to the ACA's Medicaid expansion for a combined one million uninsured residents in their states. That same math explains why Governor Jan Brewer, certainly no fan of Barack Obama or Obamacare, accepted the federal Medicaid expansion on behalf of 300,000 Arizonans:

"It's pro-life, it's saving lives, it is creating jobs, it is saving hospitals."

And for red states, it's virtually free.
After all, the federal government will pay for 100 percent of the cost of the Medicaid expansion until 2017 and 90 percent after that. But the billions the "opt-out" states will have to come up with in future years will be more than offset by their extra costs to compensate hospitals and other providers for the care of the uninsured. As Ezra Klein and Evan Soltas summed up a recent analysis by the RAND Corporation of 14 Medicaid rejecting states:

It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.
So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That's a lot of self-inflicted pain to make a political point.

Just ask the people who run Georgia's hospitals. Republican Governor Nathan Deal said no to $33 billion in new federal Medicaid funding over the next decade. But as the federal government significantly reduces funding on Disproportionate Share Hospital (DSH) payments for the care of the uninsured, states like Georgia which turned down Obamacare's Medicaid dollars will be on the hook to make up the difference. For Grady Memorial Hospital, the largest in the metro Atlanta area, what could have been an annual boon of $60 million and coverage for 27,000 uninsured patients instead will be a $45 million loss. Georgia taxpayers will have to pay more even as hospitals likely cut services. All because a Republican Governor said "no" to free money from Washington, DC.
If anything, the deal roadblock Republicans are denying their residents is even better than this math shows. After all, the Affordable Care Act is funded in large part by higher taxes on upper-income Americans, people who tend to live in more affluent Democratic states. In keeping with the general dynamic of "red state socialism," blue state taxpayers would help underwrite health care for their red state brethren.
The bamboozling of red staters by their elected representatives hardly ends there. 34 states have refused to set up their own health care exchanges, instead leaving the task to the federal government. As we learned last week, one result is that the other 16 states are spending tens of millions of dollars more on outreach and customer service to help their residents sign up for insurance. With six million uninsured--24 percent of its entire population--Texas is spending less ($11 million) on outreach and customer service than Minnesota, where only about half a million currently lack coverage. And while Colorado is "a hive of preparation, with a homegrown insurance market working closely with state agencies and lawmakers to help ensure the law's success," in Missouri by contrast "looking for the new health insurance marketplace, set to open in this state in two months, is like searching for a unicorn." Constituents looking for help from GOP Representatives like Jason Chaffetz (R-UT) and Tim Huelskamp (R_KS) will be told to "call Obama."

"Given that we come from Kansas, it's much easier to say, 'Call your former governor,'" said Rep. Tim Huelskamp (R), referring to HHS Secretary Kathleen Sebelius.
"You say, 'She's the one. She's responsible. She was your governor, elected twice, and now you reelected the president, but he picked her.'" Huelskamp said.
"We know how to forward a phone call," said Rep. Jason Chaffetz (R-Utah).

When red staters find their online exchanges, they may not be very happy about what they find there. In places like Mississippi, where Governor Phil Bryant rejected Insurance Commissioner Mike Chaney's plea to let his agency manage the Magnolia State marketplace, many counties will have few options from which to choose. But thanks to their stricter regulation of insurers and investments in their own state exchanges, blue states like California, New York, Oregon, Colorado and Maryland are offering a wide range of insurance plans at premiums at or below the forecast from the Congressional Budget Office:

The early success of those blue state outreach campaigns combined with the millions of red staters being left needlessly uninsured by their elected officials is contributing to higher forecasts for the number of Americans who will purchase coverage through the Obamacare exchanges.
Given the blue states' greater affluence and superior health care, Republican apologists need a different metric to redefine red state failure as success. Conveniently, the conservative Mercatus Center as George Mason University is happy to step into the breach with its "Freedom of the 50 States" rankings for 2013. But if you were looking for something like adherence to Roosevelt's Four Freedoms (of expression, of religion, from want and from fear), the Mercatus Center is the wrong place. Emphasizing low taxes, limited regulation, tort "reform" and so-called "right-to-work" laws as just some of its measures of "freedom," Mercatus put North Dakota, South Dakota and Tennessee at the top of its list. All told, only two of the top 15 states voted for Barack Obama in 2012, whereas 8 of the bottom 10 went Democratic. In this right-wing tall tale, California and New York are the least free states in America.
Try telling that to a woman seeking an abortion or a gay couple wanting to get married.
A couple, say, like Hans Bernhard and Mitch Null. As Bloomberg reported in June ("Gay Marriage Shows States Luring Discriminated Couples"), the two "say they may leave North Carolina -- taking their daughter, their jobs as a veterinarian and an information technology business operations manager at Cisco Systems Inc. (CSCO) and the tax revenue from their properties":

Following the U.S. Supreme Court's decision to overturn a key part of the Defense of Marriage Act, the couple is considering moving to Maryland, where they could have a recognized marriage and guaranteed access to the related federal benefits. Bernhard could also become a lawful father to the couple's 1-year-old daughter, Eva, since North Carolina law prevents residents from adopting a child if they aren't married to the legal parent.
"As Eva grows, when friends of hers ask her, it would be nice for her to be able to say, 'My dads are married, and they love each other dearly, and they love me dearly, and we're just like anybody else,'" said Bernhard, 34.

Everybody else, that is, in the 13 states and the District of Columbia which now recognize same-sex marriages. Every single one of them voted for Barack Obama for President in 2012. And together, they represent a third of America's gross domestic product. And if other states don't changes their laws soon, they percentage is certain to grow.

There are multiple reasons for the blue state marriage bonus. The prospect of weddings, gifts and tourism from 800,000 couples tying the knot is just one of them. But that $9.5 billion windfall--$259 million in New York City alone one year after that state legalized marriage equality--is just the beginning. In his controversial book The Rise of the Creative Class more than a decade ago, Richard Florida suggested cities with large and thriving gay populations--a proxy for diversity, open-mindedness and culture--would win the economic development race by attracting the programmers, marketers, analysts and artists so desired by 21st century employers. But whether or not Florida got his chicken and egg backwards, the American business community is leaving little doubt about where it stands.
Goldman Sachs CEO Lloyd Blankfein recently explained that "America's corporations learned long ago that equality is just good business and is the right thing to do." And those corporations will find the workers that can give them a competitive advantage. John Taft, CEO of RBC Wealth Management-U.S. put it bluntly:

"Companies who create an environment where employees are free to be authentically and completely who they are have more engaged employees and that translates into client and customer satisfaction. I can tell you that if you do not extend benefits to same-sex partnerships, you are not competitive in the business world right now. The bottom line for excluding that population set from your benefit policy is going to be compromised not helped."

The cities and states that don't follow his advice are going to be left behind by the millions of gay Americans (and those who support them) who will vote with their feet.
Just ask the state universities in Virginia, where the Tea Party duo of Governor Bob McDonnell and his would-be successor Attorney General Ken Cuccinelli cracked down on protections and benefits for gay faculty. As the Washington Post asked just this week:

Not long ago, a tenured professor at the University of Virginia's College of Arts and Sciences moved to a university in New York because her same-sex partner, diagnosed with cancer, couldn't get covered by her health insurance in Virginia. A physician at U-Va.'s medical school decamped for an Ivy League school because state law doesn't recognize her relationship with her partner or their children, so she couldn't get them coverage.
How many more talented minds have to leave before Virginia takes concrete action to protect publicly employed academics and thus the quality of their universities?

Virginia is not alone. Michigan and Texas are just some of the states beginning to grapple with the "gay brain drain."
There is also a little mentioned irony for social conservatives determined not to respect the equality and freedom of gay Americans. Studies by the nonpartisan Congressional Budget Office (CBO) and other groups show that marriage equality will save both federal and state governments money. Apparently, freedom for gay Americans isn't just free; it pays dividends.
But while the expansion of marriage rights to all Americans seems merely a matter of time, the protection of our reproductive rights is another matter. And where Republicans are currently in charge, those rights and the freedoms they make possible are most at risk.
Coming from the party that pretends to "protect the doctor-patient relationship," that development is more than a little ironic. Mandatory and invasive ultra-sound procedures, bans on abortion access after six weeks, expensive and unnecessary regulations for clinic facilities and funding for so-called "crisis pregnancy centers" that deceive clients are just some of the measures that are making access to abortion services for women in many states a thing of the past. Meanwhile, the party of tort reform is trying to legally require that American doctors commit medical malpractice. In many states, physicians must withhold potentially life-saving care or, conversely, provide unneeded tests and procedures. When it comes to topics like "fetal pain," so-called "post-abortion syndrome" and the mythical breast cancer link, doctors are mandated to lie to their patients. And if they remain silent about severe fetal conditions which might lead a woman to terminate her pregnancy, physicians would be immunized from liability.

For starters, consider a typical definition of medical malpractice like this one published by the National Institutes of Health:

Medical malpractice is defined as any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient.

For the likes of Arizona Rep. Trent Franks or Texas Governor Rick Perry, the patient doesn't even enter in the equation. As the Dallas Morning News explained the debate in Austin over legislation designed to force the closure of 37 of the state's 42 clinics:

The House...would ban abortions after 20 weeks of pregnancy, increase standards for abortion clinics, make doctors who perform abortions gain admitting privileges at an area hospital and mandate protocols -- opposed by the American College of OB/GYNs -for pills used to induce abortions.

When it comes to mistreating and misleading American women, a quick glance around the country shows that Lone Star State Republicans have a lot of company.
Consider, for example, the unprecedented bill signed earlier this year by Kansas Governor Sam Brownback. While the current draft dropped a provision "that would have banned abortion clinic workers from volunteering to bake cupcakes for their children's schools," the scope of the legislation is startling. As Huffington Post reported:

The state House Federal and State Affairs Committee passed a 70-page bill that would tax abortions, establish life beginning at fertilization...and prohibit state employees from performing abortions during the workday. The bill also would require doctors to tell women that abortion causes breast cancer, even though the claim defies scientific fact. The bill is likely to pass.

To say that the mythical abortion-breast cancer connection "defies scientific fact" is an understatement. That link has been firmly rejected by organizations including the American Cancer Association and the National Cancer Institute, which concluded that "abortion is not associated with an increase in breast cancer." Nonetheless, the Bush administration repeatedly claimed otherwise on federal government web sites aimed at teenagers and pregnant women. As a 2006 Congressional investigation found, 20 of 23 federally-funded "pregnancy resource centers," facilities often affiliated with antiabortion religious groups, incorrectly told women "that abortion results in an increased risk of breast cancer, infertility and deep psychological trauma." Nevertheless, when Kansas legislators held hearings on the subject of supposedly cancer-causing abortions, only one witness was asked to testify:

The testimony in front of the committee on Federal and state affairs came from Dr. Angela Lanfranchi, an oncologist specializing in breast cancer. The committee did not hear any other testimony before drafting H.B. 2598.

But Republicans don't merely want American doctors to proactively lie to their patients in order to discourage abortion; they want them to withhold the truth as well. Kansas, like Arizona and a growing number of red states, is seeking to ban so-called "wrongful birth" lawsuits. As the AP explained last year, "Those are lawsuits that can arise if physicians don't inform pregnant women of prenatal problems that could lead to the decision to have an abortion." In Kansas, SB 142 declares:

"No civil action may be commenced in any court for a claim of wrongful life or wrongful birth, and no damages may be recovered in any civil action for any physical condition of a minor that existed at the time of such minor's birth if the damages sought arise out of a claim that a person's action or omission contributed to such minor's mother not obtaining an abortion."

Think of it as a Republican's anti-choice, anti-trial lawyer dream. As President Bush famously proclaimed back in 2004:

"We need to do something about these frivolous lawsuits that are running up the cost of your health care and running good docs out of business. We've got an issue in America. Too many good docs are getting out of business. Too many OB/GYNs aren't able to practice their love with women all across this country. See, I don't think you can be pro-doctor and pro-patient and pro-hospital and pro- trial lawyer at the same time."

Apparently, you can't be pro-life and pro-women's health--and pro-truth--at the same time.
(Last year, an Oregon couple won a $3 million judgment in a case where the hospital's negligence, and not the doctor's silence, led to birth of a Down's syndrome child the mother would not otherwise have carried to term. As The Oregonian noted, "The judge prohibited media in the courtroom from photographing or recording images of the couple, whose attorney said had received death threats.")
The Republican obliteration of the doctor-patient relationship manifests itself in myriad other ways as well. As ThinkProgress noted earlier this year, despite a clear scientific consensus to the contrary, Texas, Georgia, Arizona and other GOP states have passed--or are seeking to pass--so-called "fetal pain" bills banning abortion after 20 weeks. That effort follows the almost decade-long effort of South Dakota and several other states to require doctors to advise women about mythical "post abortion syndrome," the utterly unproven risk of depression and suicide supposedly more likely to result following an abortion procedure.
When it comes to that supposed "deep psychological trauma," the conservative Supreme Court of the United States has made junk science - and condescension - the law of the land. In 2007, Supreme Court Justice Anthony Kennedy issued his shocking opinion in Gonzales v. Carhart. Kennedy put the nonexistent "post abortion syndrome" at the heart of his reasoning in upholding the federal ban on what Republicans deemed "partial birth abortion." As Ruth Marcus lamented, Kennedy basically decided that doctors had no right to perform the rare but medically necessary procedure because, in essence, women might get the vapors:

"Respect for human life finds an ultimate expression in the bond of love the mother has for her child," Kennedy intoned. This is one of those sentences about women's essential natures that are invariably followed by an explanation of why the right at stake needs to be limited. For the woman's own good, of course.
Kennedy continues: "While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained." No reliable data? No problem!

In the five-plus years since, a mountain of studies (including a new analysis in the Journal of Psychiatric Research last year) has debunked Kennedy's dangerous pseudo-science about abortion and mental health. Sadly, that these conservatives' claims aren't true has been no barrier to continuing to repeat them--and mandating that doctors and so-called "pregnancy crisis centers" warn women about them.
(Speaking of the dangerous nexus of junk science and legal paternalism, Oklahoma Republicans are seeking to prevent insurance plans from covering contraception for women "because it suppresses and disables who they are.")
Of course, conservative anti-choice leaders aren't content to violate the sanctity of the doctor-patient relationship. In state after state, they are violating women's bodies and privacy as well.

In Tennessee last year, GOP lawmakers tried to invite scrutiny - and intimidation - for women and their doctors with the Life Defense Act. Among other things, House Bill 3808 would "require the Department of Health to release more information on abortions, including the name of the doctor who performed the procedure and demographics about the women who receive them." (Similar laws in Oklahoma, North Carolina and Texas are currently facing court challenges.) As sponsor Rep. Rep. Matthew Hill, R-Jonesborough, put it:

"The Department of Health already collects all of the data, but they don't publish it. All we're asking is that the data they already collect be made public."

Sadly, that is not the only abomination that results when Republicans codify their philosophy of "Your Bodies, Our Minds."
Texas, Virginia and Alabama are just some of the red states demanding that women seeking abortions undergo and pay for medically unnecessary ultra-sound tests their physicians oppose. Even leaving aside the "forced rape" bills considered in Virginia, Alabama and other states, Republican legislators are dictating the terms of the doctor-patient relationship with the ultra-sound laws. Last year, a Federal Appeals Court upheld Rick Perry's new statute in Texas requiring abortion providers "to show or describe an ultrasound image to a woman of her pregnancy and to play sounds of the fetal heart." As Reuters explained:

While a woman seeking an abortion can decline to view the legally required ultrasound, she cannot decline to hear the physician's description of it unless she qualifies for an exception due to rape, incest or fetal abnormality.
A coalition of medical providers sued in June to block the law, arguing that it made doctors a "mouthpiece" for the state's ideological message. The First Amendment includes protections against compelled speech.
The challengers, represented by the Center for Reproductive Rights, also argued that disclosure of the sonogram and fetal heartbeat was not "medically necessary" and therefore beyond the state's power to regulate the practice of medicine.

In Wisconsin, Republicans are pushing a bill mandating that women considering an abortion must first undergo a trans-vaginal ultrasound. (Asked his position on the needless process required by the legislation, GOP Congressman Sean Duffy responded he didn't know what a trans-vaginal ultrasound is because "I haven't had one.") Meanwhile, Indiana recently adopted its own law mandating a trans-vaginal ultrasound before abortion, but only after dropping the requirement for a second violation two weeks after.
Republican states aren't just mandating what false statements doctors must say to and which unneeded and costly procedures they must perform on American women. Now in states like Virginia and Mississippi, GOP leaders are dictating where these affronts to the doctor-patient relationship can legally take place. Since in 2006, all Magnolia State facilities performing second and third trimester abortions must meet the same regulatory standards as full surgical hospitals, 36 pages of rules in all. As a result, the entire state of Mississippi, one of the poorest in the nation, now has only a single abortion clinic (the Jacksonboro Women's Health Clinic). For now. Meanwhile in Alabama, the so-called "Women's Health and Safety Act" would effectively close the last five clinics in the state:

Critics charged the bill sets impossible standards that have little to do with patient safety and that the bill stems from a template created by the pro-life group Americans United for Life.
"This bill targets regulatory standards of architectural structure, equipment and staffing that are totally unnecessary and cannot be met by the clinics," said Gloria Gray, director of the West Alabama Women's Health Center in Tuscaloosa. "How does requiring a six-foot hallway make it safer for a woman to have an abortion?"

And so it goes. In Arkansas, Republicans overrode a Governor's veto to pass the harshest abortion bill in the nation. Banning abortions after 12 weeks, the Arkansas law takes on Roe v. Wade directly by defining fetal "viability" at 12 weeks when, it is claimed, a heartbeat is first detected. While three-quarters of U.S. counties have no provider of abortion services, Iowa and other states are proposing law that would prohibit doctors from prescribing and administering abortion-causing medication via tele-medicine video conferencing systems. (As the New Republic recently documented, "Several states have recently passed or are considering legislation to limit access to abortion drugs online and off.") And while another Iowa legislator seeks to define abortion as murder and a New Mexico Republican briefly sought to have victims of rape or incest having abortions classified as felons for destroying evidence, Alaska is taking a new path to standing between a woman and her doctor:

A bill that would decide what makes an abortion medically necessary got its first hearing Wednesday, getting the stamp of approval from a developmental psychologist and two doctors with histories of opposing abortion rights.

Of course, Republicans long ago decided that they, and not American women, men and their doctors, will decide what constitutes "medically necessary" and is vital for the "health of the mother." During the 2008 presidential election John McCain used air quotes to dismiss "an exception for the mother's health and life" altogether:

"Just again, the example of the eloquence of Sen. Obama. He's [for] health for the mother. You know, that's been stretched by the pro-abortion movement in America to mean almost anything. That's the extreme pro-abortion position, quote, 'health.'"

Back in 2000, future GOP vice presidential nominee Paul Ryan took an even harsher line during a debate over the so-called "partial birth" abortion ban. (As NPR explained, the very rare intact dilation and extraction (used only 2,200 times out of 1.3 million procedures performed in 2000) was resorted to precisely to protect the health of the woman in certain late-term pregnancies.) Ryan declared:

"The health exception is a loophole wide enough to drive a Mack truck through it. The health exception would render this ban virtually meaningless."

What is really being rendered meaningless, of course, is the very doctor-patient relationship Republicans pretend they want to protect. In a country in which a majority of people have consistently said the procedure should be legal in some or all cases, the constitutionally-protected right to an abortion is under threat. And for the most part, the assault is happening in the same red states where draconian voter ID laws are putting the franchise at risk, where right-to-work laws are jeopardizing the future of labor unions and where crackdowns on undocumented immigrants are targeting millions of Hispanics, including those who have been in country for decades.
Meanwhile in the blue states, something altogether different is going on. While GOP governors like Sam Brownback (R-KS) are slashing spending and starting a race to the bottom with business tax giveaways, Jerry Brown has California back in the black without taking another ax to social services and education. Meanwhile, hundreds of thousands of Americans are finally getting the right to marry, raise their families and be recognized by their governments--just like everyone else. And after years of Republicans telling them to "just go to the emergency room," millions more will be able to obtain the health insurance that can help them both overcome sickness and avoid financial disaster.
Those dramatic improvements in the quality of life are major steps in achieving the American Dream. And they're mostly happening where Democrats govern--and expanding the blue state advantage.


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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