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“A Steady Drumbeat”: Republican Governors Buck Party Tenets To Seek Expanded Medicaid

Republican governors are pressing forward to expand Medicaid even after being stymied by lawmakers in their own party.

As the Obama administration vows to help develop plans that will pass muster with conservatives, the governors of Utah and Wyoming said they still want the health care program for the poor broadened. Georgia Gov. Nathan Deal, who declined to act in 2013, may seek a federal waiver to make insurance available to more residents. Louisiana’s Republican legislature also opened a legal door.

Their views challenge party orthodoxy, even if some governors are crafting their own proposals and denying that what they’re doing is expanding Medicaid. Twenty states have refused the expansion under President Barack Obama’s 2009 health care overhaul because of cost and ideological opposition. The resistance is easing as states see a chance to recoup tax dollars and help hospitals get paid for charity care.

“This is about your citizens’ financial and health security, and it’s also about the economic health of your states,” Sylvia Mathews Burwell, U.S. secretary of health and human services, said Saturday at a National Governors Association meeting in West Virginia. “We want to help you design a system.”

This month, Alaska became the 30th state to expand, including 10 with Republican governors, according to the nonprofit Kaiser Family Foundation, a health-research group in Menlo Park, California. Gov. Bill Walker, a first-term independent, used his authority under state law to accept the expansion unless the legislature returns by September 1 and votes it down.

“I did it unilaterally because it was the right thing to do,” Walker said in an interview.

Governors in Tennessee, Utah, and Wyoming lack the ability to act alone, and their Republican-led legislatures declined to adopt expansion this year.

Even so, Utah’s Gary Herbert plans to meet with legislative leaders this week and said he hopes to call a special session in September to pass what he’s calling an alternative to Medicaid expansion.

Herbert’s program also would require a waiver from Medicaid officials for elements designed to appeal to Republicans, such as having applicants get job training.

“I’m optimistic,” Herbert said in an interview. “I think our approach is better than traditional government-assistance Medicaid.”

In Georgia, lawmakers last year blocked the governor from expanding Medicaid without their approval. A provision tucked into this year’s budget, though, allows the state to pursue a waiver.

Wyoming Gov. Matthew Mead called his expansion effort “a colossal failure.” Still, he hopes to bring it back in February’s budget session or in 2017.

“It’s going to take probably some time and continued work by all of us to eventually get to that point,” Mead said.

Tennessee Gov. Bill Haslam, a Republican, said he doesn’t know whether he’ll try next year after failing in February.

While Louisiana Gov. Bobby Jindal, a Republican presidential candidate, has been an adamant opponent, his state still could move, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

Jindal leaves office at year’s end, and Republicans running to replace him have all expressed support for expansion in some form, she said. The legislature has passed a provision requiring hospitals to pay the state’s share of expansion.

“I don’t think we are going to see a super-large number of states moving forward,” Alker said. “But it is a steady drumbeat.”

 

By: Mark Niquette and Margaret Newkirk, The National Memo, July 29, 2015

August 1, 2015 Posted by | Affordable Care Act, Medicaid Expansion, Republican Governors | , , , , , , , , | 1 Comment

“Florida Gov Scott No Help In Time Of Crisis”: When The Going Gets Tough, Rick Scott Heads Straight For The Airport

Florida Gov. Rick Scott removed his Harry Potter invisibility cloak and flew to Washington the other day.

There he begged for billions of federal dollars from a person he is suing, Sylvia Burwell, the secretary of the Health and Human Services Department. Burwell patiently listened to the governor and, predictably, sent him back to Florida with nothing.

Last summer the feds informed Scott that the government was phasing out a fund that reimburses local hospitals for taking care of low-income patients, basically replacing it with an expanded version of Medicaid.

At first Scott was in favor of the Medicaid move, even though it was a tangent of Obamacare. Then the governor changed his mind. Later, as an afterthought, he sued Burwell and the HHS.

The state Senate supports Medicaid expansion; the House doesn’t. Tallahassee has been paralyzed by the dispute.

In a snit, the House packed up and adjourned the session early, leaving Florida with no budget. Leaders in the Senate were furious.

Remember, these are all Republicans, ripping at each other like addled meerkats.

And where was the newly re-elected Republican governor, leader of the party?

Gone, is where he was — jetting to crucial functions such as the grand opening of a Wawa gas and convenience store in Fort Myers and the debut of a humongous Ferris wheel in Orlando.

It’s impossible to imagine any of the fully functioning governors in Florida’s past — Lawton Chiles, Bob Graham, Jeb Bush, to name a few — vanishing from Tallahassee during a Code Red meltdown of the Legislature.

But Scott isn’t a functioning governor. He is the emptiest of empty suits — no talent for leadership, no muscle for compromise, no sense whatsoever of the big picture.

When the going gets tough, Scott heads straight for the airport. This is what happens when you elect a guy with his own private jet.

Last week’s trip to Washington was pure theater. Scott’s lawsuit over the low-income health funds is a loser, and he knows it. He was trying to do something to give the impression he was awake and experiencing cognitive activity.

In fact, he has been laser-focused on the future — not Florida’s future, but his own. He’s looking ahead to a possible bid for the U.S. Senate in 2018.

(We’ll pause here while you choke on your cornflakes.)

It’s astounding but true — while the legislative process disintegrated in bitter confusion, the governor was airing TV commercials cheerily touting his imaginary accomplishments.

Yes, they were short commercials. And, yes, little of what he claimed to have done for Florida had actually happened, lawmakers having already tossed his proposed budget into the metaphorical Dumpster.

There were no tax cuts, no hefty increase in spending for public schools, no big boost for Everglades funding. Yet Scott’s commercials made it sound like a done deal.

Relax, Florida. All is well!

Perhaps that’s how it looks from 38,000 feet, though not from the rotunda of the Capitol.

It’s weird for a politician to openly resume campaigning so soon after being re-elected, but weird is the norm for the Scott administration. Since the law prohibits a third term as governor, he can only be thinking about Bill Nelson’s Senate seat.

This would be a far-fetched scenario almost any place except Florida, where Scott has already proven that, if you’re rich enough, there’s no such thing as baggage.

Currently he remains one of the state’s most unpopular political figures. He won the November election mainly because his opposition was Charlie Crist.

Yet with money from his “Let’s Get To Work” political committee, the governor has begun the uphill task of inventing a positive legacy upon which to run three years from now.

In the TV commercials, he plays the role of a hard-charging, hands-on visionary, leading Floridians to prosperity one new job at a time. He smiles. He talks. He is, briefly, visible.

Tallahassee is one of the cities where Scott showed his commercials, yet it didn’t move the needle. He was on the plane when he should have been on the ground.

While the Legislature didn’t need any help disgracing itself, Scott’s disappearing act made things worse by validating the public’s view of all state government as insular and incompetent.

As the House and Senate prepare to reconvene next month, desperately trying to salvage some credibility, the governor seems content with his role on the sidelines, essentially a cheerleader for himself.

Coming soon to a Wawa near you.

 

By: Carl Hiaasen, Columnist for The Miami Herald; The National Memo, May 11, 2015

May 13, 2015 Posted by | Florida Legislature, Medicaid Expansion, Rick Scott | , , , , , | 4 Comments

“You Don’t Need A Hazmat Suit”: Want To Help Combat Ebola? Get A Flu Shot

On Friday morning, the Obama administration announced that it was appointing Ron Klain, the former chief of staff to Vice President Joe Biden, to become the Ebola “Czar” to oversee all efforts to combat the disease. This isn’t much of a surprise. After all, the president told reporters Thursday night that he would consider making such a move. But there is another, much more subtle message, hidden in this move: Get a flu shot.

When he spoke to reporters Thursday, Obama expressed complete satisfaction with his current team overseeing the Ebola response: Thomas Frieden, the head of the Centers for Disease Control and Prevention, Sylvia Mathews Burwell, the secretary of the Health and Human Services, Homeland Security Advisor Lisa Monaco, and National Security Advisor Susan Rice. But each of those four have other duties as well. Monaco and Rice are both heavily involved in coordinating the airstrikes in Iraq and Syria.

For Frieden and Burwell, their attention will soon be partially diverted to flu season. “We’re going into flu season, which means, by the way, that people should be looking to get their flu shots,” Obama said. “We know that every year tens of thousands of people potentially die of the flu, and a hundred-thousand or more may be actually going to the emergency room and hospitalized because of the flu. So that’s something that Tom [Frieden] also is responsible for.”

As I noted Friday morning, there is no reason to fear Ebola. You don’t need to wear a hazmat suit when you travel. But if you are feeling helpless and want to do something to help combat the disease, get a flu shot. The symptoms for the flufever, nausea, vomitingare very similar to those of Ebola. That means the more people who get the flu this year, the more people are going to panic about potential cases of Ebola, cases that the vast, vast majority of the time will prove false. Reducing the number of people who get the flu will help quell that panic.

And, by the way, the flu killed 50,643 Americans in 2012. That’s another very good reason to get a flu shot.

 

By: Danny Vinik, The New Republic, October 17, 2014

October 18, 2014 Posted by | Communicable Diseases, Ebola, Influenza | , , , , | Leave a comment

“Memo To GOP”: The War Over Big Government Health Care Is Over, And You Lost

The federal government has released new data on Medicaid enrollment showing that with the implementation of the Affordable Care Act, six million Americans were added to the program’s rolls. That’s six million low-income people who now have health coverage, who can see a doctor when they need to and who don’t have to worry about whether an accident or an illness will send them spiraling into utter financial ruin.

The numbers reveal something else, too, something that should horrify conservatives: we’re well on our way to health-care socialism.

Okay, that’s an exaggeration. But only a slight one. And at a time when the press is realizing that Republicans are losing their taste for anti-Obamacare bloviating (more on that in a moment), it shows that Bill Kristol’s nightmare has nearly come true.

Back in 1993, Kristol wrote Republicans an enormously influential memo advising that the best approach to Bill Clinton’s health reform plan was not to do everything they could to kill it outright. If any plan managed to pass, he warned, “it will re-legitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.”

Now let’s look at where we are today. Prior to ACA implementation, there were just under 59 million people enrolled in Medicaid and CHIP, the program that covers poor children. States that accepted the ACA’s expansion of Medicaid signed up a total of 5.2 million new people. The states that rejected the expansion signed up an additional 800,000; these are “woodwork” enrollees, people who were already eligible under their state’s (often absurdly restrictive) rules, but came out of the woodwork to sign up because of all the attention to health care. Add them in, and there are now 64 million Americans on Medicaid and CHIP.

On top of that, there are now over 52 million seniors on Medicare. There are another 9 million veterans enrolled in the Veterans Health Service.

That’s a total of 125 million Americans getting their insurance from the federal government (or, in the case of Medicaid, a federal-state program). The current U.S. population is 318 million. That means that 39 percent of us, or just under two out of every five Americans, are recipients of government health insurance.

As a liberal, of course, I believe that’s a good thing, though just how good varies from program to program (I’ve spent enough time fighting with private insurance companies to wish I could be insured by the government). Conservatives, on the other hand, view this as a disaster. What they’ve only partly come to terms with is the fact that it’s going to be almost impossible for them to do anything about it.

It’s true that Republicans appear to have realized that while the ACA remains unpopular, the idea of repealing it is even less popular. Which is why, as the November election approaches, they’ve almost stopped trying to elevate the issue. As Sam Baker points out, Republicans passed on the opportunity to use the confirmation of Sylvia Burwell to be HHS secretary as a forum to relitigate the law, and the bills circulating around the Hill on health care are now more likely to be small-bore fixes. Notes Baker: “Anyone who’s been around Capitol Hill and health care for the past four years can see it — the anti-Obamacare fire just isn’t burning as hot as it used to.”

Beyond that, as this blog has documented, multiple Republican Senate candidates are now mouthing support for Obamacare’s general goals and have essentially been reduced to gibberish when trying to explain their “repeal and replace” stance.

But the story is bigger than all of this. Republicans may have to accept that while we may not have the single-payer system liberals want, government still dominates American health care, and that isn’t going to change.

It isn’t just that Republicans could stage another fifty ACA repeal votes in the House and accomplish just as little as the last 50 repeal votes did. Rather, it’s that even if Republicans took back the White House and both houses of Congress, moving people off their government insurance would be next to impossible.

One of the most important lessons of the last 20 years of health reform is this: people fear change. That’s what the Clinton administration found out when their attempt at reform crashed and burned, in large part because the Clinton plan would have meant a change in coverage for most Americans. The Obama administration took that lesson to heart in creating its plan, which was designed to give coverage to people who lacked it but offer only new protections to those who already had insurance. That was also the reason for the false but endlessly repeated “if you like your insurance, you can keep it” assurances — they knew that if most Americans, particularly those with somewhat-secure employer plans, thought they’d have to endure some kind of change, then they’d once again be gripped by fear.

Any Republican plan to unwind the ACA is going to run headlong into people’s fear of change and be stopped in its tracks. Are you going to push 64 million Medicaid and CHIP recipients off their current insurance and onto private plans? Are you going to move away from employer-provided coverage? Are you going to privatize Medicare?

Perhaps, given the right circumstances, Republicans could overcome that fear. But I wouldn’t bet on them finding a way to do it.

 

By: Paul Waldman, The Plum Line; The Washington Post, June 5, 2014

June 9, 2014 Posted by | Affordable Care Act, Medicaid Expansion | , , , , , , , | 1 Comment

   

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