“Daring The Sick And Needy”: Time to Protest Against Republican Governors For Shameful Threats
Greg Sargent reports on the decision of five Republican governors to screw impoverished and working people out of the health care they are supposed to get from Medicaid under the Affordable Care Act. As Sargent explains:
Iowa governor Terry Branstad has now become the fifth GOP governor to vow that his state will not opt in to the Medicaid expansion in the wake of the Supreme Court ruling. He joins the ranks of Louisiana’s Bobby Jindal, Florida’s Rick Scott, South Carolina’s Nikki Haley, and Wisconsin’s Scott Walker.It’s worth keeping a running tally of how many people could go without insurance that would otherwise be covered under Obamacare if these GOP governors make good on their threat.
The latest rough total: Nearly one and a half million people.
…And counting. Sargent rolls out the breakdown estimates for the five states, with Florida leading the pack with more than 683,000 citizens at risk by Governor Scott’s threat. Sargent adds,
Of course, it’s still unclear whether these governors will go through with their threats. David Dayen and Ed Kilgore have both been making good cases that they will. As Dayen and Kilgore both note, some of these GOP governors are relying on objections to the cost of the program to the states — even though the federal government covers 100% of the program for the first three years and it remains a good deal beyond — to mask ideological reasons for opting out…Dayen rightly notes that the media will probably fail to sufficiently untangle the cover stories these governors are using.
If there is a silver lining behind the shameful threats of the five Republican governors, it is that there is a good chance that their actions will provoke mass demonstrations in at least some of their states, hopefully right in front of the gubernatorial mansions, where possible. And wouldn’t it be justice, if those demonstrations were lead by people with serious health problems, bringing along their oxygen tanks, wheelchairs, dialysis machines and other health care devices, joined by nurses and hospital workers in uniforms for exactly the kind of photo ops these governors don’t want?
Perhaps the key player in mobilizing mass demonstrations against the Republican Medicaid-bashers would be the nurses unions, which did such an outstanding job of making former Governor Schwarzenegger eat crow in CA over staffing ratios in hospitals.
In a way, the five governors are daring sick and needy people to protest against being targeted for health hardships. Given the large numbers of those threatened in these states, it’s an arrogant dare they may regret very soon — as well as on November 6.
By: J. P. Green, Democratic Strategist, July 3, 2012
“Failures Of Spin”: Republicans Really Don’t Give A Crap About The Uninsured
Republican Senate leader Mitch McConnell is ordinarily a spinner of unusual skill. He’s relentlessly focused on his message and doesn’t let any interviewer frame a question in a way he (McConnell) doesn’t like. Which is why it was a little odd to see Fox News’ Chris Wallace catch him without a handy talking point when it came to covering the uninsured. This excerpt is a little long, but you have to see the whole thing:
WALLACE: All right, let’s move on. If voters elect a Republican president and a Republican Senate, your top priority will be, you say, to repeal and replace “Obama-care.” And I want to drill down into that with you. One of the keys to “Obama-care” is that it will extend insurance access to 30 million people who are now uninsured. In your replacement, how would you provide universal coverage?
MCCONNELL: Well, first, let me say the single the best thing we could do for the American health care system is to get rid of “Obama- care,” get rid of that half a trillion dollars in Medicare cuts, get rid of the half a trillion dollars in taxes. In other words, the single biggest step we could take in the direction of improving American health care is to get rid of this monstrosity.
WALLACE: But if I may, sir, you’ve talked about repeal and replace. How would you provide universal coverage?
MCCONNELL: I will get to it in a minute. The first step we need to take is to get rid of what is there, this job-killing proposal that has all of these cuts to existing health care providers. Secondly, we need to go step by step to replace it with more modest reforms. There will not be a 2,700-page Republican alternative. We will not take a meat axe to the American health care system. We will pull out a scalpel and go step by step and make the kinds of more modest changes that would deal with the principal issue which is cost. Things like interstate sales of health insurance. Right now you don’t have competition around the country in the selling of health insurance. That is a mistake. Things like lawsuit reform. Billions and billions of dollars are lost every year by hospitals and doctors in defensive medicine. Those kinds of steps…
WALLACE: But respectfully sir, because we are going to run out of time and I just want to ask, what specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?
MCCONNELL: That is not the issue. The question is, how can you go step by step to improve the American health care system? It is already the finest health care system in the world.
(CROSSTALK)
WALLACE: But you don’t think the 30 million…
MCCONNELL: What our friends on the other…
(CROSSTALK)
WALLACE: You don’t think the 30 million people that were uninsured is an issue?
MCCONNELL: Let me tell you what we are not going to do. We are not going to turn the American health care system into a Western European system. That is exactly what is at the heart of “Obama- care.” They want to have the federal government take over all of American health care.
And there you have it. Obviously, McConnell can’t come out and speak the truth, which is that while there are a few changes Republicans would like to see on health care, not only isn’t it an issue they care very much about, they really don’t give a crap about people who don’t have insurance. Never have, and probably never will. First of all, those just aren’t their people, and second of all, actually helping the uninsured requires things they don’t like, such as expanding Medicaid.
But that doesn’t mean there’s nothing they can say. McConnell ought to know that when asked questions like this, Republicans are supposed to say, “The way you expand coverage to everyone is to increase competition and unleash the free market, not through big government blah blah blah.” That way it looks like you’ve actually responded to the question, even though you haven’t actually said anything. The great thing about conservative talking points is that they can be used almost anywhere, no matter how empty they are. McConnell is seriously off his game.
I stand by my prediction that Republicans are going to stop talking about health care within a few days. They just don’t feel comfortable with the topic.
By: Paul Waldman, Contributing Editor, The American Prospect, July 2, 2012
“The Wingnut Line”: Rick Scott Announces Florida Won’t Take Medicaid Money
It’s not shocking that Rick Scott becomes the first governor to announce officially that his state (Florida) won’t accept the new Medicaid money under the health-care law. In case you’re not up on the deets, it’s the subsidies for poor and working-class people, up to 133 percent above the poverty line, to buy insurance.
Funny. I seem to remember a time when Scott was quite eager to take Medi-CARE money! That wasn’t his. You remember what I’m talking about.
So this is what social programs mean to Scott. As a private-sector businessman, something to steal from. As a public “servant,” something to play political games with. Floridians will die so that he can be first in the wingnut line.
I don’t know the precise number, but in a state that size, surely a couple million people/families who’ll be eligible for care under the new law in 2014–families of four up to $88,000 are eligible for the subsidies–will be denied the chance to buy coverage at subsidized rates because Scott has refused this money. From a policy perspective, this is the next battleground, the pressure point of resistance for the hard-shell ideologues. How many states will really sacrifice billions in federal dollars for the sake of ideology, and how many will do it before the election so they get a gold star from Rove?
Those interested in what we used to call facts may want to read through this nice primer from the Center on Budget and Policy Priorities, which describes the Medicaid transfer from the feds to the states and explains how the federal government will actually be picking up 93 percent of the costs over the next nine years.
As to biggest health-care news of the weekend, the John Roberts switch reported by CBS yesterday, I will have much more to say about that story tomorrow. But watch these Republican governors. If not for the poor people in their states, I say fine, let them refuse it. Saves me money since I live in Maryland and they’re mostly moocher states anyway. It’s just a few more of my tax spare change not going to Mississippi. All right by me.
By: Michael Tomasky, The Daily Beast, July 2, 2012
“Facing The Reality Of Politics”: Will Red State Governors Opt Out Of Medicaid Expansion?
While supporters of Obamacare are cheering the Supreme Court’s ruling upholding the constitutionality of the law, the celebration may
be short-lived as focus begins to shift to the one key aspect of the Affordable Care Act that was limited by the decision – the expansion of Medicaid to bring health insurance to approximately 17 million previously uninsured Americans.
As originally drafted and passed into law, states that failed to adopt the expansion and offer Medicaid coverage to anyone earning less than 133 percent of the Federal Poverty Level risked losing 100 percent of the money they receive from the federal government towards their state run Medicaid programs, even as currently offered.
In the ruling handed down on Thursday, the court held that such a penalty was unconstitutional and that the federal government is not permitted to punish the states in such a manner, leaving it to the states to decide if they want to stand pat with the Medicaid programs they currently operate or accept the expansion —and the federal largesse that comes with it.
Under the law, the federal government will pick up 100 percent of the cost of expansion for three years, 95 percent for the two years that follow and 90 percent of the costs thereafter. The expansion will allow the states to provide the benefit to many more low income Americans without taxing their state budgets at all for three years and then only slightly in the years that follow.
Currently, the federal government picks up the tab for about 55 percent of the costs of a state Medicaid program.
Those governors who are strong objectors to Obamacare will, no doubt, feel a strong ideological urge to reject the expansion and leave things as they are. But is that really going to fly? After all, conscientious objection to Obamacare is one thing but the reality of politics is something else entirely.
So far, there have only been angry ‘rumblings’ from Republican governors like Sam Brownback of Kansas and Bobby Jindal of Louisiana who say they will continue their objection to the ACA by refusing to begin organizing a healthcare exchange in their respective states and wait for the outcome of the November election. Other governors, such as Texas’ Rick Perry, who has refused federal money in the past, are staying a bit quiet on the subject, saying only that they will look into the matter and make a decision at a later time.
While it is to be expected that GOP governors—particularly those who refused to implement the requirements of Obamacare until they heard from the Supreme Court—would engage in a bit of sabre rattling, we can expect few, if any, to be foolish enough to pass up the opportunity to expand their Medicaid programs when Washington is offering such an exception deal for them to do so.
As National Journal’s Ron Brownstein points out, the 26 states that sued to block the Medicaid expansion contain over half of the nation’s unemployed and an even greater percentage of the nation’s uninsured population. Texas—one of the plaintiff states in the healthcare lawsuit—alone accounts for slightly over 6 million of the uninsured, 2 million of whom would gain coverage under the Medicaid expansion.
Additionally, because the federal government picks up virtually all of the costs attached to covering more people through expanded Medicaid, the program represents a massive transfer of money to those red states that tend to have less generous Medicaid programs already in existence. As a result, a state like Texas, with a rather sparse program, is going to get an enormous sum of federal cash where Massachusetts, which already has a generous program, will get very little in federal funding.
Are these red state governors really going to sit by and watch the taxes their citizens pay to the federal government flow to the benefit of their neighboring states as the recalcitrant governors allow their own residents to miss the benefit of that money?
I don’t think so. Ideological opposition is one thing—denying access to health care to voters who could certainly use it when, to do so, would cost the state a relatively tiny amount of money, is just dumb politics.
The pressure will not come only from the voters.
If there is one lobby that is highly supportive of the Medicaid expansion it is the nation’s hospitals. For them, covering millions of low income Americans means dramatically less free medical services being doled out to people who cannot pay. With more of those who have depended on free emergency room care as their sole means of getting health care now eligible to have Medicaid coverage, hospital balance sheets can be expected to look a lot better in the coming years.
Expect lots of huffing and puffing on this topic in the coming days.
Expect GOP governors to continue pressing the case that a Romney victory means saving their states from the further economic distress that these politicians will claim to be the fate of expanded Medicaid.
But remember that this Medicaid expansion is the bargain of the century for each and every state in the union that does not already offer generous Medicaid programs—especially the red states—and that beneath the inevitable bluster, there isn’t a Republican or Democratic governor in the country who doesn’t understand that passing up a sweet deal like this will bring unhappy political results.
My prediction?
Medicaid expansion, as written in the Affordable Care Act, will take place in every single state in the nation, without exception.
By: Rick Ungar, Contributor, Forbes, June 30. 2012
“Tolerating Poor People”: Republicans Explore New Moral Depths On Medicaid
As the lawsuits challenging the Affordable Care Act worked their way up to the Supreme Court, I always found the challenge to the expansion of Medicaid to be the strangest part. Quick context: the program provides insurance for poor people, splitting the cost between the federal government and the states. But the current rules say that each state gets to set its own eligibility standards, which meant that if you live in a state run by Democrats and you’re poor, you can get Medicaid, but if you live in a state run by Republicans, you have to be desperately poor to get Medicaid. For instance, in Mississippi, a family of four has to have a yearly gross income below a princely $9,828 to qualify. Because if a family is living high on the hog with their $10,000 a year, they aren’t really poor, right?
Fortunately, the Affordable Care Act fixed this, by changing Medicaid so that everyone with up to 133 percent of the federal poverty level ($30,657 for a family of four) would qualify. And to make things easier on the states, the bill provided that the federal government would pick up almost all of the tab. The federal government pays 100 percent of the cost of paying for the new enrollees through 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent from then on. In other words, the federal government is saying to states, “Here’s a bunch of free money to insure a whole lot of your citizens, which will make them healthier and more productive.” And almost every state run by Republicans replied, “How dare you do such a thing to us! It’s unconstitutional! We’re suing!”
And unfortunately, the Supreme Court gave them the right to turn down the money, so each state gets to decide whether it wants to accept the expansion. The irony is that this change in Medicaid is much, much more valuable to the states that have been the stingiest with Medicaid up until now. Massachusetts, for instance, already sets Medicaid eligibility at 133 percent of the poverty level, so they get no new money. It’s the Republican states with Scroogian eligibility who will get the most benefit, insuring millions of their citizens at little cost. But they’re the ones who don’t want it.
It’s pretty obvious that many Republicans wish there was no such thing as Medicaid at all. But if they have to tolerate poor people getting health care, they want to make sure as few of those poor people get it as possible. Because after all, if you can take your kids to the doctor whenever they get sick, how are you going to learn that being poor proves how sinful you are?
When this all comes down in 2014, the Republican governors and legislators who choose to opt out of the Medicaid expansion shouldn’t be allowed to claim that it’s a budgetary issue, because it isn’t—it’s free money, as far as their state budgets are concerned. They’re already trying. Here’s Phil Bryant, the governor of Mississippi, saying that the state doesn’t have the money to cover the estimated 330,000 people in the state who would get insurance paid for by the federal government. Here are Republican officials in Florida, where around a million people could get coverage under the Medicaid expansion, pleased as punch that the Court gave them the opportunity to say “No coverage for you!” to those poor Floridians.
So these Republican officials will be saying to their own citizens, “The federal government is offering to give you free health insurance, but we won’t let you have it. Your health is less important than us making a statement about how much we hate the welfare state and how much we hate Barack Obama and everything he touches.” They believe that it’s better for a person to have no insurance at all than to get insurance from the government. That position is morally vile enough in the abstract, but when they’re actually confronted with a choice to make about whether to allow their citizens to have health insurance, some of them are going to say no. I struggle to find words to describe how despicable and cruel that is.
Now, it’s possible that once that money is actually being offered, the states will all say yes. That’s what Nancy Pelosi argued yesterday. But that depends on the Republican leadership of those states actually giving a crap about their poor citizens. Let’s just say we should believe it when we see it.
By; Paul Waldman, Contributing Editor, The American Prospect, June 29, 2012
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