Long strange trip

 I've been wracking my brain trying to think of what to say about the events of the week and the years that went before it. For most of the fall, I've been very concerned about the possibility of a coup, quasi-legal or otherwise. I'm still wondering what kinds of violent stunts white nationalist groups may unroll and what other long term damage has been done to the democratic process, imperfect as it is. 

I'm hoping that the nation's flirtation with fascism or at least authoritarianism is at least waning.

Aside from issues of authoritarianism, the last four years have involved a lot of defensive fights, mostly revolving around health care (food security too, but that's another story). If there's been a central theme of my nearly 32 years at AFSC, health care would be it.

My first big fight was the Pittston strike, which was mostly about retiree health and pension benefits. These were also factors in the 1990 teachers' strike and the 1990-92 Ravenswood lockout. Ditto the fights about "reforming" workers compensation that lasted for a decade between the mid 1990s and 2000s. 

The coming of welfare "reform" in 1996 started another decade or so of sporadic fights related to Medicaid. These included issues like transitional coverage for people leaving cash assistance, the possibility of block grants, waivers and such. 

Then came efforts to get the state to implement the federal Children's Health Insurance Program in 1998 and then to expand eligibility for it, eventually up to 300 percent of the federal poverty level by 2011. My late co-worker Carol Sharlip was a major player in building support for this in the early years.

In 2009-2010 came the push to enact what eventually became the Affordable Care Act. I remember going to public hearings around the state and witnessing the WV version of the birth of the white backlash and the Tea Party. These included paranoid ravings about the World Health Organization taking over and someone heckling a priest during an opening prayer. And, yes, people who wanted to keep the government's tentacles off Medicare. There were street actions, press conversations, calls, emails, op-eds, bus trips to DC, and all that. Then lots of outreach and education when it passed.

(There were some serious debates within AFSC about whether to sign on in support of the bill. Some didn't think it was good enough. I may or may not have stopped talking with some people after that.)

The version we got was the Senate's rather than the more generous House version in March 2010. Here's a blog post I wrote about it at the time. Then the 2012 US Supreme Court decision which let it stand but made Medicaid expansion--the real public option--a state decision. The biggest social justice victory of my lifetime was then-Governor Tomblin's decision to expand it. Here's a report we published in an effort to nudge the governor in 2013. My retired colleague Beth Spence did the interviews and photography.

I would never have guessed the state would do such a great job at enrolling people. At it's peak around the time of the 2016 election, the expansion covered nearly 180,000 West Virginians (after four years of assaults by the Trump administration, I think enrollment is around 160,000 now). The new president, aided by WV's attorney general, promised to do away with the whole ACA as soon as he came into office.

It was an all-hands-on-deck moment. Health advocates scrambled to the defense. My co-worker Lida Shepherd and I worked with Cabin Creek Health Systems to interview people covered by the ACA and publish the results and generate other media, including a widely seen video report in the New York Times. Given that WV has been ground zero for the opioid epidemic, protecting the ACA, which opened up recovery to thousands, was critical.

We worked with allies to do all the usual stuff. Some friends of ours, nicknamed "the Capito six," were arrested for sitting in at the WV Republican senator's Charleston office. I remember protesting outside WV's giant Boy Scout center when the President spoke. People put lots of effort into bolstering Senator Manchin's support for the ACA. He eventually came around to a "fix, don't nix" position. In a closely divided Senate, WV was in a critical spot, with a conservative Democrat and fairly moderate Republican. People hit it with all they had.

The critical moment came in July 2017 when a dying John McCain cast a deciding vote after returning from hospital treatment for brain cancer, basically saving the day. Here's a post on that occasion that includes his eloquent statement.

After a pause to catch our breath, WV health care advocates turned next to fight off bad state legislation regarding work reporting requirements for Medicaid expansion that would have kicked tens of thousands of low income West Virginians off the program in 2019 and 2020. I'm hoping that COVID-19 has shown this to be a Really Bad Idea.

By the time of the 2020 election, the ACA was battered but still afloat, although it wasn't clear if it could survive another four years of federal assaults. Then there was the added wrinkle of the US Supreme Court taking up another repeal attempt with three Trump appointees. The decision is expected as soon as this spring, but early deliberations seem promising.

So I guess this is another catch the breath moment. We're still far from universal care, but it's been a long hard fight to get as far as we have. I'm grateful to the many friends who have been in the fight from the beginning. Like the ACA, we're battered but still around.

Counting the cost of health care repeal

 It’s too soon to say, but the people who want to overturn the Affordable Care Act, a group that includes West Virginia’s attorney general, are closer than before to getting what they want, even in the midst of a pandemic that has already killed over 200,000 Americans.

Opponents of the ACA, often referred to as Obamacare, give many reasons for wanting to kill it, although I suspect that, for many, the main reason is that it can be associated with a Black man.

But what would it mean for ordinary Americans if the ACA haters get what they want? The answer is pretty grim, if you do the math.

One feature of the ACA is protection of people with preexisting conditions in qualifying for health insurance. According to the federal Department of Health and Human Services, as many as 133 million Americans, over half of the non-elderly adult population, have some such condition.

Given the frailties of the human body, it has been argued that “life is a preexisting condition,” or at least one waiting to happen. This was especially true for women before the ACA passed, for reasons of medical costs associated with pregnancy, breast cancer and conditions unique to them. The National Women’s Law Center said that before the ACA “just being a woman could be considered a preexisting condition.”

Then there’s Medicaid expansion, a part of the ACA that became a state option after a 2012 U.S. Supreme Court decision. According to the Kaiser Family Foundation, 39 states and the District of Columbia, have adopted this measure, which covers about 12 million Americans, most of whom are low-income working people and many of whom are the “essential workers” that everyone else depends on these days.

The ACA guarantees that states that adopt the expansion will never have to pay more than 10 percent of the costs. Without it, states would be unable to sustain coverage.

About 160,000 West Virginians are covered by the expansion at any given time and probably 200,000 or so are covered during a year. Aside from improving and saving lives, federal expansion funding also helps keep rural hospitals and health care facilities open and supports thousands of jobs.

Medicaid expansion has been a huge help in confronting the opioid epidemic. According to the Georgetown Center for Children and Families, “Medicaid expansion was associated with a substantial increase in opioid addiction therapies, particularly in states with high opioid overdose rates.”

Nationwide, about 800,000 Medicaid expansion recipients are dealing with opioid addiction.

A 2020 article in the Journal of the American Medical Association found that states that adopted Medicaid expansion had a decrease in opioid deaths, compared to states that hadn’t expanded Medicaid.

I’ve interviewed people in recovery about the role Medicaid expansion has played in their access to treatment. One woman summed it up neatly: “Without it, I’d be either dead or in jail.”

Then there are those who buy health care on the marketplaces. Kaiser reports that, in 2020, this amounts to 11.4 million Americans and over 20,000 West Virginians. Of these, an investigative article in The New York Times said that, “If the marketplaces and subsidies go away, a comprehensive health plan would become unaffordable for most of those people and many of them would become uninsured.”

The Times also reports that ACA repeal would hit Medicare recipients as well, affecting around 60 million Americans and over 440,000 West Virginians. Among other effects, if the law were struck down, “Medicare beneficiaries would have to pay more for preventive care, like a wellness visit or diabetes check, which are now free. They would also have to pay more toward their prescription drugs.”

Young Americans also would take a hit. The ACA allows about 2 million young adults to keep their parents’ health insurance up to age 26. The last numbers I could find suggest that about 20,000 young West Virginians are covered in this way. Without it, companies could withdraw coverage.

Killing the ACA also would dramatically increase the cost of health care, including uncompensated care, raising copays and premiums as these costs are passed on to individuals and families. The Urban Institute reports that “Demand for uncompensated care would increase by $50.2 billion, an increase of 82% compared with ACA levels.”

Oh yeah, and then there’s the prospect of millions of Americans losing health coverage while COVID-19 is still ravaging the country and the world.

To sum it all up about ACA opponents, and to paraphrase Winston Churchill, seldom have so few tried to do so much harm to so many. God help the country if they get what they want.

(This ran as an op-ed in the Charleston Gazette-Mail.)

Another one to watch

I've kind of been obsessed with health care policy for pretty much my whole career with the American Friends Service Committee, which began in 1989.

The first big fight I ever had, the Pittston coal strike (1989-90), was largely about health benefits for coal miners and their families, especially for retirees. Health care was a major issue in other good labor struggles from the Ravenswood Aluminum lockout (1990-92) to the recent WV work stoppages by teachers and school service workers.

In terms of public policy, lots of fights in the era of welfare reform (1996-early 2000s) had to do with health care. These included enacting the Children's Health Insurance Program at the federal level, followed by several pushes here to get the state to implement and expand the program. That culminated in 2011, when then Governor Tomblin expanded eligibility to 300 percent of the federal poverty level.

There were also efforts in that period to make sure people got "transitional Medicaid" when they left public assistance, along with supportive services related to minimal dental and vision care.

Then came the epic struggle to enact the Affordable Care Act. Misnamed Obamacare, it's really more like the Senate version of a reform bill. The House version was better, but with the death of Senator Edward Kennedy in August 2009, the senate version was the only game in town. It passed in March 2010.

I remember all hell breaking loose at town meetings in WV and around the country in 2009. At one in Huntington, a conspiracy theorist argued that reform meant something like a military takeover by the World Health Organization. You know, black helicopters and microchips in the butt. Apparently, they haven't made it out my holler yet.

At another event in southern WV, a  Catholic priest got heckled by someone during the opening prayer, with a shout of "How much are you getting paid?"

Efforts to repeal it began as soon as efforts to defeat it in Congress failed. In 2012, the US Supreme Court weighed, affirming the constitutionality of the law but making a key piece of it, Medicaid expansion, a state option.

People here worked hard to persuade Tomblin in 2013 to make the expansion, which he did with characteristic caution, seeking an actuarial opinion that fortunately underestimated the benefits of the expansion to WV. The effects were and are huge.

While quite a few states jumped on right away, others, particularly in the south and west, held out. A series of state by state fights ensued. I think each time a state decides to expand it, the harder it will be to undo the whole thing.

(I'm going  to skip over the epic fights since the 2016 election to block Trump, WV attorney general Patrick Morrisey and others of that ilk to take it all away from millions of Americans, not to mention the next US Supreme Court ruling, which is expected to come early next year. I get tired just thinking about it.)

The last time a state expanded Medicaid was in Oklahoma in June, where voters narrowly approved the expansion despite a flood of dark money..

Which brings us to tomorrow, when voters will take up the measure in Missouri. The following alert went out from Joshua Saleem, director of AFSC's St. Louis program to Friends and contacts in that state:

On August 4, Missouri voters will have the chance to make history and save lives by voting “Yes!” on Amendment 2, which would expand Medicaid to cover around 200,000 currently uninsured state residents. The expansion would particularly benefit adults in working families earning up to 138% of the federal poverty level.

This step makes sense in “ordinary” times by extending health care, opening the path to recovery from addiction, easing the path to reentry for formerly incarcerated people, supporting hospitals and health care providers, creating jobs and generating economic activity—but these aren’t ordinary times. In these times of a global pandemic that has yet to slow down, a yes vote is absolutely imperative.

Medicaid expansion is a provision of the 2010 Affordable Care Act. It was intended by Congress to apply across the nation, but a U.S. Supreme Court decision made it a state option.  As of now, 38 states, including the District of Columbia, have expanded Medicaid. Missouri should join their ranks.

The vote could be close. In Oklahoma, voters approved the expansion in June—but by a bare margin of one percent. Millions of dollars in dark money will be spent to defeat the measure.

This is why we’re asking you do three things: vote yes, share this email with friends, and do all you can to get out the vote.

Since its founding over 100 years ago, the American Friends Service Committee, following the Quaker belief in the value of all persons, has worked to promote economic rights as human rights. It has supported access to health care internationally as well as at the national and state level in the United States.

It doesn’t often happen that ordinary people have the opportunity to make such a huge difference with such simple steps, but this is one of those times. Please help us make the most of it.

It will be the latest round in a series of struggles that probably began in the USA in 1912 when former president and presidential candidate Theodore Roosevelt first proposed something like universal health care as the candidate of the Progressive Republican Party.

I plan on staying up as long as it takes for the vote to be counted.











 

The politics of health care in a pandemic

In a recent post about health care, I suggested that Oklahoma's ballot measure on Medicaid expansion would be one to watch. Well, sure enough, voters in that heavily Republican state approved the measure by a little over 50 percent. Considering the dark money that went into opposing it, I'd call that a landslide. Dollars seem to count more than votes most days.

Interestingly, Oklahoma was the first state to expand Medicaid during the COVID-19 pandemic. But it may not be the last. Missouri is scheduled to vote on the measure August 4. And so far, expansion has passed in every state where it was put on the ballot.

As I've argued many times before, it's good news any time a state takes advantage of this best provision of the Affordable Care Act. First, it improves and saves lives. Second, it creates jobs and generates a lot of economic activity. Third, it helps more people stay in the workforce. Fourth, each expansion makes it a bit harder to get rid of the whole thing.

Back to Oklahoma. This is also the state that took up the Trump administration's horrible idea of accepting a cap on Medicaid spending. Looks like that ain't gonna happen.

This article from Politico argues that the pandemic has upended the Trump/Republican dream of rolling back health care. I don't know if that's true, since the US Supreme Court could still do a lot of damage.

Still, I think we can agree that the optics, in the parlance of our time, of taking health care away from people or keeping them from getting it to start with just don't look that good. In an election year.

We'll see. But this is another reminder that all news isn't bad.

Doing the math: what repealing the Affordable Care Act would mean for WV

At the risk of being a downer, I feel the need to point out what’s at stake for West Virginia in the latest effort on the part of the president (and the state attorney general) to kill the Affordable Care Act in court.

Spoiler: a lot.

Let’s start with recovery from addiction and mental health. Back in 2017, state officials said that the ACA, and particularly Medicaid expansion, helped bring treatment for addiction to 50,000 West Virginians. That number has no doubt gone up since then.

Recently, Lori Kersey reported in the Gazette-Mail that low-income West Virginians got $90 million worth of mental health and substance abuse treatment last year and almost $300 million over the last four years.

She cited data from the state Department of Health and Human Resources that the state’s expanded Medicaid program provided around $58 million in mental health and substance abuse treatment in 2015. It increased to $61 million in 2016, $79 million in 2017 and $90 million in 2018.

I’ve talked with people who are convinced that access to that treatment saved them from death or worse and brought them back to the land of the living. Now they’re clean, putting their lives together, taking care of their children, holding down jobs and paying taxes.

As Jesus said in one of his most famous parables, “be glad for this, your brother was dead, and is alive again. He was lost and is found.” (Luke: 15:32)

Now imagine all that gone.

Then there’s this: According to the DHHR, as of April 1 of this year, 160,356 West Virginians were covered by Medicaid expansion, a state option under the ACA. Most of these people are holding down jobs. Another 22,600 state residents bought coverage under the ACA exchange. Then there are around 12,000 young people in the state who can stay on their parent’s insurance until age 26, another ACA provision.

Then there’s the fact that the ACA helped reduce prescription drug “donut hole” costs under Medicare Part D for the approximately 240,170 West Virginia seniors who participate in the program. The icing on the cake is the fact that the ACA brings hundreds of millions of dollars to our economy, creating thousands of jobs and helping to keep rural hospitals and health care providers going.


The Urban Institute has estimated that repealing the ACA could result in the loss of 16,000 jobs and $9.1 billion in state economic impact.

Imagine all those dollars and jobs, too.

Then remember that those are just the numbers, but behind the numbers are real people, families and friends, people we know, work with and love.

Screwing over that many people of all ages with one stroke would be quite an accomplishment, even by today’s standards.

It would be the next worst thing to a natural disaster of biblical proportions, except the harm would be caused by the deliberate action of a handful of people.

If it comes to that, I don’t think it will be forgotten anytime soon.

(This appeared as an op-ed in today's Gazette-Mail.)

What's at stake for WV in the health care fight

If you want to know what's at stake for West Virginians in the fight to preserve the Affordable Care Act (ACA), which is once again under attack by Prince Joffrey President Trump, consider this info by Gazette-Mail reporter Lori Kersey:

Low-income West Virginians received $90 million worth of mental health and substance abuse treatment last year, and nearly $300 million over the last four years, under a law the Trump administration is trying to repeal, according to West Virginia health officials.

Under the Affordable Care Act, commonly known as Obamacare, West Virginia expanded its Medicaid program to those who make up to 138 percent of the federal poverty line.

According to the West Virginia Department of Health and Human Resources, the state’s expanded Medicaid program spent about $58 million on mental health and substance abuse in fiscal year 2015, $61 million in 2016, $79 million in 2017 and $90 million in 2018.

Then there's this: according to the WV Department of Health and Human Resources, as of April 1, 160,356 West Virginians were covered by Medicaid expansion, a state option under the ACA. Another 22,600 state residents got coverage under the ACA exchange. Then there are around 12,000 young people who are able to stay on their parent's insurance until age 26, another ACA provision.

Then there's the fact that the ACA brings hundreds of millions of dollars to our economy, creating thousands of jobs and helping to keep rural hospitals and health care providers going.

Those are just numbers, but behind each number is a story. Here's a link to some collected from people who gained coverage thanks to Medicaid expansion.

This is our concern, Dude.

How I survived year one of the Cheeto Apocalypse (although there are a few days left)

(2017 would have gone much better if Arpad the Magnificent, pictured above, was still around)

Well, year one of America's latest dark journey is about to end. I can't say I'll miss it much.

Greed and hatred triumphant. Fascism and white supremacy's moment in the sun. Sealing the deal on oligarchy. Still there were moments.

In this post, I want to write a bit about how I got through it. I'm interested in your ideas as well. After all, the dark journey isn't anywhere near over yet. So, in no particular order, here goes:

1. Obviously, certain people and animals helped, starting with La Cabrera my partner.
Without her there wouldn't even be goats to name and exploit in this blog. Then there are friends, family (literal and metaphorical) and comrades, with some overlap there. I've been blessed to have a great group of people to work and talk **** with. It's also been a pretty good year for gallows humor.

2. Spy novels. A while back I listened to a lecture series on the history of espionage. The lecturer mentioned some notable fiction on this subject, including the novels of Alan Furst, which are all set in the 1930s and 40s and deal with resistance to the Nazis, which for some unknown reason seemed to fit my mood. I devoured all 14 one after another. He needs to get busy again. (Now I'm on John LeCarre, although I read him more for nostalgia about the good old days of the Cold War, which may not have been what the author was going for.)

3. Hoopla. My local public library, which hasn't been privatized and auctioned off just yet, has this feature by which you can download books (audio and electronic), music, and videos to smartphones and other devices. I go through tons of audiobooks while driving, running and doing tasks that don't take a lot of thought (my favorite kind). With CD books, I was always at risk of misplacing and losing discs, which was a pain. Hoopla changed all that. Hoopla also helped me take a...

4. Wisdom bath. With Hoopla's help I was able to listen to unabridged recordings of Herodotus' The Histories, Thucydides' Peloponnesian War, and Plutarch's Lives. I'd read them all before at least once, but it was nice to pound them down in order. Herodotus's story of the Greco-Persian War, heavy on wonders and tall tales, is a moral study of the dangers of hubris. Plutarch has been mined for 2000 years for lessons and inspiration. His Lives were also the source of several of Shakespeare's plays. Thucydides' no-nonsense account of how a great democracy went off the rails was like a warning.

5. The Resistance. I couldn't believe the size of the Women's March in Washington, in Charleston and around the country--or the many groups springing up around WV and elsewhere which are determined to fight back.

I had the privilege to travel around the state to meet and work with "new" and "old" groups of people committed to social justice from Huntington to Concord to Lewisburg to Parkersburg to Wheeling to Buckhannon to Morgantown to  Berkeley Springs to Charles Town, with plenty of stops in between. To use the language of spy novels (see #1) this meant many more assets to work with.

7. The fights. There were several in the legislature, a few of which were successful. Much of the year was devoted to trying to preserve recent gains in health coverage, particularly Medicaid expansion, which brought coverage to around 175,000 working West Virginians. At first it looked like flat-out ACA repeal was a slam dunk but that didn't happen, thanks to the hard work of people all over WV and the nation. Then there was the #taxscam tax reform fight, which didn't go as well. More fights, starting with CHIP reauthorization, are on their way. It may not have done any good, but I was also lucky enough to have some soapboxes to rant from in the form of newspapers, radio and such.

8. Physical activity. No marathon this year (but watch out, 2018!) but there were plenty of foot miles slogged, not to mention martial arts, yoga and such. I'm especially grateful to my Okinawan karate lineage, which includes legends like Funakoshi, Itosu, Kyan, Matsumura and Sakugawa.

9. Coffee and box wine, for obvious reasons and at different times of day. Oh yeah, and some attendance of Episcopal church services.

10. Myths, stories and ancient teachings. The Buddha on impermanence, insubstantiality and suffering. The Bhagavad Gita on following one's path or dharma: "It is better to fail at your own dharma than to succeed at someone else's." The Norse idea of Ragnarok, a final battle doomed to fail but still worth fighting. Dante's allegory of the need for both human effort and divine grace.

Then there's Tolkien's idea of "eucatastrophe," an unexpected turn of events that brings good news when all seems hopeless. One of those would be nice right about now. Who knows--we might even get one in the new year.

TaxScam in a nutshell

Here's what I think we need to know about the highly partisan version of tax "reform" now being pushed through the senate:

1. George W. Bush passed massive tax cuts and what we got was....permanent prosperity? Oh, wait, it was the biggest crash since the Great Depression. I'm not saying the tax cuts were the sole cause, although they did contribute to the financial bubbles that led to it. But it's obvious that tax cuts don't guarantee growth or prosperity or economic stability.

2. This is a Trojan horse. The massive transfer of wealth to those who already have it will eventually crowd out funding for things like Medicare, Medicaid, student aid, food security, housing etc.

3. There are plenty of "starve the beast" Republicans who want that to happen. They hope a crisis will force cuts to domestic programs.

4. Then there's the whole thing about adding $1.5 trillion+ to the deficit for no good reason.

5. Whatever cuts some middle class people will get is a sugar high. Those cuts are temporary, while cuts to corporations and the wealthy are permanent.

6. Due to the tilt of the programs towards the wealthy, people in 19 states, including West Virginia, will eventually pay more in 2027 than they do under current law.

7. Then there's the consequences of repealing the Affordable Care Act's individual mandate, which will greatly increase the number of uninsured Americans and drive up costs for everyone else.

I mean, golly, what could possibly go wrong?

Having it both ways

So this past week we heard that the president declared America's opioid crisis to be a public health emergency. We can at least agree on that. 

Too bad he didn't mention anything about the funding needed to deal with it.

In 2015, there were more than 2.5 million Americans with opioid use disorder according to the Substance Abuse and Mental Health Services Administration. That year, more than 33,000 Americans died of opioid overdoses, which is triple the death rate for 2000. The United Nations Office on Drugs and Crime reports that the US, with less than 5 percent of the world's population, accounts for about a quarter of drug related deaths.

Unfortunately, the same person who declared the emergency also wants to destroy the Affordable Care Act, which has brought drug treatment to many Americans.

According to the American Journal of Public Health, the ACA has expanded treatment options through four main mechanisms: expanded coverage, insurance rules requiring substance abuse treatment, enhanced mental health parity, and opportunities for integrating substance abuse treatment with mainstream health care. An estimated 1.6 million Americans received coverage through Medicaid expansion alone.

So it seems that what we have here is the declaration of an emergency along with a declaration of war on one of the few things that is actually working to deal with it.

More of a tweet

Well, a Republican senator had the courage to break with the leadership in order to save health care coverage for over 200,000 West Virginians. Too bad the senator in question was from Arizona.

The Walking Dead, health care version: action needed

As recently as last week, it looked like efforts to repeal the Affordable Care Act--and take away health care for millions of Americans--was dead. But this is the era of zombies or walkers, when things that should long ago have been dead and decently buried shuffle around to devour the living.

The latest walker to show signs of being dangerously undead is the Graham-Cassidy bill, which is rapidly gaining momentum. It's not clear whether senators who opposed earlier repeal efforts will hold the line. And here's an added wrinkle: the window to pass this zombie bill closes Sept. 30. After that, changing the health care law will require bipartisan support, which some senators have actually been working on.

According to the WV Center on Budget and Policy, Graham Cassidy will cut West Virginia's Medicaid funding by $2 billion by 2027. It would convert funding for expanded Medicaid to a temporary block grant while also undermining traditional Medicaid. On top of that, it would further disrupt the individual market. Read more about all that here.

You probably saw this coming, but it's time once again to contact WV Senator Shelley Moore Capito and remind her of her statement that "I did not go to Washington to hurt people."

Here's how:

OFFICE LOCATIONS

• BECKLEY, WV

  220 North Kanawha Street
  Suite 1
  Beckley, WV 25801
  Phone: 304-347-5372
  Directions
 

• CHARLESTON, WV

  500 Virginia Street East
  Suite 950
  Charleston, WV 25301
  Phone: 304-347-5372
  Directions
 

• MARTINSBURG, WV

  300 Foxcroft Avenue
  Suite 202A
  Martinsburg, WV 25401
  Phone: 304-262-9285
  Directions
 

• MORGANTOWN, WV

  48 Donley Street
  Suite 504
  Morgantown, WV 26501
  Phone: 304-292-2310
  Directions
 

• WASHINGTON, DC

  172 Russell Senate Office Building
  Washington, DC 20510
  Phone: 202-224-6472
  Directions

Getting real about fixing health care

A lot of great quotes have been attributed to Winston Churchill, British Prime Minister during the World War II era. Too bad he didn’t actually say some of them.

That’s probably true of one of my favorites, although I’m not going to let that stop me now.

The nonquote I have in mind goes like this: “Americans can always be counted on to do the right thing — after they’ve tried everything else.”

(He really should have said that.)

That line came to mind after the latest health care roller coaster ride that ended with Arizona Sen. John McCain’s movie-moment no vote.

In his statement, McCain had this to say:

“We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”

To paraphrase, we’ve already tried everything else. Maybe it’s time to do the right thing, which would consist of keeping what’s working and fixing what isn’t.

Maybe it’s a pipedream in this moment of extremism, but it would be the best solution for the American people.

While I’ve spilt a lot of ink (or pixels) defending parts of the Affordable Care Act, I’ve never been an uncritical supporter. At best, it’s an extremely indirect way of getting part way to where we should be, i.e. covering all Americans. It works really well for millions of people — including around 225,000 in West Virginia — but not much or even not at all for others.

Recently, my co-worker, Lida Shepherd, with help from Andy White, interviewed several people impacted by the ACA who received care from Cabin Creek Health Systems. Some purchased health care on the exchange and some were covered by Medicaid expansion. A former coal miner received additional help for black lung due to ACA amendments pushed through by the late great Sen. Robert C. Byrd, D-W.Va.

Nearly all of those we interviewed had pre-existing conditions, including cancer, diabetes, heart disease, irritable bowel syndrome, thyroid disorders, Hashimoto’s syndrome, sleep apnea, addiction, anemia, arthritis, endometriosis and more

We didn’t talk to enough people to get a scientific sample, but it gave us a pretty good sense of where people were.

Generally, those who received care through Medicaid expansion were very enthusiastic about it. Others, who received care through the exchange, were glad to have coverage, but some were more critical, especially those experiencing rising premiums, co-pays and out-of-pocket expenses.

For those in recovery, addiction treatment through Medicaid expansion was a godsend. One woman put it this way: “I wouldn’t be here without it, that’s for sure. I wouldn’t have a job. I wouldn’t have a home. It’s affected my whole life. Before I came here, I didn’t have a job. Now I’m an assistant manager. I’m healthy. I’m happy. My son has a great life. He’s happy.”

Another woman echoed that sentiment: “You literally wake up one day after you’ve had nine months or more of sobriety and you’re like — OK, I didn’t realize it but my house is clean every day. My daughter always has clean clothes and food. Her hair is always done.”

In some cases, the ACA was a mixed blessing, but still a blessing. The former miner related how he and his wife purchased coverage on the exchange for her, only to find out that she had a potentially fatal heart condition. He said that news “just took the bottom out of my world.”

Thanks to the coverage, she could get lifesaving but expensive surgery. He said, “Obamacare, although I paid a severe co-pay and a severe out-of-pocket pay, which was roughly $15,000 combination of the two, they picked up the rest of the bill. In that perspective, I got a bargain, though it was a large amount of money.”

A woman struggling with several pre-existing conditions and buried in out-of-pocket costs was frustrated with the ACA but said, “You tell me how I’m going to get insurance coverage by anybody else if this does completely go away, because I have pre-existing conditions. I can’t not have health care. I’m terrified. What am I going to do?”

If I had to sum up what everyone had to say in one sentence, it would be something like, “Make it better if you can, but don’t take it away!”

Otherwise, as one gentleman put it, “You might as well dig some graves, ’cause you’re going to be burying them.”

In a less-irrational world, the fits and starts (mostly fits) of repeal would give way to basic problem-solving on issues such as bucking up the individual market. According to the Commonwealth Fund, a private, nonpartisan health foundation, “The immediate concern is stabilizing marketplaces to ensure that the 17 million to 18 million people getting coverage through the individual market will be able to successfully re-enroll during this fall’s open enrollment period.”

Other basic steps would include ensuring that basic plans are offered in areas currently “bare” or without a plan available, and dealing with the issue of reinsurance, which causes problems for patients when one insurance firm acquires another.

West Virginia’s senators, Joe Manchin and Shelley Moore Capito, are uniquely positioned to move the discussion in a more productive direction if they seize the moment.

In any case, I hope all members of Congress and the current administration will consider what one person had to say about it: “Take away your own health care and see how you like it.”

(This appeared as an op-ed of mine in yesterday's Gazette-Mail.)

Could this be real?

I may be dreaming, but I think I just saw an article in the NY Times about how some in Congress are working in a bipartisan way to fix the parts of the ACA that most need fixing, i.e. the individual markets. Some ideas about how to do this are laid out by the non-partisan Commonwealth Fund, a health care foundation. This approach is in stark contrast to certain screeching tweet threats, which some lawmakers from both parties fear will totally destabilize individual coverage for millions of Americans.

I'm not sure how realistic this is, but it would be nice if we could keep the parts that work and actually do some problem solving on the rest.

Wow

Looks like I inadvertently picked an eventful weekend for a family road trip. At the time we planned it, nobody could have known that the latest round in the health care fight would come to a climax while we were traveling.

I tried as best I could to follow events by peeking at Twitter, but by bedtime it looked like curtains for the Affordable Care Act...which would mean curtains for real for some who would lose coverage.

I was blown away to learn this morning that John McCain earned Uber-Maverick status by his vote, which effectively killed this attempt to repeal (and maybe replace) the ACA.

I did not see this coming. In fact, when he came back from his hospital stay and voted for the Motion to Proceed, I was feeling pretty snarky. It seemed to me that he came back from receiving health care to a vote to take it away from others.

I was SOOOO wrong and I apologize to Senator McCain for even thinking this.

Instead, he chose that dramatic moment to act with the all too rare courage of a statesman. A longtime opponent of the ACA, he wants whatever happens with health care to be an improvement for the American people done in an open and transparent way.

Here's his statement:

"From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people. The so-called ‘skinny repeal’ amendment the Senate voted on today would not accomplish those goals. While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens. The Speaker’s statement that the House would be ‘willing’ to go to conference does not ease my concern that this shell of a bill could be taken up and passed at any time.

“I’ve stated time and time again that one of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict-party line basis without a single Republican vote. We should not make the mistakes of the past that has led to Obamacare’s collapse, including in my home state of Arizona where premiums are skyrocketing and health care providers are fleeing the marketplace. We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve."

Talk about a profile in courage. I hope his stand will help bring about a ration effort to fix what's broken with the ACA while keeping what works, one that follows the oath of Hippocrates: "First do no harm."

Talk about a movie ending--one that I'd like to see.

Thank you, Senator McCain! I wish there was more of this kind of courage closer to home.

Shortest blog post ever

In West Virginia, the journey from courage to cave-in takes about a week.

Last chance?

Not to be too dramatic about it, but this could be the last chance to try to preserve health care for millions of Americans, including kids, seniors and working people. In WV alone nearly 300,000 kids are covered by Medicaid, which also pays for over half of births and around 70 percent of long term care. Medicaid expansion as of today covers around 171,000 West Virginians.

Last week, Senator Capito seemed to be standing strong. Today it's hard to tell. And tomorrow is show time.

What can you do? You probably saw this coming, but keep calling Senator Capito's offices (the more the  merrier) and say something like "Stay strong. Vote no on taking away health care from WV."

DC office:  202-224-6472
Beckley: 304-347-5372
Charleston: 304-347-5372
Martinsburg:  304-262-9285
Morgantown: 304-292-2310

Lotta ins, lotta outs

The ongoing health care controversy reminds me of a line from The Big Lebowski. But then, almost everything reminds me of a line from that move. The line is question is "This is a very complicated case, Maude. You know, a lotta ins, lotta outs, lotta what-have-you's." Some of those are laid out in this story from WV Public Broadcasting.

In the latest Front Porch podcast, I gave some props to WV Senator Shelley Moore Capito for her statement on preserving coverage for her constituents in the state. I'm hoping that wasn't a case of speaking too soon. It's a bit hard to interpret her latest statement on the subject.

Worst case interpretation: she votes for a bad bill after some cosmetic changes are made to the old ones. Better case is that she really does hold out until there are guaranteed protection for things like traditional Medicaid, Medicaid expansion, CHIP and opioid treatment.

In a rational world, not that one exists anywhere near this one, there would be some bipartisan problem solving to fix the parts of the Affordable Care Act that need fixing, such as the individual market, while keeping what is working.

Recently, we interviewed several people affected by the ACA in Kanawha County WV. Some loved the coverage they had. Some hated it. All seemed to agree on this core message: "Make it better but don't take anything away."

Good news for and from WV

As Joe Biden might say, "Golly, this could be a significant development" in the ongoing fight over the fate of the Affordable Care Act and the millions who gained coverage through it.

Let's review the last week or so. First, Senate Majority Leader Mitch McConnell was hell bent on pushing through another bad version of ACA repeal and replacement. See my latest rant about that here. Then, Republican defections effectively took that off the agenda. Then McConnell, along with Prince Joffrey President Trump, called for repeal without replacement, another really bad idea. Now, that possibility just got a good bit more remote after WV Senator Shelley Moore Capito issued a strong statement opposing repeal without replacement.

She's not the only one but her decision is crucial. Here's her statement:

“As I have said before, I did not come to Washington to hurt people. For months, I have expressed reservations about the direction of the bill to repeal and replace Obamacare. I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia’s decision to expand Medicaid, especially in light of the growing opioid crisis. All of the Senate health care discussion drafts have failed to address these concerns adequately. 

“My position on this issue is driven by its impact on West Virginians. With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.” 

The fight isn't over...but this latest round might be. Congratulations to everyone in WV who worked so hard to make this happen.

I strongly encourage any and all from WV to pick up the phone and call both her local and DC offices and say a big "Thank you!" Here's the link. I'm about to pick up the phone myself.

Not there yet

It's too soon to pop any corks yet, but it is at least encouraging that WV Senator Shelley Moore Capito has come out strongly against the senate version for repealing and replacing the Affordable Care Act.

According to an article published in The Hill,

“I only see it through the lens of a vulnerable population who needs help, who I care about very deeply,” she said during an interview with Politico that was published Sunday. “So that gives me strength. If I have to be that one person, I will be it.”

Between now and whatever happens next, it will be important to continue to contact her office first to say thanks for this stand and second to encourage her to hold the line. We need to provide as much political cover as possible for her to do this.

Here are some more reasons why this is important and here are some ideas for immediate action.

Once to every soul and nation

When I was growing up, my mother used to drag me to church nearly every week, often with considerable resistance on my part.

Once there, I didn’t always pay a lot of attention. Since we were Episcopal, we at least got up and down a good bit, which was better than just sitting.

(Not to mention the whole bread and wine thing ...)

But you never know what’s going to stick.

I remember one time when a hymn hit me like a thunderbolt. It was “Once to Every Man and Nation,” written by the New England poet and abolitionist James R. Lowell (1819-1891). Nowadays, in the spirit of gender inclusiveness, people often sing it as “Once to every soul and nation.” But its point is as stark and sharp as ever.

The message is that, sometimes, we have to make a huge decision, one that will affect ourselves and others and will define us for as long as memory lasts.

Here’s one version of the opening verse:

“Once to every soul and nation, comes the moment to decide,

In the strife of truth with falsehood, for the good or evil side;

Some great cause, some great decision, offering each the bloom or blight,

And the choice goes by forever, ’twixt that darkness and that light.”

(Some well-meaning idiot later took it out of the Episcopal hymn book on the bogus theory that we always get more than one chance. In real life, however, that’s not the case.)

Later, I thought of this hymn when I learned about French existential philosophy with its emphasis on the need to choose.

That movement was shaped during the Nazi occupation of France, when people’s decisions really mattered — and often came just once. Should one collaborate with the occupation forces? Should one resist? If so, how might this impact loved ones? Should one try to be neutral? Was that even possible?

Closer to home, the classic Appalachian labor song “Which side are you on?” makes the same point.

Fortunately, most of us don’t have to make big decisions like that very often. But sometimes we do.

West Virginia Sen. Shelley Moore Capito is in that difficult position. She’s one of a handful of senators who will be critical in deciding whether millions of Americans lose health care they gained with the Affordable Care Act to help pay for yet more tax cuts for the rich.

She’ll also be deciding whether to make deep cuts to the Medicaid system, a 52-year-old federal/state program that provides care to around 70 million Americans, including children, seniors and people with disabilities.

In West Virginia, the traditional Medicaid program covers around 208,000 children, which is one out of every two. It also covers the births of around 10,600 babies each year, or 52 percent of the total. It covers 44,000 seniors, including in-home and nursing home care, as well as 124,000 people with disabilities who need critical care. The expanded Medicaid coverage covers around 175,000 adults, most of whom come from working families.

Aside from saving lives and helping people fight illnesses and addiction, that translates into thousands of jobs in the health care field and brings hundreds of millions of dollars to West Virginia’s economy — far more than coal or other extractive industries.

Capito and other Republican moderates are under immense pressure to pull the plug on millions of Americans to please Senate Majority Leader Mitch McConnell, not to mention other powerful politicians and the big-money individuals and groups that pull the strings. Not going along could affect their political careers in Washington.

But Senator Capito has also expressed concerns about undermining Medicaid, taking away health care from ordinary West Virginians and making it harder for people to get help with addiction. She’s been a champion of covering kids since she supported enacting the Children’s Health Insurance Program in the state legislature in the 90s. Her father voted for the passage of Medicare and Medicaid when he served in Congress in the 1960s.

So far, she’s stood with the people of West Virginia and rejected the initial Senate bill, which would have taken care away from 22 million Americans, according to the Congressional Budget Office. In a recent statement, she said the bill, as drafted, “will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply and harms rural health care providers.”

But it’s not over yet, and pressure on her and other moderates will continue to mount, especially if a few cosmetic changes are made to the proposed legislation.

I don’t envy their position. But in this once-in-a-lifetime decision, I hope Sen. Capito and her colleagues continue to think of all the people here who will be affected.

I’m reminded of these words of Abraham Lincoln at another critical time: “in times like the present, men [and women] should utter nothing for which they would not willingly be responsible through time and eternity.”

(This appeared as an op-ed in the Charleston Gazette-Mail.)