Luminarias to signify the human impact of Medicaid Expansion at the Capitol on May 16, 2013. Photo courtesy of Progress Missouri.

From Progress Missouri:

Resolute Missourians Illuminate Human Cost of Failure to Expand Medicaid

1,500 luminarias lit at Capitol Thursday night to signify human impact of Medicaid Expansion

Jefferson City – As the General Assembly prepares to finish a legislative session defined by the failure to expand Medicaid for working Missourians, frustrated citizens gathered on the steps of the Capitol to light 1,500 luminarias to represent the lives that would be saved every year if legislators fully expand Medicaid to 138% of the federal poverty level.

“Medicaid Expansion is a moral imperative, and our commitment to this issue will not end with this legislative session,” said Rev. John Bennett of Jefferson City.  “Missourians’ lives are at stake, and we will continue to demand our legislature pass full Medicaid Expansion for our uninsured neighbors and family members.”

“Since our state motto is, ‘The welfare of the people shall be the supreme law,’ shouldn’t we care about the living conditions of our neighbors?” said Rev. Theresa Danieley of St. Louis.”For Christians, I believe the answer is a resounding yes. In Matthew 22, Jesus teaches us that the greatest commandments are to love God and to love our neighbors as ourselves. In the Episcopal Baptismal Covenant, we promise, with God’s help, to love our neighbors as ourselves, to respect the dignity of every human being, and to strive for justice and peace.”

A recent study in the New England Journal of Medicine found full Medicaid Expansion will save thousands of lives for impacted consumers; in Missouri, 15,000 lives would be spared in the first full decade of expansion.

The state of Missouri has an opportunity to expand Medicaid coverage to Missourians making up to 138% of the Federal Poverty Level. Federal funding will cover the costs of this expansion for the first three years and the state of Missouri will never pay for more than 10%. Estimates are that this expansion would allow more than 260,000 uninsured Missourians to gain coverage and create more than 24,000 new jobs in Missouri. However, the state legislature must act to extend this critical coverage to Missouri families.

The public relations disaster continues. A White House petition on the incident:

We petition the Obama Administration to:

remove all Medicare funding from Research Medical Center in Kansas City, MO.

As a direct result of this hospital denying a gay partner to visit his spouse, and allowing blood family’s decisions to over-ride the legal spouse and denying him visitation this institution has thumbed its nose at the Administrations policy enacted in 2011. All Medicare eligibility needs to be removed from this hospital and complete audit of its policies needs to take place. In addition we demand that the Obama Administration reaffirm its commitment to allowing gay spouses visitation privileges even if the sick person’s family objects.

Created: Apr 11, 2013

Issues: Family, Health Care, Human Rights

Signatures needed by May 11, 2013 to reach goal of 100,000 99,087

Total signatures on this petition 913

That was quick.

More teabagger drivel, introduced today in the Missouri House:

HB 995

Declares the federal Patient Protection and Affordable Care Act as unauthorized by the United States Constitution and creates criminal penalties for persons enforcing or attempting to enforce the act

Sponsor: Frederick, Keith (121)

Proposed Effective Date: 8/28/2013

LR Number: 2201L.02I

Last Action: 4/02/2013 – Introduced and Read First Time (H)

Bill String: HB 995

[….]

“…creates criminal penalties for persons enforcing or attempting to enforce the act…”

That’s gonna be some monster court docket.

“…Declares the federal Patient Protection and Affordable Care Act as unauthorized by the United States Constitution…”

Uh, I do believe the United States Supreme Court has already weighed in on this.

Ripley: Did IQs just drop sharply while I was away?

Nope, well before you left.  

Previously:

Three years ago today (March 23, 2013)

Today, via Twitter:

Rep. Vicky Hartzler ‏@RepHartzler 30m

We usually celebrate bdays but today’s 3rd Birthday of the “Affordable” Care Act isn’t something to celebrate with its higher taxes & costs. 7:49 AM – 23 Mar 13

And, a reply:

Ryan Stevens Ryan Stevens ‏@blogvader

@RepHartzler There are approximately 40 million people in this country who’d disagree with you, now that they can get health care. 8:17 AM – 23 Mar 13

And, some snark:

Michael Bersin ‏@MBersin

@blogvader Yeah, but they’re part of that 47% of takers who are causing irreparable harm to the 1%. We can’t have that in this great nation. 11:07 AM – 23 Mar 13

President Obama’s signature on the Patient Protection and Affordable Care Act.

From the White House:

Affordable Care Act at 3: Looking Forward and Expanding Access

Secretary Kathleen Sebelius

March 22, 2013

11:55 AM EDT

Three years ago, the Affordable Care Act ushered in a new day for health care.

Since then, more than 6.3 million seniors and people with disabilities with Medicare have saved more than $6.1 billion dollars on prescription drugs.  Nearly 71 million Americans got expanded access to preventive service at no charge through their private insurance plans, and 47 million women now have guaranteed access to additional preventive services without cost sharing. More than 3.1 million young adults who were uninsured were able to gain coverage by being able to stay on their parents’ insurance policies until they turned 26.  And parents no longer have to worry about insurers denying coverage to their children because of a pre-existing condition.

Americans are getting more value for their health care dollars due to the health care law. Affordable Care Act initiatives are promoting coordinated care; paying for quality, not quantity; and dramatically reducing fraud and waste, contributing to the slowest growth in national health spending in 50 years.

Consumers also saved $2 billion in 2012, because of programs to review premium rates and to require insurers to provide rebates if they do not spend at least 80 percent of premiums on care, rather than overhead, such as executive pay and marketing.  And the law’s initiatives have extended the life of the Medicare Trust Fund by eight years….

At the Missouri Ethics Commission:

C131014: Continue To Care Committee

Po Box 7181 Committee Type: Campaign

Kansas City Mo 64113

(816) 213-2862 Established Date: 01/25/2013

[….]

Ballot Measures Election Date Subject Support/Oppose

Kansas City Question 1 04/02/2013 Healthcare/City Of Kansas City Support

[….]

Over the last few weeks:

C131014 02/08/2013 CONTINUE TO CARE COMMITTEE The Civic Council of Greater Kansas City 1200 Main, Suite 230 Kansas City MO 64105 2/8/2013 $50,000.00

C131014 02/08/2013 CONTINUE TO CARE COMMITTEE JE Dunn Construction Company 1001 Locust Street Kansas City MO 64106 2/8/2013 $10,000.00

C131014 03/04/2013 CONTINUE TO CARE COMMITTEE Kansas City Free Health Clinic 3515 Broadway Kansas City MO 64111 3/4/2013 $10,000.00

C131014 03/06/2013 CONTINUE TO CARE COMMITTEE Blue cross blue shield of Kansas City Po box 419159 Kansas City MO 64141 3/6/2013 $10,000.00

C131014 03/08/2013 CONTINUE TO CARE COMMITTEE Health Care Foundation of Greater Kansas City 2700 E 18th Suite 220 Kansas City MO 64127 3/8/2013 $120,000.00

C131014 03/21/2013 CONTINUE TO CARE COMMITTEE Northland Health Care Access P.O. Box 14414 Parkville MO 64152 3/21/2013 $10,000.00

C131014 03/21/2013 CONTINUE TO CARE COMMITTEE The Health Alliance of Midamerica 7015 College Blvd, Suite 150 Overland Park KS 66211 3/21/2013 $12,500.00

C131014 03/21/2013 CONTINUE TO CARE COMMITTEE Saint Luke’s Health System 10920 Elm Ave. Kansas City MO 64134 3/21/2013 $10,000.00

C131014 03/22/2013 CONTINUE TO CARE COMMITTEE Truman Medical Centers 7900 Lee’s Summit rd. Kansas City MO 64139 3/22/2013 $20,000.00

[emphasis added]

They’re not waiting for Obamacare to kick in. Why would that be?:

….It is important that Kansas Citians vote yes on Question 1 on April 2 because the cost of NOT renewing the Health Levy would significantly exceed the cost of renewing it. If we don’t renew the levy, patients who are unable to receive needed care will become an additional cost the city has to shoulder. And, private hospitals that aren’t getting paid for providing services to uninsured or underinsured patients will be forced to raise their costs for everyone else. This is not a new tax but a continuation of the existing Health Levy. In short, the Health Levy is a common sense solution to prevent a much larger problem….

Continue to Care

[….]

   On April 2, 2013, Kansas City is asking voters to approve Question 1, which will renew the approximately one-third of Kansas City’s Health Levy that is set to expire next year. It is important to note that the city’s safety net providers are not asking for a new tax, but rather the continuation of an existing levy dedicated to providing basic health care for the underserved.

   The Health Levy is an important investment for the city because it helps offset the costs of uninsured and underinsured patients while keeping health care costs lower for the rest of us. It also helps create stronger, healthier communities.

   Equally important, the Health Levy supports the Kansas City economy by investing in thousands of health care jobs.

   Specifically, Question 1 requests renewal of 22 cents of the current tax levy dedicated to ambulance services, emergency medical services, and hospital and public health purposes for a period of nine years. Funding would support Truman Medical Centers, and non-profit neighborhood health centers, including Northland Health Care Access, Cabot Westside Health Center, Swope Health Services, KC Care Clinic, and Samuel U. Rodgers Health Center.

   An owner of a home assessed at $100,000 pays less than $4.00 per month to help provide essential health care services in our community.

   Last year, this portion of the Health Levy helped pay for more than 140,000 health care visits in Kansas City. One out of every ten Kansas Citians benefited from this levy.

   Question 1 will ensure critical funding for Kansas City’s safety net health care providers; without it the safety net providers simply cannot continue to provide quality care for the residents who need it the most.

       These services included vital mental health services treating serious and persistent mental illness for adults, children and families.

       And, these visits include supporting emergency, inpatient, and prescription assistance for those who would not otherwise have access to the care.

   Some crucial health care programs, such as mammograms, childhood immunizations, nutrition programs that control obesity and early childhood interventions will be discontinued if this portion of the Health Levy is not renewed.

   Safety net providers in Kansas City deliver more than $130 million dollars in uncompensated health care services every year. When voters first approved this levy in 2005, that figure was $56 million for Truman alone. This portion of the Health Levy generates approximately $15 million dollars per year to help cover a portion of those costs. The need has increased significantly since 2005 and the city’s safety net clinics have stepped up to meet that need.

   The Health Levy supports safety net providers that impact our local economy, including:

       More than 8,500 jobs through employing doctors, nurses and other health care professionals

       Millions in capital investments such as the $4 million Cabot Clinic on Kansas City’s Westside

       Hundreds of thousands of dollars and hours invested in outreach to neighborhoods, community centers and businesses to support health in Kansas City

       In addition, Safety Net Clinics pay more than $5 million in earnings tax

It’s the right thing to do.

We received the following from Representative Chris Kelly (D):

Expanded Health Care Coverage in Missouri

By Rep. Chris Kelly

The most important issue facing the next Missouri General Assembly is whether to expand health care coverage for uninsured Missourians who have incomes below 138% of the Federal Poverty Level (FPL).  (FPL equals an income of $23,050 for a family of four.)

The costs and benefits of expansion have been analyzed in three separate studies: one by the Missouri Office of Budget and Planning, one by the Kaiser Foundation, and one by the University of Missouri Medical School in cooperation with Dobson, DaVanzo & Associates.  The MU study is the most conservative, so I will rely upon it.  The projected economic benefits and the number of Missourians covered by the expansion are substantially higher in the other two studies.

The Federal Affordable Care Act (ACA, also known as Obamacare) allows states to expand their medical coverage to 138% of FPL.  The Federal government will pay 100% of the cost through 2016.  That percentage will phase down to 90% in 2020. About 161,000 additional Missourians would receive medical coverage under the expansion.  Absent expansion, those Missourians will continue to live without health insurance.  When they experience health problems, they show up at hospitals and are treated–but the cost of that care is not completely compensated.  We all pay the cost of their treatment. It is redistributed through increases in our health care premiums or absorbed by the hospitals as uncompensated care.  

There is a provision in law whereby hospitals receive money to offset the cost of uncompensated care (called DSH or Disproportionate Share Hospital allotments).  The DSH provision will be substantially reduced.  It has been replaced by the option for states to expand coverage.  That means that Missouri hospitals will lose DSH payments and, if there is no expansion of Medicaid coverage, they will also absorb the cost of treating people with no insurance–a huge financial burden.

Statewide, the cost of decreased DSH payments will be roughly a half billion dollars.  Losses to hospitals resulting from other changes in law will be about $2.6 billion.  On the other hand, if Missouri expands coverage, the State will receive an additional $8.2 billion from the Federal Government in the years between 2014 and 2020.  The state will be required to pay about $333 million, all occurring after 2017.  The economic expansion would include an additional 24,000 new jobs with a payroll of nearly $7 billion and a total impact on Missouri’s economy of more than $16 billion.  Tax revenues to the State would increase by more than $850 million. The tax revenue from the increased jobs and economic activity will generate more than double the cost of expansion.

Viewing the loss of DSH payments at a local level, Christian Hospital in St Louis County will lose about $30M dollars.  The combined losses to Boone Hospital and the University of Missouri in Columbia will be about $28M.  Proportional losses will occur to hospitals in Springfield, Kansas City, St Joseph, Cape Girardeau and Joplin.  The pattern is the same for all larger hospitals.  They will be seriously harmed, but will survive.

Having grown up in a rural community with a small hospital, I wondered what was likely to happen in rural Missouri.  I studied the probable result of expansion of Medicaid verses non-expansion in West Plains, Missouri as an example.

Ozarks Medical Center (OMC) is a 114-bed hospital, serving eleven counties and about 160,000 people.  The closest large hospital is in Springfield, 100 miles away.   OMC will lose about $2,225,000 as a result of the reduction of the DSH provision.  OMC will still be required to treat all who appear at its door.  In the event that those patients do not have insurance, OMC will not be fully compensated for that care. The hospital estimates that cost next year to be approximately $6-8 million.

On the other hand, if the State were to expand Medicaid coverage, more than 9,000 additional people would have medical insurance in the West Plains service area.  In addition to the benefits of medical insurance for those patients, the entire South Central Region will experience an economic benefit.  The Federal contribution in the region is estimated to be $463M.  More than a thousand jobs would be created. The total economic benefit to the region would be almost $800M.  Much of this expansion would occur in Howell County.  More patients mean more pharmacists, more nurses, more physical therapists, etc.

OMC is larger and stronger than some other rural hospitals. As one looks east toward the Bootheel, the situation becomes more troubling.  The hospitals are smaller and their patient populations are poorer.  If Missouri does not expand coverage, Missouri could lose more than a dozen rural hospitals–perhaps as many as twenty-five–a tragedy for rural Missouri.

I recently heard a story that illustrates the importance of these institutions to their communities.  In 2007 a devastating tornado destroyed the entire town of Greensburg, Kansas.   The people had to decide whether to rebuild.  Many said, if the hospital rebuilds, we will too.  Rural hospitals are often the economic nuclei of their communities.  Their loss would in some cases mean that their communities would lose the critical mass necessary to stay economically viable.

There is only one rational conclusion:  Missouri will gain far more than it loses from the expansion of health care coverage.

Opponents of expansion say, “We cannot afford it,” but these claims are simply an expression of opposition to the concept of “Obamacare” without analysis of the actual economic costs and benefits.   Whether one supports or opposes the underlying philosophy of Obamacare, it is the law of the land. Missouri should not undermine the solvency of its own hospitals and decimate the economic lifeblood of many rural communities just for the sake of demonstrating political purity. The Legislature has an obligation to examine what is economically best for the State of Missouri.  We should work together to find a solution we can all live with.

From the actual press release from the junior senator from Kentucky:

“….Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so. The whole thing remains unconstitutional. While the court may have erroneously come to the conclusion that the law is allowable, it certainly does nothing to make this mandate or government takeover of our health care right,” Sen. Paul said….

[emphasis added]

Yes it does, moron.

Marbury v. Madison, 5 U.S. 137 (1803)

….The Constitution vests the whole judicial power of the United States in one Supreme Court, and such inferior courts as Congress shall, from time to time, ordain and establish. This power is expressly extended to all cases arising under the laws of the United States…

….It is emphatically the province and duty of the Judicial Department to say what the law is….

….So, if a law be in opposition to the Constitution, if both the law and the Constitution apply to a particular case, so that the Court must either decide that case conformably to the law, disregarding the Constitution, or conformably to the Constitution, disregarding the law, the Court must determine which of these conflicting rules governs the case. This is of the very essence of judicial duty.

If, then, the Courts are to regard the Constitution, and the Constitution is superior to any ordinary act of the Legislature, the Constitution, and not such ordinary act, must govern the case to which they both apply.

Those, then, who controvert the principle that the Constitution is to be considered in court as a paramount law are reduced to the necessity of maintaining that courts must close their eyes on the Constitution, and see only the law.

This doctrine would subvert the very foundation of all written Constitutions. It would declare that an act which, according to the principles and theory of our government, is entirely void, is yet, in practice, completely obligatory. It would declare that, if the Legislature shall do what is expressly forbidden, such act, notwithstanding the express prohibition, is in reality effectual. It would be giving to the Legislature a practical and real omnipotence with the same breath which professes to restrict their powers within narrow limits. It is prescribing limits, and declaring that those limits may be passed at pleasure.

That it thus reduces to nothing what we have deemed the greatest improvement on political institutions — a written Constitution, would of itself be sufficient, in America where written Constitutions have been viewed with so much reverence, for rejecting the construction. But the peculiar expressions of the Constitution of the United States furnish additional arguments in favour of its rejection.

The judicial power of the United States is extended to all cases arising under the Constitution….

[emphasis added]

Rand Paul is a fucking idiot. We lose to these people?

Representative Emanuel Cleaver (D) released a video on the Supreme Court decision:

Representative Emanuel Cleaver (D): This is certainly a historic day in this country, but not, but not a day to deepen our divisions or throw up our hands and celebrate and say our work is done. For all Americans, Republicans, Democrats, the states and the federal government must continue to work together to make sure healthcare is functional, full, and fair. Because of healthcare, millions and millions of seniors like my ninety year old father are getting free preventive services, children are not being denied coverage, and young adults are covered under their parents’ plan. These are big and important differences helping millions of Americans focus on their jobs and quality of life instead of worrying about what will happen if they and their family members get injured or sick. I know there are many who disagree with this decision. I hear from you. I know that there are many of you, but I pledge to work with and listen to any and everyone who calls. You need information about this unprecedented plan to insure all Americans. And so, if you have questions please don’t hesitate to call my office. I look forward to hearing from you. This is, I repeat, a truly historic day.

Previously: Ask Nixon about Medicare for All (June 27, 2012)

Governor Jay Nixon spoke at Missouri Boys State on the campus of the University of Central Missouri in Warrensburg on Sunday, June 17, 2012. We were there. We heard his speech and the question and answer session that followed. We recorded it.

In today’s St. Louis Post-Dispatch:

Nixon: Health care stance explained at Boys State

JEFFERSON CITY • Gov. Jay Nixon has responded to Republican criticism that his position on the federal health care law has been murky, at best.

But his response still leaves some unanswered questions….

….Nixon’s office followed up by distributing audio of Nixon’s question-and-answer session with youths attending Boys State in Warrensburg — an event that took place earlier this month….

Governor Jay Nixon (D) at Missouri Boys State on the campus of the University of Central Missouri in Warrensburg on June 17, 2012.

And yes, we caught the exchange. We didn’t transcribe it at the time. So, late, here it is:

….Question: […] In your support of Obamacare what outlook do you have for health care professionals [crosstalk]…

Governor Jay Nixon: My support of what?

Question: Obamacare.

Governor Nixon: Where’d you, what, what, what, what kind of fact based? [voices: “Woo.”] I mean, where’d you get that, I, that I support that?

Question: I just assumed you were a Democrat, so. [voices: “Whoa.”]

Governor Nixon: You know, I, it, uh, I lost to a guy in the, in, in tennis from Chillicothe so I’ll assume you’re a good tennis player, too, you know. [laughter]

Um, the, uh, I don’t think that, I don’t think you should have, uh, uh, a, uh, I don’t think you should have the federal law that orders people that they have to buy insurance. I never have supported that. Uh, you know [applause], I, I, [cheers]. So, I’ll give you a second shot. Go ahead, fire away. [laughter]

Question: Okay, so what is your opinion of Obamacare and what do you think the outlook of it will have for health care officials? [crosstalk][inaudible]

Governor Nixon:  Yeah, I do think it’s, I think it comp, I think there’s a couple things. The short run it’s had some, some, some, some, some challenging effects. I mean, I think people’ve kind of frozen up, they’re not sure what’s gonna happen. And when you get, you know, o, a quarter of your economy waiting, you know, to, to, what to do next, what are the rules gonna be, I think, I think it slugs things, that slows things down. I think that’s, I think once the Supreme Court rules that, that, I think then some decisions can begin to be made.

Um, uh, clearly I think that, that some of the insurance reforms are important and needed. I think that ya, parents should have the option to con, to, to have kids on their policies much older. I don’t think you should be able to, just because you get sick an insurance company should say, [unintelligible] now it cost a hundred thousand or two or three hundred thousand we’re cutting off your insurance. I don’t think you should be able to say, uh, that, that you’re just gonna say, if you get cancer that you’re poor the rest of your life, there’s no, even if you pay for insurance for ten or fifteen or twenty years. I think there’s some really solid insurance reforms in there that are important. But I just think the states are much better positioned, because we’re much more, um, close, uh, in as far as what health care needs to be expanded. I think every kid needs to be covered. I mean, I, I, I think that, that, that, that, that while I’m interested in, kids, to say, ’cause this year I had a big fight with the legislature as they tried to cut blind health care. I mean, my golly. Um, you know, it, it’s, so, I think that kids and, and disabled folks, uh, ex, the expansions that, that’ll help them, uh, are important. Uh, I think some of the stuff that, that, that messes with the market, uh, and, and drives too much on the government side is problematic. I wish they had go, had, had gotten rid of a, a prohibition that we currently have as states that makes it impossible for us to bid, for example, for drugs, uh, you know the quantities of drugs. So, I think that, that, uh, uh, I’m not sure what the Supreme Court will do, uh, but it’ll good to get that done and us then get back to what we’re doing before, which is running these programs from the state level, uh, with, with some federal dollars coming in. But I think this, this, uh, uh. I, I think that that level of sweeping reform and, and the, and the, the constitutional principle of saying that the federal government can pass a law saying you have to buy something, I just, maybe it’s just because I’m from Missouri, but I, I don’t, I don’t like that, they, they haven’t done that before. I, I, you know, I, I think we live in a, in a, uh, in a society that should be much more, much more free. And I understand economically why, if you’re gonna sit there theoretically and say you ought to do it that, that, that folks would, would do it. But I just have never supported that. [inaudible][applause]…

“…But I just think the states are much better positioned, because we’re much more, um, close, uh, in as far as what health care needs to be expanded…”

“…this year I had a big fight with the legislature as they tried to cut blind health care. I mean, my golly…”

Game, set, match. If you don’t see the incompatibility of those two statements I’ll spell it out for you. If we have federal health care reform the Missouri General Assembly won’t be able to cut health insurance for blind people. Instead they’ll be better able to use their time erecting bronze busts of right wingnut radio jocks.

As we hear in some Democratic Party circles: “Jay Nixon is the best republican governor we’ve ever had.”

Also previously:

Missouri Boys State 2012 (June 16, 2012)

Attorney General Chris Koster at Missouri Boys State 2012 – Q and A (June 17, 2012)

Governor Jay Nixon (D) and Kansas City Mayor Sly James at Missouri Boys State 2012 (June 18, 2012)

Kansas City Mayor Sly James at Missouri Boys State 2012 (June 18, 2012)

James Carville at Missouri Boys State 2012 – photos (June 19, 2012)

James Carville at Missouri Boys State 2012 (June 19, 2012)