“It’s All Or Nothing”: The Obama Administration Plays Hardball On Medicaid
When the Supreme Court upheld the Affordable Care Act, it also gave Republican states a gift by saying they could opt out of what may be the ACA’s most important part, the dramatic expansion of Medicaid that will give insurance to millions of people who don’t now have it. While right now each state decides on eligibility rules—meaning that if you live in a state governed by Republicans, if you make enough to have a roof over your head and give your kids one or two meals a day, you’re probably considered too rich for Medicaid and are ineligible—starting in 2014 anyone at up to 133 percent of the federal poverty level will be eligible. That means an individual earning up to $14,856 or a family of four earning up to $30,657 could get Medicaid.
Republican governors and legislatures don’t like the Medicaid expansion, which is why nine states—South Dakota, plus the Southern states running from South Carolina through Texas—have said they’ll refuse to expand Medicaid (many other states have not yet said whether they’ll do it). But some states asked the Obama administration whether they could expand Medicaid a bit—maybe not cover everyone up to 133 percent like the law says, but add a few people to the rolls. And yesterday, the administration said no. It’s all or nothing: either you expand Medicaid up to 133 percent, or you get none of the new money. Was that the right thing to do? Well first, let’s talk about that money.
These Republican states offer worries about cost as their reason for rejecting the Medicaid expansion. But in truth, it’s an incredibly sweet deal for them. Right now, the federal government generally pays half of the cost of Medicaid, with the state picking up the other half. But the federal government will pay 100 percent of the cost of new Medicaid recipients signed up because of the expansion between 2014 and 2016. After that the federal contribution will step down to 90 percent by 2020, where it will stay forever more. So the state gets to insure a whole bunch of its citizens for nothing at first, and eventually for only 10 cents on the dollar. And in return they get reduced costs for uncompensated care, and a healthier, more productive citizenry with more money to spend. Some studies have projected that states will more than make up for their 10 percent contribution with health care savings they’ll get from an insured population; that’s likely to be particularly true among those states whose Medicaid eligibility standards are currently the stingiest, who not coincidentally have the highest rates of uninsured citizens (and, also not coincidentally, are precisely those states where the Republican leadership is refusing to accept the expansion).
And yet, the most conservative among them won’t take the deal. The federal government is saying to the states, Here is a bunch of free money for you to give health insurance to your uninsured poor citizens. And these states are saying, No way! Their justification of budget worries is so unpersuasive that it’s impossible to avoid the conclusion that they would rather see people have no insurance, and thus be poorer, sicker, and die sooner, than get Medicaid via Obamacare. It’s truly a moral abomination.
By playing a little bit of hardball and not letting states get away with a partial expansion, the administration is betting that before long the states will find all this free money to insure their citizens irresistible. And they may be right. That’s what happened when Medicaid was established in 1965; few states signed up at first, but before long they all did. Right now these governments are being pressured by some powerful interests to take the expansion, particularly the hospitals who have to deal with patients with no way to pay their bills. If they expanded Medicaid a little but not fully, that pressure wouldn’t be as intense and they could claim they expanded coverage. This way they won’t be able to hide behind a partial expansion and claim they did the right thing. Let’s hope the administration is right, because millions of Americans’ futures depend on it.
By: Paul Waldman, Contributing Editor, The American Prospect, December 11, 2012
“Democracy Loses”: Michigan Passes “Right To Work” Law With Support Of Koch Brothers
Without one hearing or any public comment in the midst of a lame-duck session after an election where Republicans lost five seats in the State House and their presidential candidate lost the state by 9.5 percent, Republicans in both Michigan’s House and Senate have passed so-called ‘right to work’ legislation.
Republican governor Rick Snyder, who campaigned as a moderate and continually said that ‘right to work’ was not on his agenda now, says he will sign the legislation.
Thus Michigan will become the 24th state in the union to pass legislation that bars unions from automatically collecting dues from all employees covered under a collective bargaining agreement. This highly symbolic move to strike at the heart of unions in the state where unionized auto workers helped create the middle class would not be possible without the support of multi-billionaires, specifically the Koch brothers and Rich DeVos, founder of Amway.
The bill that Snyder will sign is nearly identical to model legislation written by Koch-funded group American Legislative Exchange Council. Another Koch-funded group, Americans for Prosperity, has been advocating for the legislation, reportedly pressuring lawmakers including Senate Majority Leader Randy Richardville, who had previously refused to support the anti-union measure. For the Kochs, the intent of the bill is to clearly to diminish the power of the group that fuels the progressive movement–organized labor.
A group calling itself “Freedom To Work” has deluged Michigan’s TV airwaves in support of the legislation, arguing that the bill would both create jobs and “protect collective bargaining.”
According to state rep. Brandon Dillon, Freedom To Work is funded by Amway’s DeVos, a Michigan resident who ran for governor against Jennifer Granholm in 2006 and lost.
Longtime Michigan political advisor Dana Houle insists that this bill isn’t about making Michigan more competitive, as Governor Snyder suggests. It’s a about enacting a vast scope of right-wing legislation.
“Don’t anyone think that passing ‘right to work’ in Michigan is about economics, about jobs, about business,” Houle said. “It’s about wiping out the political and electoral power of unions so they can’t stand in the way of Dick DeVos electing apparatchiks who will enact his radical religious-right and anti-public schools agenda.”
Outside the Capitol, thousands of union supporters protested and several were hit with pepper spray, including former congressman Mark Schauer.
Unions are considering their options to undo the bills, which were designed so they cannot be overturned by a popular vote.
For those still wondering how ‘right to work’ or ‘right to work for less’ or ‘freedom to freeload’ could happen in a union stronghold like Michigan, take a look at this helpful breakdown of where the AFL-CIO thought the votes would come from. It turns out they were right.
Photo: AP Photo/Carlos Osorio; Chart: AFL-CIO
By: Jason Sattler, The National Memo, December 11, 2012
“Saving Medicare From The GOP, Again”: Raising Medicare Age Won’t Save Money But Will Cost Lives
Raising taxes on the rich alone won’t close the deficit or erase the national debt, as Republicans superciliously inform us over and over again. But in their negotiations with the White House to avert the so-called fiscal cliff, Congressional Republicans seem obsessed with a change in Medicare eligibility whose budgetary impact (when compared with ending the Bush tax cuts for the wealthy) is truly negligible — but whose human toll would be immense.
That Republican imperative is to raise the Medicare eligibility age from 65 to 67.
Why do Speaker John Boehner and the Republican majority in the House so badly want to put Medicare out of reach of elders younger than 67? It will be costly to their most loyal voting constituency among older whites. And it won’t save much money, according to the nonpartisan Kaiser Family Foundation’s latest study – which shows that the estimated $148 billion in savings over ten years is largely offset by increased insurance costs, lost premiums, and higher subsidies that will be paid as a consequence. The Center on Budget and Policy Priorities offers an even more stringent analysis, which shows that raising the eligibility age in fact will result in total costs higher than the putative federal savings — which amount to around $50 billion over ten years. Contrast that with the savings achieved by ending the Bush tax cuts for the wealthy, which amounts to well over $1 trillion during the same period — and it becomes clear which party wants to reduce deficits.
Assuming that the savings are mostly mythical, the only sensible assumption is that Republican politicians and financiers simply hate Medicare, a highly successful and popular federal program that the right has been trying to destroy, with one tactic or another, ever since its establishment in 1965. They don’t really care whether their alleged solutions save money or improve efficiency. They want a privately-funded medical system that preserves profits rather than a system that improves and expands health care, as Medicare has done for almost half a century.
What the Republicans evidently desire most in their “reform” crusade is to exacerbate inequality among the elderly – because that is the only assured outcome of their plans.
The impact of raising the Medicare eligibility age by two years will fall most heavily upon older African-American and other minorities, as they are still known. The projected damage is summarized clearly in a chart posted on Monday by Sarah Kliff at the Washington Post’s Wonkblog. The number of uninsured among the elderly will be increased for all groups, but the greatest increase will be among minorities, who will also become more likely to postpone medical care because they lack coverage. The net effect of those changes, to project from what we already know about people who lack of insurance and postpone care, will be earlier deaths and much suffering.
Even more broadly, delaying eligibility is a direct assault on the standard of living of working-class Americans, especially those who have earned their way through physical labor. By age 65, people who have spent decades engaged in hard physical work – as firefighters, nurses, or other first responders, to consider the most obvious examples – are ready to stop working. Medicare is a critical element of their ability to retire, but Washington elites, especially on the right, are obtusely unsympathetic to their conditions.
It is up to the Democrats in Washington, especially President Obama, to protect Americans from such policy proposals, which are economically idiotic and socially inhumane. For there is one objective that the Republicans would certainly achieve if they induce the President to accept, or worse, propose, any such plan: They will discredit his second term before it has begun.
By: Joe Conason, The National Memo, December 11, 2012
“Save The Babies Or Save The Budget”: Dear Conservatives, Your Opposition To Family Planning Comes With A Huge Price Tag
Conservatives have long painted themselves as the guardians of fiscal sanity. But they have also fashioned themselves as the guardians of the innocent babies being preyed upon at Planned Parenthood. Even though abortions make up just 3 percent of the services Planned Parenthood provides—and many clinics don’t provide them at all because of restrictions placed on the funding they receive—conservatives have long held a legislative grudge against the organization and have even broadened their contempt to other family planning clinics.
That deep-held distaste for women’s health providers led Texas lawmakers last year to slash $73 million from all of its family planning services and shift the money to other areas of the budget. This blunt instrument hit all of the state’s women’s health providers, but was meant to target Planned Parenthood and deny it taxpayer dollars—even though the clinics that received state subsidies for care never performed abortions.
This may be in line with their staunch opposition to what they see as a baby-killer, but that ideology comes with quite the price tag. News has surfaced that for the two-year period between 2014 and 2015, poor women are expected to deliver nearly 24,000 babies that they wouldn’t otherwise have had if they had access to state-subsidized birth control. Those extra births will cost taxpayers as much as $273 million, with between $103 million to $108 million of that hitting the state’s general revenue budget alone. Much of the cost comes from caring for those infants through Medicaid.
Lawmakers may not care about what this means for the lives of the low-income women who are now bearing and raising children whose births they would have otherwise prevented had they had access to contraception. But conservatives, the fiscally responsible party, are now thinking twice about the budgetary implications. The New York Times reported last week that “a bipartisan coalition is considering ways to restore some or all of those family planning dollars, as a cost-saving initiative if nothing else.” It’s not like the budget hit should come as a surprise, however. When the cuts were initially debated, an estimate was circulated that they would lead to an extra 284,000 births at a cost of $239 million. Yet the cuts passed, “a price that socially conservative legislators were willing to pay in their referendum on Planned Parenthood,” as the Times reports.
And unfortunately, the ideological battle against Planned Parenthood will not be brought to a complete cease-fire, even in the face of these stark numbers. Planned Parenthood will almost certainly be excluded from any reinstated family planning funding because of an existing ban against taxpayer money going to providers who are “affiliated” with clinics that perform abortions, even if they don’t do so themselves. While there are other women’s health providers in the state, RH Reality Check’s Andrea Grimes set out to find out whether the hundreds of listings on Texas’s website actually provide the services women need. She found that “many of them don’t provide any kind of contraceptive care, don’t take Medicaid Women’s Health Program clients, or are simply misleading duplicate listings.”
And the ones that do offer the right services likely won’t be able to meet the huge increase in demand. Grimes cites a study that found that Planned Parenthood accounted for half of the state’s women’s healthcare, serving nearly 52,000 clients. The remaining providers mostly serve ten or fewer patients. That’s just not going to cut it for all of the women who now need to find care.
Continuing to deny funding to Planned Parenthood will keep costing the state, even if other clinics see their funding reinstated. To the tune of an estimated $5.5 million to $6.6 million as a result of paying for the entire women’s health program on its own, rather than receiving the 90 percent federal matching funds, as well as paying for a higher number of births that will have to be covered by Medicaid funds.
Texas is a huge state, so its case sticks out like a sore thumb. But it’s not the only one to go after family planning services and Planned Parenthood. As the Guttmacher Institute reports, last year some states felt compelled by the federal push to ban federal funds from going to Planned Parenthood to look at whether providers in their states that use private funding for abortion should be barred from receiving state funding or, in some cases, federal Medicaid reimbursements. Currently, six states prohibit some providers from receiving family planning funds and in three the restrictions apply to those that provide abortion or are affiliated with agencies that do.
So conservative lawmakers across the country will now be faced with a choice: save the babies or save the budget. Because it’s clear that you can’t do both. Organizations that provide contraception—and, it must be said, abortions—not only do great service to the women who need to control their fertility and their lives. They do great service to taxpayers. By giving women access to contraception, publicly funded family planning organizations save us $3.74 for every dollar we spend in avoided Medicaid costs associated with unplanned births. Their services saved federal and state governments $5.1 billion in 2008.
As Texas has just found out, those aren’t imaginary numbers. They are very real. Whoever says that contraception and abortion aren’t economic issues should take a second look. They have a huge impact on women’s financial situations. But, perhaps higher on conservatives’ checklist, they have an enormous impact on the budget.
By: Bryce Covert, The Nation, December 10, 2012
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