Tonight there is a Art Walk in my town. I went out to see what was happening and met my representative in Jefferson City, Denny Hoskins.  He will be the next Speaker Pro Tem.

I have wanted to ask him for awhile the contradiction between his position on being pro-life and his opposition to Medicaid Expansion.

Our brief exchange below the fold.

We know each.  He was going to his office, so I knew the conservation would have to be brief.

I began by confirming he is “pro-life”.  He responded that he is.

I then asked: Isn’t Medicaid expansion pro-life?

He said no.

I responded to that “no” by asking incredulously “Isn’t providing health insurance to the working poor pro-life?”

As he goes into his office he says with an ironic tone, “I thought Obamacare will save us all.”

I noted “Medicaid Expansion is Obamacare.” He repeated what he said.

I have no idea whether he is really so stupid that he doesn’t know Medicaid expansion is an important component of Obamacare or not.  He will be one of the leaders in the Missouri House.

Given how quick his response came, I suspect he is.  

Whatever his intelligence is, it seems Republicans like him will do nothing in Missouri to expand Medicaid and help Obamacare be a success.

 

Today, via Twitter:

Rep. Vicky Hartzler @RepHartzler

Throwback Thursday! #TBT [….] 12:42 PM – 2 Oct 2014

One respondent didn’t appreciate the sophomoric attempt at humor:

John Wells ‏@JDubMo

@RepHartzler Hilarious. If only you worked to improve government instead of shutting it down. 12:49 PM – 2 Oct 2014

Zing.

Yesterday, via Twitter:

Rep. Vicky Hartzler ‏@RepHartzler

We were told #Obamacare wouldn’t fund abortions; nonpartisan GAO report says otherwise #brokenpromises [….] 7:22 AM – 16 Sep 2014

There is a link to a press release for the republican Majority Leader, not the Government Accountability Office report.

A constituent reply:

Bob Yates ‏@OldDrum

@RepHartzler Obamacare has brought insurance to millions of Americans without insurance. Is that pro-life or not? 8:18 AM – 16 Sep 2014

Good question. No answer yet, just crickets.

The summary of the report from the Government Accountability Office:

[….]

Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered in health insurance exchanges-known as qualified health plans (QHP)-may cover abortion services as a benefit consistent with federal and state law. Federal law applicable to QHPs for the 2014 benefit year prohibits the use of federal funds made available to offset the cost of QHP coverage to pay for abortion services except where the pregnancy is the result of rape or incest, or the life of the pregnant woman would be endangered unless an abortion is performed. QHPs may cover abortion services that do not meet that exception (referred to as non-excepted abortion services), but state law may restrict the circumstances under which coverage can be provided. For the 2014 benefit year, 17 states do not allow QHPs to provide non-excepted abortion services, and 6 states permit the coverage of such services only in certain limited circumstances. Among the remaining 28 states (including the District of Columbia) with no such laws, in 5 states all QHPs cover non-excepted abortion services; in 15 states some QHPs cover non-excepted abortion services; and in 8 states no QHPs cover non-excepted abortion services. Nationally, 1,036 QHPs in these 28 states cover non-excepted abortion services and 1,062 QHPs do not.

Of the 18 issuers from which GAO obtained information-which offered nearly one-quarter of the QHPs covering non-excepted abortion services in the 28 states-all but three issuers indicated that the benefit is not subject to any restrictions, limitations, or exclusions. All 18 issuers also indicated that their abortion services benefit is subject to the same requirements as other benefits, such as enrollee out-of-pocket costs-including deductibles, copayments, and coinsurance-and prior authorization requirements, all of which can vary depending on the location where the service is provided. To estimate the cost of the coverage of non-excepted abortion services, issuers indicated that they generally reviewed historical costs for these procedures. All but one of the issuers from which GAO obtained information estimated the cost of coverage of non-excepted abortion services to be less than $1 per enrollee per month-the minimum amount required to be estimated under PPACA for these services, and all but two of these issuers rounded the amount up to $1 to comply with PPACA. The highest cost estimated by the issuers GAO collected information from was $1.10 per enrollee per month. Fifteen issuers and a state-based exchange which bills enrollees on behalf of issuers did not itemize the premium amount associated with non-excepted abortion services coverage on enrollees’ bills nor indicate that they sent a separate bill for that premium amount. Six issuers GAO contacted indicated that they provided information about coverage for abortion services to consumers before they enrolled in QHPs, while others indicated that consumers shopping for QHPs would need to call the issuer to obtain such information.

[….]

PPACA requires QHPs to cover a package of essential health benefits. While this package does not include abortion services, QHPs may cover those services, consistent with federal and state law. GAO was asked to provide a list of QHPs that do and that do not cover abortion services and for additional information on issues related to that coverage. This report describes whether non-excepted abortion services are covered by QHPs within the 28 states with no laws restricting such coverage for the 2014 benefit year and provides additional information-such as the scope and the cost of non-excepted abortion services coverage-for selected QHPs that cover such services.

[….]

[emphasis added]

Evidently Representative Hartzler (r) doesn’t expect anyone to read the actual report, just the breathless right wingnut press release.

There’s a very instructive set of interactive maps put together by Jonathan Cohn on The New Republic Website. What they tell us is how much money each state that has rejected the Obamacare Medicaid expansion has lost in federal dollars overall and per capita.

They tell us that Missouri has forfeited 17.8 billion dollars to date, which translates into a per capita loss of 2,967 dollars. The only states where GOP intransigence has hurt its citizens more are Texas, Florida, Georgia, North Carolina, and Tennessee, or, in per capita terms, Mississippi, Tennessee, North Carolina, South Carolina, Georgia, Alabama, Florida and Louisiana. Distinguished company, almost all states where, by just abut every measure, the quality of life tends to bottom out way, way down there … at the absolute bottom.

Remember these numbers when you hear GOP lawmakers in Jefferson City poormouth when it comes to paying for state services. File it right up there with what you know about that big taxcut for wealthy elites and business cronies, the tax cut that, magically, our revenue-strapped state could afford while, at the same time, lawmakers are claiming we can’t expand Medicaid on the federal dime because … well, in the dimly imagined, apocalyptic future that animates GOP “big government” paranoia, bringing our federal dollars back to the state might somehow, incomprehensibly, cost us too much. Of course, these would be the same folks who seem to be really, truly convinced that cutting rich folks’ taxes will summon the economic growth fairy who will sprinkle the state with some of the same prosperity fairy dust that Sam Brownback used to talk about – before S&P downgraded Kansas’ bond rating for the second time.  

Representative Vicky Hartzler (r) on the IRS, today via Twitter:

Rep. Vicky Hartzler ‏@RepHartzler

Just passed spending bill which stops IRS Conferences & videos, stops targeting by IRS, & prohibits IRS from enforcing Obamacare. 12:47 PM – 16 Jul 2014

I suppose in the future the IRS will just have to rely on spontaneous confessions from tax scofflaws.

As has become the norm, a few very interesting replies:

Alexandra ‏@aliemalie

.@RepHartzler aren’t you suing to enforce Obamacare? why are you now telling the IRS not to enforce Obamacare? so confusing! 12:48 PM – 16 Jul 2014

Heh. Good questions. You were expecting consistency?

Bob Yates ‏@OldDrum

@RepHartzler And is a great boon to tax cheats. 3:37 PM – 16 Jul 2014

For the right wingnut republicans in Congress that’s a feature, not a bug.

Oopsie.

Governor Jay Nixon vetoed SB 508 today. In his veto message [pdf] he pointedly made reference to a major error in the bill due to its cut and paste origins from a right wingnut American Legislative Exchange Council (ALEC) template:

Governor of Missouri

[….]

July 7, 2014

TO THE SECRETARY OF STATE OF THE STATE OF MISSOURI

Herewith I return to you House Committee Substitute for Senate Bill No. 508 entitled:

[….]

I disapprove of House Committee Substitute for Senate Bill No. 508. My reasons for disapproval are as follows:

House Committee Substitute for Senate Bill No. 508 contains a number of worthwhile provisions that can become law with my action on other legislation. However, this legislation does not receive my approval due to a significant drafting error.

House Committee Substitute for Senate Bill No. 508 would impose additional restrictions on the licensure of an individual as a “navigator,” one who provides information or services in connection with eligibility, enrollment, or the program certification of any health benefit exchange operating pursuant to the Affordable care Act. Section 376.2004.6 of the bill would require an applicant for a navigator license to submit two full sets of fingerprints to the Missouri Highway patrol “for the purpose of obtaining a state and federal criminal records check under section 43.540 and Public Law 92-554 [sic].”

The bill’s reference to Public Law 92-554 should be to Public Law 92-544. This mistaken reference to Public Law 92-554, which deals with alcohol abuse and prevention, instead of to Public Law 92-544, which deals with federal criminal records, was included in model legislation developed by the American legislative Exchange Council (ALEC) entitled the “Navigator Background Check Act,”….

[….]

It appears that in copying and pasting from the ALEC model act, the General Assembly failed to correct this incorrect reference to Public Law 92-554.[….] While some may believe that such an error is “close enough” for a model act, it cannot be allowed to become the law of this State. Particularly in an area of the law that is subject of ongoing litigation, a glaring defect such as this cannot simply be ignored. Accordingly, this measure does not receive my approval.

In accordance with the above-stated reasons for disapproval, I am returning House Committee Substitute for Senate Bill No. 508 without my approval.

Respectfully submitted,

s/

Jeremiah W. (Jay) Nixon

Governor

Heh. If they were in junior high school the General Assembly would get an “F” on the assignment. Come to think of it, they are still in junior high school. And they deserve the grade.

The Supreme Court decision in Burwell v. Hobby Lobby Stores [pdf] summarized:

Alexandra ‏@aliemalie

Shorter #SCOTUS: Corporations are people, women are not. #HobbyLobby 9:23 AM – 30 Jun 2014

And other commentary:

A. N. Devers ‏@andevers

Women take birth control for medical health reasons, not for religious reasons. They are now imposing other people’s religions on employees. 9:26 AM – 30 Jun 2014

Adam Griffiths ‏@adamgriffiths

It’s probably a good thing that on days like today #SCOTUS has that buffer zone, no? 9:21 AM – 30 Jun 2014

Jessica Podhola ‏@jessicapodhola

I’m incorporating. I’ll have more rights that way. #SCOTUS #waronwomen 9:35 AM – 30 Jun 2014

jess mcintosh ‏@jess_mc

Good thing elections never hinge on the votes of women. 9:31 AM – 30 Jun 2014

Just a bit of sarcasm:

MrJM ‏@MisterJayEm

Great News!!1! The Court’s narrow decisions only affect: 1) working women’s reproductive rights & 2) work traditionally performed by women. 9:36 AM – 30 Jun 2014

Andrew Shaughnessy ‏@andrewshag

Founders would roll over to know that corporations held stronger power than people in the eyes of #SCOTUS 9:27 AM – 30 Jun 2014

Imani ABL ‏@AngryBlackLady

So #SCOTUS refuses to recognize that women’s repro healthcare is actually healthcare. Which is sweet. And by “sweet” I mean “typical.” 9:33 AM – 30 Jun 2014

Top Conservative Cat ‏@TeaPartyCat

Supreme Court rules that corporations have the right to impose a theocracy on their employees, but limited that right to Christian men. 9:47 AM – 30 Jun 2014

David Waldman ‏@KagroX

If you own enough stock, you can write your own exceptions to federal law. That’s pretty cool. 10:00 AM – 30 Jun 2014

Hailey ‏@haileym77

I suppose that my greatest mistake in life was being born as a female rather than as a corporation. #HobbyLobby #SCOTUS 11:03 AM – 30 Jun 2014

Thanks for nothing, Ralph.

Remember back in 2011 when Rep. Ann Wagner was running to be the Republican National Committee chair? Specifically when she tried to outman the men on the candidate list when it came to gun love?:

Republican National Committee chair candidate Ann Wagner blew away the competition when Grover Norquist asked each candidate at today’s debate how many guns they own.

“About 16,” replied Wagner, whose family actually just got a new gun case for Christmas.

Current RNC Chairman Michael Steele and Mario Cino don’t own any guys. Reince Priebus has five, and Saul Anuzis said he feels “very inadequate” owning just four.

Back in those days you had to feel for poor Ann who, as one of the few women with a stomach strong enough for our modern GOP, had to cope with all that angry, old, white testosterone. Especially since, when push came to shove,  her 16 guns weren’t enough to prevail against Reince Pirebus’ teeensy, tiny five.

Recently, however, given the party’s need to attract women, and the few that the party has to hand, Wagner has seen her star ascending – to the extent that she has become one of the players involved in helping select a new GOP majority leader now that Eric Cantor has been tea-partied out of the Congress. Consequently, given Wagner’s status in the GOP’s effort at female outreach, our task over the next few weeks is to be alert for a possible change in her pronouncements on the topic of the Affordable Care Act (ACA or Obamacare).

Why, you may ask? Wagner, after all has been running in tandem with the repeal-the-ACA crowd, and, true to her faux woman of the people stance, has regularly solicited ACA horror stories that she can pass along without real verification, but with an “I told you so” smirk instead. Why, you ask, should she change? Simply because there’s a big problem with this strategy. Most of the horror stories have proven to be bogus and all the signs are that the Affordable Care Act is succeeding. Consequently, as Greg Sargent observes, the GOP is scrambling to develop a new rhetorical tack:

Reuters reports GOP officials have conducted reams of research to retool their message, with an emphasis on appealing to women. The problem: Balancing the base’s demand for an undying commitment to obliterating the law with swing voters’ desire to keep the good things in it. Solution: Use the phrase “start over” instead of “repeal,” because “start over” supposedly resonates with women.

It’ll be interesting to see if this new direction takes with the members of the Missouri delegation, but especially with Wagner – precisely because she’s not only a woman, but a woman of the sort that the GOP establishment hopes can speak effectively to female swing voters. It’s going to be fun watching to see how emphatically Wagner adopts this line if at all. If she does, these are, according to Sargent, the points to watch for:

The new “start over” message will not paper over the basic problem Republicans face here, which is that they want the base to thrill at their anti-Obamacare zeal while also reassuring swing voters they can have the good stuff in the law without the bad. Indeed, as you watch this “new” message, keep an eye on whether GOP candidates actually do call for “starting over” in any meaningful or substantive sense. Instead, you’ll likely hear them claim they want to “start over” while mouthing support for the law’s goals of expanding affordable coverage and consumer protections, while refusing to take a stand on whether key aspects of it – such as the Medicaid expansion – should actually be done away with.

If Wagner and the other Missouri GOPers do decide that “start over” is the way to go, we need to make sure that they have a good story about how they are going to replace the benefits that the ACA has given to Missourians. A recent Department of Health and Human Services report tells us that the average insurance premium for Missourians getting insurance through the ACA exchanges is only $59. Without ACA subsidies, premiums for similar private market insurance would have cost on average $344; the ACA subsidized insurance is 85% cheaper.

If Wagner, specifically, starts talking about “starting over” we need to hold her feet to the fire and demand to know how what she has in mind would work better than the ACA. There are better systems out there, but I’m willing to bet that hardcore Republicans would never sign on to them. Instead, As Sargent noted in an earlier article about the effort of Republicans to maneuvre around the incipient success of Obamacare:

… surely these Republican evasions are also newsworthy. They go right to the heart of the GOP’s approach to the central policy debate of the Obama era, shedding light on Republicans’ widespread inability to mount an even remotely credible policy response to fundamental questions that debate raises about how, or whether, government should act to expand health care to the poor. And they cast doubt on the veracity of the Obamacare-is-a-disaster political narrative that is central to the highly consequential midterm elections now underway. All this should be part of the story.

Missouri Republican politicians put the squeeze on middle class and working taxpayers all the time – just consider their reckless tax cut for the rich, a taxcut that will decimate Missouri’s coffers with little benefit for the ordinary Joe. They’re willing to risk tax dollars any old day when it comes to serving their rich patrons or pandering to their base – here you can reflect on the potential costly court cases that will result if Brian Nieves’ gun law nullification bill manages to squeak through. Or think about the beaucoup bucks that will be spent paying for ID cards and other nonsense if Republicans manage to get their way about voter ID – money spent to solve an imaginary problem (although the actual problem Republicans hope to address – voting Democrats – may not be so imaginary).  

By far the worst example of such waste can be found in the GOP’s to-the-death opposition to the Obamacare Medicaid expansion. You know that by refusing to expand Medicaid they’re not only depriving poor Missourians of health insurance that will, for many, be a matter of life and death, but they’re depriving the state of billions in federal Medicaid support. You also know that failing to expand Medicaid will cost the state many potential new jobs in the health sector. Hospitals will also bear the cost of the GOP Obamacare tantrum when they have to continue to treat the uninsured who don’t qualify for either Missouri Medicaid or the Obamacare exchanges in their emergency room, but with considerably smaller federal subsidies to do so. Many might actually be forced to close.

But these costs are all old news. There’s yet another potential strain on the state budget, if Republicans remain obdurate. Obamacare’s coverage mandate along with the publicity about insurance coverage has led many previously uninsured people who are eligible for Medicaid to sign up for coverage, people that Wonkblog’s Jason Millman identifies as “woodwork enrollees,” as in folks coming out of the woodwork. So how does this potentially strain Missouri’s budget? Here’s how:

From a state budget perspective, there’s an important difference between the woodwork population and those newly eligible under the Medicaid expansion. Under the Affordable Care Act, the federal government pays 100 percent of the costs for the Medicaid expansion population through the end of 2016, with the state share gradually increasing to no more than 10 percent. New woodwork enrollees are funded under the traditional Medicaid structure, in which the federal government on average pays 57 percent of the cost – though the federal share varies by state.

In Missouri the actual percentage paid by the state is 64% so the cost will be higher than average, although Millman speculates that fewer folks may come forward in states that don’t have their own exchanges since there’s been less healthcare outreach push to enroll the citizens of in those states. Millman goes on to say that:    

States knew the woodwork effect was coming and had time to prepare for it, since the ACA was passed more than four years ago. The big question is just how accurately were they able to predict its impact.

Except, of course, states like Missouri which is run by Republicans equipped with ideological and partisan blinders. It’s doubtful whether our feckless leaders could manage to plan their way out of a paper bag, much less plan for increased Medicaid enrollment – especially without the increased federal subsidy. These are, after all, the tax-cutting imbeciles who ignored all the contrary evidence and cost the state budget somewhere between $600 to 800 million dollars and $4.8 billion dollars yearly, depending on who you believe.  

Steve Benen notes that many of the most ardent supporters of Obamacare’s Medicaid expansion don’t belong to constituencies that sway Republican lawmakers:

When we watch the debates unfold over Medicaid expansion, we expect to see folks like the uninsured, family advocates, religious leaders, and progressive activists pushing for conservative policymakers to do the right thing. For many Republicans, however, these aren’t constituencies with meaningful political capital.

But here in Missouri, GOP disregard towards any opinion that doesn’t reflect the most radical rightwing biases or, alternatively, the preferences of the GOP big-money backers seems to have morphed into outright hostility. Witness the response of Rep. Myron Neth (R-17) to the recent protest by 300 Missouri religious leaders who interrupted House proceedings. Some of the pastors sang hymns and there was chanting. The capital police were summoned and twenty three clergymen were peaceably arrested. The protest was clearly a last-ditch effort to do something to change the hardcore GOP determination to deny insurance coverage to poor Missourians – a life and death issue for many. Here is how the petulant Neth, who seems to have been expressing the emotions of many of his GOP colleagues as well, reacted to what the Kansas City Star characterized as “couple dozen pastors singing ‘Amazing Grace'” :

Well, I can almost definitively say that we will not be expanding Medicaid this year. It was just derailed by the very people that want it to happen. The large number of Medicaid supporters, many clergy included, started a protest in the Senate gallery and had to be forcibly removed. I even believe some of the clergy were taken into custody.

There have been several Republicans, Sen. Silvey and Rep. Torpey to name a few, leading the charge behind the scenes to possibly get something done and they were making some strides in doing so. However, now I am sure that the Senators and others who have traditionally opposed it will now really dig in their heels on our efforts to get something done.

But Neth wasn’t finished expressing his pique with Missourians who exercise their right to freedom of expression. When people responded to the snitty little statement above with what seems to have been heated indignation, letting him know that that they didn’t appreciate a lawmaker treating principled individuals motivated by the common good as if they were rowdy high schoolers who would now have to forgo prom because they made too much noise, he dug in deeper:

I was surprised at a number of negative responses I got from my mid-week report. By no means am I surprised that some people disagree with me on certain issues. However, the tone and content of many of the responses were extremely rude and disrespectful. I do not see how people expect me to respond or seriously consider feedback when it is delivered in such a poor manner. I understand one’s passion on a given issue and that, at times, there might be disappointment, but sending an abrasive message dilutes anything that might be said and carries much less weight than a cordial and well stated response.

Doesn’t it leave a foul odour in the vicinity of the capital when a lawmaker thinks it’s reasonable to imply that something of such life-and-death importance as insurance coverage should be withheld because Mr. Big Poohbah Legislator Neth doesn’t think its supporters were properly deferential? What’s worse, of course, is that Neth and his GOP colleagues didn’t have the slightest intention of extending Medicaid – certainly not without privatizing or otherwise weakening the program. But, of course, when it becomes time to take responsibility for his actions, it’ll be so much easier to blame the folks who cried for help because they didn’t conform to his ideas of decorum. The Kansas City Star editorial gets it just right:

Missouri lawmakers are big on free speech. Unlimited campaign contributions, we are told, are a form of free speech. There are no limits on lobbyist gifts because, hey, lobbyists and their clients have the right to free speech.

Surely these free-speech champions will support the right of the pastors to make their voices heard. At the very least, don’t use them as an excuse for denying health coverage to 300,000 people.