Tag Archives: Medicaid

They get no credit for finally doing what they should have done in the first place

30 Wednesday Jun 2021

Posted by in Missouri General Assembly, Missouri House

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During the latest regular legislative session the right wingnut controlled Missouri General Assembly failed to continue the legislation enabling the previously non-controversial Federal Reimbursement Allowance [FRA] program for Missouri.

There is a looming deadline for legislation to implement the program before it impacts Medicaid and forces cuts in other general revenue funded areas.

Governor Mike Parson (r) called a special session of the General Assembly in an attempt to deal with the mess.

Today in the Missouri House:

House Communications @MOHOUSECOMM
The House has truly agreed to and finally passed SB 1 (Extends the sunset on certain health care provider federal reimbursement allowances and modifies provisions relating to certain family planning health care services) with a vote of 140-13. #moleg
[….]
1:24 PM · Jun 30, 2021

You know, finally doing the right thing.

Now the governor has to sign it.

Previously:

“The buck stops…somewhere over there” (June 22, 2021)

On the mark (June 22, 2021)

Now what? (June 22, 2021)

Denny Hoskins (r): sleeping through school as an aspirational model for life (June 23, 2021)

If you take the health care out of Medicaid, is it still Medicaid? (June 25, 2021)

It’s taking long enough (June 26, 2021)

It’s taking long enough

26 Saturday Jun 2021

Posted by in Healthcare, Missouri General Assembly, Missouri Senate, social media

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During the latest regular legislative session the right wingnut controlled Missouri General Assembly failed to continue the legislation enabling the previously non-controversial Federal Reimbursement Allowance [FRA] program for Missouri.

There is a looming deadline for legislation to implement the program before it impacts Medicaid and forces cuts in other general revenue funded areas.

Governor Mike Parson (r) called a special session of the General Assembly in attempt to deal with the mess. The General Assembly is now in that special session.

John Rizzo (D) [2019 file photo].

Senator John Rizzo (D):

J O H N R I Z Z O @JohnJRizzo
The MO Senate has passed a 3yr FRA. This version has NO LANGUAGE banning birth control & NO LANGUAGE defunding providers. Good work by all involved, especially the Senate Women who removed the list of birth control from the final bill.
1:18 AM · Jun 26, 2021

Early this morning, From the Senate Journal [pdf]:

Journal of the Senate
FIRST REGULAR SESSION
FIRST EXTRA SESSION
FOURTH DAY—SATURDAY, JUNE 26, 2021
[….]
REPORTS OF STANDING COMMITTEES

Senator Hough, Chairman of the Committee on Governmental Accountability and Fiscal Oversight, submitted the following report:

Mr. President: Your Committee on Governmental Accountability and Fiscal Oversight, to which was referred SS No. 3 for SB 1, begs leave to report that it has considered the same and recommends that the bill do pass.

THIRD READING OF SENATE BILLS

SS No. 3 for SB 1, introduced by Senator Hegeman, entitled:

SENATE SUBSTITUTE NO. 3 FOR
SENATE BILL NO. 1

An Act to repeal sections 190.839, 198.439, 208.152, 208.437, 208.480, 338.550, and 633.401, RSMo, and to enact in lieu thereof seven new sections relating to MO HealthNet. Was taken up.

On motion of Senator Hegeman, SS No. 3 for SB 1 was read the 3rd time and passed by the following vote:

YEAS—Senators
Arthur Bean Beck Bernskoetter Brown Cierpiot Crawford
Eigel Eslinger Gannon Hegeman Hough Luetkemeyer May
Mosley O’Laughlin Razer Rehder Riddle Rizzo Roberts
Rowden Schatz Schupp Washington White Wieland Williams—28

NAYS—Senators
Brattin Burlison Koenig Moon Onder—5

Absent—Senators—None
Absent with leave—Senator Hoskins—1
Vacancies—None

The President declared the bill passed.
On motion of Senator Hegeman, title to the bill was agreed to.
Senator Hegeman moved that the vote by which the bill passed be reconsidered.
Senator Rowden moved that motion lay on the table, which motion prevailed.
[….]

Denny Hoskins (r) [2016 file photo].

Previously:

“The buck stops…somewhere over there” (June 22, 2021)

On the mark (June 22, 2021)

Now what? (June 22, 2021)

Denny Hoskins (r): sleeping through school as an aspirational model for life (June 23, 2021)

If you take the health care out of Medicaid, is it still Medicaid? (June 25, 2021)

If you take the health care out of Medicaid, is it still Medicaid?

25 Friday Jun 2021

Posted by in Missouri General Assembly, social media

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Uh, no.

During the latest regular legislative session the right wingnut controlled Missouri General Assembly failed to continue the legislation enabling the previously non-controversial Federal Reimbursement Allowance [FRA] program for Missouri.

There is a looming deadline for legislation to implement the program before it impacts Medicaid and forces cuts in other general revenue funded areas.

Governor Mike Parson (r) called a special session of the General Assembly in attempt to deal with the mess. The General Assembly is now in that special session.

The Red Lily, Anatole France

…For the poor it consists in sustaining and preserving the wealthy in their power and their laziness. The poor must work for this, in presence of the majestic quality of the law which prohibits the wealthy as well as the poor from sleeping under the bridges, from begging in the streets, and from stealing bread…

Representative Mary Elizabeth Coleman (r) [2019 file photo].

Today:

MaryElizabethColeman @meaccoleman
For the record. No one is talking about banning contraception. There is discussion about tax payers NOT buying them. I can’t imagine there is anything the left doesn’t want the government to pay for.
10:26 AM · Jun 25, 2021

Some of the responses:

For the record, you cannot stop the Government from paying for healthcare, including Birth Control. This is all a scam on pro life voters.
Also for the record, birth control, by far, the best way to prevent abortions & is extremely cost effective for the gov’t; saves huge $$.

Birth control is a mandatory medical service under Mo Health net, as funded by Federal Medicaid $$.

What’s next? Republicans decide taxpayers shouldn’t pay for insulin? Blood pressure meds? Where does this stop?

Actually, they want nothing at all.

What’s next is other meds/conditions that only impact women. The goal is to subjugate women. No medical necessary hysterectomies, no mammograms, no Pap smears. Republicans will keep trying to control women.

For the record, it’s just that we understand basic economics: Birth control is cheaper than unplanned kids.

How does “only” banning it for people only on Medicaid make what you’re saying any better?

You want taxpayers to shoulder the burden of lawsuits that will arise when police in our state try to enforce federal gun laws, get sued for it, and then sue the state in return.

Likewise, your contempt for most life is readily apparent in your desire to milk as many pregnancies out of low-income women as possible and then callously ignore the healthcare needs of both them and their babies. Single moms can only make $3000 to qualify for Medicaid as is 1/2

2/2 and you would deny them even that unless your bizarre and unfounded grudge against contraception is made into a law that will never be viable anyway. You are running for State Senate on phony pro-life gesturing.

For the record the issue is the RIGHT trying to remove common medical care coverage in place for decades essentially banning covered contraceptive care & medication used to treat endometriosis. I can’t imagine there’s any reproductive healthcare the RIGHT would willingly pay for.

Every single study shows the countries with the fewest abortions are those that provide taxpayer funded healthcare with a broad range of contraceptive options. You’re anti-abortion? Covering contraceptives & providing great pre-natal care is the way to achieve this.

Meanwhile, we are NOW, because of the obstinance of THE RIGHT, talking about no Medicaid coverage at all. Who does that hurt? Mother’s, children, and you know what? It hurts YOU the taxpayer. Missouri insurance plans go up. Hospital bills go up. Our tax $ doesn’t go as far.

So, Mary Elizabeth, don’t even begin to come at THE LEFT when 89% of all Americans approves of birth control, even Catholics use birth control, and the taxpayers at large are THRILLED to pay this fractional amount to cover this form of healthcare.

Birth control is healthcare. I pay for yours if you choose/need so. And I don’t quibble over what’s covered or not. Same for someone on Medicaid. Every woman deserves that right to make those healthcare decisions.

Mary doesn’t want to share that she and her family want full access to all of these services and privacy to make those decisions but ultimately her goal is to take that right from Missouri women. We see your long game Coleman and we call BS.

Also I can pretty much guarantee that “the left” doesn’t want a single penny of Missouri revenue going to make the state a theocracy

Nice try. When you can’t afford something, you can’t access it. It’s a ban on contraception. Your party needs to stop treating Americans like dumb-dumbs.

This logic she is playing here is absolutely dangerous. Coleman knows better. This logic can be used as to ban other medical options and treatment plans. This is not limited government. This is a violation of people’s freedom to a safe and healthy life.

You’re an embarrassment

For the record you are narrow minded and short sighted.

Previously:

Now what? (June 22, 2021)

Denny Hoskins (r): sleeping through school as an aspirational model for life

23 Wednesday Jun 2021

Posted by in Missouri General Assembly, Missouri Senate

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It’s there. In ink.

The first page of the United States Constitution [1787] – National Archives

The first page of the United States Constitution [1787] – National Archives – detail

[….]
Article. I.
[….]
Section. 2.
The House of Representatives shall be composed of Members chosen every second Year by the People of the several States, and the Electors in each State shall have the Qualifications requisite for Electors of the most numerous Branch of the State Legislature.

No Person shall be a Representative who shall not have attained to the Age of twenty five Years, and been seven Years a Citizen of the United States, and who shall not, when elected, be an Inhabitant of that State in which he shall be chosen.

Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons. The actual Enumeration shall be made within three Years after the first Meeting of the Congress of the United States, and within every subsequent Term of ten Years, in such Manner as they shall by Law direct. The Number of Representatives shall not exceed one for every thirty Thousand, but each State shall have at Least one Representative; and until such enumeration shall be made, the State of New Hampshire shall be entitledFederal to chuse three, Massachusetts eight, Rhode-Island and Providence Plantations one, Connecticut five, New-York six, New Jersey four, Pennsylvania eight, Delaware one, Maryland six, Virginia ten, North Carolina five, South Carolina five, and Georgia three.
[….]

“…Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons…”

Free Persons. Three fifths of all other Persons.

Denny Hoskins (r) [2017 file photo].

“Useless laws weaken the necessary laws.” – Charles-Louis de Secondat, baron de La Brède et de Montesquieu (1689 – 1755)

Today in the legislative special session which is supposed to address the right wingnut controlled Missouri General Assembly failure in the regular session to continue the legislation enabling the previously non-controversial Federal Reimbursement Allowance [FRA] program for Missouri:

FIRST EXTRAORDINARY SESSION
SENATE BILL NO. 5 [pdf]
101ST GENERAL ASSEMBLY
INTRODUCED BY SENATOR HOSKINS.
2833S.01I ADRIANE D. CROUSE, Secretary
AN ACT

To amend chapter 160, RSMo, by adding thereto one new section relating to public school
curriculum and instruction.

Be it enacted by the General Assembly of the State of Missouri, as follows:

1 Section A. Chapter 160, RSMo, is amended by adding thereto
2 one new section, to be known as section 160.2550, to read as
3 follows:

1 160.2550. 1. For the purposes of the provisions of
2 this section, “divisive concepts” shall mean concepts that:
3 (1) One race or sex is inherently superior to another
4 race or sex;
5 (2) The United States is fundamentally racist or
6 sexist;
7 (3) An individual, by virtue of his or her race or
8 sex, is inherently racist, sexist, or oppressive, whether
9 consciously or unconsciously;
10 (4) An individual should be discriminated against or
11 receive adverse treatment solely or partly because of his or
12 her race or sex;
13 (5) Members of one race or sex cannot avoid treating
14 others differently with respect to race or sex;
15 (6) An individual’s moral character is necessarily
16 determined by his or her race or sex;
17 (7) An individual, by virtue of his or her race or
18 sex, bears responsibility for actions committed in the past
19 by other members of the same race or sex;
20 (8) Any individual should feel discomfort, guilt,
21 anguish, or any other form of psychological distress on
22 account of his or her race or sex;
23 (9) Meritocracy or traits such as a hard work ethic
24 are racist or sexist, or were created by a particular race
25 to oppress another race;
26 (10) Promote any form of race or sex stereotyping,
27 including ascribing character traits, values, moral and
28 ethical codes, privileges, status, or beliefs to a race,
29 sex, or an individual because of his or her race or sex; or
30 (11) Promote any form of race or sex scapegoating,
31 including assigning fault, blame, or conscious or
32 unconscious bias to one or more members of a race or sex and
33 including claims that, consciously or unconsciously, any
34 person is inherently racist, sexist, or inclined to oppress
35 others by virtue of their race or sex.
36 2. It shall be the policy of the state board of
37 education not to promote or allow divisive concepts in
38 public school curricula or instruction.

What a pandering ahistorical fool.

Uh, in 1787, at the founding of our nation and in our Constitution there were those who were not “free Persons” who were defined as 3/5 of a person. If that isn’t fundamentally racist, what is?

The Red Lily, Anatole France

…For the poor it consists in sustaining and preserving the wealthy in their power and their laziness. The poor must work for this, in presence of the majestic quality of the law which prohibits the wealthy as well as the poor from sleeping under the bridges, from begging in the streets, and from stealing bread…

Previously:

“The buck stops…somewhere over there” (June 22, 2021)

On the mark (June 22, 2021)

Now what? (June 22, 2021)

Too stupid to remember to breathe (June 23, 2021)

On the mark

22 Tuesday Jun 2021

Posted by in Claire McCaskill, social media

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During the latest regular legislative session the right wingnut controlled Missouri General Assembly failed to continue the legislation enabling the previously non-controversial Federal Reimbursement Allowance [FRA] program for Missouri.

There is a looming deadline for legislation to implement the program before it impacts Medicaid and forces cuts in other general revenue funded areas.

Claire McCaskill (D) [2018 file photo].

Today:

Claire McCaskill @clairecmc
I cannot adequately describe the disfunction & chaos that is MO state govt right now. Refusing people’s will on Medicaid expansion,refusing to re-up pro forma law that also leaves billions of Fed $ on the table,passing unconstitutional backwoods bullshit on guns. So embarrassing.
9:13 AM · Jun 22, 2021

Previously:

“The buck stops…somewhere over there” (June 22, 2021)

“The buck stops…somewhere over there”

22 Tuesday Jun 2021

Posted by in Missouri General Assembly, Missouri Governor, social media

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“…Let me be clear, if FRA is not extended during a special session before July 1, there will be no other opportunity…”

During the latest regular legislative session the right wingnut controlled Missouri General Assembly failed to continue the legislation enabling the previously non-controversial Federal Reimbursement Allowance [FRA] program for Missouri.

From the Missouri Hospital Association:

Federal Reimbursement Allowance (FRA)
Missouri’s Federal Reimbursement Allowance program directly benefits Missouri’s economic and health care infrastructure. This highly successful public/private partnership serves as a model of vision, creativity and cooperation.

In 1991, Missouri’s health care and governmental leaders were facing significant budgetary challenges. In response, the FRA program began as a voluntary program; it was expanded and enacted into law as a provider tax in 1992. Hospitals provide funds to the state, and Missouri’s Medicaid program (now called MO HealthNet) uses these funds to earn federal matching dollars.

The FRA program has evolved to maximize federal matching dollars and reduce the burden of MO HealthNet on state general revenue. The FRA is a major source of revenue to the state, surpassing all but the two largest sources of general revenue. Today, it is a major funding stream for MO HealthNet. This releases traditional general revenue to be used for other state priorities.

There is a looming deadline for legislation to implement the program before it impacts Medicaid and forces cuts in other general revenue funded areas.

But, you know, leadership in Missouri:

Governor Mike Parson (r) [2018 file photo].

Yesterday afternoon:

Governor Mike Parson @GovParsonMO
Today, we are laying out the grim reality our state is facing if the Federal Reimbursement Allowances (FRA) and related programs are not extended. Thread
4:31 PM · Jun 21, 2021

Governor Mike Parson (r) continuing:

The FRA program reduces the burden of MO HealthNet expenses on the state budget and maximizes federal dollars coming to our state AND affects hundreds of thousands of Missourians.

When the General Assembly adjourned regular session back in May, they did so without passing legislation that extended this program. This must be passed as soon as possible or necessary and substantial budget restrictions will need to be made.

This is extremely unfortunate considering we are witnessing general revenue reports that are outpacing projections and an economy that is very strong.

Come July 1, if FRA is not extended, my administration will be forced to make budget restrictions across state government and the consequences would be felt by ALL Missourians.

Without the extension of the FRA and other allowances revenues that are used to balance the budget will simply not exist.

If political maneuvering over extending this program persists, the budget passed in early May will be in direct conflict with our state’s financial reality.

To be clear, this means that we would need to close a nearly $1.4 billion funding gap over the next two years.

Meaning, investments in our state through education, workforce development, and infrastructure would have to be put on hold, and that is frankly unacceptable.

Our investments focus on improving our state and preparing our future generations for tomorrow and without them our state could fall behind.

I know I am not willing to accept that, and I hope that the General Assembly is not either.

We have been transparent with legislators on what restrictions could look like and what is on the line, so it is only right that Missourians know too.

Restrictions and Vetoes will include withholds to…

[….]

Even recent legislative wins we are eager to sign, would effectively be rejected due to the pending budget gap.

My staff & I have had countless conversations with House & Senate Leadership, and they are aware of these harmful consequences if we fail to extend these programs.

For those that want to move the goal post yet again… know that YOU and YOU alone will own this and the devastating effects on Missourians and our economy if the FRA is not extended.

This is a time that demands leadership among legislators.

My office has done all we can, and we are counting on the General Assembly to deliver and protect ALL Missourians.

We will continue to work with House and Senate leadership to come to a solution by noon tomorrow.

Let me be clear, if FRA is not extended during a special session before July 1, there will be no other opportunity.

Time is of the essence. We must get this done!

Some of the responses:

Translation: I am going to cut those things anyway, I just want to place the blame somewhere else.

So pick one dude. Either you want Feds involved or you don’t. So while you all were so pressed about getting HB 85 passed this was going on? Your priorities are loud and clear.

The grim reality is you are blind to the people of Missouri. Your state has the highest number of covid cases, yet you do not address it.

That would take actual leadership.

Maybe consider a thread on Covid in MO and all the out state people who think vaccines are the work of the devil?

“The buck stops.. somewhere over there” – gov parson

Wait, let me get this right, Fed money ok,. Fed Gun laws not ok.

Maybe we should put it to a vote of the people!
Oh, right. Never mind.
#ShowMeCluelessness!

Thank goodness we can fine our police for following federal laws!

There are clear priorities.

Just think about the consequences if the same thing happens to unemployment benefits.

But wait, I thought you don’t think you need the federal government’s laws or direction? Why isn’t Missouri’s budget fine without the federal funds?

“Today, I am laying out the grim reality that my decision to give massive tax breaks to deadbeat corporations will mean screwing over you and your children yet again.”

-Mike Parson

And yet, despite the vote of the people, you are unlawfully holding up Medicaid expansion.
Like most republicans, you want it both ways.

Absolutely a failure of leadership by you and a failure to govern by the the Republican Party.

This is 100% on you and your GOP buddies in legislature.

Hilarious that you tweet about maximizing ‘federal dollars coming to our state’ when 1) you did not expand Medicaid, which would have been a LOT of federal dollars and 2) you just signed a nullification law. You don’t want the federal government but you’ll sure grab their cash!

You are such a ridiculous figure, such a godawful stooge, such an incompetent boob that it’s beyond belief.

You’re a monster, you know that don’t you?

Are we supposed to feel guilty because we the people voted to expand our healthcare and you jerks didn’t do the work to make that happen?

And now you will gut everything else we actually need and actually rely on while playing victim.

The grim reality is that you & your GOP malcontents are killing this state. Literally.

That’s a lot of words for a guy who’s dumb as a bag of hammers. No way you wrote this.
Sincerely, Missouri

Governor Mike Parson (r) [2019 file photo].

Because Medicaid expansion is “too expensive”

28 Monday Oct 2019

Posted by in Missouri General Assembly, Missouri House

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The only difference between men and boys is the price of their toys.

Today:

Panel wants Missouri to apply for first Hyperloop certification track (VIDEO)

Missouri should be first state to apply for to have a high-speed Hyperloop system built within its borders. That’s the recommendation released today from the Special Blue Ribbon Panel on Hyperloop formed by Missouri House Speaker Elijah Haahr (R-Springfield).

The Panel wants Missouri to be first in building a national certification track. It would be the first step toward seeing a Hyperloop connection between Kansas City and St. Louis, offering passengers a trip between the two in less than 30 minutes.

Haahr said the Hyperloop would keep Missouri at the forefront of transportation technology developments and revolutionize the movement of passengers and freight across the state, while opening up the possibility for ultra-fast travel to other locations in the country in the future. It is also projected that it would reduce fatalities in I-70 as well as carbon emissions.

The test track would cost between $300-million and $500-million.
[….]

And when this comes to pass, those of us in the great unwashed will be able to make the same trip by ox cart in three weeks. Or so.

Speaker Elijah Haahr (r) [2019 file photo].

So, why hasn’t Medicaid Expansion happened in Missouri?

31 Sunday Mar 2019

Posted by in Healthcare, Missouri General Assembly, social media

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Good question.

From Representative Kip Kendrick (D):

Kip Kendrick @Kip_Kendrick
Missourians represent at least a quarter million of these individuals.

Kaiser Family Foundation @KaiserFamFound
Nationally, 2.5 million poor uninsured adults fall into the “coverage gap” that results from state decisions not to expand Medicaid.
They earn too much to qualify for Medicaid, but not enough to…

3:09 PM – 30 Mar 2019

Rep. Kip Kendrick (D) [2019 file photo].

The human toll, from the Kaiser Family Foundation:

Table 1: Uninsured Adults in Non-Expansion States Who Would Be Eligible for Medicaid if Their States Expanded by Current Eligibility for Coverage, 2017

State Total Currently Eligible for Medicaid Currently in the Coverage Gap (<100% FPL) Currently May Be Eligible for Marketplace Coverage (100%-138% FPL**)

Missouri 232,000 13,000 124,000 95,000

[emphasis added]

And:

[….]

The ACA Medicaid expansion was designed to address the high uninsured rates among low-income adults, providing a coverage option for people with limited access to employer coverage and limited income to purchase coverage on their own. In states that expanded Medicaid, millions of people gained coverage, and the uninsured rate dropped significantly as a result of the expansion. However, with many states opting not to implement the Medicaid expansion, millions of uninsured adults remain outside the reach of the ACA and continue to have limited options for affordable health coverage. From 2016 to 2017, non-expansion states saw a significant increase in their uninsured rate, while expansion states saw a decrease.

By definition, people in the coverage gap have limited family income and live below the poverty level. They are likely in families employed in very low wage jobs, employed part-time, or with a fragile or unpredictable connection to the workforce. Given limited offer rates of employer-based coverage for employees with these work characteristics, it is likely that they will continue to fall between the cracks in the employer-based system.

It is unlikely that people who fall into the coverage gap will be able to afford ACA coverage, as they are not eligible for premium subsidies: in 2019, the national average unsubsidized premium for a 40-year-old non-smoking individual purchasing coverage through the Marketplace was $478 per month for the lowest-cost silver plan and $340 per month for a bronze plan, which equates to nearly eighty percent of income for those at the lower income range of people in the gap and more than a third of income for those at the higher income range of people in the gap.

If they remain uninsured, adults in the coverage gap are likely to face barriers to needed health services or, if they do require medical care, potentially serious financial consequences. Many are in fair or poor health or are in the age range when health problems start to arise but lack of coverage may lead them to postpone needed care due to the cost. While the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be an important source of care for the remaining uninsured under the ACA, this system has been stretched in recent years due to increasing demand and limited resources.

Most people in the coverage gap live in the South, leading state decisions about Medicaid expansion to exacerbate geographic disparities in health coverage. In addition, because several states that have not expanded Medicaid have large populations of people of color, state decisions not to expand their programs disproportionately affect people of color, particularly Black Americans. As a result, state decisions about whether to expand Medicaid have implications for efforts to address disparities in health coverage, access, and outcomes among people of color.

[….]

From former State Representative Chris Kelly (D):

Chris Kelly @repckelly
And virtually all of them are working.
Props to @Kip_Kendrick for articulating this serious problem.
7:31 AM – 31 Mar 2019

But, the right wingnut republican majority in the Missouri General Assembly can’t believe this problem has adverse affects on rural Missourians? Right.

Successful Medicaid innovation in Missouri may die thanks to AHCA

20 Monday Mar 2017

Posted by in Uncategorized

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The Missouri Medicaid environment:

Missouri’s GOP legislature has been adamant that they will never take up the Obamacare offer to provide health care coverage for poor Missourians by expanding Medicaid coverage. In fact, they’re trying to jump the gun on Trumpcare’s not-so-stealthy attack on Medicaid with SB28, which  would request “a global waiver from HHS to transform the state’s Medicaid into a block grant program, which would be federally capped and adjusted for inflation, state gross domestic product, population growth and other factors.” This move would , according to health care advocacy groups, “cut necessary funding for healthcare services for Missouri’s most vulnerable citizens.”

The Good News

Given this anti-Medicaid predisposition in the state, it’s all the more surprising to learn that, thanks to Democratic former governor Jay Nixon, Missouri took aggressive advantage of the provision in the Affordable Care Act (ACA) (a.k.a. Obamacare), the 2703 grant program, that allocated funds so that 25 Missouri community medical centers could experiment with providing a wide range of coordinated – mental, physical, dental and counseling – services in a community “health home” environment. The results in Missouri have been wildly successful:

According to a review by the Missouri Department of Mental Health, the results of the 2703 grant program in that state have been impressive. The more than 23,000 Missourians who have received care under the health home initiative met or exceeded six of nine benchmark goals for disease management after the ACA-supported expansion. For patients with diabetes alone (America’s most costly disease, at approximately $332 billion a year), the number with controlled blood glucose levels rose from 18 percent to 61 percent. The percentage of patients with hypertension and cardiovascular disease who controlled their blood pressure went from 24 to 67 percent, and their good cholesterol levels soared from 21 to 56 percent. On the cost side, hospitalizations and emergency room visits for this group dropped 14 percent and 19 percent respectively. This saved the state $31 million just in the first year of the program, and the savings have continued, according to Natalie Fornelli, manager of integrated care at Missouri’s Division of Behavioral Health. In 2015, Missouri’s health home program won the American Psychiatric Association’s Gold Achievement Award for community health services. The program is now considered a national model.

The Bad News:

Under Trumpcare, the funding that supports these programs is likely to disappear:

At the national level, the fate of the 2703 program is also in doubt. It’s possible that, as Republican lawmakers in Washington and the Trump administration wrestle with the complexities of repealing and replacing Obamacare, they’ll conclude that failing to continue the 2703 grants will likely cost more in tax dollars than it saves, even as it would deprive hundreds of thousands of poor, mentally ill Americans the coordinated treatment that can save their lives. But, as Sidney Watson, a professor at the Saint Louis University School of Law and an expert on health care access for the poor, observes, Trump’s new Health and Human Services secretary, Tom Price, “has expressed a lot of skepticism about the Medicare and Medicaid demonstration centers.”

Tom Price? Skepticism? No kidding. They guy believes in freedom. Freedom to die, that is. As Politico notes, Price’s “vision for health reform hinges on eliminating much of the federal government’s role in favor of a free-market framework built on privatization, state flexibility and changes to the tax code.” He’s a member of the Association of American Physicians and Surgeons, a far right fringe medical group that declares Medicare “evil” and “immoral.” You can bet that they and their most prominent member, Tom Price, don’t think much of Medicaid either. The better a federal health program does, the more these fools believe it saps our moral fiber, inculcates dependency and undermines physician freedom – the  whole right wing drill, in other words..

Those of you who are calling your representatives and senators and begging them to save our health care, forget about the truly awful AHCA and maybe just fix Obamacare’s relatively minor problems, might also want to bring up the 2703 program and its proven success here in Missouri. Surely the Republicans can’t be so stupid that they’ll argue with success.  Or, on second thought, maybe they will.There is that whole Dump and Dupe AHCA effort. If that isn’t arguing with success – Obamacare increased the ranks of the insured by 20 million, after all – then I don’t know what is.

What does Governor Greitens have in common with the Liar-in-Chief?

04 Saturday Feb 2017

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Did the title give it away? Do you think the commonality shared by Jefferson City’s GOP Boy Wonder and the Orange Buffoon might have something to do with a willingness to exploit the reptilian brain of the base by presenting made-up stories to explain unpleasant facts? Stories that shift blame by exploiting carefully nurtured negative, emotionally evocative connotations? Stories like the one Governor Greitens told when he claimed Missouri’s budget shortfall is due to Obamacare?

There’s no rightwing buzzword with greater negative emotive impact for the red meat base than “Obamacare” – or at least that’s been true in the past. Now that it might disappear, however, lots of folks are experiencing a newfound appreciation for the ACA, a.k.a. Obamacare. Which is why GOPers are also desperate to paint the by-and-large successful initiative as a dead-on failure – that, they hope, will make it easer when they do repeal with no meaningful replace, and the masses, including their prone-to-snarl base, lose their insurance and start dropping like the flies they might as well be when it comes to the consideration they can expect from members of the Great Orange Pumpkin party.

These facts likely explain why our novice Governor tried to blame Missouri’s budget shortfall and the very nasty cuts he’s made on Obamacare. But they don’t make his lie right. Either Baby Big Chief hopes to pull the wool over our eyes, or he isn’t quite as smart as he’s cracked up to be. Despite the bushwa he’s trying to sell, Obamacare had nothing to do with the two cost factors he, or at least his spokespeople, cite:

1. Increases in Medcaid caseload: It’s likely that publicity for Obamacare resulted in more Medicaid applications, but it seems to me that the guilty party here is really the Missouri Republican party, not Obamacare:

  • The Missouri GOP legislature refused the federal (Obamacare) Medicaid expansion.
  • Medicaid expansion would have saved the state $100 million a year.
  • Medicaid expansion would have accommodated even more growth than the increase – mostly needy children – that the state is now struggling to cover

2. Soaring pharmaceutical prices: Here we have two villains only peripherally related to Obamacare –greedy Big Pharma and the Republicans who enabled them by throwing hissy fits about not including pharmaceutical cost controls back when Obamacare was being formulated and there was still some foolish hope that a few GOPers would come on board:

  • Obamacare at its inception failed to build in regulation of prescription drug prices, and proposals to use Medicare’s clout to bargain down drug prices were mooted thanks to persisitent aforesaid GOP vapors over “big gubment” intrusion.
  • Unregulated Big Pharma decided to milk the market for all its worth.
  • Many new drugs have come onto the market with sky-high and higher prices
  •  P.S. It’s a problem that could be fixed were saner minds ever to prevail.

And guess what? Both of these problems will continue to get worse if Obamacare goes away. Greitens just doesn’t seem to understand or refuses to acknowledge the real problem behind his budget troubles:

These budget cuts are a big deal. Tax cuts have been a disaster – one that Greitens threatens to make worse. State spending had been pared down to the bone before we ever heard of Eric Greitens. If he goes ahead and returns value for dollars to all those dark-money and upfront donors who funded his campaign and cuts taxes even more, it’s gonna be hello to that raggedy-ass Kansas state of being. If you think today’s cuts are bad, just wait. Greiten’s wealthy donors will make out big and the rest of us will bear the costs. And worst of all for Governor Baby Boy, he may not have a fanciful Obamacare crutch to lean on .