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      Obamacare Keeps Winning

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      Its North Carolina victory is a sign of larger changes.The government benefits began their existence as objects of partisan rancor and harsh criticism. Eventually, though, they became so popular that politicians of both parties promised to protect them.It was true of Social Security and Medicare. And now the pattern seems to be repeating itself with Obamacare.Consider what has happened recently in North Carolina: Only a decade after the state’s Republican politicians described the law as dangerous and refused to sign up for its expansion of Medicaid, Republicans and Democrats came together to pass such an expansion. The Republican-controlled House in North Carolina passed the bill 87 to 24, while the Republican-controlled Senate passed it 44 to 2.“Wow, have things changed,” Jonathan Cohn wrote in a HuffPost piece explaining how the turnabout happened.Obamacare — the country’s largest expansion of health insurance since Medicare and Medicaid in 1965 — is still not as widely accepted as those programs. North Carolina became the 40th state to agree to expand Medicaid under Obamacare, which means that 10 states still have not, including two of the largest, Texas and Florida. In those states, more than 3.5 million adults lack health insurance as a result.But the list of states signing up for the program seems to be moving in only one direction: It keeps growing.Source: Kaiser Family Foundation‘Humiliation’In its growing acceptance, Obamacare resembles other major parts of the federal safety net:When Congress was considering Social Security in 1935, conservatives and many business executives bitterly criticized it. One Texas newspaper described Social Security as “a huge sales tax on everybody on behalf of the oldsters.” A Wall Street Journal editorial predicted that the law would eventually be reason for Congress to look back in “humiliation.” Not exactly: Social Security is so popular that it is known as a third rail in American politics.When Congress was debating Medicare in the 1960s, Ronald Reagan — then an actor with a rising political profile — attacked the program as a step toward socialism. If it passed, Reagan warned, “We are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.” As president, Reagan praised and supported the program.After Congress created Medicaid — a health-insurance program primarily for low-income households — in 1965, some states did not initially join it. Arizona became the last to do so, in 1982.Roberts and McCainIn the initial years after Obamacare’s passage in 2010, it was similarly divisive. Blue states embraced it, while many red states rejected its voluntary Medicaid expansion. In Washington, congressional Republicans and Donald Trump tried to repeal it. Some Republican-appointed judges invalidated parts of it, and every Republican appointee on the Supreme Court except Chief Justice John Roberts voted to scrap the law.Twice, it survived by a single vote — first, by Roberts’s 2012 Supreme Court vote, and then by Senator John McCain’s late-night vote against its repeal in 2017. Since then, however, Obamacare has been gaining Republican support.The next year, voters in Idaho, Nebraska and Utah — red states, all — passed ballot initiatives expanding Medicaid. Oklahoma, Missouri and South Dakota have since done so. Montana’s state legislature has also approved an expansion.American Medical Association Communications DivisionIn 2019, Gov. Andy Beshear of Kentucky, a Democrat, narrowly won election in a Republican state by pledging to protect an earlier Medicaid expansion. In North Carolina, Roy Cooper, also a Democrat, became governor in a 2016 upset partly by campaigning in favor of an expansion — and was able to sign one this week.(Before it takes effect, Cooper and the legislature must agree on a state budget.)These developments are a sign of the law’s growing popularity. And that popularity isn’t especially mysterious: In a country with high levels of economic inequality and large numbers of people without health insurance, Obamacare has increased taxes on the affluent to subsidize health care for poor and middle-class families. At root, it is an effort to reduce inequality.Winning the middleEven with its flaws — including its often complicated process for signing up for insurance — the law has achieved many of its aims. The number of Americans without health insurance has plummeted. In states that have refused the Medicaid expansion, by contrast, rural hospitals are struggling even more than elsewhere because they do not receive the law’s subsidies for care.Greenwood Leflore Hospital — in the Mississippi Delta — is an example. It recently closed its intensive-care unit and maternity ward, as our colleague Sharon LaFraniere has reported. Nationwide, states that did not quickly accept Medicaid expansion have accounted for almost three-quarters of rural hospital closures between 2010 and 2021, according to the American Hospital Association.Similar problems in North Carolina were a reason that Republicans there reconsidered their opposition to Medicaid expansion. “We had these people coming down to Raleigh, farmers, business owners, people from rural areas, they were advocating, telling stories,” one Republican state representative told HuffPost.Many Republicans still oppose Obamacare, and some hard-right members of Congress also favor cuts to Medicaid — as well as to Medicare and Social Security. In a country as polarized as the United States, there isn’t much true political consensus. But Obamacare has won over the political middle more quickly than seemed likely not so long ago.Related: The number of people signing up for insurance through Obamacare has surged over the past two years, partly because of a new subsidies signed by President Biden.THE LATEST NEWSPoliticsMike Pence must testify to the grand jury investigating Trump’s role in the Jan. 6 Capitol attack, a judge ruled.Republicans are trying to create obstacles to voting for college students, who lean Democratic.An election for a swing seat on Wisconsin’s Supreme Court has become an expensive political fight.A.I. is already affecting the 2024 elections, producing fake images of Trump getting arrested and videos that mimic Biden’s voice.Migrant DeathsA mourner in Ciudad Juárez, Mexico.Go Nakamura for The New York TimesAt least 38 people died in a fire at a migrant detention center in Mexico, near El Paso, Texas. The fire started after a protest.U.S. policies have created overcrowding and desperation at the border.BusinessLawmakers grilled federal regulators who were supposed to supervise Silicon Valley Bank before it collapsed.Prosecutors added a foreign bribery charge to the list of crimes already pending against the FTX founder Sam Bankman-Fried.Alibaba Group, China’s e-commerce giant, is splitting into six business groups.Other Big StoriesThe shooter who killed six people at a Nashville school this week had legally purchased seven guns recently, the police said.Myanmar’s military dissolved the political party of the imprisoned opposition leader Aung San Suu Kyi.Russia sent a 13-year-old girl to an orphanage after her father criticized the war in Ukraine.An appeals court reinstated the murder conviction of Adnan Syed, the “Serial” podcast subject who was freed after more than 20 years in prison, and ordered a new hearing.OpinionsThe success of Israel’s protests suggests that its democracy is healthier than many feared, Bret Stephens writes.How can doctors better discuss dying with their patients? Start by trusting them, Dr. Sunita Puri writes.MORNING READS“La Ronde Enfantine,” painted circa 1862.The Fitzwilliam Museum, CambridgeStolen painting: He lost a Courbet when he fled the Nazis. His heirs are getting it back.15-minute city: A professor is getting death threats for his walkable urban design plan.A discovery: He solved a math problem by finding what’s known as an einstein.Midday snooze: Can a nap make up for a bad night of sleep?Advice from Wirecutter: Pick the best VPN.Lives Lived: Born into poverty in the segregated South, Randall Robinson galvanized Americans against South African apartheid and advocated on behalf of Haitian refugees. He died at 81.SPORTS NEWS FROM THE ATHLETICN.C.A.A. women’s tournament: Iowa vs. South Carolina is the Final Four matchup many wanted — and the one the sport deserves.A potential $6 billion deal: Multiple bidders have submitted offers to buy the Washington Commanders, including a group that includes Magic Johnson as an investor. Patriots won’t pursue Jackson: New England is out of the Lamar Jackson stakes, and plans to stick with Mac Jones as its quarterback.ARTS AND IDEAS The pistachio Suprême croissant from Lafayette.Julia Gartland for The New York TimesThe ever-changing croissantApparently there’s no end to the forms a croissant can take.Ten years after the Cronut, pastry chefs are twisting croissant dough into pinwheels and squiggles, tying it in knots and stacking it into cubes. They are turning it into breakfast cereal, tie-dyeing it and, in one case, wrapping it around baguettes.When the baker Scott Cioe wanted to lure crowds to Lafayette, a Manhattan restaurant, he turned to croissant dough, coiling it into a photogenic swirl he called the Suprême. “We eat with our eyes as well as our hands,” Cioe told The Times.PLAY, WATCH, EATWhat to CookJulia Gartland for The New York TimesTry cooking pasta like risotto, adding liquid gradually so that the noodles absorb it completely. The result is a creamy, rich dish.What to WatchRob Lowe and John Owen Lowe star in “Unstable,” a new Netflix series that exaggerates their barbed father-son dynamic.What to Listen toLana Del Rey’s ninth album asks big, earnest questions and isn’t afraid to get messy.Late NightStephen Colbert called the Nashville shooting horrible and familiar.Now Time to PlayThe pangrams from yesterday’s Spelling Bee were calculator and coloratura. Here is today’s puzzle.Here’s today’s Mini Crossword, and a clue: Really awesome (four letters).And here’s today’s Wordle. Thanks for spending part of your morning with The Times. See you tomorrow. — DavidP.S. Nicholas Nehamas is joining The Times from The Miami Herald, to cover Ron DeSantis.Here’s today’s front page. “The Daily” is about Israel.Matthew Cullen, Lauren Hard, Lauren Jackson, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Ashley Wu contributed to The Morning. You can reach the team at themorning@nytimes.com.Sign up here to get this newsletter in your inbox. More

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      The Iran Hostages, and a Plot to Thwart Carter

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      More from our inbox:Why the U.S. Invaded Iraq: Theories AboundWhite Supremacy PropagandaCare at the End of Life“History needs to know that this happened,” Ben Barnes now says of his trip to the Middle East in 1980.Christopher Lee for The New York TimesTo the Editor:Re “43-Year Secret of Sabotage: Mission to Subvert Carter Is Revealed” (front page, March 19), about an effort to delay release of the American hostages in Iran to weaken Jimmy Carter’s re-election campaign:By way of apology to Mr. Carter, Ben Barnes details the mission to ensure that the 52 Americans held hostage by Iran were not released on Mr. Carter’s watch. Mr. Barnes’s candor, though overdue, is welcome, but his apology is somewhat misdirected.While Jimmy Carter might rightly claim that he suffered defeat in 1980 because Ronald Reagan’s campaign engaged in a contemptible plot, he was nevertheless a “second tier” victim.More than 50 Americans were held in terror for 444 days, not knowing whether they would live or die. If, as Mr. Barnes implies, his mission resulted in extending the hostages’ captivity, they stand at the front of the line of those to whom he should apologize.Mark SteinbergLos AngelesTo the Editor:How would President Jimmy Carter have responded to this news that, according to Ben Barnes, the G.O.P. was involved in an effort to thwart Mr. Carter’s efforts to win the American hostages’ release?I was on Air Force One accompanying Mr. Carter in the days leading up to the 1980 election. All efforts were focused on getting those Americans home.Our last hope came when news reached Mr. Carter at 2 a.m., Chicago time, on the Sunday before the election. Learning that the Iranian mullahs had modified their demands, the president put off campaigning and raced back to Washington. Unfortunately, Mr. Carter realized that obstacles remained.Imagine if he’d just learned that a Republican ally of President Reagan had been spreading the word in Arab capitals that Iran should keep the 52 hostages until after he had taken office? Imagine if Mr. Carter had gotten this story just before his final debate with Ronald Reagan? It would have put the G.O.P. challenger on the defensive.Imagine if …Chris MatthewsChevy Chase, Md.The writer, the former longtime host of the MSNBC show “Hardball,” was a speechwriter for President Carter.To the Editor:Ben Barnes’s revelations that political operatives met with overseas governments before the 1980 presidential election didn’t surprise me. The release of American hostages from Iranian captivity a few minutes after Ronald Reagan was inaugurated in 1981 was too much of a coincidence.This unwarranted interference in American foreign affairs by private citizens reminded me of Richard Nixon’s intrigues to entice the South Vietnamese government to stall the Paris peace talks in an effort to derail a Democratic victory in the 1968 presidential election.Shame on all those involved for risking American lives to benefit their political ambitions.Paul L. NewmanMerion Station, Pa.To the Editor:Thanks for an important and credible addition to the narrative of the Iran hostage crisis.An addendum: John Connally and Ben Barnes would almost certainly have received a chilly response to their scheme from President Anwar el-Sadat of Egypt, who was close to President Carter and loyal to him.Moreover, at the time of the trip, Sadat had welcomed his friend, the recently deposed shah of Iran, to Egypt, and the shah died there in July. Thus there is little chance Sadat conveyed the Connally-Barnes message to Tehran, though other Middle Eastern heads of state might have done so.Jonathan AlterMontclair, N.J.The writer is the author of “His Very Best: Jimmy Carter, a Life.”Why the U.S. Invaded Iraq: Theories AboundOnly a statue of Saddam Hussein remained standing at an Iraqi communications center that was the target of a bombing attack by American forces in 2003.Tyler Hicks/The New York TimesTo the Editor:“Two Decades Later, a Question Remains: Why Did the U.S. Invade?,” by Max Fisher (The Interpreter, March 19), suggests that the triggering motive for the 2003 invasion of Iraq will remain unknown.The article says “a critical mass of senior officials all came to the table wanting to topple” Saddam Hussein, the Iraqi leader, “for their own reasons, and then talked one another into believing the most readily available justification”: weapons of mass destruction.The clear goal was to topple Mr. Hussein. Recall that President George W. Bush desired revenge on Mr. Hussein for an attempt on his father’s life and that he was reportedly advised that only wartime presidents become great.The missing piece of the puzzle is that neoconservative advisers, with an array of reasons for toppling Mr. Hussein, were able to play on President Bush’s personal aspirations to get the go-ahead for the invasion.Richard ReillyOlean, N.Y.To the Editor:“Two Decades Later, a Question Remains: Why Did the U.S. Invade?” gives plausible answers. Another possible explanation was foretold by President Dwight D. Eisenhower, in his 1961 farewell address.He warned of “the unwarranted influence” of the “military-industrial complex,” telling us, in effect, that those who make money from war and those whose careers benefit from these actions have both influence and a shared interest in military interventions.His words are still worth heeding.Barbara H. ChasinIthaca, N.Y.The writer is emerita professor of sociology at Montclair State University and the author of “Inequality and Violence in the United States: Casualties of Capitalism.”White Supremacy Propaganda Michael Dwyer/Associated PressTo the Editor:Re “White Supremacist Propaganda Soared Last Year, Report Finds” (news article, March 10):The alarming rise of white nationalist vandalism and propaganda, the majority of which is being spread by Patriot Front, is more than offensive — it is often a criminal offense. Legislators, prosecutors and law enforcement should recognize the dangers these attempts to intimidate, recruit and inspire violence pose to American communities.White nationalist activities are occurring nationwide, are coordinated and are often evading accountability in local jurisdictions. The arrest of 31 Patriot Front members preparing to disrupt an L.G.B.T.Q.+ Pride celebration in Idaho last summer should have been the notice federal authorities needed. After the mass arrest, 17 organizations called on the Department of Justice to open an investigation into Patriot Front.We hope that The Times’s coverage of this disturbing trend adds urgency to the appeal for federal action against these dangerous campaigns of hate. Our local communities — and our democracy — can’t afford to be left to manage this threat alone any longer.Lindsay SchubinerBerkeley, Calif.The writer is the program director for the Western States Center, a nationwide group that works to strengthen inclusive democracy.Care at the End of Life Nadia HafidTo the Editor:Re “Aggressive Care Still Common at Life’s End” (The New Old Age, March 14):As a nurse practitioner in a large hospital, I see this kind of aggressive care all too often.In addition to the physical and emotional stress it places on patients and families, there’s a financial cost, since such care isn’t free.I will never forget an older man who spent his last months in one of our I.C.U.s. His wife not only lost him when he died but also their house, as the cost of medical care made her unable to pay the mortgage.These kinds of nonmedical consequences need to be considered, acknowledged and regularly assessed for. Something else our health care system doesn’t do.Marian GrantReisterstown, Md. More

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      Biden Looks to Bolster Support Among Seniors With a Focus on Health Care

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      In a trip to Las Vegas, President Biden warned that Republicans would endanger popular programs like Social Security and Medicare.LAS VEGAS — One of President Biden’s promises to America’s seniors when he first campaigned for the Oval Office was this: You will pay less for health care.So on Wednesday, with a possible re-election announcement getting closer every day, the president traveled to Las Vegas to boast that millions of older adults would save on their medications thanks to the health care legislation he championed last year.Because of the Inflation Reduction Act, he said, seniors will no longer have to make co-payments for some recommended vaccines like shingles and tetanus, saving them an average of $70 each year in the future.“For seniors on fixed income who often need expensive medications to stay healthy, that constant question is can they take the medications and can they pay the bills without giving up important elements of their life,” Mr. Biden told an audience at the University of Nevada, Las Vegas.“It’s not just your health,” he said. “It’s about your dignity. It’s about your security.”In the 2020 election, Mr. Biden came up short among people 65 and older to former President Donald J. Trump, 48 percent to 52 percent. The president and his advisers are hoping to increase his support among that group in 2024 by arguing that its financial and medical security will be better protected with Mr. Biden in office.The centerpiece of that argument so far has been the fate of the government’s primary retirement programs, Social Security and Medicare. Mr. Biden has been aggressive in seizing on proposals by a handful of Republican politicians to argue that the party would put the popular programs in danger.He said as much on Wednesday, standing in front of a sign at the University of Nevada that said “Lowering Costs for American Families.” The president recounted his State of the Union speech this year, when several Republican lawmakers called him a liar for claiming that they wanted to cut the social safety net programs.“I hope it’s true,” he said, noting that the legislators were being filmed as they denied any interest in doing any damage to Medicare and Social Security. “But I’ll believe it when I see it,” he said.Beyond that issue, however, the administration argues that older Americans will also be grateful for the president’s efforts to keep costs down, especially when it comes to their medications, at a time when prices have been rising sharply.In addition to the $70 average savings on vaccines, White House officials said on Wednesday that seniors across the country would benefit from provisions in the Inflation Reduction Act that penalize drug companies when they increase the cost of a drug faster than inflation..css-1v2n82w{max-width:600px;width:calc(100% – 40px);margin-top:20px;margin-bottom:25px;height:auto;margin-left:auto;margin-right:auto;font-family:nyt-franklin;color:var(–color-content-secondary,#363636);}@media only screen and (max-width:480px){.css-1v2n82w{margin-left:20px;margin-right:20px;}}@media only screen and (min-width:1024px){.css-1v2n82w{width:600px;}}.css-161d8zr{width:40px;margin-bottom:18px;text-align:left;margin-left:0;color:var(–color-content-primary,#121212);border:1px solid var(–color-content-primary,#121212);}@media only screen and (max-width:480px){.css-161d8zr{width:30px;margin-bottom:15px;}}.css-tjtq43{line-height:25px;}@media only screen and (max-width:480px){.css-tjtq43{line-height:24px;}}.css-x1k33h{font-family:nyt-cheltenham;font-size:19px;font-weight:700;line-height:25px;}.css-1hvpcve{font-size:17px;font-weight:300;line-height:25px;}.css-1hvpcve em{font-style:italic;}.css-1hvpcve strong{font-weight:bold;}.css-1hvpcve a{font-weight:500;color:var(–color-content-secondary,#363636);}.css-1c013uz{margin-top:18px;margin-bottom:22px;}@media only screen and (max-width:480px){.css-1c013uz{font-size:14px;margin-top:15px;margin-bottom:20px;}}.css-1c013uz a{color:var(–color-signal-editorial,#326891);-webkit-text-decoration:underline;text-decoration:underline;font-weight:500;font-size:16px;}@media only screen and (max-width:480px){.css-1c013uz a{font-size:13px;}}.css-1c013uz a:hover{-webkit-text-decoration:none;text-decoration:none;}How Times reporters cover politics. We rely on our journalists to be independent observers. So while Times staff members may vote, they are not allowed to endorse or campaign for candidates or political causes. This includes participating in marches or rallies in support of a movement or giving money to, or raising money for, any political candidate or election cause.Learn more about our process.Officials said that 27 specialized drugs recently met that criteria, and that their makers would be required to pay rebates to the federal government for the extra costs. Administration officials said that older Americans might see some savings in the future as drug companies keep prices lower to avoid having to pay the rebates.“Some people with traditional Medicare or managed care Medicare may stand to save starting in just a matter of weeks,” Health and Human Services Secretary Xavier Becerra told reporters before the president’s appearance.Mr. Biden also highlighted the impact that his health care actions have had on the cost of insulin, which is a common — and usually expensive — drug for many seniors who suffer from diabetes.The president’s health care law caps the price of insulin at $35 per month for older adults, and Mr. Biden has succeeded in persuading two of the three biggest drug manufacturers to lower costs for younger people in need of insulin. Eli Lilly announced this month that it would cap out-of-pocket costs for insulin at the same $35. Novo Nordisk said it would cut the cost of its insulin drug by 75 percent.The focus on medical costs for older adults has been part of Mr. Biden’s agenda since before he became president. His campaign website said under the heading “The Biden Plan for Older Americans” that seniors in the United States “deserve to retire with dignity — able to pay for their prescriptions and with access to quality, affordable long-term care.”But his policy ambitions are now part of a political effort to win back some in that demographic who have trended toward Republicans as the average age of people living in the country increases each year.A group of about two-dozen Republican lawmakers is pushing legislation to repeal the Inflation Reduction Act, a move that White House officials and the president have seized on. Mr. Biden wants to make his Republican White House rival — whomever that turns out to be — pay for a repeal effort by suggesting that it will hurt older adults.In a statement last month, the White House said that efforts to repeal the law “would give tens of billions of dollars in subsidies back to Big Pharma, raise seniors’ prescription drug prices and raise taxes on an estimated 14.5 million people — all while increasing the deficit.”Mr. Biden’s visit to Las Vegas comes just weeks before he is expected to announce that he is running for a second term. Nevada is a critical swing state that Democrats need in their column if they want to retain control of the White House for another four years. In 2020, Mr. Biden won the state with 50.06 percent of the vote, to Mr. Trump’s 47.67 percent.Wednesday’s speech took place at the William F. Harrah College of Hospitality, a nod to the service unions that are extremely powerful in Las Vegas and an important Democratic constituency. More

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      America Is Breaking Our Hearts

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      Gail Collins: Bret, I have a lot to ask you about government spending and deficits and … all that stuff. But first, we really need to talk about all the recent mass shootings and what to do about them, right?Bret Stephens: In Britain or Germany these sorts of mass shootings are, at most, once-every-other-year events. Over here, hardly a day goes by without something like this happening. And the horror doesn’t just lie in the carnage. It’s that we’ve become accustomed to it. Dostoyevsky wrote, “Man grows used to everything, the scoundrel!” That’s the state of our nation.Gail: I wondered whether I should even bring the matter up yet again. But we can’t just give up and shrug in silence.Bret: You know I’m in favor of repealing the Second Amendment, not for the sake of banning guns but for making it much harder for just anyone to own them. Otherwise, in a country with more firearms than people, I doubt that ordinary gun control can make a real difference. Your thoughts?Gail: Do love the fact that I converse with a conservative who wants to repeal the Second Amendment. Sign me up.Bret: Don’t get your hopes up that I’m speaking for other conservatives.Gail: It may seem crazy in the face of all this carnage, but I’ve always wondered if we could change the argument to gun pride — that people shouldn’t be allowed to own guns until they prove they can shoot. Just hit a reasonably sized target. Obviously you don’t need a good aim to fire an assault rifle into a church or movie theater, but if we could just come to a consensus on requiring competence, that might be a first step toward rational firearm regulations.Bret: I would design the test differently. Start with a 100-question test on gun use, safety and legal requirements, with a passing grade of 90. Next, a psychological fitness test, conducted in person by trained personnel. Then heavy liability insurance requirements for gun store owners. Oh, and a drug test for purchasers. Anything to hinder disturbed young men, who are most frequently the culprits in the worst of these mass shootings, from getting their hands on rapid-fire weapons.After that, gun owners can boast to their friends that not only can they shoot, but also that they’re smart, sane, solvent and sober. But you wanted to discuss … government spending.Gail: That’s the issue of the moment, right? Congress has to do something about raising the debt ceiling or the economy will collapse somewhere down the line. Or at least that’s the theory.Republicans want to tie the raising of said ceiling to major league cuts in spending. No matter how much Kevin McCarthy swears that won’t involve cuts to Social Security or Medicare, it’s almost impossible to imagine they aren’t on the table. What’s your recommendation?Bret: Well, the Republicans’ current strategy has all the intelligence of Foghorn Leghorn, the Looney Tunes rooster: They’re trying to play a game of chicken with the Biden administration when, deep down, they know they’re the ones who are going to chicken out. It would be economically destructive and politically suicidal to let the federal government default on its debt. So we will probably go through this terrifying charade until a handful of swing-district Republicans break ranks and vote with Democrats to raise the debt ceiling.Gail: I do like that last scenario you mentioned. But don’t you think the bottom line is problematic, too? If Congress cuts spending to balance the budget as some Republicans have suggested, it could mean big cuts to very popular programs like Social Security and Medicare.Bret: Other than trying to find ways to slow the rate of spending growth, I can’t imagine there would be cuts to either program. They’re popular with Republican voters, too, after all. And there’s no way anything is going to happen except on a bipartisan basis. Any suggestions for fixes that don’t involve large tax increases?Gail: Well, some people may regard this as a tax increase, but I want to propose some tax fairness. For some reason, Social Security payroll taxation stops at about $160,000. So a person making a million dollars a year doesn’t pay anything on about $840,000.Let’s get rid of that ceiling, Bret. What do you say?Bret: I wouldn’t object to raising the cap provided Democrats would be willing to push up the retirement age by four or five years. As for Medicare reform, my guess is it will never happen. Instead, I’m betting that in 20 years we’re going to have a terrible but “free” single-payer system for part of the population and an excellent but expensive universe of private providers. As for actual budget cuts, maybe we could end stupid subsidies like the one for ethanol production. But that one is way too popular with farm-state Republicans.Different subject, Gail: Memphis.Gail: Bret, I spent a lot of my early career — way back in the ’70s — hanging out with the chief of police in New Haven, Ed Morrone, who was just so smart. He told my husband Dan, who was a police reporter then, that the most important job of a cop was “to keep people who hate one another apart.”Bret: Oh, it’s like figuring out the seating arrangement at Thanksgiving. Sorry, go on.Gail: In those days, that made so much sense. But in Memphis, the people doing the hating were the police themselves, who apparently got mad because a driver they had targeted for some reason made them run until they were out of breath and then started crying for his mother while they began beating him up.Now we have a dead young man, a bereaved family and a city in turmoil. Every well-run law enforcement organization in the country is going to have to cope with a new level of suspicion. Those cops have ruined their own reputations, deeply wounded community relations, and I am confident they’re going to pay for their terrible misdeeds after criminal trials.Your thoughts?Bret: I was moved by Tyre Nichols’s mom, RowVaughn Wells, when she said she’d pray for the police officers who killed her son, along with their families. It’s a spirit of compassion and dignity the city desperately needs now.Gail: Not just the city, the whole country.Bret: That said, I’m also reluctant to draw sweeping conclusions, either about this case or from it. Memphis has one of the highest per capita murder rates in the country, and the city desperately needs competent and effective policing. Police brutality obviously remains a serious challenge throughout the country. But so do reports of de-policing, in which cops retreat to their precinct stations because they don’t want to be out on their beats, or the equally dangerous trend of demoralized and demonized police departments that have led to serious staffing shortages across the country.Gail, at the end of our conversation last week — sometime after I’d committed the mortal sin of endorsing gas over electric stoves — we promised readers that we would discuss who, among Democrats, would be the best candidate to face Ron DeSantis should he become the G.O.P.’s presidential nominee. Give me some names.Gail: Well gee, I was looking forward to another discussion about kitchen stoves, but OK.Bret: Of all the ways I’ve irritated our readers over the years, who knew that my ignorance of induction cooktops would be the worst?Gail: We both wish Joe Biden would retire and open the door for someone younger, but it sure doesn’t look likely. If he runs, Governor DeSantis, who’s 44, would be a daily reminder that Biden is in his 80s.Bret: If it gets to that, Biden had better hope that Donald Trump brings back Teddy Roosevelt’s Bull Moose Party to split the conservative vote. Because otherwise, President DeSantis it shall be.Gail: Age isn’t a problem for most of the Democrats who’d be likely to succeed Biden as nominee. And there’s a raft of promising possibilities people are talking about — a half-dozen governors, several senators and a couple of members of Biden’s administration.Some of the names I like hearing are Senator Amy Klobuchar, Gov. Gretchen Whitmer of Michigan, Pete Buttigieg, the transportation secretary, and Josh Shapiro, the newly ensconced governor of Pennsylvania. Kamala Harris, you will note, is not on my list.Bret: I noticed.Gail: The public needs a chance to look all these people over in a serious, long-term way. Which would happen if Biden announced he isn’t running again. Please, Mr. President …Bret: One other strong contender I’d like to mention: Gina Raimondo, the commerce secretary and former governor of Rhode Island. She would be the best candidate in a general election because of her strong centrist appeal — and the best president, too. And people ought to start keeping an eye on Gov. Wes Moore of Maryland, even though it is probably much too soon for him — or Josh Shapiro, for that matter — to start considering a presidential bid.Gail: Yeah, I guess it’s only fair that people who get elected governor should put in a year or two before they start running for higher office.Bret: Before we go, Gail, I was saddened to read about Victor Navasky’s death this month at 90. I probably disagree with 99 percent of what gets published in The Nation, the magazine he led for so many years. But he was a happy warrior for his causes, wrongheaded as some of them were (like championing the innocence of Alger Hiss). But I’ll take a cheerful opponent over a sour fellow-traveler any day.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      Biden Hammers Republicans on the Economy, With Eye on 2024

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      The president has found a welcome foil in a new conservative House majority and its tax and spending plans, sharpening a potential re-election message.WASHINGTON — President Biden on Thursday assailed House Republicans over their tax and spending plans, including potential changes to popular retirement programs, ahead of what is likely to be a run for re-election.In a speech in Springfield, Va., Mr. Biden sought to reframe the economic narrative away from the rapid price increases that have dogged much of his first two years in office and toward his stewardship of an economy that has churned out steady growth and strong job gains.Mr. Biden, speaking to members of a steamfitters union, sought to take credit for the strength of the labor market, moderating inflation and news from the Commerce Department on Thursday morning that the economy had grown at an annualized pace of 2.9 percent at the end of last year. In contrast, he cast House Republicans and their economic policy proposals as roadblocks to continued improvement.“At the time I was sworn in, the pandemic was raging and the economy was reeling,” Mr. Biden said before ticking through the actions he had taken to aid the recovery. Those included $1.9 trillion in pandemic and economic aid; a bipartisan bill to repair and upgrade roads, bridges, water pipes and other infrastructure; and a sweeping industrial policy bill to spur domestic investment in advanced manufacturing sectors like semiconductors and speed research and development to seed new industries.Republicans have accused the Biden administration of fanning inflation by funneling too much federal money into the economy, and have called for deep spending cuts and other fiscal changes.Mr. Biden denounced those proposals, including a plan to replace federal income taxes with a national sales tax, curb safety net spending and risk a government default by refusing to raise the federal borrowing limit without deep spending cuts. Why, he asked, “would the Americans give up the progress we’ve made for the chaos they’re suggesting?”Speaker Kevin McCarthy and House Republicans have not yet released a detailed or unified economic agenda.Haiyun Jiang/The New York Times“I will not let anyone use the full faith and credit of the United States as a bargaining chip,” Mr. Biden said, reiterating his refusal to negotiate over raising the debt limit. “The United States of America — we pay our debts.”But the president also sought to reach out to working-class voters — in places like his native Scranton, Pa. — who have increasingly voted for Republicans in recent elections. Mr. Biden said those voters had been left behind by American economic policy in recent years, and he tried to woo them back by promising that his policies would continue to bring high-paying manufacturing jobs that do not require a college degree to people who feel “invisible” in the economy.“They remember, in my old neighborhoods, why the jobs went away,” Mr. Biden said, vowing that under his policies “nobody’s left behind.”The Biden PresidencyHere’s where the president stands as the third year of his term begins.State of the Union: President Biden will deliver his second State of the Union speech on Feb. 7, at a time when he faces an aggressive House controlled by Republicans and a special counsel investigation into the possible mishandling of classified information.Chief of Staff: Mr. Biden plans to name Jeffrey D. Zients, his former coronavirus response coordinator, as his next chief of staff. Mr. Zients will replace Ron Klain, who has run the White House since the president took office two years ago.Voting Rights: A year after promising a voting rights overhaul in a fiery speech, Mr. Biden delivered a more muted message at Ebenezer Baptist Church in Atlanta on Martin Luther King Jr.’s birthday.The speech built on a pattern for Mr. Biden, who has found the new and narrow Republican majority to be both a political threat and an opportunity.Republicans in the chamber have begun a series of investigations into Mr. Biden, his family and his administration. They have also demanded deep cuts in federal spending in exchange for raising the borrowing limit, a position that risks an economic catastrophe given the huge sums of money that the United States borrows to pay for its financial obligations.The president has refused to tie any spending cuts to raising the debt limit and has called on Congress to increase the $31.4 trillion cap so the nation can continue paying its bills and avoid a federal default..css-1v2n82w{max-width:600px;width:calc(100% – 40px);margin-top:20px;margin-bottom:25px;height:auto;margin-left:auto;margin-right:auto;font-family:nyt-franklin;color:var(–color-content-secondary,#363636);}@media only screen and (max-width:480px){.css-1v2n82w{margin-left:20px;margin-right:20px;}}@media only screen and (min-width:1024px){.css-1v2n82w{width:600px;}}.css-161d8zr{width:40px;margin-bottom:18px;text-align:left;margin-left:0;color:var(–color-content-primary,#121212);border:1px solid var(–color-content-primary,#121212);}@media only screen and (max-width:480px){.css-161d8zr{width:30px;margin-bottom:15px;}}.css-tjtq43{line-height:25px;}@media only screen and (max-width:480px){.css-tjtq43{line-height:24px;}}.css-x1k33h{font-family:nyt-cheltenham;font-size:19px;font-weight:700;line-height:25px;}.css-1hvpcve{font-size:17px;font-weight:300;line-height:25px;}.css-1hvpcve em{font-style:italic;}.css-1hvpcve strong{font-weight:bold;}.css-1hvpcve a{font-weight:500;color:var(–color-content-secondary,#363636);}.css-1c013uz{margin-top:18px;margin-bottom:22px;}@media only screen and (max-width:480px){.css-1c013uz{font-size:14px;margin-top:15px;margin-bottom:20px;}}.css-1c013uz a{color:var(–color-signal-editorial,#326891);-webkit-text-decoration:underline;text-decoration:underline;font-weight:500;font-size:16px;}@media only screen and (max-width:480px){.css-1c013uz a{font-size:13px;}}.css-1c013uz a:hover{-webkit-text-decoration:none;text-decoration:none;}How Times reporters cover politics. We rely on our journalists to be independent observers. So while Times staff members may vote, they are not allowed to endorse or campaign for candidates or political causes. This includes participating in marches or rallies in support of a movement or giving money to, or raising money for, any political candidate or election cause.Learn more about our process.But Mr. Biden, who is facing a divided Congress for the first time in his presidency, is increasingly acting as if the newly empowered conservatives have given him a political opening on economic policy. As he prepares for a likely re-election bid in 2024, he is seizing on the least popular proposals floated by House members to cast himself as a champion of the working class, retirees and economic progress.Mr. Biden’s speech on Thursday waded deep into policy details, including the acreage of western timber burned in fires linked to climate change, the global breakdown of advanced chip production and the average salary of new manufacturing jobs, as he recounted his legislative accomplishments.House Republicans have not yet released a detailed or unified economic agenda, and they have not made a clear set of demands for raising the debt limit, though they largely agree that Mr. Biden must accept significant spending curbs.But members and factions of the Republican conference have pushed for votes on a variety of proposals that have little support among voters, including raising the retirement age for Social Security and Medicare and replacing the federal income tax with a national sales tax.Mr. Biden has sought to brand the entire Republican Party with those proposals, even though it is not clear if the measures have majority support in the conference or will ever come to a vote. Former President Donald J. Trump, who has already announced his 2024 bid for the White House, has urged Republicans not to touch the safety-net programs. Other party leaders have urged Republicans not to rule out those cuts. “We should not draw lines in the sand or dismiss any option out of hand, but instead seriously discuss the trade-offs of proposals,” Senator Michael D. Crapo of Idaho, the top Republican on the Finance Committee, wrote in an opinion piece for Fox News, in which he called for Mr. Biden to negotiate over raising the debt limit.Representative Kevin Hern, Republican of Oklahoma, who sits on the House Ways and Means Committee, told a tax conference in Washington this week that there are “lots of problems” with the plan to replace the income tax with a so-called fair tax on consumption. Those include incentives for policymakers to allow prices to rise rapidly in the economy in order to generate more revenue from the sales tax, he noted.“Let’s just say it’s going to be very interesting,” Mr. Hern said at the D.C. Bar Taxation Community’s annual tax conference. “I haven’t found a Ways and Means member that’s for it.”Despite those internal disagreements, Mr. Biden has been happy to pick and choose unpopular Republican ideas and frame them as the true contrast to his economic agenda. He has pointedly refused to cut safety-net programs and threatened to veto such efforts.“The president is building an economy from the bottom up and the middle out, and protecting Social Security and Medicare,” Karine Jean-Pierre, the White House press secretary, told reporters this week. “Republicans want to cut Social Security, want to cut Medicare — programs Americans have earned, have paid in — and impose a 30 percent national sales tax that will increase taxes on working families. That is what they have said they want to do, and that is clearly their plan.”The focus on Republicans has allowed Mr. Biden to divert the economic conversation from inflation, which hit 40-year highs last year but receded in the past several months, though it remains above historical norms. On Thursday, he chided Republicans for a vote to reduce funding for I.R.S. enforcement against wealthy tax cheats — a move the Congressional Budget Office says would add to the budget deficit, and which Mr. Biden cast as inflationary.“They campaigned on inflation,” Mr. Biden said. “They didn’t say if elected, they planned to make it worse.”Progressive groups see an opportunity for Mr. Biden to score political points and define the economic issue before the 2024 campaign begins in earnest. That is in part because polls suggest Americans have little appetite for Social Security or Medicare cuts, and have far less focus on the national debt than House Republicans do.“It is a political gift,” said Lindsay Owens, the executive director of the Groundwork Collaborative, a liberal nonprofit in Washington. More

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      Britain’s Cautionary Tale of Self-Destruction

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      In December, as many as 500 patients per week were dying in Britain because of E.R. waits, according to the Royal College of Emergency Medicine, a figure rivaling (and perhaps surpassing) the death toll from Covid-19. On average, English ambulances were taking an hour and a half to respond to stroke and heart-attack calls, compared with a target time of 18 minutes; nationwide, 10 times as many patients spent more than four hours waiting in emergency rooms as did in 2011. The waiting list for scheduled treatments recently passed seven million — more than 10 percent of the country — prompting nurses to strike. The National Health Service has been in crisis for years, but over the holidays, as wait times spiked, the crisis moved to the very center of a narrative of national decline.Post-Covid, the geopolitical order has been thrown into tumult. At the beginning of the pandemic, commentators wondered about the fate of the United States, its indifferent political leadership and its apparently diminished “state capacity.” Lately, they have focused more on the sudden weakness of China: its population in decline, its economy struggling more than it has in decades, its “zero Covid” reversal a sign of both political weakness and political overreach, depending on whom you ask.But the descent of Britain is in many ways more dramatic. By the end of next year, the average British family will be less well off than the average Slovenian one, according to a recent analysis by John Burn-Murdoch at The Financial Times; by the end of this decade, the average British family will have a lower standard of living than the average Polish one.On the campaign trail and in office, promising a new prosperity, Boris Johnson used to talk incessantly about “leveling up.” But the last dozen years of uninterrupted Tory rule have produced, in economic terms, something much more like a national flatlining. In a 2020 academic analysis by Nicholas Crafts and Terence C. Mills, recently publicized by the economic historian Adam Tooze, the two economists asked whether the ongoing slowdown in British productivity was unprecedented. Their answer: not quite, but that it was certainly the worst in the last 250 years, since the very beginning of the Industrial Revolution. Which is to say: To find a fitting analogue to the British economic experience of the last decade, you have to reach back to a time before the arrival of any significant growth at all, to a period governed much more by Malthusianism, subsistence-level poverty and a nearly flat economic future. By all accounts, things have gotten worse since their paper was published. According to “Stagnation Nation,” a recent report by a think tank, there are eight million young Brits in the work force today who have not experienced sustained wage growth at all.Over the past several decades, the China boom and then the world’s populist turn have upended one of the basic promises of post-Cold War geopolitics: that free trade would not just bring predictable prosperity but also draw countries into closer political consensus around something like Anglo-American market liberalism. The experience of Britain over the same period suggests another fly in the end-of-history ointment, undermining a separate supposition of that era, which lives on in zombie form in ours: that convergence meant that rich and well-​governed countries would stay that way.For a few weeks last fall, as Liz Truss failed to survive longer as head of government than the shelf life of a head of lettuce, I found myself wondering how a country that had long seen itself — and to some significant degree been seen by the rest of the world — as a very beacon of good governance had become so seemingly ungovernable. It was of course not that long ago that American liberals looked with envy at the British system — admiring the speed of national elections, and the way that new governing coalitions always seemed able to get things done.Post-Brexit, both the outlook for Britain and the quality of its politics look very different, as everyone knows. But focusing on a single “Leave” vote risks confusing that one abrupt outburst of xenophobic populism with what in fact is a long-term story of manufactured decline. As Burn-Murdoch demonstrates in another in his series of data-rich analyses of the British plight, the country’s obvious struggles have a very obvious central cause: austerity. In the aftermath of the 2008 global financial crisis, and in the name of rebalancing budgets, the Tory-led government set about cutting annual public spending, as a proportion of G.D.P., to 39 percent from 46 percent. The cuts were far larger and more consistent than nearly all of Britain’s peer countries managed to enact; spending on new physical and digital health infrastructure, for instance, fell by half over the decade. In the United States, political reversals and partisan hypocrisy put a check on deep austerity; in Britain, the party making the cuts has stayed steadily in power for 12 years.The consequences have been remarkable: a very different Britain from the one that reached the turn of the millennium as Tony Blair’s “Cool Britannia.” Real wages have actually declined, on average, over the last 15 years, making America’s wage stagnation over the same period seem appealing by comparison. As the political economist William Davies has written, the private sector is also behaving shortsightedly, skimping on long-term investments and extracting profits from financial speculation instead: “To put it bluntly, Britain’s capitalist class has effectively given up on the future.” Even the right-wing Daily Telegraph is now lamenting that England is “becoming a poor country.”Of course, trends aside, in absolute terms Britain remains a wealthy place: the sixth-largest economy in the world, though its G.D.P. is now smaller than that of India, its former colony. And while the deluded promises of Brexit boosters obviously haven’t come to pass, neither have the bleakest projections: food shortages, crippling labor crunches or economic chaos.Instead, there has been a slow, sighing decay — one that makes contemporary Britain a revealing case study in the way we talk and think about the fates of nations and the shape of contemporary history. Optimists like to point to global graphs of long-term progress, but if the political experience of the last decade has taught us anything, it is that whether the world as a whole is richer than it was 50 years ago matters much less to the people on it today than who got those gains, and how they compare with expectations. Worldwide child mortality statistics are indeed encouraging, as are measures of global poverty. But it’s cold comfort to point out to an American despairing over Covid-era life expectancy declines that, in fact, a child born today can still expect to live longer than one born in 1995, for instance, or to tell a Brit worrying over his or her economic prospects that added prosperity is likely to come eventually — at the same level enjoyed by economies in the former Eastern Bloc.Can Britain even stomach such a comparison? The wealthy West has long regarded development as a race that has already and definitively been won, with suspense remaining primarily about how quickly and how fully the rest of the world might catch up. Rich countries could stumble, the triumphalist narrative went, but even the worst-case scenarios would look something like Japan — a rich country that stalled out and stubbornly stopped growing. But Japan is an economic utopia compared with Argentina, among the richest countries of the world a century ago, or Italy, which has tripped its way into instability over the last few decades. Britain has long since formally relinquished its dreams of world domination, but the implied bargain of imperial retreat was something like a tenured chair at the table of global elders. As it turns out, things can fall apart in the metropole too. Over two centuries, a tiny island nation made itself an empire and a capitalist fable, essentially inventing economic growth and then, powered by it, swallowing half the world. Over just two decades now, it has remade itself as a cautionary tale.David Wallace-Wells (@dwallacewells), a writer for Opinion and a columnist for The New York Times Magazine, is the author of “The Uninhabitable Earth.” More

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      Obamacare Is Everywhere in the Unlikeliest of Places: Miami

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      A decade after the Affordable Care Act’s federal health insurance marketplace was created, its outsize — and improbable — popularity in South Florida persists.MIAMI — Lídice Hernández opened an insurance agency last year on a busy street, affixing to the storefront a logo that has become deeply familiar in South Florida: a white sun rising over the red stripes of the American flag, all encased in a big, blue O.“Obamacare,” it read underneath.Similar displays are common along some of Miami’s main thoroughfares, almost 13 years after President Barack Obama’s signature health policy, the Affordable Care Act, became law and critics branded it with his name. Everywhere you look, especially during the open enrollment period that runs from November to January: Obamacare, Obamacare, Obamacare.“If we don’t use it,” Ms. Hernández explained of the moniker, “people don’t know that we sell it.”And in Miami, people really want it.On its face, the program’s outsize popularity in South Florida remains one of its most intriguing data points. The evidence is visible in every Obamacare logo deployed — not just on storefronts but on trucks, flags and billboards — to sell health insurance, as agents in the crowded local market jockey to enroll people. This year’s open enrollment period ends on Sunday.Florida has far more people enrolled in the federal health insurance marketplace created by the Affordable Care Act than any other state does, a distinction that has been true since 2015. Driving those numbers has been the Miami area, where older, Republican-leaning Hispanics appeared loath to embrace government-subsidized health insurance when the law was enacted. At the time, it ignited some of the most pitched partisan battles in the nation’s recent history.In particular, some Miamians who had fled left-wing leaders in Cuba and other Latin American countries chafed at the law’s requirement — later eliminated — that people have health coverage or face a penalty, which critics decried as “socialism.”The region has only tilted more Republican since then, flipping red in the governor’s race last year for the first time in two decades. Yet in 2022, the two ZIP codes with the most enrollees in Affordable Care Act coverage nationwide were in Doral and Hialeah, cities west and north of Miami known for their right-leaning Venezuelan American and Cuban American communities. And the county with most enrollees in the country remained Miami-Dade.Lídice Hernández opened an insurance agency in Miami last year. Scott McIntyre for The New York TimesEverywhere you look, especially during the open enrollment period: Obamacare, Obamacare, Obamacare.Scott McIntyre for The New York Times“It’s ingrained in our community,” said Nicholas X. Duran, a former Democratic state representative who used to work for a nonprofit group that encouraged Americans to enroll in Obamacare plans and now works for the health insurer Aetna. “It’s stuck.”So is the ubiquitous logo, which got its start as the symbol for Mr. Obama’s 2008 presidential campaign, said Sol Sender, who designed it. It was never intended to represent the health care law, Mr. Sender said, calling its co-opting by enterprising insurance agents “just pretty organic.”Which is not to say that policyholders, while glad to have coverage, are always happy with their plans. Gisselle Llerena, one of Ms. Hernández’s clients said she had been unable to get her insurer to sign off on a test her doctor recommended.“I have an M.R.I. pending from a century ago,” Ms. Llerena, 50, said in Spanish as she recently dropped in on Ms. Hernández’s office in a modest strip mall. “But the insurance doesn’t want to cover it.”Still, Ivan A. Herrera, the chief executive of the Miami-based UniVista Insurance agency, which caters to Hispanic people and prominently advertises Obamacare plans, said he has seen plenty of evidence that the coverage has helped people.“I know customers who have had open-heart surgery,” he said. “They never went to the doctor. They never had a blood test. They never visited a specialist. And now they can take care of themselves.”Each year, Mr. Herrera’s business has “doubled the amount of people that we have in Obamacare,” he said. “Obamacare is massive.”About 2.7 million Floridians out of the state’s population of about 22 million enrolled in a plan through the federal insurance marketplace, which the health law created, in 2022. Compared with Texas, which has about 30 million people but only about 1.8 million enrollees, “Florida is like an A.C.A. monster,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, a charity focused on health.The average monthly premium last year for Floridians with marketplace plans was $611, and for those who qualified for federal premium subsidies, the average amount was $552 per month, slightly higher than the national average, according to the Kaiser Family Foundation, a nonprofit health policy group.Early federal data suggests enrollment has jumped again for 2023, with 15.9 million plan selections nationally in the federal marketplace and those run by states, including almost 3.2 million — roughly one-fifth of the total — in Florida.That Obamacare has become part of the fabric of Florida life is also striking given the state’s early opposition to the law, led by Rick Scott, then the Republican governor. Mr. Scott, who is now a U.S. senator, barred “navigators” — those who helped people sign up for coverage — from state health department offices in an effort to undermine enrollment.The Republican-controlled State Legislature has not expanded Medicaid, the federal health insurance program for low-income people, as allowed under the Affordable Care Act, making Florida one of only 11 holdout states. About 790,000 currently uninsured Floridians would be eligible for expanded Medicaid, according to Kaiser; without it, other low-income residents have turned to the federal marketplace for subsidized coverage, which is one reason Florida has such high enrollment.Ivan Herrera, the chief executive and founder of UniVista Insurance, said his company had doubled the amount of clients signed up for federal marketplace plans each year.Scott McIntyre for The New York TimesAbout 2.7 million Floridians out of the state’s population of about 22 million enrolled in a plan through the federal insurance marketplace in 2022.Scott McIntyre for The New York TimesObamacare is also popular in the state because it is home to many retirees who are younger than 65 and not yet eligible for Medicare, the federal health insurance program for older people. Others opt for the health insurance because they have recently moved from other states and may be in between jobs. And many employers in the state do not offer working Floridians robust benefits that include health care coverage.“In South Florida especially, you’ve got a lot of people who are working in entertainment or restaurants, where they don’t have an offer of health insurance,” said Karoline Mortensen, an associate dean and professor of health management and policy at the University of Miami. That is especially true for Hispanics, she added.When the federal health insurance mandate lapsed, Dr. Mortensen found that some Latinos dropped their coverage, suggesting that they had gotten insurance only because they were required to. But Hispanic people still continued to get medical care at far higher rates than they had before the federal marketplace was created in 2013, she said.The Kaiser Family Foundation estimates that Florida is the state with the second-highest percentage of eligible people who have enrolled in an Affordable Care Act plan, said Cynthia Cox, a Kaiser vice president.She credited local leaders and insurance agents with promoting the law’s benefits, even when the state did not. Similarly, Dr. Mortensen referenced a moderate Republican state senator who, when the federal marketplace opened, urged his constituents to enroll.Ilse Torres, an insurance agent in Miami, said she had educated her clients “bit by bit” that Obamacare is not health coverage, as many of them assume, but rather a law that created a federal marketplace and required insurers to cover pre-existing health conditions.After Republicans in Congress tried but failed to repeal the law during the Trump administration, Ms. Torres said, the marketplace stabilized, drawing more major insurers and attracting new policyholders.Ms. Hernández, who voted for Mr. Obama in 2008 but later registered as a Republican, lamented that Congress had not updated the Affordable Care Act to make more people permanently eligible for subsidies to help cover their insurance premiums. (Subsidies were temporarily expanded through the American Rescue Plan and the Inflation Reduction Act, and are in effect through 2025 — a major reason for the recent enrollment bumps.) But she was pleased, she said, that Republican lawmakers had stopped trying to repeal the law.“Obamacare needs to be fixed,” she said. “But when I saw how easy it was to get it, I was like, ‘Oh my God, people don’t know about this. Why don’t more people get it?’”She and her family are now insured through the program.Susan C. Beachy More

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      What’s In (and Not In) the $1.7 Trillion Spending Bill

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      A big boost for the military, more aid for Ukraine, a preference for the lobster industry over whales and an overhaul of the Electoral Count Act are among the provisions in the 4,155-page bill lawmakers expect to pass this week.WASHINGTON — Billions of dollars in emergency aid to war-torn Ukraine and communities ravaged by natural disasters. A bipartisan proposal to overhaul the archaic law at the heart of former President Donald J. Trump’s effort to overturn the 2020 election. And a divisive oceanic policy that will change federal protections for whales in an effort to protect the lobster industry in Maine.In compiling the roughly $1.7 trillion catchall spending package that will keep the government open through September, lawmakers inserted several new funding and legislative proposals to ensure their priorities and policies become law before the end of the year.It includes funding that will guarantee the enactment of policies first authorized in bipartisan legislation approved earlier in this Congress, including money for innovation hubs established in the semiconductor manufacturing law and projects in the infrastructure law. The package also includes a round of earmarks, rebranded as community project funding, that allow lawmakers to redirect funds to specific projects in their states and districts.Here is a look at some of the provisions that would go into effect if enacted.Military spending is the big winner.The Defense Department would see an extraordinary surge in spending when adding its regular 2023 fiscal year budget together with additional funds being allocated to help respond to the war in Ukraine.All together, half of the $1.7 trillion in funding included in the package goes to defense, or a total of $858 billion. It comes after lawmakers bucked a request from President Biden and approved a substantial increase in the annual defense policy bill passed this month.The 2023 budget just for the Defense Department would total $797.6 billion in discretionary spending — a 10 percent increase over last year’s budget — representing an extra $69.3 billion in funds for the Pentagon, which is $36.1 billion above the president’s budget request.Sprinkled throughout the spending bill are hundreds of high-ticket add-ons that Congress wants to make to the president’s original Defense Department budget, such as an additional $17.2 billion for procurement that the Pentagon can largely distribute to military contractors to buy new ships, airplanes, missile systems and other equipment. The overall Pentagon procurement budget with these additional funds would be $162 billion.One of the biggest chunks of that extra money is for shipbuilding — an extra $4 billion that brings the Navy’s overall shipbuilding budget to $31.96 billion. That will allow it to buy 11 new ships, including three guided missile destroyers and two attack submarines.But that is just the start. There is $8.5 billion to buy 61 F-35 fighter jets made by Lockheed Martin and another $2.5 billion to buy 15 of Boeing’s new aerial refueling planes known as KC-46 tankers.There is also an extra $27.9 billion to help cover Defense Department costs associated with the war in Ukraine, as part of an emergency aid package to the country. That includes an extra $11.88 billion to replenish U.S. stocks of equipment sent to Ukraine — money that again will largely be used to purchase products from military contractors. That supplemental appropriation also includes $9 billion to assist Ukraine with training, equipment and weapons, as well as an extra $6.98 billion to cover U.S. military operations in Europe.— Eric Lipton and John IsmayMaking it easier (for some) to save for retirement.The package also includes a collection of new rules aimed at helping Americans save for retirement. The bill would require employers to automatically enroll eligible employees in their 401(k) and 403(b) plans, setting aside at least 3 percent, but no more than 10 percent, of their paychecks. Contributions would be increased by one percentage point each year thereafter, until it reaches at least 10 percent (but not more than 15 percent). But this applies only to new employer-provided plans that are started in 2025 and later — existing plans are exempt.Another provision would help lower- and middle-income earners saving for retirement by making changes to an existing tax credit, called the saver’s credit, now available only to those who owe taxes. In its new form, it would amount to a matching contribution, from the federal government, deposited into taxpayers’ retirement accounts.People struggling with student debt would also receive a new perk: Employees making student debt payments would qualify for employer matching contributions in their workplace retirement plan, even if they were not making plan contributions of their own.What to Know About Congress’s Lame-Duck SessionCard 1 of 5A productive stretch. More