Iowa Caucus Voters Have a Terrible Track Record in Picking the Eventual Republican Nominee

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Ben Carson

Currently candidate Ben Carson is leading the polls in Iowa among Republicans, with Trump following behind.  Does this mean Ben Carson may win the Iowa Republican Caucus?  Perhaps.  Does this mean Carson will win the Republican nomination for president?  Hold on there.  Republican voters in Iowa do not seem to be in line with the rest of the country's Republicans when it comes to picking the presidential candidate for their party.  In fact, if you leave out Republican incumbent re-election bids in which the incumbent was unopposed in the nomination process, Iowa's track record leaves much to be desired.

Mike Huckabee (2008 Iowa Caucus winner)

So should the public put much weight in polls coming out of Iowa before the actual caucus or even in the actual Iowa caucus results in January?  Probably not.  New Hampshire primary results may be a better predictor of the next Republican presidential nominee to run in the general election for President.  In the presidential elections since 1976 in which the incumbent president was not a Republican seeking re-election, Iowa Republican caucus voters only correctly chose the eventual Republican nominee for 3 out of 7 elections, or less than half.  In the past two elections they were wrong both times.  In 2008, Iowa Republicans chose Mike Huckabee and in 2012 they chose Rick Santorum; neither of which won the national party's nomination for failure to win enough republican primaries and caucuses in other states, and thus enough delegates at the party convention.  John McCain and Mitt Romney, the eventual nominees in 2008 and 2012 respectively, both won the Republican primary in New Hampshire the years they ran.  In addition to the predicting errors of 2008 and 2012, Iowa Republicans incorrectly chose George H. Bush over Ronald Reagan in 1980, and then Bob Dole over George H. Bush in 1988.  The Republican party in Iowa did not use the county caucus style election to choose the nominee of the party before 1976.    In comparison, New Hampshire voters selected the eventual nominee 5 out of those same 7 elections, and correctly did so in the last two presidential elections, unlike Iowans. 

Rick Santorum (2012 Iowa Caucus winner)

Iowan Republicans, at least those that voted in the last two presidential election, seem to prefer the candidate that is less mainstream, perhaps further to the right ideologically, and less palatable to Republicans as a whole across the country.  Carson, Huckabee, and Santorum fit this mold.

Why does this matter? 

John McCain (2008 Republican Nominee)

Mitt Romney (2012 Republican Nominee)

Iowa and New Hampshire are known as "first in the nation" in terms of the party contests for the Presidential nomination.  Iowa traditionally has held the first caucus, while New Hampshire has traditionally held the first primary.  Primaries and caucuses are both used to choose nominees of the parties for a general election.  The difference between a caucus and a primary is in the format of these elections.  Since these states are first in the nation, they give the rest of America a good opportunity to see how candidates actually fare in a competition, or an actual election.  An early win for a candidate, for example in Iowa or New Hampshire, gives the candidate a boost, or greater momentum.  This means an increase in media exposure, messaging, and campaign funds.  Winners of the Republican elections in Iowa and New Hampshire both receive the boost, but it seems as though the winners in New Hampshire, at least in recent presidential elections, are more likely to be able to carry those wins further into additional states, or at least more states than the winners in Iowa are able to.  This is likely due to the ideological placement of candidates prefered by New Hampshire voters compared to those preferred by Iowa Republicans.

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The Reason for the Discontent between the White House and the Israeli Government

Source: BBC News

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The reason for the discontent between the White House and Prime Minister Netanyahu of Israel is not related to personality or any competition for power and influence. The contention has to do with the Palestinian-Israeli conflict and much of it is a result of the continuation of Israeli settlements in the West Bank, which remains occupied by Israel since the 1967 June War.  For decades the U.S. has played a vital role in attempts to broker peace between Israel and the Palestinians.  Every attempt at brokering peace has been followed by Israeli actions that undercut any efforts at peace in the long term.  This article is not about the mistakes of Palestinian leadership or the efforts of some Palestinian groups to undercut the peace process that would entail the acknowledgement of a permanent Israeli state. Neither is this article an effort to criticize justifiable Israeli reactions to attacks of terror on its people, or to criticize measures taken by the Israeli government to prevent or deter such attacks.  The discussion of settlements has very little, and perhaps nothing to do with the vital security needs of Israel.  In the context of peace negotiations, the settlements are a separate issue from the security argument, although the Israeli settlements themselves have indeed contributed to the need for greater security.  The settlements in the West Bank must be defended which increases Israeli security demands, a need created by Israelis, and at the same time foster greater anger on the part of Palestinians towards Israel.  I say that the settlements are not part of the security argument in the context of peace negotiations because Israel's security should be about securing Israel's borders and not settlements that were unnecessarily erected outside of Israel's borders, and which, instead of contributing to Israel's security, detract from it.

Origin and Location of the Settlements

Source: BBC News

In June of 1967, after only six days of fighting, Israel emerged victorious from a war with its neighboring Arab countries  who were resentful of Israel's creation in 1949.  The spoils of war gained by Israel were territories formally in the borders of those Arab states.  These territories included the West Bank, gained from Jordan; the Gaza Strip and the Sinai Peninsula, gained from Egypt; and the Golan Heights, gained from Syria.  Today, Israel still occupies the West Bank, a territory which is the home of a substantial number of Palestinians, many of which live in refugee camps erected to house those that fled the 1949 Israeli Independence War.

Shortly after the war, the Israeli government began a policy of encouraging Israelis and Jews emigrating to the area to settle in the West Bank and the Gaza Strip. The Gaza Strip settlements, which were fewer in number, have since been dismantled and the territory handed over to the Palestinians.  The occupation and settling of Israelis in the West Bank has continued to this day and with the financial encouragement of the Israeli government through subsidies.

Settlements as Barriers to Peace

The reasons the Israeli settlements are a barrier to peace are multiple.  First, the settlements are a de facto method of expanding Israel's borders into Palestinian land.  While Israel has not formally annexed the West Bank, as it did East Jerusalem, Israel has allowed and encouraged the settlement of its own people outside its official borders and into a land that Israel occupies.  This is in violation of international norms and international law that says a country must not attempt to transplant its own native population into a country or territory in which it is occupying as a result of war.  The settlement activity of the Israelis has deeply angered Palestinians who believe even more of their land is being taken by Israel and left them feeling hopeless in their dreams of statehood.  

Second, a "two-state solution" has been essential to ending the Palestinian-Israeli conflict, or at least that has been the goal of peace brokers for the past several decades.  The "two-state solution" would mean the continuation of the state of Israel, but also the creation of a new Palestinian state, most likely out of the occupied territories of the West Bank and the Gaza Strip.  The settlements that have only grown since 1967 are increasingly making a Palestinian state impossible.  As can be seen in the map, the settlements, many of which resemble small cities with permanent structures, vary in size and are spread out across the West Bank.  The largest of course, the settlement blocks, are closer to the Western side, near and stemming out from the border between Israel and the West Bank.  Neither the Israeli government or the Israelis and Jews living in the settlements are willing to dismantle them.  For the most part, recent peace negotiations have kept the Israeli settlements intact.  If they are to stay intact and under Israeli control, the supposed Palestinian state that would be the end result of a peace agreement would be a nonviable state, with non-contiguous borders in some areas, that resembles more a slice of Swiss cheese than an actual country.  This can be seen in the graphic to the left which was a map created during the Oslo peace negotiations.

U.S. and International Frustration with Israel

Rather than freezing settlement building, which only serves to increase Palestinian and Arab anger , as well as increase the difficulty of offering Palestinians a viable state, Israel has continued to expand the settlements in the West Bank.  This has angered the international community, but especially the U.S. which has invested quite a bit of credibility, effort, money, time, and political capital into bringing peace to the region.  Also, recall that a great deal of Islamic terrorism perpetrated against the U.S. is a result of anger at the U.S. for supporting, or at least not stopping, Israeli actions deemed as harmful to Palestinians.  Therefore, the U.S. has a significant amount of "skin in the game".  

President Bill Clinton at Camp David in 2000 with Israeli Prime Minister Ehud Barak (left) and leader of the Palestinian Authority Yasir Arafat (right)

Source: The Washington Post

Despite immense U.S. efforts to help the Israelis and Palestinians to end the fighting and the enormous aid given to Israel, the settlements have continued, as has the support of the Israeli government, both in rhetoric and in financial subsidy.  This has been quite a slap in the face of the U.S.   Recall that there have been several attempts to bring both sides to the table.  The only two attempts that had promise of producing a tangible result were the peace negotiations in Oslo, Norway in 1993, and the efforts of President Bill Clinton in 2000, known as "Camp David II". The previous Camp David peace effort under President Jimmy Carter, did not deal with the Palestinian issue, but did resolve the conflict between Israel and Egypt.  Since Camp David II, both Presidents George W. Bush (remember the "Road Map to Peace") and Barack Obama have sought to kick start negotiations, but to no avail.  The sides to the conflict seem to be too far apart, partly due to the settlements.  Also, as can be seen in the graphic, the settlements have only expanded, and in so doing have significantly decreased any possibility of peace and a Palestinian State, the main component of the "Two-State Solution".  Every year the settlements become even more permanent fixtures of Israeli dominance in the West Bank.  

The goal of the U.S. to bring peace in the region is an important one considering the enormous suffering of Jews historically, the suffering currently endured by both Israelis and Palestinians, the long friendship between Israel and the U.S., and the immense anger in the Arab world towards Israel and towards the U.S. as the main supporter of Israel.  Therefore, it comes as no shock to long time observers and students of this conflict that the frustration of U.S. administrations has built up and is no longer contained behind the scenes.  To ignore the role of Israel and only chastise Palestinians is a disservice to both Israelis and Palestinians, especially the thousands that have died and will continue to die in the absence of peace.

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The Affordable Care Act (a.k.a. "Obamacare") and the Reverse Income Effect

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The Medicaid Expansion Under the Affordable Care Act

The Affordable Care Act, passed in 2010 and initially referred to as "Obamacare" by opponents, sought to expand healthcare access by regulating the healthcare insurance industry and lowering costs of healthcare and heath insurance premiums for consumers.  With the overlapping goals of covering more people and lowering the cost of healthcare, the ACA required states to expand Medicaid eligibility requirements to allow for more individuals to qualify for Medicaid.  Medicaid provides health insurance coverage at no cost for low income families with children.  Medicaid is funded by general tax revenues that are given to the states who administer the Medicaid program.  The ACA required states to expand coverage of Medicaid or else face loss of Medicaid funds altogether.  The U.S. Supreme Court ruled in 2012 that the provision in the ACA requiring states to expand their Medicaid coverage or else lose Medicaid funds was too "coercive".  Despite the promise of the federal government to cover 93-100% of the cost of covering additional people, many conservative states, in ideological and partisan opposition to the law and President Obama, declined the expansion. This is how we get to the current patchwork of expanded Medicaid coverage across the country today.  These states argue that the state cannot afford the expansion and does not support the greater role of the federal government in healthcare.  The map above shows which states have accepted the federal funding to expand Medicaid eligibility and which states have rejected the funds and expansion. The link below from Kaiser provides a more detailed description state by state.

Kaiser Family Foundation link providing state by state status on Medicaid expansion

Without the expansion limited groups qualify for Medicaid.  Of course, there is an income limit, but what most may not know is that, under the past Medicaid eligibility rules and the current rules of states that declined the expansion, only very low income individuals that have children, individuals that qualify for disability under extreme financial hardship, and low income pregnant women may qualify for Medicaid.  The Medicaid expansion opens up eligibility to more by allowing for low-income adults (with or without children) to qualify for the coverage.  Because the Supreme Court ruled that it must be state choice to expand Medicaid individuals of similar economic circumstances in two different states are under different eligibility guidelines. For example, "Tom" in New Mexico can qualify for Medicaid and have access to doctors and hospitals despite his low income, while "Sam" in Georgia does not have that same access, although both do not have children and unable to afford healthcare without financial assistance.

While some conservative/Republican dominated states in terms of party loyalty or leadership have changed their minds and accepted the expansion, most have not.  As can be seen in the interactive maps provided by The New York Times at "We Mapped the Uninsured", the states that have declined the expansion are typically conservative in their politics, with Republicans usually dominating voting for key political offices, such as Governor or the state legislature. 

The Reverse Income Effect

There is another dynamic to the Medicaid expansion issue that is of interest.  This is the phenomenon studied in Political Science known as the "reverse income effect".  Notice that the dichotomous display of color in the expanded/not expanded Medicaid map above is very similar to the pattern in the Presidential election results maps for 2008 and 2012.

In most cases the states on the Medicaid map that did NOT expand Medicaid, are the "red" states on the presidential election maps that depict which candidate, Republican or Democrat, that the state's electoral votes were awarded to.  This, of course, is typically determined by the winning candidate of the popular vote count in that state.  The New York Times maps show that the states with the highest number of uninsured are these very red states.  Also important, is that these states had the highest number of uninsured to begin with, and still do since the states have chosen not to expand Medicaid under the ACA.  Perhaps more red states in the near future will opt in to the expansion under the increasing pressure of the uninsured.

This similarity brings up the political science phenomenon of the "reverse income effect".  If we look at data depicting voting patterns among low income and then among high income individuals we see that high income individuals are more likely to vote Republican, while low-income individuals are more likely to vote Democrat.  This is usually explained by the fact that Republicans are conservative in ideology, preferring lower taxes on businesses and individuals, even on high income earners, as well as less regulation on businesses.  Higher income make up a higher percentage of business owners.  Democrats tend to be more supportive of programs and regulations designed to benefit or protect consumers and low-income individuals.  This, perhaps explains the increase in support for Democrats as income decreases.  In the 2012 Presidential Election, roughly 60% of voters earning less than $50,000 annually voted for President Obama, the Democratic candidate.  This is true for previous and recent presidential elections.   The percentage may have been higher had more low-income individuals voted in the election.  Voter turnout rates tend to be lower among lower income level groups.

The "reverse income effect" notes that while lower income individuals tend to vote Democratic, and higher income individuals Republican, the same is not true if we look at statewide data against electoral vote outcomes.  As the map to the left suggests when analyzed next to Presidential election outcome maps, the states with the lowest median income levels, the poorer states, tend to award Republican candidates more votes than Democrats for  the Presidency and various state-wide offices; while the states with median income levels in the higher ranges tend to award Democrats their electoral votes and votes for various state offices.  In the map above, the darker the blue shading, the higher the median income level of the state.  The light blue states have the lowest median income levels.  Notice that most, if not all, of the states depicting the two shades of light blue are the states that are considered to be conservative in ideological leaning and Republican  party dominated.  Therefore the lower the income level of the individual, the higher the probability of voting Democrat; but the lower the median income of the state, the higher the probability of the state giving electoral votes to the Republican.  This paradox is interesting but may be explained by the presence of other variables that influence voting.  For example, Republican dominated states are usually more socially and culturally conservative in terms of voter makeup, which may explain why these states, despite having lower incomes on average, tend to allow for Republican victories.  Additionally, minorities (especially blacks and Latinos) tend to vote Democratic for economic and political reasons, such as support for civil rights protections.  Blacks and Latinos make us a disproportionately large share of low-income earners and those living below the poverty level, which is one explanation for why votes among low-income earners tend to go to Democrats, but why statewide data suggests the opposite, higher probability of voting Republican.  

Back to the Medicaid Expansion 

Now looking at the Median income level map in comparison to the "Expand/Don't Expand Medicaid" map, it is apparent that the states that may be most in need of expanding Medicaid coverage in terms of median income levels and inability to afford healthcare without assistance, are the very states that rejected the federally funded expansion of Medicaid under the Affordable Care Act.  Therefore, the states that will not expand Medicaid have a disproportionately higher share of individuals who will not qualify for Medicaid under the current requirements but cannot afford health insurance, or even health care for that matter without assistance, assistance which their state has rejected.  

Impact of Rejecting the Medicaid Expansion on Hospital Access in Rural Communities

Citizens in rural areas, which are largely found in lower median income and conservative states will also begin losing access to hospitals and emergency services if the state continues to reject expansion of Medicaid. In the crafting of the ACA, rural hospitals agreed to lower their Medicare reimbursements in exchange for getting more patients with health insurance under the act.  Rural hospitals a high percentage of health services that are provided to those with low-incomes who cannot then pay for those services.  Therefore, having insurance coverage for low-income, such as Medicaid, means that these hospitals will receive payment for the services that they are under obligation to provide when provided to someone that is low-income or poor. However, these rural hospitals are closing one by one in states that rejected the Medicaid expansion.  Rural hospitals are facing closure because they have been hit twice, in that they lowered their Medicare costs but are not receiving payment for services in return from individuals who would be able to pay for their healthcare, but for their state's decision to deny that individual Medicaid coverage.  The closing of rural hospitals means that many individuals in this nation will be, in many cases, as much as 40 miles from the nearest hospital and emergency room.  This could mean the different between life and death, or healthy or disabled for many in rural communities.  Again, the states most impacted by this, those composed largely of rural areas, tend to be the conservative/Republican dominated states that rejected the Medicaid expansion, and will, as a result, likely see hospital closures in those areas.  In Georgia, as of November 2014, five rural hospitals have closed and another six likely to close in the future. Since 2010, 43 rural hospitals have closed nationwide.  It is likely that this gap between Medicaid-Expanded/ higher-median-income states and Medicaid-not-expanded/low-median-income states will narrow as states that rejected the expansion will be pressured to reverse course.  This will only happen as the Affordable Care Act becomes less partisan and more time has passed since the act itself was passed.  (Source: http://www.usatoday.com/story/news/nation/2014/11/12/rural-hospital-closings-federal-reimbursement-medicaid-aca/18532471/)

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