Mar 26 2013

Medicaid Expansion: Is there a downside?

Posted by Steve Ross in National Politics, State Politics

Medicaid Expansion, state by state

Since the SCOTUS ruled on Obamacare and Medicaid Expansion last summer, the number one question in the minds of people on both sides of the debate has been, What will Tennessee do?.

While the Governor said no to a state run exchange he has weighing his options on Medicaid expansion for months now. I thought a decision would be made in December, until the deadline was moved once again. According to reports, Gov. Haslam will make a decision this week on the issue.

With cocksure legislators predicting a no and a stated opposition from the Governor about bills seeking to tie his hands, how and what the decision will be is hard to predict.

Red state Governors of states like Arizona, Ohio, and Florida haven’t been able to put ideology over the massive economic impact Medicaid expansion would have on the state. Even Shelby Co. Mayor Mark Luttrell (CA Link), a Republican, albeit a more moderate one, has supported expansion.

Polls show expansion is popular in the state, garnering the support of nearly 60% of respondents.

Study (CA Link), after study, after study after study tout the positive economic impact along with the health benefits for one of the country’s most obese and least healthy states (41 and 39 respectively).

There have been far too many Op-Eds to list all of them in support of expansion (Tennessean link). And even the League of Women Voters and the Tennessee Medical Association (PDF Download) support the idea.

So what’s the rub?

Ideology over Opportunity

The principal issue seems to be ideology, though there are some reasonable sounding points that ignore a big aspect of reality pushed by those opposed to Medicaid expansion.

The primary bill seeking to block expansion, sponsored by Brian Kelsey (R-Germantown) and his former campaign manager, turned State Rep. Jeremy Durham (R-Franklin), is up for a vote in the Senate Commerce and Labor Committee tomorrow. What happens there is anybody’s guess, though it has been deferred three times over the past few weeks.

Kelsey contends he doesn’t believe the Feds will hold up their end of the bargain. There’s some reason for that skepticism. Deep cuts in 2005 and 2010 to the Medicaid system hurt patients. Its understandable, especially considering the gridlock in Washington, that someone would be concerned about bringing in a bunch of people on to the Tenncare (Medicaid in TN) roles, only to be dumped by a intransigent legislative branch in Washington.

That said, Medicaid is on the “Mandatory spending” side of the budget, not the discretionary side. That inoculates it somewhat from the whims and fights of the discretionary budget. That doesn’t mean its bulletproof, but less likely to sway with the winds of passion.

Considering all this, Kelsey’s position is ideology masquerading as sound fiscal policy mixed with a populist style distrust for the government.

What Kelsey doesn’t seem to give any credence to is the opportunity this presents, both for the people who would be receiving coverage, and those who would be gaining employment (through additional staffing and education) to help treat these individuals. Dr. Cyril Chang, Professor of Economics at the University of Memphis, and someone who has been actively involved in healthcare for a very long time estimates that for every $1 of Federal money spent in Tennessee on Medicaid expansion, the state would reap $2.60 in reward. Considering the first three years of the program the Feds are footing the bill, that’s a huge chunk of economic stimulus for the state that’s hard to ignore.

Expansion is immoral? Really?

Another argument offered up by the ultra-conservative Beacon Center of Tennessee is the idea that not only is Medicaid expansion too expensive (its free for 3 years remember) but also, somehow immoral (infographic).

Now I’m not a big fan of infographics for something this complex. The general “dumbing down” nature of the medium just doesn’t make them a good choice for such things. Also, I can only draw stick figures, so that has something to do with it.

But what the Beacon Center’s infographic has done is not only distill information, but also misrepresent it. Seriously, there’s not a single thing in this infographic that isn’t misleading or wrong. Here’s a sample:

1. Tenncare is 27% of the state budget. (Kinda True)
26% of state funds go to Tenncare…or $2.8b. However, the Feds give a 3:1 match on those dollars making the total budget for Tenncare $9b. This additional revenue makes Tenncare over 31% of total State spending. Hard to believe they lowballed it. (Close but no cigar)

2. Employers will dump people meaning more costs for TennCare
The only employers that could do that are ones paying their employees less than 133% of poverty, or about $25,000/yr for a family of 3. FYI, that’s 12 dollars an hour split amon all the earners in the household. So if there are two earners, they’re not working full time (which is not uncommon), making minimum wage, and likely don’t qualify for their employer’s healthcare plan in the first place. (Imaginary problem)

3. Loss of subsidized private insurance for people between 100% and 400% of FPL (poverty).
First, this ignores that people up to 133% would be covered. Second, aside from right wing blogs and other such drivel, I couldn’t find any sourcing on this, except for a CBO study that said about 3m people nationwide would be effected by this, or <.1% of the population. Also, House Democrats have proposed a fix for this problem, if only Speaker Boehner would allow them to present it. (Baby with the bathwater)

There’s a whole lot more wrong with the infographic. But since I have other things to do today, I’ll leave it at that. For a policy research center, seems like a lot of research isn’t being done.

Fail forward fellows. I’m sure your Koch overlords are proud of you.

There isn’t a real downside, only an ideological/partisain one

There’s no way to cover the ins and outs of TennCare expansion in a 1000 word post. That’s why I linked all the things I did…so you can see for yourself. But here’s the key takeaway that I think is really important:

• Between 330,000 and 450,000 additional people would be covered (5% to 7% of the state population)
• An additional $10.5b in direct money to the state in the first five years.
• That money doesn’t get spent and stop. At $2.60 per dollar spent, total impact would reach as high as $27b in the first five years.
• More than 10,000 good paying, skilled jobs.
• We’ll have to educate those 10,000 new workers, increasing our post-high school education numbers and enrollment in institutions of higher learning.
• A huge drop in uncompensated care, saving the state up to $1.6b in the first five years.
• Less uncompensated care means hospitals all over the state will be more economically viable, especially in rural areas where they are struggling.

So here’s to hoping the Governor does the right thing and chooses to help working poor families get some healthcare coverage. At this point, it can’t hurt us. And with the increased productivity from a healthier populace, and the decline in medical bankruptcies from a reported 62% in 2009, we’ll all feel a little fiscally, and physically healthier.

Jan 27 2010


Posted by Steve Ross in State Politics

In an article in the Chattanooga Times Free Press, Governor Phil Bredesen is quoted about the current healthcare debate in Congress and President Obama’s reported decision to shift priorities to job creation:

“I think it had gotten a little off track, with the public being very, very concerned about the economy and jobs and the prospect of losing jobs, and the Congress off designing health reform to take place in the latter part of the next decade,”

This is relatively unsurprising considering the Governor’s past as a health insurance executive and his previous statements regarding the bills currently before Congress.

What is surprising is that the Governor, a Democrat, would find something positive in the Senate’s recent loss of a Democratic super-majority. I don’t care how “liberal” a Republican Scott Brown claims to be, it’s not a “good thing” for the party or the millions of people who are both currently without healthcare, or those who are in danger of losing their healthcare.

What I don’t get is why Governor Bredesen doesn’t see the imapct that Healthcare has on the job market or the economy at large. GM’s bankruptcy was due, in large part, to the weight of decisions about providing healthcare for it’s employees that were made decades ago, when insurance was a much smaller part of the economy.

In 2006, heathcare consumed 16% of the nation’s economic output. That’s a huge segment of the economy, and the costs effect the availability of jobs negatively. Even though employers have been shifting much of the burden on employees, most can ill afford the rising costs that are outpacing inflation at an alarming rate.

By focusing on healthcare, the Congress and President Obama WERE focusing on the economy and jobs. In fact, they were focusing on one of the most out of control parts of the economy.

Think about it like this. Few would argue that we live in a global economy. Most industrialized nations have some sort of national healthcare strategy. If we are to COMPETE on a global scale, we cannot expect our businesses to carry the load of out of control healthcare costs.

Both the House and Senate bills have a means to control costs, though in very different ways.

To be honest, I don’t give a DAMN which one gets passed, but it is critical that something get passed to slow down the rising cost of healthcare now. Not only for the health and welfare of our people, but also for the health and welfare of our economy.

That Phil Bredesen doesn’t see this just baffles me.

As Rep. Jeanne Richardson (D-89, Memphis) noted:

“I think the Democrats need to do whatever they need to get health care reform passed. Period. The end,” she said.

Rep. Richardson said having the U.S. House pass the U.S. Senate bill is “the right thing to do. I mean, look, this state is cutting quadriplegics out of TennCare.”

Maybe it’s not so baffling. Any administration that can propose to cut quadriplegics off TennCare, and any legislative body that thinks that’s ok, obviously has some kind of serious problem.

I guess they just don’t get it. From the looks of it, they never will.

Aug 18 2009

What’s the DANG Message?

Posted by Steve Ross in National Politics, Policy

John Stewart nails it…as usual

The Daily Show With Jon Stewart Mon – Thurs 11p / 10c
Heal or No Heal – Medicine Brawl
Daily Show
Full Episodes
Political Humor Spinal Tap Performance
Aug 17 2009

Death Paneling

Posted by Steve Ross in activism, National Politics

I know this whole “death panel” thing has been going on for weeks now, but I’ve gotten to the point where I want to slap someone every time I hear them talk about Government pulling the plug on granny because she’s too expensive. Ugh.

We already have death panels, they’re called INSURANCE COMPANIES.

As The Memphis Liberal points out the Supreme Court has ruled that

Inducement to ration care is the very point of any HMO scheme.

The argument on the right is that you can sue an insurance company. Perhaps, but you’re still dead if you don’t get the treatment you need because some corporation hedged their bets.

It’s not like it’s ever happened before or anything.

Oh, and how does a lawsuit play with conservative notions that tort reform will magically fix what’s driving up the cost of healthcare. Come on people be consistent.

Nope, the reality is we’re talking about two different cultures. One that believes corporations are going to do what’s right for people and that the government can’t do ANYTHING right, and one that believes government’s role is to provide an equitable foundation for all Americans and that corporations are more interested in protecting shareholders than doing right by regular folks.

Which one sounds more realistic?

Seriously, conservatives have been working for 30 years to protect shareholders and corporations far more than help regular Americans. Their perspective is that if the corporation benefits, somehow so does everyone else. From the union busting that the Reagan Admin. engaged in, to trade deals that have sent American jobs hither and fro, with the help of conservative and largely southern Democrats that have served as compliant enablers, the conservative ideology has destroyed America’s manufacturing base and left us in a position where good jobs for regular people are going the way of the dodo. All the while this same “Conservative ideology” is largely responsible for a tenfold increase in the national debt over the past 28 years.

Somehow, this is supposed to provide a better quality of life for all us little people. But aside from making really affordable “cheap plastic crap” made in places most people couldn’t find on a map, the only real benefit has been the availability of second rate goods to people who used to make a first rate version of the same thing.

So when we apply this ideological difference to the healthcare “debate”, if that’s what you want to call it, you have some people talking about healthcare, and others talking about something else entirely. Sobeale hit on this back in June when talking about the difference between the left and the right on the healthcare debate.

Progressives want to give everyone healthcare. The other side wants to give everyone health insurance.

Healthcare. That’s what I’m talking about, not insurance. Insurance is the ONLY thing in the world you buy and pray you don’t have to use. Healthcare is something EVERYONE NEEDS, but that a growing minority of working Americans DON’T HAVE ACCESS TO. Sure, they can go to the doctor or the hospital, but if it’s something serious, they’ll likely go bankrupt. That’s the reality, and 50% of the people who go bankrupt every year are in that situation.

So now that the Healthcare industry has dumped some $130m since April into putting the kibosh on any plan that includes a “public option” by stirring irrational fears and mobilizing a vocal but largely uninformed group of people to disrupt anything and everything that might further the “public option”. The debate has shifted from providing healthcare to all Americans to providing Americans with insurance, something they don’t want to have to use.

This is just plain madness.

The right wing reactionaries that show up in force at Town Hall meetings across this nation are grounded in the same ideology that has helped bankrupt this county and millions of it’s citizens. They are not there to debate, they are there to debase the process, to incite fear, and ultimately, deny you a right to affordable treatment when you need it most.

This is not the huge movement that the media would play it up to be. They are not taking to the streets demanding that things stay the same. They are a couple of hundred people per district, out of some 600,000+ constituents, mobilized to make a good show of strength for a very short period of time. It’s media manipulation at it’s worst, and the media is playing the role of compliant enabler, just like those conservative Democrats who are paralyzed with fear anytime someone proposes a change that they might have to defend.

It’s time for US to take to the streets and demand REAL healthcare reform that includes a “public option”. It’s time for us to show our strength. We’re running out of time, and the media “death panel” has written the obituary on meaningful reform, and is just waiting for that last gasp before they run with it.

It’s time to move this forward lest we have to wait another 16 years, or until we reach critical mass.

It’s time.

Aug 08 2009

Cohen Town Hall

Posted by Steve Ross in activism, Memphis, Policy

cth01I just got back from the Town Hall meeting held by Tennessee’s 9th Congressional District Rep. Steve Cohen. I have to tell you, the turnout was pretty impressive. I livetweeted the event under the hashtag #cohen, as did some others at the meeting. Right now twitter search isn’t working too well, probably because of the DOS attack earlier this week, but you can follow me or just read my tweets from the event.

Thankfully, the event didn’t have as much of the hostility that’s been reported at other events, though there were some very vocal dissenters. While they were a bit disruptive, and their outbursts occasionally made it difficult to hear, the meeting went down without any real incident.

I arrived about 20 min. before the event was scheduled to start. At that point, the line was making it’s way around the corner. As we stood, waiting to enter, the line continued to grow. I’m not good at estimating numbers, but I would guess about 400+ people were in attendance.

Luckily I was near the front half of the line and was able to pick a spot upon entering. There were a lot of Seniors in the line and both the Congressional staff, and many of the attendees on both sides of the healthcare issue were cool about making sure those people had seats.

The meeting began about 15 min late, due in large part to the over-capacity crowd. The venue was pretty crowded, as the pictures that follow will show. After the pledge, which was punctuated by a shouted “under God”, and some general instructions by employees at his local office, Cohen began introducing members of his staff to groans from the people there to protest healthcare reform. Cohen brought his DC staff down for a retreat to meet with the local staff, and said he felt it was important that people know who’s working for them in DC as well as here in Memphis. At one point the crowd started getting restless, but was shouted down by a man who stood up and said, “I’m want to hear my Congressman!”, which elicited both applause and groans.

cth10After the introductions, a line of about 8 Doctors formed to talk about healthcare reform. Many expressed concern about the “public option”. Cohen made no attempts to disagree with them or anything, but allowed them each to talk for a few minutes about both the problems and their concerns. This was not scripted or pre-planned. I really think, in the end, it was an effective strategy to keep the opposition off their game, and some good points were raised, though they were difficult to hear and impossible to record due to all the mumbling and grumbling that was a constant at the event.

There were some interesting moments in the Doctor comments section, though they were hard to make out due to the noise in the room, but as I tweeted Cohen held his own for the most part. The anti-reformers interrupted just about anyone who spoke, even people who supported their position. At one point Cohen asked people to “chill”, and later challenged a guy with a ”No Government Healthcare” sign, to which he answered, “I guess you’re against the VA, Medicare and Medicaid”, which brought down the house. Also, one of the doctors noted to the anti-reformers that “yelling lies over and over doesn’t make it true”, and another said, “anger and fear was trumping truth and facts”, which brought an expected response from the anti’s.

cth13Once questions started, it became even more difficult to hear. The questions came from cards, rather than calling on people in the audience, another effective strategy at keeping the meeting orderly. Most of the questions centered around Healthcare, but some touched on Cap and Trade and other issues.

Over time, the anti folks started checking out of the meeting. Many left 30+ min early because they weren’t getting the play they wanted. Of course, the hardcore folks stayed at it, shouting all kinds of things that I can’t even remember at this point. I wish I could remember because it was some of the stupidest crap I’ve ever heard in my life, and I listen to right wing talk radio from time to time to get a laugh or get motivated against their messaging.

In the back of the room, where I was standing, the hyperbole was thick, and there was a lot of passing around right-wing chain emails and such. From that vantage point, I can say that there were more signs in support of reform, or the public option specifically than there were from the anti-reform folks, though theirs were more, shall I say, creative…if that’s what you want to call it.

cth21Cohen did his best to dispel the myths about killing grandma and the “Palin Death Panel”. I don’t think he convinced anyone on the other side, though by the end they were not feeling victorious.

After the meeting most of them just took their signs and grumbled their way out of the hall. Most of the supporters went up to say hi to the Congressman.

I wish I had been able to take better notes, though the livetweet from the phone made my juggling act pretty difficult. All in all it was a successful meeting, despite the attempts to disrupt.

Thanks to all the residents of the 9th District who gave up part of their Saturday to participate, and even those from Arkansas and the surrounding districts, whose intentions may not have been as constructive. It takes all kinds, and I hope that, perhaps some of the misgivings about healthcare reform were quieted…though I doubt it.