“When It Is In Your Power To Act”

“Do not withhold good from those to whom it is due,
when it is in your power to act.
Do not say to your neighbor,
‘Come back tomorrow and I’ll give it to you’—
when you already have it with you.”

—Proverbs 3:27-28

medicaid expansion is not yet a reality here in Missouri, if it ever will be. But it is also struggling in Virginia and Arkansas (which already has a privatized version of it that needs reauthorized in order to continue). Expansion is struggling in those states even though both, like Missouri, have Democratic governors and even though a majority of people in both states favor expanding the program:56 to 38 in Virginia, including 55% support among Republicans, and 47.5 to 32.5 in Arkansas. (And there is good evidence that Missourians favor expansion too).

The Washington Post editorial page a couple of days ago featured this explanation of what is going on in Virginia, part of which I highlight for your contemplation:

In Richmond, House GOP lawmakers have made it clear they are not interested in compromise, nor do they wish to be bothered much with the facts. Mr. McAuliffe (D), in office barely a month, has tried schmoozing and executive mansion hospitality; he is nothing if not a deal-maker. The Republicans have responded with derision and fighting words. For them, it is enough to demonize Medicaid expansion as a function of Obamacare, and hope the resulting slogans carry the day — no matter what the cost to hundreds of thousands of struggling state residents who have no health insurance.

Demonizing Obamacare, the only thing Republicans can do effectively these days, has become, of course, a way of demonizing Obama. And it works in some places. In fact, it is working very well in Arkansas, as Seth Millstein points out (which I also highlight for your contemplation):

Arkansas residents strongly support expanding Medicaid under Obamcare — that is, until you tell them the expansion is part of Obamacare. Then they don’t support it anymore. In yet another indication of how successfully Republicans have tarnished the nickname for the Affordable Care Act, a new poll of Arkansans showed that net support for the state’s private Medicaid expansion drops by 19 points when you include the word “Obamacare” in the polling questionsArkansas residents, it seems, just don’t want to like Obamacare, regardless of what’s in it.

Sad, no? And what is sadder is the fact that the only clear demonstration of competence on the part of Republican officeholders and their mouthpieces on talk radio and Fox TV is their skill in transforming Obama into Satan in so many supposedly God-fearing places.

And speaking of God-fearing places, look at this graphic based on polling done by the left-leaning Joint Center for Political and Economic Studies:

medicaid expansion in the south

Hell, where the Bible says eternal torment awaits “all liars,” will freeze over before Republican politicians in the Jesus-loving states listed above pay any attention to such polling. Because lying about President Obama, in the strange and dark religion of conservative politics, covers a multitude of sins, especially the sin of ignoring the basic needs of so many disadvantaged Americans.

“Bullet Backstops”

Tea Party freak, Sharron Angle, back when she was trying to take away Harry Reid’s senate seat in 2010, famously said in an interview with a conservative talker, Bill Manders:

Angle: I feel that the Second Amendment is the right to keep and bear arms for our citizenry. This not for someone who’s in the military. This not for law enforcement. This is for us. And in fact when you read that Constitution and the founding fathers, they intended this to stop tyranny. This is for us when our government becomes tyrannical…

Manders: If we needed it at any time in history, it might be right now.

Angle: Well it’s to defend ourselves. And you know, I’m hoping that we’re not getting to Second Amendment remedies. I hope the vote will be the cure for the Harry Reid problems.

Now, Angle—who, by the way, got nearly 45% of the vote in Nevada in her race against Reid—was suggesting, of course, that the right to murder unrepentant Democrats, who she considered to be part of a tyrannical government, was why the Second Amendment exists. And to be honest, a lot of Republicans in power, most in fact, wouldn’t publicly disagree with her Second Amendment logic, even if they would criticize her Second Amendment honesty.

Now comes the latest freak in the Republican Party to endorse the Second Amendment-sanctioned murder of legislators: Chris Nogy. This man is married to the secretary of the Republican Party in Benton County, Arkansas, chris nogywhich is uncomfortably close to Joplin, less than an hour’s drive from my house. Yikes.

Mr. Nogy is proposing the murder of legislators who voted for “socialism” in Arkansas, otherwise known as Medicaid expansion under ObamaCare. In the latest Republican Party of Benton County Newsletter, Nogy wrote (the piece was titled, “Scathing”):

…we need to get a LOT tougher if we are ever to assure that events like those that took place this week don’t happen again.

Part of me feels that this betrayal deserves a quick implementation of my 2nd amendment rights to remove a threat domestic.  Because no matter how much one group says it is inevitable to start down the road to socialism it isn’t as long as we use our creativity and energy to creating solutions that don’t take us that way.

Fortunately for Democrats, and unlike Sharron Angle’s Second Amendment strategy, Nogy is letting Democrats who voted for Medicaid expansion off the hook:

I don’t feel the same way about the Democrats as bullet backstops as I do about the Republicans who joined them.  The Democrats were doing what their party told them they had to do because they were elected to do that job.

Whew!  Thanks Mr. Nogy for at least getting your aim right!

In case you were thinking that Nogy was just kiddin’ around, he wasn’t finished:

We need to let those who will come in the future to represent us that we are serious.  The 2nd amendment means nothing unless those in power believe you would have no problem simply walking up and shooting them if they got too far out of line and stopped responding as representatives.

Damn! That gun-toter is pissed! And he ain’t apologizin’. In a response on the Benton County Republican Committee’s Facebook page, he begins with this:

This is not a retraction, this is a clarification.

After he claimed, falsely, that he “didn’t advocate violence,” he ended with this:

I believe that in a world of nameless, faceless thugs influencing our people every day, it is imperative that we become thugs with names and faces just as scary even if in a different way. If we don’t, then we lose.

Yep. He called himself a thug. No, I mean, a “scary” thug.

And if any of you are tempted to think that this Nogy creep is a lone wolf, think again. You can follow the Twitter accounts of any number of  Tea Party Republican conservatives, or you can peruse the comment sections of nearly any right-wing web site, or, heck, you can just tune into any reactionary radio station near you and listen to the same kind of stuff Nogy based his kill-the-traitors screed on:

To the turncoats that sunk us, thank you.  It is now our responsibility to make sure that you are forever remembered in history, in big, bold, letters as the ones who placed Arkansas firmly on the path to Socialism, to the desires of Obama and Sebilius [sic], and who made it easier for future traitors to introduce all kinds of other socialist laws and programs.  You set the precedent,  now I hope that we can do something to make sure the lesson learned by those who represent us in the future is that bad things will happen to you if you follow that precedent.

For some folks in this country, the metaphorical civil war going on over that Scary Negro in the White’s House, is too much metaphor and not enough war.

Billy Long’s Shame

My congressman, Ozark Billy Long, has now voted to, in the words of Salon’s Richard Kirsch, “kill tens of thousands of people. Every year.”

Hear me out, people.

Republicans in the House passed Paul Ryan’s budget today by a vote of 221-207, with all Democrats voting against it. Ten Republicans, some of them because it wouldn’t inflict enough pain and misery and death on the country, also voted against it.

But Ozark Billy apparently considered the bill sufficiently painful to warrant his vote. The Associated Press reported today’s macabre theatrics this way:

WASHINGTON — The Republican-controlled House passed a tea party-flavored budget plan Thursday that promises sharp cuts in safety-net programs for the poor and a clampdown on domestic agencies, in sharp contrast to less austere plans favored by President Barack Obama and his Democratic allies.

And thanks to Barack Obama and his Democratic allies, Ryan’s budget will never get to do its killing, killing that is quantifiable because, as Richard Kirsch, pointed out:

when more people lack health coverage, more people die.

It is uncertain just how many people would be threatened by the Republican vote to, among other things, end ObamaCare and mangle Medicare and Medicaid, because we still don’t know how many Republican governors and Republican-dominated legislatures will refuse to expand Medicaid coverage under the Affordable Care Act.

But we do know that studies have found that somewhere between 26,000 and 45,000 people die needlessly prematurely because they don’t have health insurance. And the Ryan-Long-Republican budget, if it were to become law, would see to it that the needless deaths continue.

Kirsch says,

I’ve grown tired of providing a veneer of respectability to people in power –people with good health insurance, coverage that provides them with access to the best medical care, and pays most of their bills – who deny their constituents a basic human right.

Yes, I’ve grown tired of it, too. Thus, today I say that Billy Long, my representative in Congress, voted to allow countless Americans to die needlessly, even if Democrats will see to it that some of them won’t have to.

And to further strip off the veneer, I say today that those of you who went to the polls last November and cast a vote for Billy Long bought yourself a share of his shame.

A Peep Inside The Strange Minds Of Two Missouri Legislators

Jeffrey Messenger was elected in 2012 as a Republican in Missouri’s House of Representatives. He represents the 130th legislative district, about 50 miles east of Joplin. He lives in the town of Republic.

Thanks to his last campaign bio page, we learned that Messenger is a hard working guy with roots firmly planted in rural America. We also learned he owns a business that makes prosthetic limbs for those unfortunate folks who need them, and we found out he “is in the process of building another full time facility in Joplin, Missouri.” Good for him.

And we also learned that Messenger claimed his experience in the prosthetic limb business would somehow make him a better legislator:

Since being involved in Kessler Heasley Artificial Limb Co. Jeff has been able to increase his knowledge in the benefits as well as the pitfalls of Medicare, Medicaid, and Private Insurance, and understands the frustration for individuals when it comes to insurance coverage…

Jeff decided several years ago he wanted to get involved in politics. He feels he has the experience and the know how it will take in Jefferson City to get the job done.

Experience and know-how.  He can get the job done, he said. He “understands the frustration for individuals when it comes to insurance coverage,” he claimed.

Wednesday evening in Springfield, at a town hall with other Missouri legislators, Jeffrey Messenger, the man who understands people’s frustrations “when it comes to insurance coverage,” explained to those gathered why he is opposed to Missouri expanding insurance coverage under ObamaCare.

As reported by the Springfield News-Leader:

Messenger pointed out what he views as potential problems with expansion.

Messenger said that larger businesses will be penalized under the Affordable Care Act if they fail to provide health insurance to employees working 30 hours or more. To avoid the penalty, companies will cut employee hours down to under 30, he said.

These workers, because they work fewer hours and make less, will be more likely to qualify for an expanded Medicaid, and this will add an unanticipated strain to the system, Messenger said. He described it as a kind of loop.

“It just keeps growing and growing and growing,” Messenger said.

You get it? Businesses will screw their employees out of hours so they don’t have to provide them with health coverage, which will in turn make those employees candidates to get health insurance under Medicaid expansion, and therefore we shouldn’t expand Medicaid to help them. It’s all very simple, really. And very cruel.

Messenger not only “understands the frustration for individuals when it comes to insurance coverage,” he is willing to ignore that frustration, or really, to exacerbate it. Oh, by the way, Messenger’s campaign web page informs us that Jeff is “Pro-Life 100%.” Thank God.

As grievous as Messenger’s message to Missourians was during Wednesday night’s town hall, by far the dumbest and most offensive comment made about Medicaid expansion in Missouri was made by another Republican legislator, Lyndall Fraker, who represents folks east of Springfield and lives in Marshfield.lyndall fraker

But before we get to his dumb and offensive comment, Fraker’s campaign bio indicates that he proudly managed the Walmart store in Marshfield, which is interesting since Walmart is planning on taking cynical advantage of ObamaCare by excluding workers who work less than 30 hours a week from its health insurance plans.

Now, Fraker is not responsible for what Walmart honchos do, but he did say his Walmart experience made him realize “what a passion he had to serve others.” Goody, goody, now we’re ready for his comment on Medicaid expansion.

Here is the News-Leader’s account:

Fraker said it would be hard to roll back expansion once it’s happened.

“It’s hard to take candy away from a baby,” Fraker said. He used the metaphor of him and his wife buying a refrigerator. He said if his family couldn’t afford it, their approach would be to wait and see.

Candy from a baby. I can see where health insurance is like candy, can’t you? Sure it is. And people who need health insurance but can’t afford it are like babies. I can see that. And by God we can’t give those babies candy because it will be hard if we have to take it back. They’ll whine and cry and stuff.

And I can see where health insurance is like buying a new refrigerator, can’t you? Absolutely it is. If you can’t afford a new fridge, just wait and see what happens. And if you don’t have a fridge that works, you could store your food in an ice chest. Just don’t count on a Republican legislator to provide you with the ice. And if you don’t have a refrigerator and don’t have any ice, you can just stop eating. Eventually you won’t have to worry about the fridge or the ice.

The News-Leader reported that someone in the town hall “took offense to Fraker’s characterization, and he apologized.”

For what? Why did Lyndall Fraker apologize? For revealing how his mind works? How he really thinks about this issue?

We all should write him and thank him, and Jeff Messenger, for a moment of honesty. This is who these people are, my friends, this is who they are.

Missouri Medicaid Expansion: A Matter Of Life And Death

Missouri Governor Jay Nixon was here in Joplin on Wednesday.

Susan Redden of the Joplin Globe reported that Nixon was in town “to assert that Medicaid expansion would be a good business decision for the state.” From the story:

With officials of area hospitals and health care providers standing behind him, Nixon told a Joplin crowd that rejecting the Medicaid expansion available under the Affordable Care Act would send tax dollars collected in Missouri to other states where the coverage has been expanded.

“The question is narrow: Will we bring back those federal tax dollars to help the state or not?” the governor said in a presentation at the Robert W. Plaster School of Business at Missouri Southern State University. “If we don’t, other states will get the help, and we’ll pay the bill.”

The article notes that some 300,000 Missourians will benefit from the expansion of Medicaid, and in the words of Governor Nixon,

the people it will help are working folks who otherwise are going to end up in the emergency room.

Naturally, since the expansion will help “working folks,” many Republicans are against it, including leadership in our right-wing-dominated legislature. But the Missouri Chamber of Commerce and some local chambers, but not yet including Joplin, are on board because they recognize the foolishness of rejecting the expansion, just to spit in the eye of Barack Obama.

Expanding Medicaid happens to be good for business and employment:

Nixon cited a study by the University of Missouri suggesting that the additional funding for health care would create 24,000 new jobs in Missouri the first full year of the expansion. And, he said, states that don’t expand coverage could be put at a competitive disadvantage when small businesses are looking to add jobs, which often start on the lower end of the wage scale.

“If businesses are paying the same wage, and workers are getting health coverage in one state and not another, it could make a difference,” he said.

Medicaid expansion is projected to bring back to the state $1.8 billion in the first full year of coverage, and $5.7 billion over three years, Nixon said. “If we take a pass, Missouri residents pay that money in taxes, but it goes to other states,” he said.

As most of us know, the Supreme Court, in upholding the constitutionality of the Affordable Care Act, ruled that the provisions in the law that required states to expand Medicaid coverage to folks earning below 138 percent of the federal poverty level went too far. The Court’s decision allowed states to opt out of the expansion, even while staying in the Medicaid program.

Some Republicans claim our state can’t afford to expand Medicaid. But the entire cost of the expansion is covered by the federal government from 2014 through 2016. Then, until 2020 the states have to cover 5% of the annual cost, and after 2020, the states have to cover 10%. And that’s it.  Providing health insurance to 300,000 working folks in Missouri is a damn good deal.

And it’s a good deal for hospitals and other health care providers, who clearly recognize the foolishness of keeping poor people from getting health insurance. Those poor folks often seek care—expensive care—at emergency rooms, and much of that care—mandated by EMTALA—is uncompensated.

The federal government, through Disproportionate Share Hospital allotments, provides support to hospitals (“safety-net hospitals“) that treat the uninsured who can’t pay. In 2011, that support amounted to $11.3 billion, a little more than one-fourth of the estimated cost ($41.1 billion) to hospitals for providing care to those who can’t afford it.

The Affordable Care Act, because its purpose was to insure people and reduce uncompensated care, lowers federal payments to hospitals that treat those who can’t pay. But because the Supreme Court made the expansion voluntary and because many Republican governors and legislatures hate Obama and ObamaCare, the states who opt out are burdening the hospitals in their states with extra costs.

That’s why here in Joplin Governor Nixon met with local hospital leaders, who have given him their blessing. One of those leaders, Paula Baker, president of Freeman Health System, said,

He didn’t need to sell us on it.

But beyond the finances of the Medicaid expansion, there is the human element. Consider this from The Incidental Economist, a blog dedicated to studying America’s health care system:

First of all, Medicaid is good for health. Let’s start with a simple truth: having health insurance is better than not having health insurance. Not only is health insurance good for health, but it actually saves lives. Medicaid is, of course, health insurance. Therefore, it comes as no surprise that studies show Medicaid improves health. Now some people have garnered a lot of attention by claiming that Medicaid actually hurts people. They’re citing studies that show correlation, not causation. Medicaid doesn’t cause bad health; people who qualify for Medicaid are more likely to have bad health for other reasons. There’s a huge randomized controlled trial of Medicaid going on in Oregon right now, and that’s the kind of study you’d do to prove causation. It’s showing that Medicaid is good for health.

Expanding Medicaid is not only a good thing to do in terms of finances, it is “good for health.” It is good public policy. It is the right thing to do. And it does save lives, as was suggested in the Globe article. A woman named Patricia Bailey was visiting a local Joplin clinic that serves a significant number of folks on Medicaid:

Bailey, 61, of Joplin, said she has been on Medicaid for the past four years. Without it, she said, she wouldn’t have sought treatment that included three hospitalizations.

“I couldn’t have afforded it. I think I’d probably be dead,” she said.

More than the money, more than anything else, as Missourians, as Americans, we should expand Medicaid coverage because for some folks, it is a matter of life and death.

The Bad Part Of The Supreme Court’s ObamaCare Ruling And How Republicans May Use It To Screw The Needy

In my post on the health care law ruling yesterday I mentioned I would save for another day what I meant by this:

judging by this decision, I see only two consistent “liberals” on this court, Ginsburg and Sotomayor.

What I meant was their just refusal to join the other seven justices—including the usually sensible Steven Breyer and the ideologically suspect Obama appointee, Elena Kagan*—in ruling unconstitutional (it’s complicated, so see here) any attempt by the feds to terminate existing Medicaid money to states (almost all Republican-controlled states, of course) who might refuse to go along with the ACA’s expansion of Medicaid, an expansion that would enable millions of needy folks to get health insurance.

But, as usual, the needy just don’t have quite enough friends in powerful places.

For those who don’t know, Medicaid, created along with Medicare in 1965, is a federal-state effort designed to provide medical and health benefits to poorer folks, including children, who would otherwise go without all but emergency health care at hospitals. It is funded by both state and federal sources, the funding formula based on per capita income in the various states, with no state going without at least 50% federal funding (the average the feds pay is 57 percent).

The ability to withdraw all Medicaid funding, not just that associated with the expansion, was seen as a big stick in getting reluctant (red) states to do the right thing.  And the Supreme Court—again, including two justices appointed by Democrats—held that the federal government cannot coerce states or penalize them in such a manner, even if it is to do the right thing. Paul Clement, who argued the case for the bad guys, characterized this part of the decision as “really quite significant.”

Yes, it is. Here’s how USA Today summarized it:

The court struck down a portion of the law that would have forced states to accept a major expansion of Medicaid to all Americans earning up to $30,733 for a family of four or risk losing all federal funds under the program.

Roberts called that part of the Affordable Care Act “a gun to the head” by threatening as much as 10% of states’ budgets.

By removing the “gun to the head,” the Court has made it voluntary for the states to  provide expanded health insurance for its neediest citizens, to folks with incomes at 133 percent of the national poverty line.

And even though the federal government is picking up nearly all of the tab for the expansion, inevitably there will be Republican opposition, since that political party is long on hatred for Obama and short on love for the neediest among us.

Don’t believe me? How about this headline and story from the AP:

Top Mo. Republicans oppose Medicaid expansion

JEFFERSON CITY, Mo. (AP) – Top Missouri Republicans say they have no intention of expanding Medicaid eligibility as a result of the Supreme Court’s ruling on the federal health care law.

The story relates that Missouri House Majority Leader Tim Jones will not consider the expansion, and the stripper-lovin’ Lt. Gov. Peter Kinder falsely called it a “break-the-bank provision.”  Obviously, these unkind gentlemen don’t give a damn about the Missourians who would be helped, including doctors who treat patients who can’t pay, nor do they appear to give a damn about Missouri hospitals, most of whom have to absorb themselves or pass on to others the cost of uninsured patients they are required by law to treat.

Reportedly, the White House believes that all of the states will go for the expansion, since they all participate in Medicaid now with considerably less federal funding help than the new law provides.  But as a student of bullheaded Tea Party extremism, I can tell you that I suspect more than a few red states will opt out of providing more health services to those folks—many of whom are ongoing victims of Republican economics—who can’t afford them otherwise.

____________________________

* I had my doubts about Kagan’s appointment two years ago; I was for Diane Wood as Obama’s pick to replace John Paul Stevens.

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