Happy 10th, Affordable Care Act!

Happy 10th birthday, Affordable Care Act! Here's a blog post I wrote at the time President Obama signed it into law:

It's official. President Obama signed the health care reform bill into law yesterday.

He told those in attendance that

We have just now enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care.

Critics of the bill may point out that this isn't exactly the case, but there's no denying that this is a landmark piece of legislation that will extend health coverage to millions who have been doing without it. The New York Times calls it

the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.

It remains to be seen whether the immediate benefits (political and otherwise) will outweigh the blowback. This item from Politico argues that the former will come before the latter, but I'm not sure I agree. It always seemed to me that a major drawback of the legislation was that the major expansion of health coverage via Medicaid and subsidies won't hit until several years down the line, meaning that the risks might hit earlier than the benefits.

Still, it probably will be hard for those who want to repeal it to win much of a crowd by saying "Bring back the donut hole" for Medicare Part D, or "let's cut those young people off their parent's insurance" or "Bring back denials of coverage for pre-existing conditions!"

The game has changed, although it's hard to guess just how or how much.

Not all bad, continued

You wouldn't know it by its recent political climate, but West Virginia is arguably the biggest beneficiary of the dreaded Obamacare around the country. 

As the Charleston Gazette-Mail's David Gutman reports, in 2013, before most of it went into effect, around 29 percent of state residents were uninsured. Today, that number is 9 percent, thanks largely to the decision by Gov. Tomblin to expand Medicaid.

According to CDC data, Gutman reports:

West Virginia’s decline in the uninsured rate, though, is more than four points greater than the next-largest decline (Kentucky saw its uninsured rate fall by almost 16 percentage points) and more than double the national decline of 7.6 percentage points. 

Nationwide, 7.4 million more people had health insurance in 2015 than in 2014, and the rate of uninsured — 9.1 percent for all people, 12.8 percent for adults — was the lowest the annual survey has ever found. 

In West Virginia, those numbers also are at record lows — a 6.1 percent uninsured rate overall, and 8.9 percent for adults. 

 Medicaid expansion now covers 175,000 low income West Virginians, which is about 55,000 more people than my most optimistic estimates a few years back. The state also has the highest percentage among the states of residents on public insurance programs.

Holy unacknowledged social democracy, Batman!

You can read the rest here.

Three on health care

It has been fascinating to watch the rollout of the Affordable Care Act and all the dramas and subplots involved. Three items about it recently caught my eye.

First, government-sponsored health care is making it easier for some people to become entrepreneurs.

Second, this item from Politico suggests that the ACA has moved from being an election game changer to background noise.

Third, some people who have benefited most from the ACA seem to have a bit of trouble putting 2 and 2 together.

No doubt there will be more drama to come.

Hit or miss?

You may have heard of Tuesday's split court decisions regarding aspects of the Affordable Care Act. Here's coverage from the Charleston Gazette. The good people at the DC-based Center on Budget and Policy Priorities don't seem too worried about it. All I know is that it is amazing, sad and disgusting to see the lengths to which some people will go to keep other people from having health care.

Which craziness is crazier?

Paul Krugman raised an interesting question in his column today, wherein he compared right wing craziness over the Affordable Care Act with right wing craziness over climate change, any talk of which is apparently "Marxist" according to some folks. The question, which he didn't ask in so many words, was which craziness is crazier.

Based on my WV perspective, I think the two kids of craziness are rather distinct. Health care reform craziness approaches full blown clinical paranoia, as in weird beliefs about death panels, microchips and a takeover of the US system by the World Health Organization. Climate craziness, at least at the highest levels, seems to have a bit more method to the madness: it's about the money.

Actually addressing climate change might cost some corporations a bit in the short run while saving all kinds of grief in the long run. Or, more likely, in the not so long run. The sad thing is, the longer climate change craziness delays meaningful action, the harder it will be to figure out a way to actually help miners and places like WV without cooking our future.

MORE ON THAT here.

NOTE: I'm traveling this week so posts may be irregular. Not that they aren't anyway.

Stating the obvious

This is pretty much what one would expect, but these days stating the obvious isn't that obvious. States that have embraced the Affordable Care Act (aka Obamacare, although it was really the US Senate's bill) have seen their rate of uninsured residents go down.

I'd give WV a pretty good grade. As far as expanding Medicaid and helping to enroll newly eligible people, an A+ for sure. As for encouraging people to sign up via the marketplace or exchange, not so much. Still, I estimate that the percentage of uninsured West Virginians has dropped by around 60 percent since Jan. 1 of this year, all due to the ACA.

A scary business

I mentioned earlier that I just got around to reading Laurence Leamer's The Price of Justice: A True Story of Greed and Corruption, about WV's adventures in Masseyland. Here's a paragraph that jumped at me:

Blankenship and his cohorts made it a scary business to live in West Virginia and dare to suggest that the state could no longer be so dependent on coal for economic growth. Not a single major politician in the state directly faced the realities of a declining coal industry and a future in which, if the state's leaders did not wake up, the historic coal fields would be nothing but wastelands of the lost and the left behind. Politicians knew if they offered even the mildest criticism, the coal industry would immediately vilify them as traitors and look for ambitious candidates to challenge them. There would be no easy solutions and no technical magic wand that could place mini-Silicon Valleys, for instance, up mountain hollows--but no one was asking the questions that had to be asked.

I would say there there were some exceptions, such as Senator Byrd in his last years or Senator Rockefeller as he approaches retirement. There are even some state legislators who want to move in a post-colonial direction. But overall the paragraph stands.

HERE'S A SURPRISE. The rich rule.

ON THE BRIGHT SIDE, nonviolence trumps violence when it comes to making revolutions.

SPEAKING OF VIOLENCE, this item argues that climate change is just that.

DOING THE NUMBERS. Here's a look at health care reform enrollment.

GOAT ROPE ADVISORY LEVEL: ELEVATED

Good news and a less than flattering portrait

The thing to keep in mind in WV is that things aren't all bad all the time. In fact, some really good things are happening. The last post mentioned the minimum wage increase bill that was signed by Gov. Tomblin yesterday.

Here's another example:  thanks to a stellar enrollment effort by the WV Department of Health and Human Services, around 105,000 low income working West Virginians have signed up for the expanded Medicaid program under the Affordable Care Act. An additional 20,000 signed up for private coverage via the marketplace/exchange. When you consider that a good number of other folks found out they were eligible for other programs as a result of all the outreach, I think it's safe to say that the number of uninsured West Virginians has dropped by about 60 percent this year alone.

THAT WAS THE GOOD NEWS. Here, via The  New Yorker, is the unflattering portrait. I think the writer nailed it.

GOAT ROPE ADVISORY LEVEL: ELEVATED

One thing I'm thankful for this year...

...is Pope Francis I! Here's a good look at his latest statement on the "new tyranny" of unfettered capitalism.

Sample quotes:

"Just as the commandment 'Thou shalt not kill' sets a clear limit in order to safeguard the value of human life, today we also have to say 'thou shalt not' to an economy of exclusion and inequality. Such an economy kills."

and

 "How can it be that it is not a news item when an elderly homeless person dies of exposure, but it is news when the stock market loses 2 points?"

and

 "I prefer a Church which is bruised, hurting and dirty because it has been out on the streets, rather than a Church which is unhealthy from being confined and from clinging to its own security."

and

 "As long as the problems of the poor are not radically resolved by rejecting the absolute autonomy of markets and financial speculation and by attacking the structural causes of inequality, no solution will be found for the world's problems or, for that matter, to any problems."

TWO FOR THE ROAD ON THE AFFORDABLE CARE ACT. Here's Dean Baker stating the obvious, an important thing to do in these times! And here's a reminder that some states show it can work.

GOAT ROPE ADVISORY LEVEL: ELEVATED

What melancholy Danes?

It looks like Shakespeare's Hamlet may be an exception. According to a recent study, Denmark was rated the happiest country in the world. According to this Alternet article,

The six factors for a happy nation split evenly between concerns on a government- and on a human-scale. The happiest countries have in common a large GDP per capita, healthy life expectancy at birth and a lack of corruption in leadership. But also essential were three things over which individual citizens have a bit more control over: A sense of social support, freedom to make life choices and a culture of generosity.

The article didn't say as much, but I wonder whether a shortage of Whackadoodles might also contribute to national felicity.

MR. MOJO NOT RISIN'. West Virginia's junior senator has good days and bad days. Lately, it's more of the latter.

MORE REASONS WHY WE NEED A FUTURE FUND here.

DOG BREEDS YOU'VE NEVER HEARD OF discussed here.

SOS!  Speaking of canines, the Spousal Unit has been perusing dog rescue sites again. Help!

GOAT ROPE ADVISORY LEVEL: ELEVATED

Three for the road

It's the end of a long week for me and possibly for you too, Gentle Reader. I'm still jazzed from news earlier in the week that over 45,000 low income working West Virginians signed up for the expanded Medicaid program as part of the implementation of the Affordable Care Act. I've heard that it's over 50K now but haven't been able to verify that.When I know more you will (and if you know first let me know).

SPEAKING OF WHICH, here's Krugman on reform becoming real.

WHAT CENTURY IS THIS, anyway?

URGENT SPORK-SNOUTED ANCIENT ELEPHANT UPDATE here.

GOAT ROPE ADVISORY LEVEL: ELEVATED

I'm in so much trouble

Over the years,the Spousal Unit and I have had a disagreement or too. No, really. One of these is about guinea hens. I think they're so ugly they're cute. She thinks they are loud, messy and obnoxious.

But last night when a friend emailed saying he had some baby guineas and asked if I wanted any, I replied with a profanity-laced affirmative. I was mostly kidding. He was serious. Before I really thought it through I was on my way to my buddy's farm.

I wound up coming home with 11 babies who are now residing in a box in the house with a heat lamp shining above.

They are kind of cute at this point but they are already LOUD. The only consolation is that one guinea peeping is almost as loud as all of them peeping together so there's really not much difference, really, between having three or four and having eleven. That's my story anyway.

They do seem to quiet down a bit when I sing "Mule Skinner Blues" to them, but that's not something once can do 24/7

So while guineas are in the house, El Cabrero is in the doghouse.

YOU ALREADY KNEW THIS: austerity is a bad idea.

IN THE CROSSHAIRS. House Republicans are targeting food stamps (aka SNAP). Here's the lowdown.

ALSO A TARGET, of course, is the Affordable Care Act. Here's some interesting public opinion research on that topic.

WANT TO REDUCE PRISON ADMISSIONS? Try reducing the dropout rate.

CAT YOGA. You knew they did it. Here are some outstanding examples.

FINANCIAL ADVICE on a 4x6 index card.

GOAT ROPE ADVISORY LEVEL: ELEVATED

A champion for children (and someone else completely different)

Last Friday I  had the opportunity to attend an event celebrating the Children's Health Insurance Program which featured on of the key architects of that law, to wit WV's senior senator Jay Rockefeller. During the program, several medical and mental health professionals spoke about the benefits of the program, which also covers dental and mental health.

CHIP, enacted in 1997 in Congress and expanded repeatedly in WV since then, now covers children in families earning up to 300 percent of the federal poverty level. It has made a huge impact in health coverage. One number I've heard thrown around is that since the program began, around 40 million children have benefited from the program.

In WV, CHIP outreach, which also enrolls eligible children in Medicaid, has reduced the number of uninsured children to practically zero. As one dentist said at the event, "you just don't see uninsured children anymore."

That is quite a legacy and may be the greatest of Rockefeller's many contributions.

MEANWHILE, ON THE DARK SIDE, WV Attorney General Patrick Morrisey and his rich friends don't have to worry about affording health care. So instead they worry about how to keep others from getting it. Nice.

The fire down below

One thing that's exciting about the current push to raise the minimum wage is the growing  grassroots action by low wage workers. It's nice when there is pressure from below coming from all over the place. Here's a look at the growing momentum. I hope it keeps on growing.

THE BIGGEST LOSERS under the current system are discussed here.

GET OVER IT. Here's the Washington Post attempting to talk sense to the GOP about health care.

GOAT ROPE ADVISORY LEVEL: ELEVATED

Spite is expensive

So far 21 states, fortunately NOT including West Virginia, have pledged not to expand Medicaid health coverage to low income working adults under the Affordable Care Act. I suppose all kinds of justifications can be given but I think it boils down to spite. And to contempt for poor people. And because some people can't stand the idea of a black man in the White House. Or some combination thereof.

Whatever may be the case, and, yes, I know I was being snarky, spite is expensive. According to a new Kaiser/Urban report, nearly two-thirds of those who would have benefited from the expansion live in state states that have either refused it or have not yet decided. This means 6.4 million Americans going without health care unnecessarily. Those states are also giving up over $50 billion federal dollars in 2016 alone. Go figure.

More links and facts here.

Gratuitous book and film plug

Image by way of wikipedia.

A while back, I read a strange, dreamlike post-modern novel that interlaced several related stories over a period of time stretching from the mid 1800s to centuries in the future. If that rings any bells, the Gentle Reader is already thinking of British author David Mitchell's Cloud Atlas.

When I  heard a couple of years ago that someone was making a movie version I didn't think it could be done. I was wrong. The film was as dreamlike as the book. Different of course as it 's a different medium. But I'd say the filmmakers did it right.

There is a kind of Mahayana Buddhist tone to the whole that that is more explicit in the film than the book about how cause and effect ripple out through time with never ending consequences. Two other themes are love and rebellion, which aren't bad.

For what it's worth, I'd recommend both. But both take work. I think I'm going to wind up revisiting both.

ATTEMPTED SABOTAGE. Here's a good Gazette editorial on the Affordable Care Act.

SPEAKING OF WHICH, if you live in WV, click here to learn more about how to help thousands of uninsured state residents sign up for health care next year.

FOOD STAMPS. Here's a story about the latest attack on this program and what it could mean for people in West Virginia, where around 1 in 5 rely on them.

GOAT ROPE ADVISORY LEVEL: ELEVATED

The glorious imaginary library of *******

One of the weirdest writers I've ever read is the Argentinian Jorge Luis Borges. His work is very surrealistic. One frequent quote about it is that it embraces "the character of unreality in all literature." The words supernatural realism come to mind, minus the realism.

For example, in a one-paragraph short story, he tells of an empire where the art of map-making was so precise that one map of the empire was the exact same size as the empire itself and "coincided point for point with it."

Anyway, out of the blue I was struck by a story idea right up his alley, one that wouldn't be much longer than a paragraph itself. It would be about an imaginary library so fantastic that people come from all over the world to admire it. I must have been channeling Borges' ghost. Alas, I don't think I have what it takes to write it.

Maybe I'll read it someday. In that imaginary library.

THE POLITICS OF HEALTH CARE REFORM. This could be interesting to watch.

OF APES AND ANGELS. Here's the latest from primatologist Frans De Waal about evolution, apes, ethics and religion.

ANIMALS THAT OUGHT TO BE. Here's a whimsical look at composite critters we wish really existed. There are probably books about all of them in that glorious imaginary library.

GOAT ROPE ADVISORY LEVEL: ELEVATED

Mother's Day and much more

Lots of people celebrated Mother's Day this Sunday. I wonder how many know that the mother of Mother's Day, Anna Jarvis, was a West Virginian. A social activist, over time she became disillusioned by the commercialization of the day she helped to create. Read a bit more here.

WHAT'S THE PLAN? In this op-ed by a friend of mine, the writer asks Congresswoman Shelley Moore Capito, an opponent of the Affordable Care Act, exactly what she proposes as an alternative.

AND WHAT'S AFFORDABLE? In this one, yours truly responds to the same theme.

GASSED UP. Here's one by another friend of mine on how WV can do better in regulating and otherwise managing the Marcellus Shale gas play.

FEED TO ACHIEVE. Here's more on new WV legislation to combat child malnutrition and improve health and school performance.

GOAT ROPE ADVISORY LEVEL: ELEVATED

We recognize our own rejected thoughts

One of my favorite Dylan songs--and the list is long--is "Trust Yourself" from the underrated album Empire Burlesque. In it, Bob strikes the familiar American chord of self reliance.

That theme might have been most forcefully laid out in a much sunnier manner in  Ralph Waldo Emerson's 1841 essay of the same title. That essay and the vehemence with which it pushed its argument may have been in part a reaction to some of the hostile reviews and controversy that came in the wake of his controversial Harvard Divinity School Address (see previous posts).

It's easy to misunderstand what Emerson meant by self-reliance. The essay is not a paean to unregulated capitalism. Rather it is a call to intellectual and spiritual independence, as this selection from the opening power shows:

To believe your own thought, to believe that what is true for you in your private heart is true for all men, — that is genius. Speak your latent conviction, and it shall be the universal sense; for the inmost in due time becomes the outmost,—— and our first thought is rendered back to us by the trumpets of the Last Judgment. Familiar as the voice of the mind is to each, the highest merit we ascribe to Moses, Plato, and Milton is, that they set at naught books and traditions, and spoke not what men but what they thought. A man should learn to detect and watch that gleam of light which flashes across his mind from within, more than the lustre of the firmament of bards and sages. Yet he dismisses without notice his thought, because it is his.

I'm not sure I'd go that far, at least with the thoughts that flit like bats around my head, but he does have a point. I have on more than one occasion read, heard, or seen something in print or in some work of art that had previously occurred to me but that I did nothing to capture. He puts it like this:

In every work of genius we recognize our own rejected thoughts: they come back to us with a certain alienated majesty. Great works of art have no more affecting lesson for us than this. They teach us to abide by our spontaneous impression with good-humored inflexibility then most when the whole cry of voices is on the other side. Else, to-morrow a stranger will say with masterly good sense precisely what we have thought and felt all the time, and we shall be forced to take with shame our own opinion from another.

Ralph can be a bit out there sometimes, but passages like this make up for some of that. At the very least, they challenge the reader to not let some many ideas and inspirations get away.

PRISON REFORM is on the legislative agenda in WV, where a decent bill promoted by the governor sailed thorugh the state senate. I hope it succeeds in the house. These efforts got a boost in, of all places, the New York Times.

ECONOMIC INEQUALITY. Here are some snapshots from the growing divide.

THREE YEARS AND COUNTING. The Affordable Care Act had a birthday this weekend. The Spousal Unit and I actually attended a party in its honor (we didn't have to buy gifts anyhow). Here's a look at how it's working so far.

GOAT ROPE ADVISORY LEVEL: ELEVATED

The shadows of life

As West Virginia's Democratic governor mulls over expanding Medicaid to over 100,000 working West Virginians, I hope he might give some thought to some things his Republican counterpart in Ohio had to say:

...in this case, extending Medicaid benefits will help us on many levels, including the positive impact this decision can have on the mentally ill and the addicted. Some of them live under bridges, some of them live on streets, some of them are in our jails tonight. One of the sheriffs that I was with the other day told a story of a man whose life had gone really perfectly. He got sick, started living in the woods. He's now in jail. He wraps scriptures around his fingers to ward off evil. The sheriff told me, he doesn't belong in our jails. It's a chance to rebuild the safety net that we've all wanted to since we have released people from, from these mental hospitals. 

My personal faith in the lessons I learned from the good book, they're like, run my life. I mean, I'm serious they're very important to me. Not just on Sunday, but just about every day. I gotta tell you, I can't look at the disabled, I can't look at the poor, I can't look at the mentally ill, I can't look at the addicted and think we ought to ignore them.

For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can  help them. And I want all of you to think about this.