Today, via Twitter:

barb shelly ‏@bshelly

#MOLeg “sanctity of life” committee grasping for an irregularity in Columbia clinic opening. No bombshell yet. [….] 1:40 PM – 13 Aug 2015

Yael T. Abouhalkah ‏@YaelTAbouhalkah

Glad colleague @bshelly is watching Planned Parenthood witch-hunt. Don’t need to see more #moleg shenanigans today  [….] 1:52 PM – 13 Aug 2015

Sean Nicholson ‏@ssnich

This ‘hearing’ is actually dumber than I expected #moleg 1:53 PM – 13 Aug 2015

Peak Wingnut can never be realized, nor will the Wingnut Event Horizon ever be broached.

Grace Haun ‏@gracehaun

The bombshell is a “Cmte on the Sanctity of Life” isn’t discussing #Medicaid expansion #MoLeg [….]2:06 PM – 13 Aug 2015

Bingo!

“…I look forward to working with the General Assembly next session to finally bring our tax dollars home and provide affordable health coverage to hundreds of thousands of hard-working Missourians through Medicaid expansion.”

A statement released by the office of Governor Jay Nixon:

Gov. Nixon statement on ruling by the U.S. Supreme Court in King v. Burwell

June 25, 2015

Jefferson City, MO

Gov. Jay Nixon today issued the following statement regarding the U.S. Supreme Court’s ruling in King v. Burwell.

“Today’s ruling is good news for hundreds of thousands of working Missourians who will continue to have access to affordable health coverage through the federal exchange,” said Gov. Nixon.  “However, it is important to note that there are hundreds of thousands more Missourians who continue to be denied access to affordable health care due to the Missouri legislature’s inaction on Medicaid.

“Today’s ruling by the Roberts Court to uphold the Affordable Care Act a second time removes all doubt that the ACA is and will remain the law of the land.  There are no more excuses for continuing to send our tax dollars to other states and denying 300,000 working Missourians the opportunity to access affordable health care coverage through Medicaid expansion.  I look forward to working with the General Assembly next session to finally bring our tax dollars home and provide affordable health coverage to hundreds of thousands of hard-working Missourians through Medicaid expansion.”

A guy can dream.

Previously:

* SCOTUScare! (June 25, 2015)

Rep. Vicky Hartzler (r): has a SCOTUScare! sad (June 25, 2015)

So how do we know that Obamacare is a success? There’s all the standard measures: enrollment numbers, decreases in uninsured, stable or dropping medical costs, deficit savings, etc. – which are all looking great, by the way. And then there’s Kit Bond’s recent Op-Ed in the St. Louis Post-Dispatch.

An editorial note at the end of the post, notes that Bond’s lobbying firm has taken on the thankless task of promoting the Obamacare Medicare expansion – an expansion that the obdurate, anti-Obama, ideologically-blindered State Legislature just won’t countenance (if you listen carefully you just might hear the sound of tiny stamping feet and spluttering screams of “no, no, we won’t, you can’t make us” echoing off in the distance). The Op-Ed reveals Bond’s strategy for dealing with the ferocious anti-Obama-on-funny-but-misguided-principle crowd in and out of the legislature: pretend that Medicaid expansion has nothing to do with the loathsome program.

The first thing you will note about the Op-Ed is it’s evasiveness. It only mentions the Medicaid expansion once, near the end of the piece, and only equates it with the Obamacare legislation obliquely. Instead, Bond, cleverly cries a few tears over the problem of hospital closings in Missouri, problems he attributes mostly to “Obamacare-mandated cuts in funds hospitals receive for uncompensated care – the care hospitals are required by law to provide regardless of folks’ ability to pay.”

Since Bond knows his audience very well, he fails to point out that these hospital closings could far more honestly be attributed to the failure of the legislature to accept the Medicaid expansion funds offered through Obamacare, funds for care which was intended to take the place of the emergency room as the main mechanism for care of the uninsured and so offset the loss of federal emergency care dollars – and emergency room care is, incidentally, a far more costly and inefficient way of dealing with the uninsured than granting insurance through Medicaid. Aren’t Republicans supposed to be the financially responsible ones?

Instead Bond argues that the answer to the loss of these funds is to enable hospital mergers as a way to keep the hospitals pinched by the loss of emergency room funds functioning in underserved communities. And then he decries the fact that the Federal Trade Commisison (FTC) review process, which has the power to okay or deep-six a proposed merger, is, guess what, thorough. Or, the short version, the FTC does what it’s supposed to do and Bond knows that that gets his intended audience hot under the collar because, you know, big government:

Despite helping to create the problem for hospitals with expensive new mandates and cuts to reimbursements, the federal government is now making it difficult for these hospitals to deploy this private-sector solution. Currently, the Federal Trade Commission is moving painfully slow to evaluate any proposed merger or system expansion. Reviewing applications through the narrow lens of a century-old anti-trust law, the FTC is taking months or even years of bureaucratic analysis to approve these hospital partnerships – often too late for a community on the brink of losing its only hospital and largest employer.

Despite Bond’s anti-Obamacare, anti-FTC song-and-dance, Obamacare has actually been fueling hospital consolidation. But, Bond’s encomium to the merged entity that became  BJC HealthCare in the St. Louis area offers only one view of the possible outcomes of such mergers. Ill-considered consolidations have the potential to raise consumer prices, create physical access problems, as well as barriers to access to reproductive health services. As an article in Becker’s Hospital Review points out, there are a number of factors that determine whether a merger will be benign or harmful. Hence the FTC review process. It’s there to protects us, the consumers of health services – something Republicans don’t seem to understand or care about.

But of course, this whole, lengthy argument is not the real point of Bond’s Op-Ed, and is stealthily followed by this little tidbit:

Inaction by legislators in Jefferson City is also putting our health care safety net in Missouri at risk. State Sen. Ryan Silvey, R-Kansas City, has proposed a solution to reform our state’s Medicaid program that would increase access to care for hardworking Missourians, protect our health care safety net in rural and urban communities, and safeguard the state’s budget.

Unfortunately, anger over Obamacare has confused the issue, and right now, legislators are refusing to consider this common-sense solution … .

Senator Silvey’s proposal? Simply a way to try to make Obamacare Medicaid expansion somewhat palatable to the GOP heads-up-their-backsides contingent of the state lege. Such expansion, all by itself, could take care of the squeeze that the loss of federal emergency room dollars creates for hospitals. But – and here’s the magic of Bond’s rhetoric – in this article, it’s been aligned with “common-sense,” GOP-acceptable solutions to healthcare problems that Bond alleges to have been caused by that big winger bogey, big government, including – wait for it – Obamacare itself. One could read this article and leave persuaded that Silvey’s proposals have nothing to do with Obamacare and are only exciting opposition because the tentacles of evil Obamacare have confused the thinking of the poor souls in the Missouri capital.

Wow! Talk about tangled logic. Kit Bond, I salute you.

What this tells us is that conservatives who are capable of distinguishing their front from their backsides, know that Obamacare is a success and that now is the time to get Missouri in on it and let Missourians share that success. The deviousness of this piece of casuistry also reaffirms that reasonable conservatives also understand the real reason that Missourians don’t have this benefit – unbalanced, hysterical hatred of Barack Obama on the part of GOPers who can’t accept the failure of the dream of the conservative Reich that took root during the Bush years, and on the part of constituents who either fear and hate the black man in the white house, mostly because of that black-white dichotomy, or who credulously swallow all the nonsense their Foxified leaders have been spewing in their war against the godless, socialist Kenyan and his Nazi hordes.

And the funny thing? Politicians like Bond were more than willing to fan this hysterical fervor; they thought it was their ticket back into power. Now they have to serve it – or, as Bond is trying to do in his Op-Ed, trick the true believers and give GOPers in the lege a way to save face. Because Obamacare is a success and now we know they know it too – they just can’t say it out loud.

Yesterday evening the Missouri Rural Crisis Center sponsored a panel discussion on the Affordable Care Act (Obamacare) and Medicaid expansion in Missouri. The center has been organizing these discussion across the state. Last night the panel included Aaron Swaney, a certified application counselor with the Family Health Center; Amanda Avent, Corporate Events Director, American Heart Association; Ruth McKinney, Family Development Specialist, Missouri Valley Community Action Agency; Mike Sutherland, Public Policy Director, Missouri Budget Project; Brendan Cossette, Director of Government Affairs, Missouri Primary Care Association; Brian Smith a rural organizer with the Missouri Rural Crisis Center; and Reverend Heather Jepsen, Pastor at First Presbyterian Church in Warrensburg.

The panel for the Missouri Rural Crisis Center’s discussion on the Affordable Care Act and Medicaid expansion held in Warrensburg on April 2, 2015.

The panel outlined the economic and budgetary reasons for implementing Medicaid expansion (specifically, the coverage gap) in Missouri. They also explained the practical impact on rural communities – with the current absence of expansion hurting rural hospitals and local economies.

The was some hand wringing on the part of some panel members about being polite when contacting recalcitrant representatives in the General Assembly. Individuals in the audience expressed frustration about their representatives’ lack of understanding and knee jerk ideological opposition to Obama and Medicaid expansion.

Members of the General Assembly who represent the area did not attend the event.  

The panel took questions from the audience. Interestingly, one individual couldn’t quite grasp the negative economic and moral implications of denying access to health care to the working poor. Everyone else in attendance appeared to get it.

Reverend Heather Jepsen, First Presbyterian Church, Warrensburg.

Reverend Heather Jepsen, Pastor, First Presbyterian Church, Warrensburg: ….You’ve heard the numbers and you’ve heard the logic. I’m here to give a faith perspective on expanding Medicaid. As you may or may not know, all faith traditions encourage their followers to care for the vulnerable and the most needy in their communities. Obviously I’m from the Christian faith. When Jesus Christ is asked to sum up the whole of the tradition he says, Love your God and love your neighbor. To ignore our neighbors in need is to ignore our God and to ignore our faith. We call ourselves a Christian nation and then we turn around and create a system where health care becomes a privilege for the wealthy rather than a right for every individual in our midst. There is absolutely no excuse for this coverage gap. As people of faith [applause] we should consider it an act of faith to demand that our legislators put, make policy changes that care for all people in our state. We should demand it. It is a faith act. Go out and do it for your neighbor and for your God. [applause]

Now, to get the right wingnut republican controlled Missouri General Assembly to understand that.

Late last night:

Yael T. Abouhalkah ‏@YaelTAbouhalkah

Meanspirited but true to form. MT @mcbridetd @Medicaid4MO MO Senate votes 9-25 against Medicaid expansion 11:06 PM – 31 Mar 2015

Jeremy LaFaver ‏@jeremylafaver

After the Senate debate, #MedicaidExpansion rejected on a party-line vote. Okay. If you don’t like our solution, where is yours, MOGOP? 11:06 PM – 31 Mar 2015

Andrew Miller ‏@AndrewMillerKC

. @jeremylafaver Call it the “I hate Barack Obama Missouri Medicaid Expansion Bill” and it will pass #MOLeg in 10 minutes. 11:19 PM – 31 Mar 2015

That about sums it all up.

It seems that House Rules Committee Chairman Pete Sessions (R-TX) is worried that undocumented immigrants are driving up our murder statistics:

SESSIONS: Every day, all along border states, maybe other places, there are murders by people who have been arrested coming into this country, who have been released by the Obama administration, I believe in violation of the law, who are murdering Americans all over our cities.

We hold the Democrat Party and the President accountable for this action.

Of course, surprise, surprise, Sessions is, so to speak, dead wrong. Worse, he’s using what are probably purposely skewed statistics. As Think Progress observes:

The Washington Post’s Fact Checker ranked Sessions’ statistics with four Pinocchios, the highest rating given for inaccurate statements. They found no evidence that undocumented immigrants who benefited from the president’s immigration policies were responsible for the deaths of Americans on a daily basis.

Nevertheless, Sessions approach to the issue – blame the President and the Democratic party – suggests that we need to take a look at who or what is really, verifiably, killing Americans and assign blame accordingly.

Let’s start with the number of poor Americans who will die in those states that have failed to expand Medicaid. A study published early last year puts the number of deaths in Missouri that will result from lack of medical attention at between 218 and 700 people a year. The estimated number of deaths each year in all of the states combined that have opted of Medicaid will fall between 7,115 and 17,104. By Sessions logic, the folks responsible for these deaths will be the Republican lawmakers who refused to hold their nose and endorse a conservative health care reform offered up by a black, Democratic president. How will we hold the GOP contingent in Jefferson City accountable for all those dead Missourians? Who will hold the Republican lawmakers in the other recalcitrant states accountable for what they have done in the service of rampant conservatism run amok?

Then let’s move to the King vs. Burwell Supreme Court challenge to Obamacare itself. If the justices uphold the challenge, the result could be the unraveling of the entire healthcare reform and a return to chaos in the healthcare system. People will lose their healthcare. The result will will be dead Americans:

A brief filed on behalf of multiple public health scholars and the American Public Health Association, estimates that “over 9,800 additional Americans” will die if the justices side with the King plaintiffs. It reaches this conclusion by starting with an Urban Institute study showing that 8.2 million people will become uninsured in this scenario. As other research examining Obamacare-like reforms in the state of Massachusetts found that “for every 830 adults gaining insurance coverage there was one fewer death per year,” that translates to between 9,800 and 9,900 deaths if the justices back the plaintiffs in King.

So using the Sessions rule, who do we hold responsible for these deaths? Maybe start with the rightwing lawyers who, working under the aegis of the rabidly conservative American Enterprise Institute (AEI), and the Koch brothers-funded Competitive Enterprise Institute (CEI), spent a couple of years scoring the Act looking for a opening for an attack – and found it in a typo -you’ve got that right, a typo. Add in Republican lawmakers who vociferously support the lawsuit and who, they assure us,  will refuse to correct the typo that forms the basis of the challenge. Will anyone hold the rightwing think tanks, their corporate underwriters and their tame Republican politicians accountable for these deaths?

How about the estimated 24,000 lives that are lost in the U.S. as a result of lax regulation of coal particulates in the air? How about the thousands of coal miners who die yearly – according to Wikipedia, 3,200 miners died in 2007 alone – due to lax regulation of the mining industry? Shouldn’t the party of no regulations along with their corporate funders be held accountable for these and other deaths related to the failure to enact and enforce appropriate regulations?

I could go on and on counting off the various mechanisms of death for which the Republican party should be held accountable – we haven’t even touched on the wars pushed by Republican neo-cons in the past or their desire to embroil us in another similar war in Syria, Iraq, Iran, or what-have-you, or the massive die-offs that will result from climate-change ignored – but space and patience forces me to curtail the list.

There are two main implications to this death narrative. The first is that the GOP’s major operative principle is, “Give me market liberty or death,” and the inevitable resulting deaths are palatable to the Republican power-brokers and their underwriters because they are usually limited to the helpless and hopeless. That does not mean that the rest of us are helpless or hopeless to act or, at the very least, make sure that the blame is justly allocated.

Second, the potential deaths enumerated above are especially obscene just because they are potential. They could be avoided. But because of the willful obduracy of a few power-mad ideologues, the cynicism of and greed of other politicians, along with the equally willful ignorance of the people who vote for them, that’s probably not going to happen. Or it won’t happen if those of us who are appalled by the current and potential death-toll don’t get off our duffs and do something right now.

*Cross-posted to DailyKos with a few alterations.

Senator Claire McCaskill (D) met for coffee early this morning in downtown Warrensburg with Johnson County Democrats (and anyone else who showed up). She spoke at length about the 2014 election, the Missouri General Assembly, Medicaid expansion, the Affordable Care Act, and also took questions.

Senator Claire McCaskill (D) in Warrensburg – October 8, 2014.

[….]

Senator Claire McCaskill (D): ….I have watched, from afar, Jefferson City. And, you know, um, I’ve spent some time in Jefferson City. And it isn’t as if I don’t understand what this state is. I think you all know I get Missouri….I get that there are a lot of conservative people in this state. But if you step back from it and you look and you see that I have been elected and reelected statewide four times. [Governor] Jay Nixon has been elected and reelected state, in statewide office one, two, three, four, five, six times. [Secretary of State] Jason Kander was elected, [State Treasurer] Clint Zweifel was elected, [Attorney General] Chris Koster was elected. All of these are Democrats that are winning statewide. Now how do you reconcile that with the Missouri legislature, because the Missouri legislature is way, way, way to the right? It’s so far to the right you can hardly see it on the horizon. And the reason that’s happened is because of two things. One, they controlled redistricting, but, more importantly is because they have recruited candidates, funded candidates, and helped candidates run and win and….we behaved, well, you know, that Jeff City, it just is hopeless. You know, they’re in charge and there’s nothing we can do. Well, they cast votes that are completely out of step with most Missourians. I guarantee you they’re out of step with the people that would be in Gary [Grigsby]’s district [51st Legislative District]. Um, I could go through a list. I mean, how many Missourians want them to be spending time on Sharia law? Um, how many Missourians really think Agenda 21 is a problem? How many Missourians think it’s a good idea to tell the local sheriff and the local police department that if they’re gonna work on an interdisciplinary task force with Federal officers they could go to jail if they arrest somebody in that effort that has a gun that’s prohibited by the Federal government. They wanted to put local law enforcement in jail for cooperating in a Federal investigation that could involve guns. I mean, this is crazy time….

[….]

…You know what people of this state want from their state legislature? They want good roads and bridges, they want good public education, and they want to make sure that their money is being spent wisely. They don’t want rape victims to have to wait three days to terminate a pregnancy that their rapist caused. They don’t want that. Vast majority of Missourians do not want that….

[….]

Question: …You must fight, the Democrats must fight no matter what happens in November, it [the Affordable Care Act – “Obamacare”] must not be repealed.

Senator Claire McCaskill (D): Well, it won’t be repealed as long as, uh, Barrack Obama is President of the United States. Um, and I do, I will tell you that I think our, I’m traveling next week on behalf of my colleagues, I do think that, um, we are in pretty good shape. It’s gonna be close across the country. Um, but I will be surprised if we don’t hold on….

[….]

….The election that will determine the future of health care reform in this country, as to whether or not we continue down the path, will be, um, electing Hillary Clinton in, in twenty-sixteen. I will be back here and this place will be full, wall to wall, with people, I hope, working, um, on behalf of Hillary Clinton in twenty-sixteen.

Question: I think the one, the one issue that the state Republicans are the most opposite of their constituents is on Medicaid expansion. Because, a lot of my Republican friends, that is the one thing that they are really the most distressed about, is that we haven’t expanded Medicaid in the state and we didn’t accept the Federal money, because they have family members who should be Medicaid eligible and are not. And I see that’s just the most vulnerable issue for these, for, you know, at least our state representatives is that they didn’t support that.

Senator Claire McCaskill (D): There are, we have three hundred thousand Missourians, so you can speak to this when people that you, you talk to them, we have three hundred thousand Missourians who are working. You know, when people hear Medicaid I think they think of people that aren’t working. These are people that are working. They are working two and three jobs. They are making too little money to get on the [ACA] exchanges, but they make more money than they can do to get Medicaid. So, the, the weird thing is that, um, you know, we’ve got this gap. And that is all because they have turned down the Federal money that would, that would expand. [voice: “Our Federal money.”]  Our Federal money is going to other states for their health care. And it is really hurting rural Missouri, uh, because in many rural communities the number one employer is the hospital. And these hospitals are dying on the vine. I mean, they are desperate. And that’s the irony, is the reddest parts of the state are gonna suffer the most  ’cause that’s where a lot of the working poor are, people that are working two or three minimum wage jobs and don’t have insurance at work. And they can’t, they can’t get on the exchanges and they don’t qualify for Medicaid. Um, so it is really crazy. I mean, it would be, imagine if the Republicans said, you know, we’re not gonna take Federal Highway funding. They might cut it off some day so we better not take it. [laughter[ Let’s just not take Federal highway funding. We don’t want our money that we’ve paid, come back for our highways, because it’s the Federal government. And they might cut it off some day and then we’d be left holding the bag. And I’m like, well, I think you’re holding the bag now because, guess where all those people are going for health care? They’re going to hospitals who are treating them and then they’re passing on the bills to Missourians. It’s like a huge hidden tax increase. It’s craziness. And the only reason they won’t expand it is because they think it’s connected to Obamacare. So, it’s about the political messaging of Obamacare, it’s not about Missourians. It’s really unbelievable….

[….]

Senator Claire McCaskill (D) [center] with Gary Grigsby (D) [left], the Democratic Party candidate in the 51st Legislative District,

at an early morning coffee in downtown Warrensburg – October 8, 2014.

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.

 

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.