“Obamacare Breaks Through In Louisiana”: How Do You Calculate The Value Of That?
If David Vitter had been elected the governor of Louisiana, I know that this would not be happening:
Department of Health and Hospitals [DHH] will begin the massive task Wednesday (June 1) of enrolling 375,000 people into the state’s expanded Medicaid program. The department’s goal is to get Medicaid insurance cards into the hands of more than half of the people eligible for the program by July 1.
Here’s what happened after Democrat John Bel Edwards won a surprise upset victory and became the Bayou State’s governor, replacing the disastrous Bobby Jindal:
…the U.S. Department of Health and Human Services announced [yesterday] it had approved the state’s plan to use food stamp income eligibility to determine whether people qualify for Medicaid. Louisiana is the first state to receive such an approval through what’s known as a state plan amendment; six other states use a similar method but received approval through a different process that takes much longer to approve.
The approval is “a big deal,” [DHH official, Ruth] Kennedy said, because it will allow Louisiana to speed its enrollment of Medicaid recipients using income data it already has, rather than having to collect new income data from recipients. The food stamp numbers can also be used on an annual basis to reaffirm eligibility, Kennedy said, meaning “we won’t have a large number of people falling off the books.”
U.S. Health and Human Services Secretary Sylvia M. Burwell said that enrollment is “another step in our country’s march toward a health care system that works better for everyone.”
So, because a Democrat was elected governor in Louisiana, an estimated 375,000 people in that state will soon have access to health care that they did not have before and would not have otherwise.
How do you calculate the value of that?
By: Martin Longman, Political Animal Blog, The Washington Monthly, June 1, 2016
“Cleaning Up Another Republican Mess”: Louisiana Ready To Make Big Gains Through Medicaid Expansion
Few states need Medicaid expansion more than Louisiana, which made it all the more difficult to justify former Gov. Bobby Jindal’s (R) refusal to consider the policy. By all appearances, the Republican made a plainly political decision without regard for the state’s needs: Jindal wanted to be president (yes, of the United States), so he took a firm stand against “Obamacare.”
Louisiana’s current governor, Democrat John Bel Edwards, ran on a platform of Medicaid expansion through the Affordable Care Act, won his election fairly easily, and immediately adopted the policy. The Times-Picayune in New Orleans reported yesterday that the governor went directly to the legislature to explain why this was the smart move for Louisiana.
Medicaid expansion is estimated to save Louisiana $677 million over the next five years and more than $1 billion over the next decade, Department of Health and Hospitals officials told Senate Health and Welfare Committee members Monday (April 18).
The cost estimates came after Gov. John Bel Edwards testified before the committee about his decision to expand Medicaid eligibility to about 375,000 people between July 1 and June 30, 2017. DHH officials will make an effort in the coming weeks to educate legislators about the benefits of Medicaid expansion and what they said was misinformation given to the Legislature to justify not expanding Medicaid under former Gov. Bobby Jindal.
“I believe the folks in the prior administration who said we couldn’t afford Medicaid expansion, they took the worst case scenario on every variable,” Edwards told lawmakers in the GOP-led legislature. “If you look at what we’re doing in light of experience in other states … we know we’re going to save money.”
And he knows this because it’s true.
I can appreciate why this may seem a little counter-intuitive. Ordinarily, when state policymakers recommend expanding benefits to struggling families, critics will respond, “We’d like to help, but we can’t afford it and we’re not willing to raise taxes.”
But Medicaid expansion is one of those policies in which states get to do both: participating states receive federal funds to implement the program, while expanding coverage for low-income families who would otherwise go uninsured. At the same time, hospitals’ finances are strengthened as medical facilities see fewer patients who can’t pay their bills.
Since implementation of the Affordable Care Act began, how many states have found Medicaid expansion hurt state budgets? None. Republicans will be quick to argue that someday, maybe, in the future, the fiscal challenges will become more acute, but given pre-ACA reimbursement rates, there’s no reason to believe they’re correct.
It’s exactly why every governor with access to a calculator – including plenty of red-state Republicans – have found the arithmetic undeniable.
As for Louisiana in particular, as we talked about last week, the state really is having an “elections have consequences” moment right now. Gov. Edwards, the region’s only Democratic governor, hasn’t been in office long, but he’s already making strides to clean up the Republican mess he inherited.
By: Steve Benen, The Maddow Blog, April 19, 2016
“Look No Further Than The Governor’s Race In Kentucky”: The Superficiality Of The Republican Commitment To Racial Justice
Last night in Kentucky, Matt Bevin, a Tea Party-aligned Republican who unsuccessfully attempted to unseat Senate Majority Leader Mitch McConnell last year, was elected the state’s second GOP governor since the end of the Civil Rights Movement.
Conservatives are understandably elated. Bevin ran rightward even by Kentucky’s standards. His political career has been forged in the conservative backlash to President Obama, and Bevin supports both federalizing Kentucky’s extremely successful state-based health care exchange, and rescinding the state’s Medicaid expansion, which has brought coverage to over 400,000 poor Kentuckians since 2013. As a candidate for Senate, where his vote would’ve counted, he supported the outright repeal of the Affordable Care Act.
But amid the euphoria over a victorious politician who wants to roll back the tide of social justice, conservatives are also celebrating their own perceived sense of racial enlightenment. Because though Bevin and most of his supporters are white, his running mate, Lieutenant Governor-elect Jenean Hampton, is black.
In Kentucky we see the general scope of Republican minority outreach in microcosm—the touting of a popular black figurehead juxtaposed against an unrelenting pursuit of policies that harm, and are unpopular with, black voters nationally.
The most apt symbol of this conception of racial tolerance is Ben Carson, who climbed out of poverty to become the most renowned black neurosurgeon in the world. He also sits well to the right of the median Republican primary candidate, which helps explain his surge in the polls. Last week, National Review’s Jonah Golberg wrote a column arguing that Carson is “even more authentically African American than Barack Obama, given that Obama’s mother was white and he was raised in part by his white grandparents.”
Goldberg interprets the fact that a person of such authentic blackness is a popular, conservative member of the Republican Party as a matter of deep significance, when in fact it confirms that the right’s commitment to racial justice has a deeply superficial quality. After a predictable backlash to the blackness scale he contrived, Goldberg revised and extended.
“The Democrats, MSNBC, Salon, et al,” he wrote, “are so invested in their narrative that the GOP is a racist cult that they have trouble dealing with the fact that Ben Carson—a black guy—is arguably the front-runner and certainly the most popular figure in the Republican field (and drawing most of his support from precisely the voters the MSNBC crowd is most convinced are the recrudescent racist heart of the conservative movement). Rather than celebrate this huge step forward in racial progress, or at least think about what it really means, they instead ignore it, dismiss it, or attack my ‘racism’ for pointing it out. Well, to Hell with that game.”
This would fatally undermine the liberal critique of racial politics on the right, if liberals argued that Republicans belonged to a segregated party that espoused hatred for minorities no matter their politics. Instead, Goldberg is celebrating tokenism on the scale of a national, ideological movement.
That Carson is black and popular among Republican primary voters is incontrovertible. It’s also largely beside the point. The question of why Carson is popular on the right is complicated, and surely in part related to his aforementioned conservative politics, his religious devotion, and his hypnotically avuncular demeanor. But it is just as surely related to the fact that Carson absolves conservatives of their coarse and patronizing view of black voters and political leaders. Carson attributes his unpopularity with liberals to the notion that he had the temerity to “come off the plantation.”
Needless to say, the fact that Republican voters like a guy who tells them that other black people—the ones who support Democrats—are like plantation slaves doesn’t harm the liberal critique of conservative racial politics at all. Nor does it cancel out or refute the existence of racism.
The Kentucky poor are now in limbo, though their position is tellingly strengthened by the fact that Kentucky is whiter than the median state. Beneficiaries of the Medicaid expansion there are whiter and more geographically dispersed than in other states. The prologue to their story may come from Arkansas, which declined to rescind its version of the Medicaid expansion, even after voters there replaced a retiring Democratic governor with a Republican.
So there is hope. But there’s also peril. What distinguishes Kentucky is that its Medicaid expansion was undertaken unilaterally by outgoing Governor Steve Beshear. Though he softened his position during the general election, Bevin could rescind it on his own, without going to the legislature.
If he declines to do so, conservatives will consider it a great setback in their ongoing campaign against the national wave of Medicaid expansion, a campaign that has done disproportionate harm to low-income black people all over the country. And that says far more about the racial politics of their movement than the fact that Kentucky’s incoming lieutenant governor is black herself.
By: Brian Beutler, Senior Editor at The New Republic, November 4, 2015
“Ideology Standing In The Way”: How To Get Sicker, Die Sooner, And Pay More For It
It is painful that five years after passage of the Affordable Care Act, 19 states still have not taken advantage of its option to expand Medicaid. It becomes more so with each new report on the deeply flawed U.S. health system.
The latest, from the National Academy of Sciences, finds that rich people live about 13 years longer than poor people. The researchers note that consequently, rich people end up getting the lion’s share of Social Security benefits. Such inequity should be attacked at its root. At the very least, we could use available tools to help low-income people get health insurance.
The NAS report is far from the first to highlight problems in our approach and results. The Commonwealth Fund last year examined health systems in 11 western industrialized nations. For the fourth time in a decade, the United States system placed first in cost and last in what it delivers. Our system is less fair, less efficient, makes us less healthy and gives us shorter lives. All that for an average of $8,508 per person, way more than second-place Norway at $5,669. In case you were wondering, Britain’s socialized National Health Service was No. 1 at less than half the U.S. cost.
That information landed just as Allan Detsky published a New Yorker analysis of two 2013 reports on global health systems by the Organization for Economic Cooperation and Development and the National Institutes of Health. The study of the 34 OECD countries found an alarming trend: The United States ranked 20th for life expectancy at birth in 1990 and fell to 27th in 2010. On a measure combining level of health and length of life, we plunged from 14th to 26th.
The NIH report by the federal Institute of Medicine found that Americans fared worse than people in 16 “peer” countries in nine areas: infant mortality, injuries and homicides, teen pregnancy, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability. Why? The authors cite a larger uninsured population than peer countries, worse health habits, more poverty, and more neighborhoods designed to require automobiles.
We have gained a few new tools since some of those studies were done. Some, such as Michelle Obama’s “Let’s Move” initiative and money for electronic medical records in the stimulus law, are nudging us slowly in a better direction. Among the most significant advances are the ACA’s new marketplaces (where individuals can buy insurance regardless of their health status) and the law’s expansion of Medicaid (even though the Supreme Court transformed it into an option that states could take or leave).
The Medicaid expansion is designed for people who make too much to qualify for traditional Medicaid but too little to afford even subsidized private insurance plans. In states that have rejected the expansion, nearly 4 million people are stuck in an absurd coverage gap. That’s even though the federal government is footing the entire bill for the additional enrollees until 2016 and will pay at least 90 percent for them after that.
If we’re already spending a huge amount on health care, why should we sink more into it? It’s a good question — yet we might not have to spend more if we were spending more wisely. We could start by slashing our astonishing medical pricing. It costs more than eight times as much for an MRI here as in Switzerland, a typical example from a study of nine countries released last year by the International Federation of Health Plans. Just this month, The New York Times reported on a 62-year-old drug that went from $13.50 to $750 per tablet overnight.
How can we get a grip on costs? In part by getting a grip on politics. Medicare, overcoming “death panels” alarmism, recently announced it will reimburse doctors for discussing end-of-life choices with patients. That may lead to a decline in expensive, painful and futile treatments. Next, we should lift bans on research into gun violence, the better to reduce shootings and their public health costs.
Ideology is standing in the way on guns, as it is in the 19 states refusing so far to expand Medicaid. The struggles of purple-state Virginia have been among the most epic. Democratic Gov. Terry McAuliffe has been repeatedly thwarted by Republican lawmakers in his push to expand Medicaid. Last year, a disloyal Democratic lawmaker resigned and threw the state Senate into GOP hands. This year Democrats are trying to win back the chamber and, along with it, the slim chance of a Medicaid deal. In the meantime, some 350,000 Virginians are stranded in the coverage gap.
And this, dear readers, is how you get to be last place in the developed world.
By: Jill Lawrence, The National Memo, September 24, 2015
“Saving That ‘Worthless’ Medicaid”: The Idea Of ‘Worthless’ Is Correlated To The Idea Of The Life Of Poor Folks Being ‘Worthless’
As noted earlier today, it’s the 50th anniversary of the enactment of Medicare and Medicaid.
I strongly suspect the former will get more attention, because it’s a non-means tested program with an extremely powerful bipartisan constituency (despite constant GOP efforts to screw over future beneficiaries via a phased-in voucherization or some other way to shift costs to old folks). Everybody’s either on it or going to go on it if they live long enough.
Medicaid’s another matter, of course. It’s means-tested with the states having significant control over eligibility and benefits, which means it involves different sets of people (particularly now that half the states have accepted the ACA’s Medicaid expansion while half haven’t) and significantly different benefits and service delivery models in different states. With the exception of a little-understood long-term care component that pays for nursing home care for people who have disposed of most of their assets, Medicaid is a poor folks program–you know, for those people–which because it is state (and to some extent locally) operated means these poor folks are not necessarily dealing with the friendliest policy-makers, administrators or providers, particularly given Medicaid’s relatively low reimbursement rates.
But to the Republicans who have all pretty much agreed upon a policy of “block-granting” Medicaid, which means dumping the Medicaid population on the states with a fixed (and ultimately declining) sum of money and letting them do whatever they want to do with them, the question about Medicaid isn’t whether its structure and financing are giving the poor the kind of health care the rest of us would want, but instead whether it’s worth anything at all. That’s largely the function of prejudice plus a 2013 study in Oregon of people receiving and not receiving Medicaid benefits which provided some startling-sounding data on how little real benefit Medicaid created. It’s hard to read any conservative discussion of Medicaid and not hear the Oregon study “proved” Medicaid’s worthless.
So that’s why with Medicaid’s fate perhaps hanging in the balance after the upcoming election, three excellent policy writers, Harold Pollack, Bill Gardner and Timothy Just, have written an explanation of the Oregon study that rebuts its invidious use.
[P]erhaps the most important limitation of the study stems from an assumption that many readers would be unlikely to notice. [The Oregon researchers] placed a very low value—$25,000—on a year of additional life for Medicaid beneficiaries. The typical threshold used in health services research is much larger, in recent studies far above $100,000 per additional year of (healthy) life. Yet because the median income of the Oregon study participants was about one-fourth of the median income in the United States, the researchers chose to value an additional life-year at about one-fourth of the usual threshold. This assumption powerfully frames everything that follows in this analysis. After all, if you start out by assuming that Medicaid beneficiaries’ lives are worth very little, you will find that it is not worth spending much money to prolong them.
So the idea of Medicaid being “worthless” is closely correlated with the idea of the life of poor folks being relatively “worthless” (there are defensible reasons for this valuation in the study itself, but not for the way it’s being used by anti-Medicaid ax-grinders) as well. If you don’t share that premise, you shouldn’t share the related conclusion, either.
In any event, progressives should gird up their loins for a fight to save Medicaid in the near future. I’ve thought of myself as a warrior for the continuation of Medicaid ever since I was drawn into the 1981 Reagan Budget fight, wherein the administration suffered a rare defeat in its efforts to “cap” federal Medicaid spending, thus gradually making it a state-financed program. The fight just ahead could be even tougher.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, July 30, 2015
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