Just Die- Or Stay Home

Everybody plays the fool, no exception to the rule....

Not all fools (almost all, though) are Trump voters and not all Trump voters are fools.

This applies even to the elderly, some of whom are very well off. But this is inapplicable to those elderly or near-elderly who voted for Donald Trump and are not unusually affluent or who don't have offspring willing and able to care for their parents for many years.

The graph below reflects the 2016 presidential election vote based on exit polls. While 18-29 year olds (19% of the electorate) voted 55%-37% for Clinton over Trump and the 30-44 year olds (25% of the electorate) went for Clinton 50%-42%, 45-64 year olds (40% of those voting) went for Trump, 53%-44% and and individuals 65 and older (15%) voted for Trump 53%-45%.

Overall, the relatively young (18 to 44, 44% of the voters) gave Clinton 53% of their vote and Trump only 39% while the relatively old (45 and up, 56% of those voting) opted for Trump by 52% to 44%.

That's a difference of 22%, which in all likelihood would have been even greater had Trump the opportunity to run against Barack Obama.  Yet, those folks in elder care facilities, who have parents in such facilities, or who are (or fairly soon will be) contemplating the possibility of relocation there, are promised a raw detail in the American Health Care Act as written. Jon Schwarz of The Intercept explains

Many middle-class Americans are unaware that the huge cost of nursing home care – which in some areas can run over $100,000 a year — is not covered by Medicare. Those who need it and cannot pay for it themselves can generally receive coverage from Medicaid, though they usually must spend down all their savings first.

When all is said and done, Medicaid pays the bills for over 60 percent of nursing home residents — people who cannot care for themselves and without Medicaid would have literally nowhere to go.

But the AHCA slashes $880 billion dollars from Medicaid spending over the next ten years, or about one-sixth of the $5 trillion it would otherwise cost the federal government. (While these seem like enormous numbers, the U.S. economy is so big that even $5 trillion will be just about two percent of the gross domestic product over the next decade.)

The bill accomplishes these cuts in part by changing Medicaid from an entitlement, in which the federal government automatically provides states with funding based on the needs of their population, to either a block grant or a per capita allocation (at the state’s choice).

The amount states will receive per capita will be set at the average cost for recipients in 2016. It then will increase at the Consumer Price Index’s rate of medical inflation until 2020, when it will begin going up at the CPI medical rate plus one percent. While this sounds reasonable, it will inevitably have serious consequences over the next 20 years due to the aging of the baby boom generation.

This year someone born in 1950 will turn 67 years old, and probably doesn’t need nursing home care. In 2037 they will turn 87, and will be far more likely to do so.

Nursing care is one big reason Medicaid recipients over 85 cost the program 2.5 times more than those who are between the ages of 65 and 74. If Medicaid were to remain an entitlement, states would automatically receive increased federal funds to cover these greater costs as baby boomers age. Under the AHCA, the per-capita payments to states will increase far too slowly to cover them.

There are many culprits in Trump's victory other than naivete of voters.  Moreover, oldish Americans probably will lead the grass-roots opposition to the AHCA, whether through the AARP or other like-minded organizations, or individually.  Still, this tax cut for the wealthy- uh, er, health care bill- tells us how prescient one ex-congressman was.












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Let 'Em Die

In September, 2009 Representative Alan Grayson of Florida stood on the House floor and maintained

It’s my duty and pride tonight to be able to announce exactly what the Republicans plan to do for health care in America… It’s a very simple plan. Here it is. The Republican health care plan for America: “don’t get sick.” If you have insurance don’t get sick, if you don’t have insurance, don’t get sick; if you’re sick, don’t get sick. Just don’t get sick. … If you do get sick America, the Republican health care plan is this: “die quickly."

Oh, yes- Grayson is a Democrat, which at the time seemed obvious, but perhaps not so now.

Following Grayson's statement (below), House Republicans threatened, but later declined, to "introduce a resolution condemning Grayson for breaching House decorum," according to CNN at the time.







After initially being repulsed by the Representative's truth-telling, Republicans may have decided it wasn't entirely insulting.  When the GOP debate Thursday night in Houston (Houston in song here, here, and here; Trump below) turned to health care, Donald Trump made the obligatory nod to free enterprise and implied criticism of Europe, asserting "I do not want socialized medicine" and denying he ever had suggested health care in the USA should be anything like that in Canada or Scotland.  A portion of  the argument, however, included

CRUZ: Did you say if you want people to die on the streets, if you don’t support socialized health care, you have no heart.

TRUMP: Correct. I will not let people die on the streets if I’m president.

CRUZ: Have you said you’re a liberal on health care?

TRUMP: Excuse me. Let me talk. If people...

CRUZ: Talk away. Explain your plan, please.

TRUMP: If people — my plan is very simple. I will not — we’re going to have private — we are going to have health care, but I will not allow people to die on the sidewalks and the streets of our country if I’m president. You may let it and you may be fine with it...

CRUZ: So does the government pay for everyone’s health care?

TRUMP: ... I’m not fine with it. We are going to take those people...

CRUZ: Yes or no. Just answer the question.

TRUMP: Excuse me. We are going to take those people and those people are going to be serviced by doctors and hospitals. We’re going to make great deals on it, but we’re not going to let them die in the streets.

CRUZ: Who pays for it?

RUBIO: Well, can I just clarify something?

BLITZER: Gentleman, please.

RUBIO: Wolf, no. I want to clarify something.

BLITZER: Gentlemen please. I want to move on.

RUBIO: This is a Republican debate, right? Because that attack about letting people die in the streets...

That was unsettling to Marco, who believes Republicans wouldn't care about people dying in the streets. He might be right, too, because Trump's references to not letting people die under those circumstances were among the few statements last night which got no applause or whoops of support. They did, though, make it easier for Rubio to complain that the front-runner had repeated himself four times.

The real problem, of course, was not in the repetition but in what was being repeated. Part of that was Trump implying that we should stick to conservative principles but only up to a point where individuals actually would perish in front of us.

For Marco Rubio (and Ted Cruz), that point hasn't been reached and apparently never would be.  All of that either makes Alan Grayson insightful, psychic, or just one to state the obvious.














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His Legacy Awaits, Potentially

Representative Gerry Connolly of Virginia seems to be leading the charge of the pro-corporate New Democrat Coalition for fast-track authority for the Trans-Pacific Partnership and the less controversial Transatlantic Trade and Investment Partnership (TTIP or Trans-Atlantic Free Trade Agreement/TAFTA). He warns  "This is President Barack Obama’s trade deal, and we shouldn’t allow Democrats to forget that.”

Fortunately for Connolly/Obama and  unfortunately for the country, the Republican caucus, which supplied in the entire Congress zero(0) votes for the Affordable Care Act, generally has forgotten that the TPP is President Barack Obama's trade deal.  At least 172 of 245 House Repubs ar expected to vote for the deal.

No more than twenty Democrats in the House will be supporting the President's effort to obtain authority for an up-and-down vote, with no amendments allowed, in Congress for the TPP. It is clear, as it always has been, that Representative Alan Grayson will be among the majority in his Party. In the video below, among his arguments is the TPP and the TAFTA

would put our $30/hour workers directly in head-to-head competition with workers in Vietnam and Brunei, who are lucky to make 30 cents an hour. 

"Free trade" countries like that are free of health and safety rules and environmental protection, free of social security, pensions and health care, free of child labor laws, free of the right to organize, and even free of the rules against slave labor.






Charles Pierce describes the TPP as "the job-wrecking locomotive coming down the track to which the American middle class is tied."  Long-lasting and irreversible, the damage to the country nonetheless would be gradual, which might be the only factor preventing it from being President Obama's dominant legacy, exceeding that of even the Affordable Care Act. Sticking a shiv into the middle class- heckuva job, Barack.

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Die Quickly, Or At Least Get Lost

They were all over Alan Grayson.  In September, 2009,  U.S. Representative Alan Grayson said (video immediately below the quote) on the House floor

It’s my duty and pride tonight to be able to announce exactly what the Republicans plan to do for health care in America… It’s a very simple plan. Here it is. The Republican health care plan for America: “don’t get sick.” If you have insurance don’t get sick, if you don’t have insurance, don’t get sick; if you’re sick, don’t get sick. Just don’t get sick. … If you do get sick America, the Republican health care plan is this: “die quickly.”





Righteous outrage erupted.  Typical were the reactions of two Tennessee Republicans. Jimmy Duncan charged "That is about the most mean-spirited partisan statement that I've ever heard made on this floor and I, for one, don't appreciate it."  Marsha Blackburn maintained "It's fully appropriate that the gentleman return to the floor and apologize."

Republicans and members of the media were aghast but Grayson did not apologize and, after being defeated in 2010, was returned two years later by voters in his district.   And he still is unapologetic.  In an appearance with John Fugelsang (picked up by Susie Madrak) on Current TV, he noted "As I pointed out three years ago, their health care plan is: 'Don't get sick. And if you do get sick, die quickly.'"

Grayson pointed that the GOP response to periodic massacres and extreme, extraordinary weather events (e.g., Hurricane Sandy) is similar to that of the health care needs of Americans.    And he probably didn't even know about Kathryn Playford (hat tip to Hullabaloo's Digby):

Working full time and yet not being able to afford health insurance coverage literally sticks in Kathryn Playford’s throat.

The office manager for a self-storage facility and office park in North Augusta says she has put off surgery for an enlarged thyroid for years because she lacks health care coverage.

“Eventually, it may enlarge to the point where I can’t breathe,” Playford said.

The governors of Georgia and South Carolina have decided not to expand Medicaid coverage to more uninsured despite high rates of working families with no coverage.

In South Carolina, nearly half of the 766,304 uninsured, or 359,107, are working and 19.3 percent of people employed in the state lack insurance, according to the U.S. Census Bureau’s American Community Survey 2011.

In Georgia, 22.7 percent of the employed lack health insurance, and working families make up 48.3 percent of the uninsured.

The states turned down the expansion under the Affordable Care Act despite the fact that it would be fully funded for the first three years and would not dip below 90 percent federally funded in subsequent years.

In Georgia, the expansion would offer Medicaid coverage for individuals making nearly $16,000 a year and for families of four making around $32,000 a year. Within that adult population, 50.6 percent are uninsured, according to Census data.

“I would argue that those are the people that are really getting the burden of the state not investing more of its state dollars” in Medicaid, said Tim Sweeney, the director of health policy for the Georgia Budget and Policy Institute.

Advocates in a coalition called Cover Georgia will gather Tuesday at the state Capitol to rally for the state to reconsider Medicaid expansion.

Georgia Gov. Nathan Deal has said the state cannot afford it and that the federal government might not be able to continue funding it in the future.

It's not only Kathryn Playford, and it's not only Georgia and South Carolina.  In all, according to the map below, 13 states have decided not to participate in Medicaid expansion and four states (including New Jersey under the leadership of media darling Christopher J. Christie) are leaning against participating.

At worst, a few years down the road, states which extend health care to additional poor individuals will have to put up one (1) dollar for every nine (9) donated by the federal government.  Alan Grayson was- and is- right, though with a twist.  The states which reject expansion (most dominated by the G.O.P.) are adopting their own program:  "don't get sick- and if you do, don't bother us."

Via: The Advisory Board Company

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Irresponsible, Not Insane



You might think they're crazy or at least hopelessly foolish.  But they're not.

Under terms of the Affordable Care Act, the federal government pays  state governments 100% of the cost through 2017 of expanding Medicaid, with the percentage dropping to 90% in 2020.

Chief Justice Roberts deserves much of the blame for the resistance remaining to Medicaid expansion of many of the 26 states which filed suit against the PPACA.     He ruled that Congress could not deny full Medicaid funding to states choosing not to expand coverage, but only funding for the additional individuals added to the program under the Act.

No doubt some Repub legislators and chief executives fear that, with a growing national debt, the federal government would not follow through with its promise of future funding.    But they know that Democrats would continue the funding.   It is only the members of Congress belonging to their own GOP who would plausibly put at risk the nearly 100% subsidy for the needy citizens of their states.    An analogous situation exists with the effort to expand job opportunities for Americans in need of employment is demonstrative.   Think Progress found

This trend of public job depletion puts the Republican jobs agenda in stark contrast with the administration’s approach. President Obama’s American Jobs Act would not only add 1.9 million jobs next year, but makes targeted investments to arrest the trend in layoffs. The plan includes $35 billion in direct state aid infusion that will “prevent up to 280,000 layoffs of teachers, who are — along with cops and firefighters — particularly vulnerable to local government budget shortfalls.”

However, Republicans continue to block Obama’s much-needed plan because, in part, they see public job loss as a positive.

With such a sweet deal being offered the states, it is becoming increasingly clear that a large chunk of the GOP sees health care loss (for poor individuals) as a positive.   A Forbes contributor reasons
  
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.

Ron Pollack, director of Families USA, notes "it would be an act of fiscal malpractice for states to turn this down."   And Ezra Klein, acknowledging the resistance of several legislatures and chief executives nonetheless argues

that won't last forever.  and governors also have to answer to non-Republican voters who don't want their state missing out on billions in federal dollars, and to the hospitals in their state who have to treat uninsured patients that end up in their emergency room,s, and the insured voters who end up paying for their uninsured brethren.

Plus,when they want to flip-flop on the issue,they'll have an easy argument with which to do it:  It's a way to stick it to those blue states that put Obama back in Office.

Hospitals generally support the expansion.   The president and chief executive officer of the Texas Hospital Association explains "without the Medicaid expansion, many will remain uninsured, seeking care in emergency rooms, shifting costs to the privately insured, and increasing uncompensated care to health care providers.     With a strained state budget, it's hard to imagine addressing the uninsured problem in Texas without leveraging federal funds, which will now go to other states that choose to expand their Medicaid program."

Still, the Republican governor of South Carolina, Nikki Haley, now has joined the GOP governors of Louisiana, Florida,, Iowa, Mississippi, and Texas in announcing opposition to acceptance of federal dollars to boost provision of health care services to poor residents.  There will be more.   Digby comments

Here you have the Federal government paying for 100% for the first years and then 90% thereafter and they still won't ake yes for an answer.  So I think we can feel fairly confident at this point that it isn't really about the funding at ll, can't we?  It's about their belief that "those" people who don't "deserve" medical care shouldn't get it.

On the same site, and linking to Digby's commentary, David Atkins adds

It's not just about giving rich people more money.  The modern Republican establishment is most obsessed with enforcing a cosmic law of reward and punishment wherein poor people suffer and die early because they din't pull themselves up by their bootstraps enough to be rich.  It's a matter of principle, and they're more than willing to anger their allies in the hospital, health insurance and pharmaceutical industries to make ti happen.

The Ayn Rand nonsense isn't just rhetorical cover to enrich their already wealthy friends.   These People really believe in it.   They cannot be bargained with and cannot be reasoned with.  Its clear that pity and remorse are off the table, and they don't even fear the retaliation of the electorate.

Republicans (and much of inside Washington) were appalled- appalled!- when California congressman Alan Grayson, during the health care reform debate, had the temerity to declare on the House floor "if you get sick, America, the Republican health care plan is this:  Die quickly."

Health care reform passed, the prescient Grayson was defeated for re-election, the Supreme Court (somewhat) upheld the legislation, and GOP-dominated states are balking  at implementation.    There are factors at work beyond what Heather Digby Parton, David Atkins, and Alan Grayson point out.   When patients continue to flock to emergency rooms whose hospitals must, under terms of the Emergency Medical Treatment and Active Labor Act (EMTALA), continue to treat them without reimbursement, many administrators wil blame "the government."   Many of the patients, lacking Medicaid and receiving inadequate care in emergency rooms, will blame "the government."     And when South Carolina and Texas, among the national leaders in health care, are further stigmatized, residents and voters will blame "the government."

But while GOP politicians are all too pleased to see government continue to be a scapegoat, they are not reluctant to accept credit when they can.     Tuesday, Texas governor Rick Perry sent to HHS Secretary Sebelius a letter in which he declared opposition to both the state health care exchanges and medicaid expansion, arguing "the PPACA would simply enlarge a broken system that is already financially unstable."     The Medicaid provision, he wailed, "would threaten even Texas with financial ruin." Perry concluded  "I look forward to implementation of health care solutions that are right for the people of Texas.  I urge you to support me in that effort."    

That approach is not as cryptic as it appears.   Appearing on Fox News only hours after he sent the letter, the governor stated "If the federal government were serious about working with the states … what they would do is block grant those dollars back to the states."    Rick Perry to American taxpayers:  "Send money.   A lot of it.   I'll decide where it goes and take the credit.   You stink."


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A Noble Idea

Digby noted yesterday that Representative Alan Grayson (D-Fl) has introuduced a bill which would enable everyone in the country to buy into Medicare. Grayson (video below) cautions It "is not a plan for subsidies. Everyone will have to pay their own costs."

Grayson explains

It takes this enormously valuable public resource called the Medicare provider network and makes it available to all Americans..... yet only one-eighth of the public can use it. The most expensive part (of a health care plan) is to set up a provider network.

This is a good effort, so far, and bolder than President Obama's vision (eventually dropped) of a public option in which no more than ten million individuals were expected to enroll. However, it is not a single-payer program, which would not be "at cost" and fails to establish health care as a right. (Contrary to what Rush Limbaugh pretends to believe, "Obamacare" does not create a right to health care. Not even close.) But the plan would build on an existing framework- Medicare- on which, as Grayson points out, the federal government already has spent an enormous sum in establishing a provider network "from Nome, Alaska to Key West, Florida."

Digby maintains "I'm there. I think every progressive in the land should sign on."

(A)Good and (B)so what?

On July 31, 2009 the Progressive Caucus released the text of a letter addressed to House Democratic leadership in which its 60 signatories pledged

Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates – not negotiated rates – is unacceptable.... We simply cannot vote for such a proposal.

Obviously, their resolve waned, evaporated, dissolved, and eventually disappeared. The House bill contained a weak public option, the Senate bill contained none, and the Senate bill is the one currently in play. If Speaker Pelosi can round up enough votes, the bill passed by the United States Senate will be approved by the House and President Obama will promptly sign it and declare an awesome victory.

Today, Firedoglake's Jane Hamsher provides the statements of 15 House Democrats who had pledged to vote for only a bill which included a public option. Frustrated, she observes

Whatever Barack Obama wants to do will be the farthest left any piece of legislation gets, and if anyone should try to challenge from the left, the unions and the liberal organizations and party blogs would rise up to condemn them and whip them into line — even if it means completely reversing themselves and devolving into total incoherence. And they’ll be rewarded with carve-outs and corporate money and expensive advertising and personal sinecures for playing their role in facilitating the corporate cash pipeline. Because that’s the job of the ever-expanding veal pen: cover Obama’s left flank and shut down progressive opposition.

And it's hardly likely that the White House would actively support such a progressive action. As a blogger on DailyKos (how did something even questioning Barack Obama get past Moulitsas?) noted today in referring to a New York Times piece (partial link here; subscription may be necessary for full article) of last August

Hospital industry lobbyists, speaking on condition of anonymity for fear of alienating the White House, say they negotiated their $155 billion in concessions with Mr. Baucus and the administration in tandem. House staff members were present, including for at least one White House meeting, but their role was peripheral, the lobbyists said.

Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying Medicare rates — generally 80 percent of private sector rates — or controlled by the secretary of health and human services.

"We have an agreement with the White House that I’m very confident will be seen all the way through conference," one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter.

So let's support Mr. Grayson's bill- but understand that it's simply not going to happen.