Would Jesus Expand Medicaid In Missouri? I’ll Let Him Tell You (UPDATED)

“Missouri’s low income and vulnerable citizens will have access to excellent health care in order to maximize their quality of life and independence.”

—The “vision” statement of Missouri’s Medicaid program, MO HealthNet Division

I swear the following story is in your Bible:

On one occasion an expert in the law stood up to test Jesus. “Teacher,” he asked, “what must I do to inherit eternal life?”

“What is written in the Law?” he replied. “How do you read it?”

He answered, “‘Love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind; and, ‘Love your neighbor as yourself.’”

 “You have answered correctly,” Jesus replied. “Do this and you will live.”

But the expert in the law wanted to justify himself, so he asked Jesus, “And who is my neighbor?”

In reply Jesus said, “A man was going down from Jefferson City to Joplin, when he found out his job was being outsourced to China. All in one moment he lost his income and along with it his health insurance, which he needed because his wife had a serious health condition. A Religious Right preacher happened to be going down the same road on his way to vote for a Republican, and when he saw the uninsured man on the side of the road in much distress, he passed by on the other side. So too, a Teapartier, when he came to the place and saw him, passed by on the other side, as he was also on his way to vote for a Republican.

But a Samaritan, a man who believed in the social safety net, came by where the man was, and when he saw him, he took pity on him. He went to him and told him not to worry. He told him that he was voting for someone who would make sure that he and his wife had affordable health insurance, whether he had a job or not. He told him that he was voting for someone who would make sure his unemployment benefits wouldn’t dry up before he had a fair chance to get another job. Then he put the man in his car, registered him to vote, and brought him to the polling place. 

“Which of these three do you think was a neighbor to the man who lost his job and his health insurance?”

The expert in the law replied, “The one who had mercy on him.”

Jesus told him, “Go and do likewise.”

Here in Missouri, Republicans have blocked the expansion of Medicaid, which would have been fully paid for by the federal government for the next three years. After that the state would eventually pay no more than 10% of the cost, as the program is fully phased in by 2020. The point is that it wouldn’t cost the state a dime—not a dime—until 2017, and even then it wouldn’t cost much. It is estimated that in 2015 Missouri would receive $1.7 billion to help expand the program and bring insurance to more people who can’t now afford it, which could be somewhere between 260,000 and 310,000 Missourians.

Here is a look at just who would benefit if the program were expanded today, again at no cost to the state:

medicaid expansion in missouri

Right now, without Medicaid expansion in this Jesus-loving state, if you are a parent or parents in a family of four and can’t afford private health insurance but have an income over $4,475 a year (19% of the 2013 Federal Poverty Level), you aren’t eligible for Medicaid. Yes, you read that right. If you preside over a family of four and make over $4,475 a year (a bleeping year!) but don’t make enough to buy health insurance, as a parent you are not eligible for Medicaid in Missouri. If you’re wondering, that cutoff for eligibility is the lowest allowed under the federal law that initially established the national program.

Under expansion, your family situation wouldn’t matter. Neither would your disability status. If you were parenting a family of four and earned up to $31,322 a year (based on 133% of the federal poverty level for 2013), you would be eligible for help if you didn’t otherwise have health insurance. If you were a single adult, you could earn up to $15,282 a year and qualify for health insurance under Medicaid. And as a comprehensive study indicated, the expansion is not only good for the entire state (it would actually bring in more dough to the treasury), but it is especially good for folks who live in places like where I live here in the southwest corner:

medicaid expansion map

See that? Just in our part of the state more than 60,000 of our New Testament-toting neighbors would get health insurance. Hallelujah!

Except that here in this Jesus-loving town of Joplin, here in God-fearing Southwest Missouri, lives the Majority Floor Leader of the Missouri Senate, Ron Richard. I don’t know if he loves Jesus or not, but I do know he is opposed to Medicaid expansion and voted against it last week, as did every single Republican in the Senate. Here are the duties of his august position:

The Majority Floor Leader sets the schedule of bills up for consideration by the full chamber, the time spent on floor debate for legislation, and the meeting times and dates of the Missouri Senate, among other duties.

As you can see, Ron Richard is a powerful man. He can change the dynamics of the debate on the expansion of Medicaid in Missouri in less time than it would take a House Republican to say, “Impeach the socialist in the White’s House!” Below are ways to contact him:

Jefferson City Office, Pattie: 573-751-2173

Joplin Office, Gwen: 417-623-0022

Or send him a message:

http://www.senate.mo.gov/D32WebApps/Contact.aspx
http://ronrichardmosenate.com/contact.php

You can use one or all of the above methods in order to a) ask him if he loves Jesus, or b) ask him if he wants to treat his fellow Missourians like a good neighbor, or c) do what I did and send him a message like this:

ron richard websiteI respectfully ask that Sen. Richard lead the charge on expanding Medicaid in Missouri and bring some relief to hundreds of thousands of Missourians who need health insurance. We are leaving billions of dollars on the table, money that is needed here in our state to care for our own. Do the right thing, please.

_________________________________

UPDATE: Here is the email response I received from Sen. Richard. Based on this response, it wouldn’t hurt for all of you who are interested in this issue to let him know where you stand:

Thank you for your email. This was brought up on the Senate Floor for debate. This was just the first discussion on the floor and I believe there will be a lot more before we have a chance to vote on the bill. I will keep your thoughts and comments in mind as this bill becomes perfected and we vote on the measure.

Please let me know if you have any further questions or concerns.

Sincerely,

Ron Richard
Senator District 32

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“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.

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.

Free Pot For Everyone, And Other Budget Fantasies

Many liberals are criticizing Paul Ryan for essentially ignoring last November’s election results, as he released his third very dark, very Randian, budget resolution.

But it’s not that Ryan is acting as if the last national election didn’t happen. It’s that he is acting like he and Mittens actually won the damned election. In what can only be considered flat-out delusion (or that he intends to win a GOP primary in 2016), he offers the country a budget proposal that wouldn’t even become reality if Romney and Ryan had successfully duped a majority of Americans last November.

This monster would: repeal ObamaCare, slash Medicaid and food stamps, kill traditional Medicare, cut Pell grants, create lower tax rates for the rich—yet again. There is apparently no allowance for emergency spending on disasters, or the recognition that our infrastructure is crumbling and we need more not less money to fix it. Tax reform is part of the proposal, but we don’t know what the reforms are. The economic growth assumptions are also shrouded in mystery worthy of the ongoing papal conclave.

Not to mention the blinding hypocrisy of supposedly balancing the budget in ten years by using the $716 billion in Medicare cuts (used to help fund ObamaCare), cuts that Ryan and his fellow Republicans so famously campaigned against in both 2010 and 2012.

And not to mention the breathtaking dishonesty of using the $600 billion in revenue generated by Obama’s insistence on the restoration of the Clinton-era tax rates on high-income earners, which settled the fiscal-cliff nonsense this year.

This is not a serious proposal and Democrats in the Senate, who have now released details of their own budget, should revise their proposal in response to Ryan and the Republicans by including a series of people-pleasing goodies like: free health care, a free college education, forty acres and a Ford for all, a chicken in every pot, and some pot in every pipe.

Democrats can then start budget negotiations from there.

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.

Americans Endorse Socialism, Again

A new ABC/Washington Post poll conducted recently has caused some pundits to focus on the reality that Republicans are having a terrible time convincing most non-Republicans (that’s about 75% of the country, according to this poll) that the GOP is looking out for middle-class interests.

Most folks know where the loyalties of the current  Republican Party lie, and it is not with most folks but mostly with folks with the most.

But as we start thinking about the year to come, and to put the ridiculousness that is the fiscal cliff in perspective, I want to focus on one part of the poll that I am sure will get overlooked by most popular media types: America, as I have argued many times before, has a jones for socialism.

The pollsters asked this question:

17. In order to strike a budget deal that avoids the so-called “fiscal cliff”, would you accept “cutting spending on Medicaid, which is the government health insurance program for the poor,” or is this something you would find unacceptable? Do you feel that way strongly or somewhat?

Now, it might surprise some of you, I know it did me, that only 28% of the respondents said it would be “acceptable” to cut spending on health insurance for the poor. And only 13% felt “strongly” that such cuts were acceptable. A whopping  68% (53% “strongly”) found such cuts “unacceptable.”

Wow.  Think about that.  With all the doom-talk, with all the talk about falling off cliffs, there is still an overwhelming majority of folks in America who refuse to solve our fiscal problems on the backs of poor people.

This holiday season I find that inspiring.

And lest you think I am drawing an untenable conclusion from that datum, a conclusion that concludes America has embraced a rather robust form of socialism, I submit to you another question asked by the pollsters:

17. In order to strike a budget deal that avoids the so-called “fiscal cliff”, would you accept “raising taxes on Americans with incomes over 250-thousand dollars per year,” or is this something you would find unacceptable? Do you feel that way strongly or somewhat?

A staggering 74% of respondents said it was acceptable—54% felt”strongly”about it—to raise taxes on affluent Americans while also saying that any fiscal cliff deal-making should not include the poor.

That, my friends, is an endorsement of income redistribution, of socialism, right here in what right-wingers think is a center-right America.

A Fiscal Fantasy

This morning on MSNBC Ezra Klein made a great point about how most of the talk surrounding Ryan’s budget plan has been limited to the Medicare issue. But there is a lot more to it than that:

What people don’t realize about it is the cuts to other health care programs, primarily Medicaid, are almost twice  as large as Medicare…

Medicaid, of course, is a means-tested health program for low-income folks, including children, the elderly, and the disabled.  More than half of the funding for each state is provided by the feds.

According to the Kaiser Commission on Medicaid and the Uninsured, those Ryan—now Romney-Ryan—cuts Klein referenced, along with repeal of the Affordable Care Act which Romney and Ryan promise to accomplish, will in, say, Missouri mean that somewhere between 46% and 53% of folks who would otherwise be enrolled in Medicaid under current law in 2021 would not be so enrolled.

That represents between 650,000 and 750,000 Missourians whose well-being, unless the state came up with more revenue itself (!), would be sacrificed in the name of budget austerity that has as its guiding principle the idea that rich folks need more tax cuts.

But that’s not all. Klein also makes the point that the Ryan plan is designed to shrink other parts of government spending as a share of the economy, to uncivilized levels by 2050. He  presented this graph:

Klein wrote something remarkable that should be shouted from the housetops (emphasis mine):

The truth is that the Ryan budget’s largest long-term savings don’t come from Medicaid or Medicare or Social Security, or even Medicaid and Medicare and Social Security put together. They come from everything else. Ryan says that under his budget, everything the federal government does that is not Medicare, Medicaid or Social Security will be cut to less than 3.75 percent of GDP by 2050. That means defense, infrastructure, education, food safety, energy research, national parks, civil service, the FBI — all of it. Right now, that category of spending is 12.5 percent of GDP.

Think about that. A government that small could not possibly “establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity” in 2050. But it’s all nonsense, as real-time, Nobel Prize-totin’ economist Paul Krugman pointed out:

Look, Ryan hasn’t “crunched the numbers”; he has just scribbled some stuff down, without checking at all to see if it makes sense. He asserts that he can cut taxes without net loss of revenue by closing unspecified loopholes; he asserts that he can cut discretionary spending to levels not seen since Calvin Coolidge, without saying how; he asserts that he can convert Medicare to a voucher system, with much lower spending than now projected, without even a hint of how this is supposed to work. This is just a fantasy, not a serious policy proposal.

Well, what is serious is the philosophy behind the proposal, which philosophy is based on a fantasy, a fantasy that what is wrong with our fiscal house can be fixed by throwing the poor, the elderly, and the sick in the streets to fend for themselves and by shrinking government to a size that could truly be drowned in Grover Norquist’s bathtub.

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.

Throw Medicare From The Train—Part Deux

Here’s the basic outline of House Budget Committee Chairman Paul Ryan’s 2013 budget in one sentence: Ryan’s budget funds trillions of dollars in tax cuts, defense spending and deficit reduction by cutting deeply into health-care programs and income supports for the poor.”

Ezra Klein

The Associated Press story in today’s Joplin Globe (the paper’s version was shortened for publication) summed up the Ryan budget plan nicely:

Mixing deep cuts to safety-net programs for the poor with politically risky cost curbs for Medicare, Republicans controlling the House unveiled an election-year budget blueprint Tuesday that paints clear campaign differences with President Barack Obama.

The AP also reported Mitt Romney’s rather enthusiastic support for the plan:

The House Republican budget rejects the out-of-control spending and higher taxes proposed by President Obama in his budget last month. By proposing prescriptions that will strengthen Medicare for generations to come, it also highlights President Obama’s failed leadership on entitlement reform.

So, now that we know where Romney stands (a rare achievement), let’s look at some of the Ryan plan in broad strokes, as presented by the AP: (follow the link for the details):

The Republican proposal…would wrestle the federal spending deficit to a manageable size in short order, but only by cutting Medicaid, food stamps, Pell Grants and a host of other programs…

The plan calls for steep drops in personal and corporate tax rates in exchange for clearing away hundreds of tax deductions and preferences. It would eliminate oft-criticized corporate tax boondoggles but also tax deductions and credits claimed by the poor and middle class.

To cope with the unsustainable growth of Medicare and the influx of retiring baby boomers, the GOP budget reprises a controversial approach that would switch the program — for those under 55 today — from a traditional “fee for service” framework in which the government pays doctor and hospital bills to a voucherlike “premium support” approach in which the government subsidizes purchases of health insurance.

If that all sounds familiar, that’s because we saw this movie last year. The difference is that this year’s sequel is even gorier (aren’t they always?) than last year’s spine-chilling offering.  And it was meant to be that way, according to Paul Ryan:

We are sharpening the contrast between the path we are proposing and the path of debt and decline that the president has placed us upon.

Sharpening, indeed.

Perhaps most appalling—considering all the cuts in the rest of the budget and the change in Medicare—is this:

The GOP measure also would replace $55 billion in Pentagon spending cuts and $43 billion in cuts to non-defense appropriations set to take effect in January with at least $261 billion in other savings over the coming decade, including curbs to food stamps, federal employee pensions and further cuts to federal health care programs.

As The Hill reported, not only does Ryan’s plan “shield the Pentagon from nearly $500 billion in automatic cuts and roll back some of the $487 billion reduction” already approved, the plan,

also increases national defense spending to $554 billion in 2013, an increase of $8 billion over the $546 billion that was agreed to under the Budget Control Act.

Get that? The GOP budget actually increases defense spending over what was agreed to last year!

All of the above is from neutral journalists. If you want to read progressive takes on the Ryan plan, go to the Washington Post and read Ezra Klein or to the Center for American Progress, which has a series of articles presenting the details of the plan. It ain’t pretty. And there is, as always, the Center on Budget and Policy Priorities here and here.

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As for a short, non-partisan analysis of the “premium support” plan for “saving” Medicare, go to Kaiser Health News. Here is part of that analysis:

All plans, including traditional Medicare, would submit bids for how much they would charge to cover a beneficiary’s health care costs. The government would pay the full premium for the private plan with the second lowest bid, or for traditional Medicare, whichever is lower. Beneficiaries would have to pay the difference if they chose a plan that set rates higher. There could be one less expensive plan option, and beneficiaries who chose it would get a rebate for the difference…

But some critics are already arguing that the government-administered option would not be affordable and that it could cause doctors to leave the program. Critics have argued that the government-run plan would attract the sickest people, driving up its costs, while private plans would lure the healthiest.

This plan is the so-called Wyden-Ryan “compromise.” If you have wondered why a Democrat with liberal bona fides—Oregon Senator Ron Wyden—would team up with a right-winger like Paul Ryan to develop a plan to “protect Medicare,” go here and read Senator Wyden’s explanation. (You might be surprised; I was. But it is still unconscionable to give Ryan and the Republicans some political cover at a time like this, when so much is at stake.)

For a readable critical analysis of that Wyden-Ryan plan go here and here and here to get educated. It is essential to know what may happen to a vital social program.

Finally, in case any of us might think the White House will get wobbly-kneed on the Medicare proposal in the Ryan budget, remember this initial statement from Obama’s Communication’s Director Dan Pfeiffer:

We are concerned that Wyden-Ryan, like Congressman Ryan’s earlier proposal, would undermine, rather than strengthen, Medicare. The Wyden-Ryan scheme could, over time, cause the traditional Medicare program to “wither on the vine” because it would raise premiums, forcing many seniors to leave traditional Medicare and join private plans. And it would shift costs from the government to seniors. At the end of the day, this plan would end Medicare as we know it for millions of seniors. Wyden-Ryan is the wrong way to reform Medicare

Domesticating The Dogs

I don’t think there should be a profit motive in health care. I think all the health care dollars should go to care.”

—Elsa Stone, a North Haven, Connecticut, pediatrician

Well, what do you know.  The universe is starting to make sense. 

From Thursday’s USA Today:

HARTFORD, Conn. – In the past decade, most states have turned Medicaid over to private insurance plans, hoping they could control costs and improve care. Nearly half of the 60 million people in the government program for the poor are in managed-care plans run by insurance giants such as UnitedHealthcare and Aetna. 

Connecticut, the “insurance capital of the world,” is bucking the trend.

Beginning Sunday, Connecticut will jettison its private health plans from Medicaid, the state-federal health insurance program. Instead of paying the companies a set monthly fee to cover the health costs of more than 400,000 children and parents, the state will assume financial responsibility.

Why?

Glad you asked:

State officials say the companies, including Hartford-based Aetna, did not fulfill their promise of lower costs and better care.

Take that all of you private-insurance lovers out there.

Notably, our neighbor to the West, Oklahoma, one of the reddest states in the Milky Way, doesn’t trust the private insurers either, and hasn’t for a while:

Oklahoma moved away from private plans in 2005, and officials there say they have no regrets. “While achieving very encouraging marks in both member satisfaction and quality, the cost per member has grown at a very low average annual rate of 1.2% over the last five years,” says Mike Fogarty, Oklahoma’s Medicaid director.

It appears that in Connecticut (and elsewhere, of course) too much money is being spent on things that have nothing to do with health—like, say, profits. The USA Today story cited,

a 2009 state-commissioned report showing Connecticut was overpaying insurers by nearly $50 million a year–about 6% of total expenses.

Other state reports found the plans were spending too little on health services and published networks of doctors that were misleading because many doctors refused to accept Medicaid patients when “secret shoppers” called for appointments.

And, thus, the story touches, albeit indirectly, on a major problem with the very conservative Affordable Care Act:

Many doctors are happy to see the state’s experiment with managed-care plans end. Many had been frustrated with having to follow different rules for different plans. They also complained about payment delays and problems referring patients to some specialists.

You see, because too much worry is exhausted on who gets paid, the folks in the middle—doctors and patients—tend to suffer. The ACA, while guaranteeing everyone health insurance, still keeps in place that profit-minded system.  In fact, Paul Ryan’s budget plan—fully embraced by the Republican Party—would essentially do for older folks, who would have a hard time getting health care, what the ACA does for younger folks, who can’t afford or aren’t able to get health care. 

Yes, it’s true.

An important but little noticed point made in the recent controversial Politifact article, “Lie of the Year 2011,” explains:

Under the current Medicare system, the government pays the health care bills for Americans over age 65. Under the Ryan plan, future beneficiaries would be given a credit and invited to shop for an approved plan on a Medicare health insurance exchange…Ryan’s plan requires private insurers to accept all applicants and to charge the same rate for people who are the same age…

“Ryan basically proposed the Affordable Care Act for future seniors,” said Jonathan Gruber, an economist at the Massachusetts Institute of Technology, who advised both President Obama and Republican Mitt Romney on health care. “I don’t understand how you can like it for future seniors but not like it for today’s needy uninsured. That doesn’t make any sense.”

Of course, it also doesn’t make sense how most people in the country can like Medicare for seniors and not like Medicare for everyone, but Republicans have done such a darn good job of demonizing everything that comes in contact with government that it  is somewhat understandable why there is such cognitive dissonance out there.

Fortunately, some states, most recently Connecticut, are coming to their senses about how health care is delivered in this country, and it’s not through motivating private insurers with profits. And that, despite all the Republican criticism of it, is what is wrong with the Affordable Care Act.  It is an improvement over the dog-eat-dog insurance system we have now, but the dogs are still out there.

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