Recently Washington Post columnist Kathleen Parker claimed the overweening Republican problem to be messaging. According to Parker, the GOP needs to present a more positive, hopeful face to the country. She thinks their negativity permits Democrats to cast them – unfairly – as cruel and heartless villains who consequently can’t compete with a president who wins hearts and minds by tossing – ready for the conservative meme du jour, a riff on the old bread and circuses schtick – “coins and candy into the crowds.”

Unfortunately for Parker’s thesis, which largely centers on Obamacare, access to basic healthcare is a little more substantive than “coins and candy.” In fact it isn’t overstating the case to say it’s a matter of life and death. Healthcare reform is long overdue and although Obamacare, as a product of compromise reflecting diverse interests, is far from perfect, its problems are all eminently fixable. It’s a real and considerable achievement that will make all our lives a little better.

It is not the ineffective and naively liberal president they consistently  invoke that bothers Republicans, but the calm, measured, do-something-for-the-99% president who is driving them bonkers. And the resulting GOP tantrum simply reveals what they really stand for – and the picture is, as Parker correctly discerns, not very pretty, but, Parker to the contrary, the problem is more essential than bad self-presentation. Based on their actual policy preferences and lack of concern for the real problems of the vast majority of Americans, nobody can deny Republicans are a seriously bloody-minded bunch.

Slate has published this interactive map prepared by Kantar media that tracks where money is being spent on Obamacare attack ads relative to the numbers of uninsured. Guess what? More uninsured, more ads. Here in Missouri, the let’s-kill-Obamacare folks are hammering the Springfield Market where 23.5% of the inhabitants are uninsured. It’s also one of the poorest areas in Missouri.

Then, of course, there’s the content of these ads. For the most part, they seem filled with distortions and outright falsehoods. What kind of people tell lies to  make their points? Especially when those very people here in Missouri are refusing to take federal funds, our own tax dollars, to expand Medicaid coverage, all the while while bleating about the imagined evils of depending on a federal hand-out – but never one word about the evil situation where over 20% of their constituents lack access to good healthcare.

Perhaps Parker’s candy meme tells us more than she intended about who today’s Republicans really are. Wisconsin Senator Ron Johnson’s hilarious variation on the old bread and circuses business suggests that the GOP ought to be careful about which talking points they want to promulgate:

They [i.e. Democrats] are giving away candy, and it is tasty stuff,” he said. “We’ve got the drill and the Novocain to fix the cavity.

So a functioning safety net, good health care, quality education, strong infrastructure and a prosperous and growing middle class – all the concerns that animate progressives – are just like cavities? And the folks running around waving their metaphorical drills? Parker is at least partly right. Nobody wants sadists running government.    

193,420. That’s the number of uninsured Missourians who would have qualified for coverage if the state’s Republican lawmakers had accepted federal funds to expand Medicaid under the Affordable Care Act (ACA). These jokers turned down the chance to recover a big enough chunk of the tax dollars that we Missourians send to Washington D.C. to pay 100% of the expansion for three years and 90% thereafter – and, no matter what they do in the future, they’ve already cost us the first year’s 100% free ride.  

Put another way, 193,420 is the number of Missourians that we know for sure will pay the price for the Republican anti-Obamacare tantrum. The actual number is probably higher given other aspects of GOP ACA obstructionism in the state – refusing to create a state exchange, attempting to sabotage the “navigators” who have been hired to help people sign up, and, of course, the constant barrage of GOP lies and distortions about Obamacare.

The source of 193,420 number is this interactive map from a TPM report. If you take a look at it, you’ll note that the only state bordering Missouri that has also failed its ACA Medicaid eligible population is Kansas, one of the few states heading to the bottom faster than Missouri. Will somebody tell Missouri’s legislators that this is not a competition we want them to win?

Of course, it’s likely they won’t care. As the article’s author, Dylan Scott, observes:

… it’s the poorest people who make up those 4.8 million [nationwide] who are missing out. Because of a kink in the law’s language, people between 100 and 133 percent of the poverty level will still be eligible to receive financial help to purchase private coverage on the insurance marketplaces that opened Oct. 1.

But those actually in poverty will be out of luck.

And of course, the very poor are the same people our Republicans seem to have been either ignoring or targeting with destructive legislation for several years now.

Nevertheless, you could let your state rep know if 193,420 unnecessarily uninsured Missourians  not only upsets you but leads you to view his or her performance less charitably. Governor Nixon has called a meeting on Nov. 26 with the two legislative committees that  have been “studying” the Medicaid expansion issue (like it needs more study). He framed the meeting as important because Missouri’s health care system “falls short ‘delivering the quality, affordable and accountable care Missourians need and deserve.'” Messages from constituents reiterating that claim, perhaps leavened with a little – polite but righteous – indignation, might help him make that case on the 26th.

 

The folks over at Lean Forward have put together an interactive map showing where states now stand in regard to opting out of the part of Obamacare that would expand Medicaid, as per the Supreme Court finding that participation in the expanded Medicaid cannot be compelled. The map’s creators assessed statements from legislators and governors to determine the current likelihood that a given state will participate in the Medicaid expansion, while noting that the situation is still fluid.

According to the map, Missouri is a “leans no” state, based on Jay Nixon’s silence and our GOP legislators’ truculence when confronted with any aspect of Obamacare. So what harm can the latest “over my dead body” GOP posturing do? Lean Forward cites the following details:  

— Missouri Population Uninsured:  853.3K (14% of state);

— Uninsured eligible for expanded Medicaid: 207.7K;

— Federal money available for Medicaid (through 2019): $8.4B.

Let me point out that that $8.4 billion federal dollars are, as my GOP friends like to point out, our tax dollars, and if the GOPers don’t want some of what we send to Washington to come back home, I sure do. Let me ask this (rhetorical) question: What kind of imbeciles have we sent to Jefferson City? This is a good deal:

… states would spend only 2.8% more on Medicaid from 2014 to 2022 than they would have without the law, according to one study based on Congressional Budget Office (CBO) figures. And that doesn’t even take into account the savings states would realize in health-care costs for the uninsured. By opting out, states would be turning their noses up at a very good deal.

That’s not all. As health care writer Maggie Mahar observes about the governors who have indicated they won’t participate in the expansion:

If these governors dig in their heels, hospitals in their states will continue to struggle to care for millions of patients who cannot pay their bills. As the cost of uncompensated care mounts, these hospitals will shift that cost to insured patients, and premiums will rise.

Alternatively, if these states accept Washington’s offer, those Medicaid dollars would create jobs. As more low-income patients have access to care, hospitals, community health centers, labs, and nursing homes will need to hire new workers.

States desperately need those jobs. And their poorest citizens desperately need healthcare.

Of course, our GOP legislators don’t care much about jobs unless they flow from wealthy “job creators” whom they’re willing to feed generously from the public trough. And they sure as hell don’t care about the uninsured poor.

Those who have been paying attention to facts rather than GOP rhetoric know that the Affordable Care Act (ACA), a.k.a. Obamacare, has already had a positive impact in a number of areas such as permitting parents to keep their young adult children on their existing insurance policies until they are 26, providing  affordable coverage for those with pre-existing conditions, and strengthening existing and creating new community health centers (which also, incidentally, adds jobs). The primary goal of Obamacare, however, is to  extend insurance to uninsured Americans. As the Kaiser Foundation notes, starting in 2014, it will do so in two ways:

The Affordable Care Act (ACA) includes two primary mechanisms for helping people afford health coverage. Starting in 2014, people with family incomes up to 138% of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will generally be eligible for the Medicaid program. And, people buying coverage on their own in new state-based health insurance exchanges will be eligible for federal tax credits to subsidize the cost of insurance. Tax credits will be calculated on a sliding scale basis for people with family income up to four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012). …

The map below, from a new Kaiser Foundation report, shows the geographic distribution of the nonelderly Americans who stand to benefit from these twin programs:

Using the accompanying zip code based calculator provided by the Kaiser Foundation, one finds that in Poplar Bluff, Missouri 26% of the nonelderly population could benefit from these ACA programs; 20% are eligible for these programs in the Central Missouri area around Columbia. In my own relatively prosperous West St. Louis County zip code, 63011, from 8%-10% of the nonelderly population will benefit from either the Medicaid expansion or subsidized coverage available through the health care exchanges in 2014. Looks like the ACA stands to meet some serious need in much of Missouri, especially, as the map suggests, in extreme Southeastern, Northeastern and pockets in Southwestern Missouri.

Meanwhile, in the state Senate, a few die-hard anti-Obamacare zealots, like, for example, my own Senator Jane Cunningham (R-7), are standing in the way of the work that is needed to establish the insurance exchanges that the ACA mandates as the mechanism to provide low-cost, federally-regulated insurance to those who need it. They’ve stormed, raged and lied themselves blue in the face about what the ACA will do, and now they’re stalling, hoping against hope that the Supreme Court will uphold their extremist reading of the Constitution.

Bear in mind that if our intransigent lawmakers continue to stall and their trust in conservative judicial activism is not fulfilled, Missouri will not be prepared to submit a plan for an exchange by Jan. 1, 2013 – which means that the federal government will step in do the work that the state refuses to do. Given the general level of functioning that I see in Missouri governmental circles, that doesn’t seem like too much of a problem to me, but I do seem to remember that these folks are the very ones who constantly whine that the federal government can’t deal effectively with local needs.  As the News-Leader points out:

We already have a $20.8 million federal grant for the exchange. It’s not a question of money. It’s a question of political will. The Missouri House passed legislation moving the state-based exchange forward. The Missouri Senate should do the same. And Gov. Jay Nixon should be stepping out front to lead on this important issue.

Hear! Hear!

Earlier, I noted that State Senator Jane Cunningham attended Todd Akin’s kill-health-care-reform pep rally to push her Health Care Freedom Act. This bill would put a constitutional amendement on the Missouri ballot this fall that is based on fringewingers’ wistful reading of the tenth amendment, which they insist permits states, Civil War to the contrary, to opt out of federal legislation they don’t like – in this case, health care reform legislation.

The Beacon’s Jo Mannies reported that Cunningham got a standing ovation for this ill-conceived, last-ditch effort to subvert the will of the people who voted for Obama and his promises of health care reform. Do you wonder whether any of those fools applauding Cunningham had the teensiest, tiniest idea about what effect opting out of health care reform could possibly have on Missouri were it to prove possible?

Just take a look at this interactive map prepared by the Center for American Progress. Under the health care reform proposed by the Senate, 200,957 more people in Missouri would be newly eligible for Medicaid, individuals who will continue to be uninsured given the status quo.  The loss of federal funds for Medicaid that would result from “opting” out would mean that Missouri’s uninsured would continue to exceed 700,000.

Nor, as has been amply demonstrated over the past few years, can Missouri effectively address the problem of the uninsured at the state level.  As Ivor Volksy of the Wonk Room puts it:

Political considerations, special interest influence and budgetary strains have doomed previous state-based health care reform efforts and governors who believe that nullifying federal reform is in the best interest of their citizens are placing politics ahead of sound policy.

Substitute “legislature” for “governors”, and you have Missouri in a nutshell, with its 2008 nonelderly, uninsured rate of 14.5% – a rate that is probably quite a bit higher right now.

The Senate health care reform package would extend Medicaid coverage massively, providing subsidies that would reduce costs for state governments, employers, and individuals. It would also include incentives and reformulated payment systems that would work to make Medicaid more efficient. And yet there are people who will stand up and applaud a ideological nitwit like Jane Cunningham for her efforts to deny Missouri citizens needed benefits that give us good returns on our tax dollars.