2010: Anti-Incumbent, Anti-Liberal, or Anti-Democrat?

By Sean Trende

Almost all election analysts now agree that 2010 will not be a good year for Democrats. The latest RCP Averages for the major Senate races show Republicans picking up 7 Senate seats (down from 8 one month ago). This is a striking reversal from the early months of Obama’s presidency, when most forecasters were predicting Democratic gains.

The House has shown similar movement. Early in the cycle, pundits predicted sunny days for the Democrats in November of 2010, with beltway forecasters like Charlie Cook (“Obama’s Democrats are heading down a track much closer to 1934’s [when they picked up seats]”) and Stu Rothenberg (“[T]he chance of Republicans winning control of either chamber in the 2010 midterm elections is zero”) arguing that major GOP gains were close to impossible. Today it is a different story, and Cook now believes that it is hard to see how Democrats keep the House, while Rothenberg sees a 25-30 seat pickup (with gains in excess of 40 seats possible). I see a 50-seat Democratic loss as the most likely outcome, with the potential for things to get considerably worse.

One way to sort through these different scenarios is to examine what drives these losses for Democrats. Is 2010 shaping up to be an Anti-Incumbent, Anti-Liberal or Anti-Democratic year? This isn’t easily reducible to statistical testing, but I think it goes a long way toward explaining whether Democrats will lose 20 seats, 50 seats, or 80 seats. Let’s examine all three scenarios a bit more closely.

Anti-Incumbent Year: Under this scenario, the voters head to the polls this November ready to vent their frustrations with incumbents of both parties. The Democrats still lose seats, but that’s more a function of the fact that they hold more seats to begin with than anything else. Unsurprisingly, this is the story that Democrats are trying to sell (Republicans did the same in 2006 and 2008).

The recent primary elections do point toward bipartisan ire directed at Congress. The obvious stories are the headline-grabbers: Republican Senator Bob Bennett of Utah finished third at a party convention, denying him a fourth term; Democratic Congressman Alan Mollohan of West Virginia lost a primary race 56%-44%, denying him a fifteenth term. Digging beneath the headlines we see poor results pretty much across-the-board for Republicans and Democrats alike in West Virginia, North Carolina, Indiana, Utah and Nebrasksa. An incumbent receving more than 70% of the primary vote is the exception rather than the rule this season.

Nevertheless, I don’t think it is likely that this will be a generalized anti-incumbent election. The reason is pretty simple: We don’t have “anti-incumbent” elections in this country. Stu Rothenberg noted in 2006 that the closest we’ve come in the past fifty years to a generalized anti-incumbent election was 1990, when six Democrats and nine Republicans lost in the general election, and in 1978, when 14 Democrats and five Republicans were defeated that November.

Now this doesn’t mean that we’ll never have a generalized “throw the bums out” election. And if we were to have such an election, I suspect that this would be the year. But the bottom line is that primaries are just that: primaries. Come November, angry voters almost always vent their spleen on the President’s party.

Anti-liberal year: Unlike the anti-incumbent year, we do have a good template for an anti-liberal year: 1994. Now obviously I don’t mean that all liberals will lose if this is an anti-liberal year. After all, the vast majority of liberal Democrats won in 1994.

What I mean is that in 1994 we saw a backlash against liberal Democrats in conservative districts. Twenty-six of the 34 defeated Democrats came from districts that leaned Republican. As I explained last summer:

There were two controversial pieces of legislation that defined the Clinton Administration for Republican-leaning voters: the assault weapons ban and the first Clinton budget (a.k.a. the tax hike). If we look at the fifteen Democrats who voted against both pieces of legislation, only one lost (she represented a district that gave Bush a 15-point win in 1992). In fact, about half of [these Democrats] saw their share of the vote increase or stay roughly the same from 1992!

Let’s move on to Democratic incumbents who represented Republican-leaning districts who voted for only one of these two pieces of legislation. There were thirty-seven such Democrats. The casualty rate here is a little higher; thirteen of them, or thirty-five percent of them, lost. And of the twenty-two Democrats from Republican-leaning districts who voted for both pieces of controversial legislation, ten of them (45%) lost.

This is consistent with the campaign that Republicans ran in 1994. They claimed Clinton spent too much, taxed too much, and on social issues was on the wrong side of guns, gays, and God. The unintended consequence of this type of campaign, though, was that it gave Democrats who were relatively conservative and who voted against this agenda cover against the GOP message.

Let’s look at what an anti-liberal wave would look like in 2010. I think there are probably three key votes that will be talked about in conservative districts in the elections for the 112th Congress: the stimulus, cap and trade, and the health care vote. There are 73 Democrats in Republican-leaning districts; 12 of these are not seeking re-election or were defeated in a primary.

Twenty-one of these Democrats seeking re-election supported all three Democratic agenda items, while another twenty-one supported two of the three. If we assume that these Democrats lose at about the same forty percent clip that Democrats who supported the Clinton agenda lost back in 1994, that represents seventeen seats lost. Another sixteen voted for one of the three items; that would translate to a five seat loss using 1994 as an analogy. Finally, of the three who voted against all three major portions of the Democratic agenda in 2009 and 2010, let’s assume one loses.

When added to the twelve Republican-leaning open seats (Democrats lost all of the Republican-leaning open seats in 1994), that translates to a 35-seat Democratic loss; if we assume that 12 or so Democrats in marginally Democratic districts will lose as well (as was the case in 1994), that gets us about to a 1994 scenario.
We don’t have much polling to test this scenario, but the polls we do have for Democrats in Republican-leaning seats who supported the President’s agenda – Carol Shea-Porter, Tim Bishop, Debbie Halvorsen, Mark Schauer, Baron Hill, John Spratt, Harry Teague, Earl Pomeroy – have ranged from mediocre to horrible. An anti-liberal election is certainly plausible, but there’s a possibility it could get even worse.

Anti-Democrat year: Although 1994 and 2006 are generally lumped together as wave elections, they were actually two very distinct phenomena. As I noted above, many Democrats in Republican-leaning districts thrived in 1994.

But this was not the case for Republicans in 2006. Heading into those midterms, there were 27 Republicans who represented Democratic-PVI districts. After the midterms, there were 14 (today there are 8, using the 2004 PVIs). That’s more than half of the Republicans in Democratic-leaning districts losing, versus about a third of analogous Democrats losing in 1994.

The most interesting thing about 2006 is that even the Republicans who survived saw a marked decline in their performances. The only Republicans representing Democratic districts who didn’t have a close call in 2006 were Mike Castle (DE-AL), Bill Young (FL-10), Frank LoBiondo (NJ-02), Jim Saxton (NJ-03), and Peter King (NY-03); even they saw decreases in their performances from 2004. Again, this contrasts with 1994, when half of the Democrats in Republican-leaning districts who opposed Clinton’s agenda saw their percentages increase from 1992, despite the substantial national shift against Democrats.

What’s also interesting about 2006 is that it didn’t matter whether a Republican was liberal or conservative. Of the twenty most liberal Republicans in the 109th Congress, nine were defeated, one didn’t seek re-election while four won only by a whisker. This against stands in marked contrast to 1994, when only two of the twenty most conservative Democrats seeking re-election lost.

That’s because the Democrats’ theme in 2006 was not generally “vote against Jim Leach and his radical conservatism.” Such an argument wouldn’t have passed the smell test, especially since Leach was a firm opponent of the Iraq War and was the second-most liberal Republican in the House.

Rather, the argument was “if you vote for Jim Leach, you empower George W. Bush and the Republican leaders in Congress.” Dave Loebsack was actually complimentary of Jim Leach, and almost seemed sad to have to run against him at times.

If 2010 is an anti-Democrat year, rather than simply an anti-liberal year, we could see absolutely catastrophic results for the Democrats in the 73 Republican-leaning districts. If we take the fifty percent casualty rate that the Republicans suffered in 2006, add in the twelve retiring Congressmen, and again assume a dozen Democratic Congressmen in marginally Democratic districts lose, then the Democrats are on pace to lose over sixty seats.

So will this year be anti-liberal or anti-Democrat? It’s too early to say definitively. One sign may come in the special election in PA-12. This is still a Democratic-leaning district; John McCain carried it by about 1,000 votes against Barack Obama, but it also voted for John Kerry and Al Gore. It’s probably also the most heavily Democratic district remaining in Appalachia by a fair margin, save for neighboring OH-06, and voter registration still heavily favors the Democrats. Most of the district hasn’t been represented by a Republican since the early 1930s.

If Mark Critz pulls out a win by a healthy margin, then it could be a good sign that a generalized anti-Democratic mood isn’t materializing. This doesn’t rule out the anti-liberal scenario described above by any means, since Critz is running as a fairly conservative Democrat, but it does indicate that voters in marginal districts are still willing to listen to Democratic candidates who promise to vote against health care reform and the like.

But if Critz loses or barely wins, it would be an ominous sign. Democratic turnout on Tuesday will be driven by the Democratic Senate and gubernatorial primaries occurring that day, narrowing the enthusiasm gap with Republicans in a way that won’t be likely in November. If a conservative Democrat running in a conservative Democratic district with upticket races driving turnout can’t win this year, it bodes poorly for the sixty or so Democrats running in districts that vote even more Republican at the Presidential level (I’d guess there’s eighty or ninety districts represented by Democrats that vote more Republican when you look at the state and federal levels).

Other signs exist that this could be an anti-Democrat year. Democrats who have generally opposed the President’s agenda have had pretty dismal polling results crop up. Rasmussen reports that Stephanie Herseth-Sandlin leads her Republican opponent by a slender 45%-41% margin. Frank Kratovil’s own polling from last fall – taken in a much better environment for Democrats – had him leading his GOP opponent by two points. And veteran Democrat Chet Edwards is down 53%-41% against Republican Bill Flores in the Republican’s polling; Edwards isn’t disputing the numbers. Even conservative Democrats with golden last names like Boren have shown some real polling weakness.

The historical record provides no support for 2010 being a generalized anti-incumbent year; the elections to date this cycle in major statewide races certainly don’t support this scenario either. The real question is whether moderate or conservative Democrats who oppose the Beltway Democratic agenda will be given cover from angry voters, or whether the electorate will thoroughly clean house this fall. That’s where the difference between a bad Democratic year and a debacle of historic proportions can be found.

State Department Defends Official Who Expressed Regret to Chinese Over Arizona Law

FILE: Michael Posner, assistant secretary of state, is shown discussing Iran at the United Nations European headquarters in Geneva Feb. 15. (Reuters Photo)

FOXNews.com

The State Department on Tuesday defended a top-ranking diplomat who expressed regret to China last week about Arizona’s immigration law during a discussion on human rights in Washington.

Spokesman P.J. Crowley, in an interview with Fox News, disputed the notion that Assistant Secretary of State Michael Posner was apologizing to China, saying he was actually “standing up” for America by describing how debate functions in a “civil society.”

But he echoed other top Obama administration officials in describing the law as a gateway to “racial profiling” and doubled down on Posner’s comments to the Chinese.

Posner told reporters on Friday that the U.S. delegation brought up the Arizona law “early and often,” as an example of a trouble spot Americans need to work on.

“It was mentioned in the first session, and as a troubling trend in our society and an indication that we have to deal with issues of discrimination or potential discrimination, and that these are issues very much being debated in our own society,” Posner said.

The two-day talks were held in Washington and meant to ease the way for similar discussions in the future. The delegations discussed concerns with U.S. and Chinese rights issues, including Tibet and the Chinese treatment of dissidents. The United States was represented by officials from several Cabinet agencies including the Justice Department, Commerce Department and Internal Revenue Service.

The United States has a raft of concerns about human rights in China, including the government’s forced sterilization of women and mass executions.

Arizona Republican Sens. Jon Kyl and John McCain sent a letter to Posner on Tuesday demanding he retract his statement and issue an apology. They cited the 2009 Human Rights Report produced by Posner’s bureau as a reminder of the arbitrary arrests, detention and harassment of Chinese citizens by the Chinese regime.

“As the assistant secretary of state in charge of the bureau of democracy and human rights, your remarks are particularly offensive,” they wrote.

“There is no place for moral equivalency in democracy and human rights policy. The United States is the world’s leader in defending the rights of all people. Someone in your position should be proud to proclaim that,” they added.

Rep. Dan Burton, R-Ind., a member of the House Foreign Affairs Committee and a longtime critic of China’s human rights record, told Fox News he’s “tired” of seeing comments like this, particularly to a delegation from “one of the most repressive societies in the world.”

“It’s unseemly that a member of our State Department and the administration should be apologizing to China,” Burton said.

But Crowley backed Posner for bringing up the Arizona law as something of comparable concern.

“There is, as many have said, real concerns about — that this Arizona law will inevitably devolve into racial profiling. That would be a fundamental challenge to human rights around the world,” Crowley said.

Crowley acknowledged Tuesday that he has not read the Arizona law, putting him in the same boat as top officials like Attorney General Eric Holder and Homeland Security Secretary Janet Napolitano. Holder admitted last week that he has not read the 18-page law, though he has publicly warned that it could lead to racial profiling.

The Arizona law makes illegal immigration a state crime and empowers law enforcement to require people they suspect of being an illegal immigrant to provide documentation proving their legal residency. The bill specifically outlaws screening suspects based only on race or origin, though critics say police will end up profiling based on race anyway.

3 Michigan Militia Members Likely to Be Released

Mar. 29: Suspects tied to Hutaree, a militia that was preparing for the Antichrist, were charged with conspiring to kill police officers.

Associated Press

DETROIT — Three members of a Michigan-based militia accused of conspiring against the government could be going home until trial.

Rod Hansen, a spokesman for the federal court in Detroit, says Tina Stone, David Stone Jr., and Jacob Ward are expected to appear in court early Tuesday afternoon.

Hansen says prosecutors apparently have dropped their opposition to keeping the three in jail.

Gina Balaya, a spokeswoman for the U.S. attorney’s office, says there’s been an agreement between prosecutors and defense lawyers. She had no other details.

Nine members of a group called Hutaree are charged with conspiring to commit sedition, or rebellion, against the government and the attempted use of weapons of mass destruction.

Prosecutors still are appealing to keep six of the nine in pretrial detention.

Black Panthers: On the Ballot in Philly?

by Mike Roman

Jerry Jackson, notorious member of the New Black Panther Party, who was seen in the video below intimidating and threatening voters in 2008, is running for re-election as a member of the Democratic Executive Committee in Philadelphia.

Here is the “sample ballot” for the 14th Ward, 4th Division. A sample ballot is posted outside of each polling location. You can see Jackson is listed first in a field of three. The top two vote getters will be elected to a four year term as a member of the Democratic Executive Committee. In 2008, Jackson was issued a certificate by the Democratic Party to be inside of the polling place where he was seen intimidating voters.

Jackson and King Samir Shabazz were originally indicted for intimidating voters, but the Department of Justice spiked the case.

No reports of Jackson or Shabazz at the polls yet.

Cross Posted at Election Journal.

Did SEIU Pay Media Matters to Cover Up the Gladney Beating?

by Liberty Chick

People on the left are constantly asking Andrew Breitbart who funds his “operation.” It’s grown to become rather amusing, actually. For those of us who are bloggers on The Bigs, we know the truth, we see how things operate. We know there’s no giant conservative-leaning lump of cash greasing this machine. If that were the case, I for one think Andrew would probably be home with his family even more, rather than traveling around, worrying about advertising or other ways of self-funding this little “hobby” of his, as the left often like to refer to it.

But let’s just look for one moment at where some of that line of thinking comes from on the other side. I’ve written previously about the birth of Media Matters as a spawn of Rob Stein’s Conservative Message Machine Money Matrix road show, from which the Democracy Alliance was born. It’s through this organization from which much of the organization’s funding had come; in recent years, more has been spread out across other progressive organizations, but the funders often remain the same names in most cases. For instance, The Tides Foundation gave Media Matters and their Action Network over $175,000 just last year. In earlier years, groups like Montclair, New Jersey-based (hometown of Media Matters’ Eric Boehlert) Schumann Center for Media & Democracy gave the organization $500,000.

The donors’ list is vast and diverse, and we plan to cover that in detail in the future. So I’ll focus in on one set of donors to Media Matters, which is the Labor Unions. More specifically, in light of some recent posts regarding the Kenneth Gladney incident, I thought it appropriate to revisit donations made to Media Matters specifically by the Service Employees International Union.

When you look at the timeline of events and the media calendar in general leading up to the Gladney incident last August, it’s difficult not to conclude that there was collaboration amongst White House staff, components of Big Labor, and certain liberal media outlets. However, we know that all will continue to deny it.

Further, just as the flurry of media activity finally starts to wind down a bit around October last year, this is when SEIU makes three separate donations to Media Matters totaling $50,000, under the classification of “Communications”, according to the SEIU LM-2 report.

This is the type of funding that I would question in return to Media Matters. With their membership being so low and their unfunded pension expenses so high, can the SEIU really afford to be randomly donating funds to an organization like Media Matters? Perhaps SEIU purchased advertising on Media Matters’ website, but then I’d think it would be categorized as such, as others ad expenses in the LM-2 were. If not advertising, if not random donations, then what’s the reason for SEIU having donated these funds? One could logically conclude that Media Matters performed a service in return. Only they can answer that.

That said, I can simply present the basic information here and suggest that readers do their own research and draw their own conclusions, in the absence of any explanation from Media Matters.

The timeline follows below. While it is not all inclusive, it presents a collection of the most pertinent sources at that time.

8/4/2009

* 6:55 AM ET: White House launchesFlag@whitehouse.gov, its “fishy” snitch program
* 4:45 PM ET: SEIU Posts the White House snitch program & video in a post titled “Pushing Back on Right-Wing Lies on Reform“
* Margarida Jorge, National Field Director for Health Care for America Now, releases a four page memo instructing members of HCAN to fight “militant right-wing activists” and “teabaggers”. Even the URL uses the word “fight”:
http://healthcareforamericanow.org/site/fight

* Back in St. Louis, Congressman Russ Carnahan’s campaign announces Sara Howard as the new director of communications. Howard was formerly Senior Strategist at Obama for America, National Media Relations Specialist for Anna Burger / SEIU, Communications Director for Senator Mark Dayton, and spokesperson for George Soros funded American Coming Together (ACT). She also worked with Buffy Wicks while with SEIU on door-to-door campaigns in Missouri.
* 11:09 pm ET: Media Matters tries to discredit Tea Party protesters by broadly painting the entire movement as “birthers”

8/5/2009

* The DNC releases “Enough of the Mob” ad calling the protesters an “angry mob” and focuses the ad repeatedly on “right-wing birthers” disrupting town hall events.

8/5/2009

12:13 am ET, Media Matters: Special Report says “public venting” at health care town halls, ignores conservative efforts to pack events

8/6/2009

* 9:53 AM ET, Huffington Post/Sam Stein: Unions To Take On Conservative Groups Health Care Town Halls; “In a memo sent out on Thursday, AFL-CIO President John Sweeney outlined the blueprint for how the union conglomerate would step up recess activities on health care reform… also uses the specter of the infamous 2000 recount “Brooks Brothers” protest to rally its members to the administration’s side.”
* Richard Trumka, then AFL-CIO Secretary Treasurer (now President) issues a statement, slams the town halls, calls the events corporate funded and part of the conservative strategy.
* 12:47 pm ET, Media Matters: AP reported on town hall disruptions, ignored conservative strategy
* Afternoon: White House aides give Senate Democrats a recess battle plan; David Axelrod and Jim Messina tell senators, “If you get hit, we will punch back twice as hard.” See Politico: White House to Democrats: ‘Punch back twice as hard’
* Organizing for America sends out mass email for the Bernard Middle School event in St. Louis, MO:

8/7/2009

7:14 PM ET by Kate Thomas: Violent tactics at last night’s St. Louis town hall meeting

8/8/2009

10:11 am ET by Media Matters, Eric Boehlert: Inventing tales of a union ”beating”

And after this date, there are so many more, from SEIU and from Media Matters. Simply type in this Google search to retrieve a relatively thorough list.

As you’ll see from Google’s timeline, October is when the activity calmed down.

Seems to me that -hypothetically speaking, of course – if there were any sort of service arrangement in place, October would have been the most appropriate time for SEIU to make its payment installments and thank Media Matters for a job well done. (That’s of course before anyone knew things would be heating up again once the police report would become available in November)

Hm. I wonder if these types of payment installments are regulated under the financial reform bill?

Texas doctors opting out of Medicare at alarming rate

Houston retiree Kathy Sweeney has trouble finding specialists who take new Medicare patients and is worried about the possibility she one day could lose her regular doctor.

By TODD ACKERMAN

Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.

Two years after a survey found nearly half of Texas doctors weren’t taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.

“This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn’t fix Medicare soon, there’ll be more and more doctors dropping out and Congress’ promise to provide medical care to seniors will be broken.”

More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle. Texas Medical Association officials, who conducted the 2008 survey, said the numbers far exceeded their assumptions.

The largest number of doctors opting out comes from primary care, a field already short of practitioners nationally and especially in Texas. Psychiatrists also make up a large share of the pie, causing one Texas leader to say, “God forbid that a senior has dementia.”

The opt-outs follow years of declining Medicare reimbursement that culminated in a looming 21 percent cut in 2010. Congress has voted three times to postpone the cut, which was originally to take effect Jan. 1. It is now set to take effect June 1.
Not cost-effective

The uncertainty proved too much for Dr. Guy Culpepper, a Dallas-area family practice doctor who says he wrestled with his decision for years before opting out in March. It was, he said, the only way “he could stop getting bullied and take control of his practice.”

“You do Medicare for God and country because you lose money on it,” said Culpepper, a graduate of the University of Texas Medical School at Houston. “The only way to provide cost-effective care is outside the Medicare system, a system without constant paperwork and headaches and inadequate reimbursement.”

Ending Medicare participation is just one consequence of the system’s funding problems. In a new Texas Medical Association survey, opting out was one of the least common options doctors have taken or are planning as a result of declining Medicare funding — behind increasing fees, reducing staff wages and benefits, reducing charity care and not accepting new Medicare patients.

In 2008, 42 percent of Texas doctors participating in the survey said they were no longer accepting all new Medicare patients. Among primary-care doctors, the percentage was 62 percent.

The impact on doctors has not been lost on their patients. Kathy Sweeney, a Houston retiree, twice has been turned away by specialists because they weren’t accepting new Medicare patients. She worries her doctors might have to drop her if Medicare cuts go through and they can’t afford to continue in the program.

“I’ve talked to them about the possibility,” said Sweeney, who sent her legislators a letter calling on them to fix Medicare. “They’re hanging in there as long as there’s not a severe cut, but just thinking I couldn’t continue doctor-patient relationships I built up over years is disturbing. Seniors should be able to see the doctors they want.”

The problem dates back to 1997, when Congress passed a balanced budget law that included a Medicare payment formula aimed at reining in spending. The formula, which assumed low growth rates, called for payment cuts if spending exceeded goals, a scenario that occurred year after year as health care costs grew. The scheduled cuts, expected to be modest, turned out to be large.

Congress would overturn the cuts, but their short-term fixes didn’t keep up with inflation. The Texas Medical Association says the cumulative effect since 2001 already amounts to an inflation-adjusted cut of 20.9 percent. In 2001, doctors receiving a $1,000 Medicare payment made roughly $410, after taking out operating expenses. In 2010, they’ll net $290. If the scheduled 21.2 percent cut goes through, they’d net $72, effectively an 83 percent cut since 2001.

The issue caused the Texas Medical Association to break ranks with the American Medical Association and oppose health care reform efforts throughout 2009. Then TMA President Dr. William Fleming said “reform is doomed to failure” without Medicare reform and called Congress’ failure to devise a rational payment plan “an insult to seniors, people with disabilities and military families.”
No surprise to senator

U.S. Sen. John Cornyn, R-Texas, said he isn’t surprised by the new opt-out numbers, allowing that Congress’ inability to reform Medicare is leaving “seniors without access and breaking the promise we made to them.”

“The problem has been how to eliminate the cuts without running up the deficit,” said Cornyn, responding to blame U.S. Rep. Gene Green, D-Houston, placed on the Senate for not passing a House bill that would have provided a longer-term Medicare fix. “There hasn’t been the political will, but we really have no choice but to fix it.”

Cornyn acknowledged the task is daunting. The Congressional Budget Office recently estimated that eliminating scheduled Medicare payment cuts through 2020 would cost $276 billion.

The growth in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified Trailblazer Health Enterprises, the state’s Medicare carrier, they would no longer participate, up from seven in 2006. The numbers jumped to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 in 2010. From 1998 to 2002, by contrast, no more than three a year opted out.

Now, according to a Texas Medical Association new poll, more than four in 10 doctors are considering the move.

“I’ve been in practice 24 years, and a lot of my patients got old right along with me,” Culpepper said. “It’s stressful to tell them you’re leaving Medicare and they’re responsible for payments if they want to stay with you. You feel like you’re abandoning them.”