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“A Moral Issue”: Blacks, Latinos To Pay Disproportionate Price Over Blocked Medicaid Expansion

Minorities are disproportionately affected by 25 states’ decision to opt out of Medicaid expansion, a report finds.

Blacks make up 13 percent of the nation’s population but will represent 27 percent of those who will lose out on Medicaid coverage because of these states’ refusal to expand the program’s eligibility to the national standard under Obamacare, according to the 11th Annual Martin Luther King Jr. State of the Dream Report.

Latinos make up 15 percent of the population and 21 percent of the coverage gap. Whites, meanwhile, will be underrepresented—they are 65 percent of the population but have only 47 percent in the gap.

Had the Affordable Care Act been fully implemented, half of the 50 million people who were uninsured before the 2010 law was passed would gain access to coverage through the state and federal health insurance exchanges or the Medicaid expansion. Because of the 2012 Supreme Court decision that ruled states’ expansion of the program optional, 25 states have chosen not to expand Medicaid to include wage earners up to 138 percent of the federal poverty line.

The Medicaid coverage gap will leave out 5 million of the 10 million who would have gained coverage, exacerbating existing racial health disparities in the United States, a focus of Thursday’s report from the equal-rights group United for a Fair Economy.

Poor blacks are 7.3 times—and poor Latinos 5.7 times—as likely as poor whites to live in high-poverty neighborhoods that aggravate health problems. That gap is because of minorities’ limited access to health services and good food, as well as the great stresses from crime and racism, according to the report.

The data also find that 29 percent of Latinos, 19 percent of blacks, 15 percent of Asians, and 11 percent of whites were uninsured in 2012.

Republican governors are leading many of the states that have declined to expand the entitlement program. The federal government has committed to paying 100 percent of the expansion for the first few years, but the governors say they fear the feds will go back on their word, leaving states with unsustainable budget costs.

Other GOP governors have declined to expand the program out of ideological objections to an expansion of the nation’s social safety net.

The report’s authors are frustrated by the blocked expansion.

“With no expanded Medicaid, and little or no assistance to purchase insurance in the health exchanges, the actions of these elected leaders in these states are creating a vast hole in the new health care law—a 25-state coverage gap—through which nearly 5 million low income Americans will now fall,” UFE writes.

“Access to health care is, first and foremost, a moral issue,” the report continues. “It’s a question of right and wrong. Tolerating vast inequalities in health and health care along the lines of race or class sends the disturbing message that we as a society value the lives of people in various groups differently.”

Despite the blocked Medicaid expansion, the Affordable Care Act diminishes the racial health gap by expanding programs to promote diversity in health professions; supports cultural competency training to help doctors communicate with patients of color; and establishes research initiatives to explore the cause of health inequality. It also allows people with preexisting conditions—more common in impoverished neighborhoods due to the quality of life—to gain access to coverage.

But some people who do not have health insurance will continue to live without it. Others will be ineligible because of their immigration status. Still others won’t qualify because of their employment situation. Blacks and Latinos are more likely to work in lower-wage or part-time jobs where they are less likely to receive employer-sponsored coverage.

In addition to the lack of insurance and access to affordable health services, residential segregation and the stress of living in poverty are primary factors contributing to poor health in the black and Latino communities. Those types of communities are commonly found in “food deserts,” or areas of the country where people have little access to a grocery store with fresh produce and instead are surrounded by fast food joints. The report says that half of black neighborhoods lack a full-service grocery.

Among UFE’s recommendations to permanently close the racial health gap are the continued pursuit of a single-payer, universal health insurance system, where employment and work situations would no longer play a role in access, quality, and cost of care. They also, of course, hope to see all 50 states expand Medicaid and take the lead on fully implementing and supporting the Affordable Care Act.

They also propose increasing funding to permanently fund Medicaid at the federal level, heighten funding for outreach and education efforts, and allow undocumented immigrants to take part in the system. More systemic policies—more diverse housing, improved access to services in areas of extreme poverty, raising the minimum wage—would also help address the disparity between the races in overall population health.

By: Clara Ritger, The National Journal, January 16, 2014

January 21, 2014 Posted by | Affordable Care Act, Medicaid Expansion | , , , , , , , | Leave a comment

“Let’s Not Forget Medicare Advantage”: Selective Outrage Over Federal Health Care Costs

Knowing I’ve been both a critic of insurance company practices and a supporter of efforts to reform the industry, a FOX news producer reached out last week to get my take on accusations by conservatives that Obamacare will actually result in a bailout of big insurance companies.

Under the headline, “Bailing Out Health Insurers and Helping Obamacare,” The Weekly Standard on Monday urged Republicans to insist that future debt ceiling increases contain a no-bailout provision. The magazine also cited Sen. Marco Rubio’s, R-Fla., bill to repeal a provision of the Affordable Care Act designed to limit potential initial losses of insurers selling policies on the new health insurance exchanges.

I reminded the FOX producer that Republicans have been supporting — and vigorously defending — a much more expensive transfer of taxpayer dollars to private insurers than the one Obamacare foes are now concerned about.

Here’s the issue:

Lawmakers who drafted the Affordable Care Act knew that insurers would be reluctant to participate in the new health insurance exchanges — also called marketplaces — if the government didn’t create a temporary program to protect them against what’s known in the insurance world as adverse selection.

Insurers were concerned, for good reason, that the first people to sign up for coverage through the exchanges would be folks previously shut out of the insurance market — people who were older and sicker than the population at large. Those people couldn’t afford to buy coverage previously because insurers were able to charge them far more than younger, healthier people.

In many cases, insurers refused to sell coverage at any price to prospective customers with preexisting conditions. That’s a big reason why the number of uninsured Americans had reached nearly 50 million when Congress passed the reform law.

So it wasn’t the least bit surprising that the first few million who have signed up for coverage since the exchanges opened on Oct. 1 skew older than many expected. People who have been denied coverage for years are far more motivated to get insurance — and fast — than anyone else. There is not the same pent up demand among the young and healthy.

In anticipation of this, drafters of the reform law established a $25 billion risk fund to insulate insurers from big losses during the first three years. Although the risk fund has always been in the law, conservative pundits apparently just became aware of it.

Yes, $25 billion is a lot of money, but it is pocket change compared to the enormous amount of taxpayer dollars that have been flowing to private insurance companies for nearly three decades to keep them in the Medicare Advantage program, which has had the unwavering support of Republicans.

Republicans have long supported efforts to privatize Medicare, and the Medicare Advantage program is one of the ways they’ve tried to do it. Medicare Advantage is billed as a private alternative to traditional Medicare. When Americans reach 65, they can enroll in traditional Medicare or in a private plan operated by an insurer. If they opt for a private plan, the federal government still picks up the tab and transfers money to the private insurer every month.

As the U.S. Government Accountability Office explains it, the Centers for Medicare and Medicaid Services (CMS) adjusts the monthly payments it sends to private insurers to account for each beneficiary’s health status. As part of this risk adjustment process, CMS assigns each Medicare Advantage beneficiary a risk score — “a relative measure of expected health care costs,” as the GAO puts it.

We’re talking a lot of money here. In 2012 alone, the GAO calculated that the federal government spent about $135 billion on the Medicare Advantage program. The problem for taxpayers is that, according to the GAO, the government has been more than generous over the years to private insurers, having paid them way more than it should have because of shortcomings in how the risk scores are developed.

Interestingly, but not surprisingly, there was no mention of that, or any reference at all to the Medicare Advantage program, the biggest champion of which are Republicans, in The Weekly Standard’s “bail-out” story last week. If they are sincere in their alarm that Obamacare might reward private insurers with an extra $25 billion between now and the end of 2016, they should be apoplectic about the ongoing bailout known as the Medicare Advantage program.


By: Wendell Potter, The Center for Public Integrity, January 20, 2014

January 21, 2014 Posted by | Affordable Care Act, Conservatives, Health Care Costs | , , , , , , | 6 Comments

“The Breadth Of His Behavior”: Federal Judge Sent Hundreds Of Racist Messages

Last year, U.S. District Chief Judge Richard Cebull, an appointee of George W. Bush, was caught sending a racist email about President Obama from his courthouse chambers. At the time, Cebull, Montana’s chief federal judge for nearly five years, defended himself by saying the message “was not intended by me in any way to become public.”

It wasn’t long before the Judicial Council of the U.S. 9th Circuit Court of Appeals opened a misconduct review, and on Friday, we learned that Cebull kept awfully busy disseminating offensive messages to his personal and professional contacts. The Associated Press reported over the weekend:

A former Montana judge who was investigated for forwarding a racist email involving President Barack Obama sent hundreds of other inappropriate messages from his federal email account, according to the findings of a judicial review panel released Friday.

Former U.S. District Judge Richard Cebull sent emails to personal and professional contacts that showed disdain for blacks, Indians, Hispanics, women, certain religious faiths, liberal political leaders, and some emails contained inappropriate jokes about sexual orientation, the Judicial Council of the 9th U.S. Circuit Court of Appeals found.

Many of the emails also related to pending issues that could have come before Cebull’s court, such as immigration, gun control, civil rights, health care and environmental issues, the council found in its March 15, 2013, order.

In case it’s not obvious, it’s critically important for federal judges to maintain a sense of credibility and impartiality. Once a jurist is exposed as a bigot, he or she can no longer expect to rule from the bench.

In Cebull’s case, the 9th Circuit was not lenient.

The panel issued a public reprimand, instructed that the judge receive no new cases for 180 days, ordered him to complete  new round of judicial training, and told the judge he must issue an apology that acknowledged “the breadth of his behavior.”

Judicial impeachment was ruled out because he was not found to have violated any state or federal laws.

All of this, however, happened 10 months ago. Why didn’t we hear anything until now? Because Cebull resigned the same month as he received the judicial council’s report, making the sanctions moot.

That said, Judge Theodore McKee, the chief judge of the 3rd U.S. Circuit, petitioned the panel, arguing that the judicial council’s work should be made public. The committee agreed.

“The imperative of transparency of the complaint process compels publication of orders finding judicial misconduct,” the national judicial panel wrote in its decision.


By: Steve Benen, The Maddow Blog, January 20, 2014

January 21, 2014 Posted by | Bigotry, Federal Judiciary, Racism | , , , , , , | Leave a comment

“Life Is Tough Enough”: Is Bridgegate Politics As Usual, Or Beyond The Pale?

For those who are not familiar with the story — perhaps that same set of people who in questionnaires do not know where the Mississippi River or the Pacific Ocean is — Governor Chris Christie’s staff created a several-day monstrous traffic jam around the George Washington Bridge last September, apparently to get back at the Democratic mayor of Fort Lee, New Jersey for not supporting the governor for re-election. After denying for months that anything happened, the governor fired everyone he could find, held the world’s longest and most lachrymose press conference, denied all knowledge, said he was “very sad,” and seemed to conclude that he was the victim here. The poor jerks who sat in traffic for several hours apparently didn’t count.

The best and funniest column on this by far was by Gail Collins in The New York Times; I can’t come close to that, so I’ll ask the deep questions.

1. What are the odds that Governor Christie is telling the truth when he says he knew nothing?

Zero, or bagel, as they say in the finance business. I suspect he didn’t order the dirty deed, but this is exactly the kind of stunt political advisors pull when they’re riding high and want to show how tough they are. There would have been lots of smirking around the governor — remember, at the time they would have been quite proud of it — and you would have had to be about as unaware as a tree not to notice. The governor is not known for being unaware.

2. Has there been any kind of pattern that might suggest this sort of behavior was part of the governor’s genotype?

The only way you can say there was no pattern here is if you are a denier of combinatorial probabilities and a lot of introductory math. The Times has specified several incidents which sure look like revenge bullying. If I give the governor a 60 percent probability that each of these events was not part of a pattern (way above my gut feel), there’s still a 92 percent chance that this is all part of a pattern. I’m going with a pattern.

3. Is it surprising that the governor threw everyone on his staff within reach under the bus and denied knowing David Wildstein, a senior staff member and a friend since high school?

Are you kidding me? This is pure “homo politicus” stuff. Take my word on this: There is essentially no one in big-time American politics who wouldn’t gut his or her best friend in an instant for almost any temporary advantage. (The high-school friend matter is almost too easy. No one in the known universe who graduated from an American high school believed any single word, including “a,” “an,” and ” the,” of this story.)

4. Is the actual behavior just life in the big leagues or a touch disturbing?

Certainly this traffic stunt was more inventive than anything I’ve heard before, and I’ve been close to this game since 1970. The other acts were nowhere near as clever but seem to be similar to the traffic stunt in two other big ways: they feel out of proportion, and they targeted civilians, not political pros. They imposed large arbitrary penalties on normal professional people who were simply doing their jobs. But I keep coming back to the folks caught in traffic. Let’s say 500,000 people were caught in the traffic jams for, say, four additional hours each. That’s 2 million traffic jam person-hours. If I value people’s time at $20 per hour, that’s a $40 million cost, all because someone got angry that a Democratic mayor didn’t support a Republican governor who was already winning by a landslide and was simply trying to run up the score. Probably some of the commuters actually lost their jobs because of this.

So ask yourself, if you’re just a citizen, and this guy becomes president with a lot more power and lots more reasons to get angry, how likely are you to be collateral damage in some scheme some other political “advisor” comes up with? I think you have to come down on the “disturbing behavior” side. I know “politics ain’t bean bag,” as Christie said, and if one pol wants to take a whack at another pol, I couldn’t care less. But this crosses a lot of lines.

So back to the question in the title. There’s no way this is normal behavior for normal human beings. Some of it is very normal for “homo politicus,” and for athletes and hedge fund billionaires who feel particularly entitled. But the behavior at the core is way beyond the pale. Life is tough enough without leaders dedicated to getting even at your cost for the tiniest slight or the smallest act of dissent.


By: Bo Cutter, The National Memo, January 20, 2014

January 21, 2014 Posted by | Bridgegate, Chris Christie | , , , , | 1 Comment

“Republicans Lying To Themselves”: Washington Austerity At Its Most Self-Defeating

This morning, the Post has a nice report about methane leaks. A team of researchers toured DC and documented nearly 6,000 natural gas leaks in the city’s decrepit pipe system, including 12 spots where concentrations had built to potentially explosive levels.

What does this have to do with the current obsession with austerity in Washington? Quite a lot, it turns out.

You see, Republicans have been arguing that America needs savage fiscal austerity because we can’t afford to do otherwise. “Let’s be honest…we’re broke,” says John Boehner. This was and is preposterous then and now markets continue to snap up American debt, which is still at historically low interest rates. But this methane study shows the Republican budget-cutting fever at its worst and most self-contradictory. Not granting the money to repair this aging pipe system isn’t just dangerous, it costs us more money. Let me explain why.

The case is obvious when you think about it: shelling out for maintenance now is dramatically cheaper that it is to wait until after the system breaks (and blows the street apart, as the case may be). Put in beloved Republican household accounting terms: suppose a central support beam in your home has cracked, threatening the collapse of the roof. Does it make more sense to nip down to the bank for a quick loan to replace the beam now, or procrastinate and have to build a new house?

It’s even worse when we take the slack economy into account. Borrowing rates are super-low. Construction and raw material costs are cheaper than they will be later if and when the economy picks up. Every wasted day not investing in repairs and upgrades just means more expensive, catastrophic failures.

Make no mistake, this is a terrible problem. Aside from leaky methane in DC, there’s the fact that the average water pipe in this city was installed in 1935, leading to an average of about 450 water main breaks yearly. Here are sinkholes caused by blown water mains in Philly and New York City. Nationwide, for water systems alone there’s an unmet repair bill totaling in the hundreds of billions that is going up steadily, year after year, as our capital stock continues to decay.

What we should be doing is increasing federal infrastructure investments and increasing aid to states and cities, which would allow the country as a whole to start tackling its massive backlog of deferred maintenance needs. If we did this, we’d avoid the expensive emergency repairs that are now the norm for keeping American cities functioning.

That doesn’t even begin to address the need for new investments, like hugely expanded broadband networks, or new higher-speed rail lines, by the way.

In a way, this negligence on infrastructure is just dodgy accounting that would get you thrown out of any halfway decently-run business. A budget process that allows you to claim you’re “saving money” while your critical infrastructure is falling to pieces is just allowing you to lie to yourself.


By: Ryan Cooper, The Plum Line, The Washington Post, January 16, 2014

January 21, 2014 Posted by | Infrastructure, Public Safety | , , , , , | Leave a comment

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