Team O Back to Chicago, Death Planning Still Controversial, Steele Suffers

Obama Looks to Recreate 2008 Magic

"He often says that this is his biggest regret is that when he took office, because of the crisis that was presented to him, he had to spend almost every waking hour in Washington…”

-- Senior White House Adviser Valerie Jarrett on “Meet the Press.”

The administration is hinting hard that the president’s reelection bid will be based in Chicago, rather than in the DC area, as the efforts of presidents George W. Bush and Bill Clinton were.
This will be part of an overall campaign theme that Obama is still running to change Washington – an outsider and a reformer. He hopes to make John Boehner and Mitch McConnell the faces of Washington and cast himself as the guy trying to fix a broken system.
It is a way to reapply the 2008 campaign message.

This will be hard, given that Obama’s 2008 success was in large part attributable to the fact that he was a relative unknown. It’s a lot easier to be Mr. Change when you are not the chief magistrate of the federal government.

But in order to recapture the magic of 2008, the president will not only put his team back in Chicago but Obama will also be hitting the road more and more. Residents of states like Ohio, Iowa and Nevada can expect to see lots of the president in the next year.

Obama hasn’t exactly been holed up at the White House. He made 46 domestic trips in his first year, far more than either of his predecessors. But the effort to recreate the magic of 2008 will push his team to keep Obama on the road as much as possible.

The question, though, is whether that will be possible once Obama is embroiled in defending his agenda against Republican advances. A Democrat-controlled Washington has allowed Obama to mostly set his own schedule on domestic matters for 2009 and 2010. Republicans will not make choreography so easy.

But the biggest challenge will be in convincing Americans who have seen and heard so much of Obama that he represents change. Like most incumbents, Obama will have to defend his record. Doing so while simultaneously playing up his outsider credentials will require some real political Terpsichore.

No White House Shakeups

"I don't expect, quite honestly, big changes."

-- White House Press Secretary Robert Gibbs on “State of the Union” discussing personnel changes in the New Year.

For a guy who talks about change, President Obama certainly doesn’t seem to like it in his administration.

The best evidence that President Obama is satisfied with the way his first two years went is that he is not seeking a shakeup in his administration.
Some cards will be reshuffled.

Political strategist David Axelrod will leave Washington to head up the 2012 reelection bid while 2008 campaign manager David Plouffe will come to the White House as Obama’s day-to-day political soothsayer. Press Secretary Robert Gibbs has been lobbying for a new gig with a portfolio more in line with his influence with Obama.

Some vacancies must be filled.

Obama will have to replace his former top economic adviser, Larry Summers, but is not talking about any big names for job. Instead, longtime Obama economic oracle Austan Goolsbee can be expected to play a larger role.

Some vacancies will be created.

We know that key cabinet members like Defense Secretary Robert Gates are expected to make their exits this year. And others will join the post-midterm departure list.
Cabinet members to watch include those who have had tumultuous tenures (Janet Napolitano at Homeland Security and Tom Vilsack at Agriculture) and those who have had exhausting runs (Treasury Secretary Tim Geithner).

But since Obama doesn’t make much use of his cabinet and instead relies on his inner circle of longtime aides and advisers, those changes won’t mean a big shakeup. Obama has used his cabinet not as a team of rivals, but more as a collection of department heads. It is through his own administrative channels, like the czar system and his special working groups on Afghanistan and the economy that Obama likes to engage in his Socratic method of management.

So, the message coming from the White House is that because the president has succeeded, there is no need of a staff shakeup. Whether that outward projection of placidity survives once the political wars of 2011 begin, is another matter. Staying the course likely looks better in the warm like of lame duck success than it will in the cold climate of a divided Washington.

One post Obama has not been able to ever fill has been on Republican outreach. His lone Republican cabinet member, former Rep. Ray LaHood at Transportation, hasn’t shown much clout with his former colleagues. Power Play expects to see Obama try to bring another GOPer into the fold early this year.

End of Life Plan Kicks up Controversy

“The only thing new here is a regulation allowing the discussions --authorized in 2003 by the prescription drug benefit -- to happen in the context of the new annual wellness visit created by the Affordable Care Act.”

-- Statement from White House Spokesman Reid Cherlin.

New government rules encourage doctors to have patients on Medicare plan their “end of life” medical strategy.

The provision in President Obama’s national health-care law will compensate doctors for annual discussions with patients on what the Medicare recipients expect at the end and how to achieve their goals.

It’s all part of a long-standing push inside the health industry to get seniors to think strategically about the end. Most health costs come at the end of life, and convincing more seniors to pull their own plugs in advance would represent huge savings.

In order to get the $500 billion in slated Medicare cuts that are part of Obama’s health law, federal officials need to realize substantial end-of-life savings.

The Sunday New York Times reported that annual meetings to encourage patients to plot their final exits would now be covered by Medicare. Sensitive to allegations that the federal health law will encourage creeping euthanasia as government-paid doctors look for ways to save the government money, the administration hit back hard.

A spokesman pointed to language in the 2003 Bush-era expansion of Medicare that allowed for a “welcome to Medicare” visit with a doctor, which might include an end-of-life care discussion. The new policy, he said, just makes that discussion an annual event for seniors.

The message is that it may be creepy for the government to pay for people to talk about planning to die, but George W. Bush did it first.

This episode should provide some idea about how difficult it will be for the administration to realize the massive cuts to Medicare required under the new health law.

Feds Offer States Bonuses for Expanding Health Coverage

“We’ve long had a problem, more in some states than others, with an application process that is riddled with red tape.”

-- Cindy Mann, director of the federal Medicaid program, lamenting to the New York Times the difficulty in getting parents to enroll their children in the program.

The Department of Health and Human Services will announce today a special bounty being paid to states that have been successful at signing up children for Medicaid through the CHIP program.

The Obama administration is giving $206 million in rewards to be paid to Alabama and other states that showed big increases in getting kids onto the government insurance program.
The New York Times, which got the exclusive on the bounty payments and an interview with Secretary Kathleen Sebelius, explained: “4.7 million children who would be eligible for subsidized coverage if their families could be found and alerted.”

There were about 5 million kids covered by the program last year, but expanded eligibility means that children from families up to 250 percent of the federal poverty level (about $55,000 for a family of four) are now eligible, as are pregnant women and immigrant children.

In all, the 2009 expansions were said to expand access to 4 million more children.

Leaving aside the fact that the estimated number of kids who are now eligible are not enrolled is equal to 85 percent of the Obama-era expansions, the government (and the Times) offers only two reasons why parents would not sign their children up for the program: ignorance or sloth.
The only scenario discussed is one in which families are not aware of their eligibility, and need only to be “found and alerted.” Also discussed is the concern that families believe there is too much bureaucratic hassle involved in order to get free health care for their uninsured children.

And, no doubt, aggressive advertising campaigns can bring many more children into the program.
But not discussed as a motivation for the parents of those 4.7 million non-enrollees is pride. How many parents would rather forgo the health insurance benefit than have to explain to their children why they are going on the government rolls?

Parents who make $55,000 might not want to have their children know that they are considered poor enough to qualify for Medicare. For whatever reasons, rational or irrational, the non-enrollment may represent a choice, not ignorance. For many at that income level, not having health insurance at all represents a choice, or at least a set of priorities that does not highly value health coverage.

Expect states to get increasing pressure to get kids into the program, increasingly through schools, as states facing budget shortfalls balk at their share of the costs. In 2009, states spent a combined $10 billion on the program before federal matching funds. California spent nearly $2 billion alone.
Some states, like Arizona, are looking for ways to opt out of the program altogether, while other states, like Texas, have established their own alternative programs.

This foreshadows what will come as Medicaid eligibility expands across the board under President Obama’s national health-care law. States asked to shoulder new costs may balk at subsidizing health care for more and more middle class households.

Steele’s Top Backer Defects

“It’s not happening.”

-- A Republican National Committee member discussing Michael Steele’s reelection bid with Power Play.

The public defection of Republican National Committee Chairman Michael Steele’s highest-profile defender on the committee raises new doubts that the embattled chairman can advance through the first round of balloting in next month’s vote.

California committeeman Shawn Steel put out the word on Sunday, first reported by Reid Wilson at Hotline On Call, that he would back Wisconsin state GOP chairman and fellow former Steele insider Reince Priebus to lead the party.

Steel has often been Steele’s voice on the committee during the chairman’s tumultuous tenure, and his decision to publicly endorse Priebus is a sign that the 30 or 35 of the 168 members on the committee previously believed to be backing Steele aren’t going to be there.

“If Shawn is out, that means there’s been a conscious decision to walk away,” said one committee member, undeclared in support but a Steele foe, discussing the remaining Steele loyalists.

Steel’s decision to drop his homophonic friend suggests a concern among the committee members who favored Steele’s effort to shake up the RNC after the Bush era that a Steele candidacy might allow an old hand to return.

Of the four main candidates, Priebus, former Michigan chairman Saul Anuzis, former Missouri state chairwoman Ann Wagner and former RNC Deputy Chairwoman Maria Cino, Priebus and Anuzis are considered the candidates who favor a “shakeup” from the old RNC, while Cino and Wagner are seen as the picks for those looking for a return to the core competencies of the Ed Gillespie-Ken Mehlman years.

The decision by Steel to back Priebus suggests that the folks who appreciated Steele’s aims if not always his methods are hoping to avoid a return of the Gillespie-Mehlman regime by concentrating their support, even if it means Steele would be quickly eliminated.

Steele can still count on support from at least a dozen loyalists, but if he draws fewer than 20 votes in the first round of voting, he might be the first one eliminated. Steele’s only strategy for success is a late surge if other “shakeup” candidates are eliminated and it’s him versus a Bush-era candidate like Cino or Wagner.