Some good news

 North Carolina took a giant step today in the right direction. Their state legislature finalized a bill to expand Medicaid under the Affordable Care Act (ACA) to otherwise ineligible people earning up to 138 percent of the federal poverty level. It is estimated that this will benefit around 600,000 people.

But it's not just about health coverage. The expansion will bring in millions of federal dollars, create jobs, keep rural hospitals open, help people recover from Substance Use Disorder and all kinds of other good stuff.

By my count--and counting has never been my strong suit--North Carolina is the 41st state, including DC, to take this step. It's especially important that this happened in a southern state. Let's just say that if one was drawing a Venn diagram of states that resisted expansion with states that belonged to the Confederacy there is considerable overlap. At the risk of extreme understatement, this might not be entirely coincidental. But every time this happens, it puts more pressure on the holdouts to do the right thing.

A little review: Medicaid expansion was intended for all states and DC when the ACA was passed in 2010. A 2012 US Supreme Court decision upheld the constitutionality of it, but made expansion a state decision. Depending on the state, the decision could be made by ballot measure, executive decision, or legislation, which is always more complicated.

We were lucky that West Virginia's decision was made before the state turned into a ________ (you can fill in the blank) by my favorite all time governor, Earl Ray Tomblin. The state agency in charge did a fantastic job of signing people up. Lots of people I know worked really hard to make sure that happened. I'm not sure of the current enrollment numbers, but at times it has come close to 200,000 adults in a state with a population of 1.8 million, more or less.

However, we had to spend a lot of years defending it, especially during the Orange Epoch, when the late Senator John McCain, to his great credit, stopped efforts to repeal it in the senate. West Virginia was in the hot seat then too, with a conservative Democrat and a fairly moderate Republican in the persons of Joe Manchin and Shelley Moore Capito. Manchin took a "fix not nix" approach and Capito said that she "didn't go to Washington to hurt people."

Then there were state legislative efforts by out of state groups like ALEC and the Foundation for Government Accountability to impose bureaucratic hoops and reporting requirements designed to cut people off as recent as this year, which were fortunately defeated. It also was a huge relief when the US Supreme Court (!) effectively squelched efforts to undo the law in 2021.

I imagine folks in North Carolina will have to be vigilant on the enrollment process and ready to defend the expansion when efforts are made to weaken it. But it's still a great day.

Next stop...maybe Alabama? Sometimes the domino theory has its moments.

Not all bad

 Whenever there's a bit of good news on the economic justice front, admittedly not an everyday occurrence, I try to notice it. Here's the latest:

According to the Centers for Medicare and Medicaid Services (CMS for short) a record number of Americans now receive health insurance through the Affordable Care Act (ACA)...and what a fight it was to enact and protect it all these years. Specifically, more than 35 million people are either covered through the health exchange or marketplace, expanded Medicaid (21 million in states that expanded Medicaid as WV did in 2013), or basic coverage.

That's more than one out of ten Americans in a total population of around 332+ million. It's an even bigger achievement when we factor in who got that coverage. The US health care system does a pretty good job of covering the elderly via Medicare. Close to 95 percent of children are covered via CHIP, traditional Medicaid or their parents' insurance. Low income people with disabilities are likewise often covered by traditional Medicaid. Those covered by the ACA, on the other hand, are working age adults not eligible for other kinds of insurance--and those most likely to lack coverage before the ACA. 

The percent of uninsured Americans is now at an all time low of around 8.8 percent. Still too many by far, but it shows the benefits of this signature legislation of the Obama administration. And a lot of people in West Virginia worked hard to make that happen here. I hope the 12 holdout states--Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming--see the light and expand Medicaid soon (did anyone else notice that eight of those were also part of the Confederacy?). I know lots of people in those states are working on it. 

This may not last forever the way things are going, but I'll celebrate this for now anyway.

Happy 11th birthday, ACA!

It's been a bumpy 11 years since the passage of the Affordable Care Act, and there have been times I was afraid for its survival, but it's still here, thanks in no small part to the efforts of millions of people all over the place to enact and protect it. Now, we're even improving it, at least temporarily, thanks to the American Rescue Plan Act.

I know I've done this before, but I can't resist reposting this item from the day after it was signed into law in 2010, with comments from today following. To quote Dylan, "lotta water under the bridge/lotta other stuff too."

 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.

Looking at the post from 2021, I'd stand by it. I've never been big on making predictions, but I think I was right in worrying that the negative consequences, political and otherwise, would hit first, long before the benefits became apparent. Eventually the positives were felt, but not before a lot of political damage was done. And that the game really had changed.

I'd prefer not to go through all that again, however.

 

 

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.)

Messing with Medicaid is a bad idea

Back in May of 2013, then-Gov. Earl Ray Tomblin made the decision to expand Medicaid coverage to low-income families earning up to 138 percent of the federal poverty level.

By that one act, I think he did more to relieve unnecessary human suffering than any number of his predecessors. Maybe more than all of them put together.

Medicaid expansion was an option under the Affordable Care Act. It was originally intended to apply to all states, but this provision was struck down by the US Supreme Court in 2012. Since then, it has become a state option.

That decision has been a lifesaver and a game changer for tens of thousands of West Virginians. As of Feb. 19, 158,137 West Virginians are enrolled in Medicaid expansion. That’s a little shy of one out of 10 state residents, but not by much. In any given year, around 200,000 people have received coverage due to Medicaid expansion.

Most people who gained health coverage came from working families not otherwise eligible for traditional Medicaid.

A lot of the credit for that goes to the West Virginia Department of Health and Human Resources, which did an amazing job of reaching out to and enrolling eligible citizens.

I’m not sure how much this weighed on Gov. Tomblin’s decision at the time, but the expansion opened the gates of treatment for addiction and, ultimately, recovery for thousands of West Virginians struck by the opioid epidemic.

In the words of Nan Whaley, mayor of Dayton, Ohio, a city that has made great progress in reducing overdose deaths, “If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease.”

Not only did West Virginia do something right, but it did it well. That’s the good news.

The bad news is that there’s a move in the Legislature to impose a policy that has failed elsewhere. The House Finance Committee recently voted to impose on West Virginia a policy that has caused a great deal of unnecessary suffering in Arkansas.

The failed policy sounds good, at a superficial level: Let’s impose work requirements on those who receive expanded Medicaid coverage.

I’ve used this Bible verse more than once, but it still fits: “There is a way which seemeth right unto a man, but the end thereof are the ways of death.”

Instead of promoting work, it increases bureaucratic costs and reporting requirements and results in cutting people off for no good reason.

By August 2018, over 18,000 enrollees out of 62,000 — nearly one out of three — in the Arkansas program had been cut off. There’s no evidence whatsoever that those people are doing more work, but it’s a safe bet that they are worse off.

Closer to home, Kentucky has applied for a waiver to impose a similar but more draconian work requirement on its Medicaid population. According to the research of Simon Haeder of West Virginia University’s Rockefeller School of Policy and Politics, if West Virginia would follow suit, this would impact 95,000 West Virginians, including those who are unemployed or who are working but can’t get enough hours to meet the requirement.

Even if we just assume that West Virginia’s results would be similar to those in Arkansas, we would see over 46,000 people losing coverage. That would be about the same as the entire population of Huntington or Charleston — or of Pocahontas, Doddridge, Calhoun, Pleasants, Pendleton, Tucker and Wirt counties combined.

Apparently, some people didn’t get the memo that having health care isn’t a barrier to employment, it actually helps you stay in the game. I know plenty of people, myself included, who are working and paying taxes today but would probably have been disabled or dead without health care.

For that matter, cutting people off from Medicaid doesn’t just hurt those individuals, it also affects local hospitals and health care providers, reduces money coming to local communities and can have a negative effect on employment. And it drives up health care costs for everyone else by increasing emergency room visits and uncompensated care.

The main support for this seems to come from the same kind of outsider-funded astroturf groups that gave us education “reform.” Last year, one of these types of bills succeeded, resulting in new state code that took basic food assistance away from homeless people.

It’s sad to say, but some people in power evidently derive some kind of weird gratification by imposing misery on those less powerful.

Somehow, however, I don’t think most West Virginians are into that kind of thing.

I hope the majority of West Virginia legislators ultimately agree.

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

Thanks for nothing

It's hard to think of a (printable) word to describe my disgust at the fact that all three of WV's US representatives voted today to take health care away from around 225,000 West Virginians. Hardest hit of these are:

*the 175,000 people from working families who gained coverage from Medicaid expansion;

*the 24,000 or so of those who are getting  help for mental  health or addiction from the expansion; and

*the nearly 300,000 children who had coverage from either CHIP (Children's Health Insurance Program) or Medicaid at some point during 2016. Up till now, WV was a national leader in covering kids. With the whole health care system now in chaos, we may soon be leading the nation in throwing kids under the bus.

If you want to contact your representative to tell them (OK, their staff) how you feel, you can call:

Congressman David McKinley 1st district, Phone: (202) 225-4172

Congressman Alex Mooney, 2nd district, Phone: (202) 225-2711

Congressman Evan Jenkins, 3rd district, Phone (202) 225-3452

Meanwhile, the action will head to the senate, where Congresswoman Shelley Moore Capito will be a crucial swing vote. You can call her office at 202-224-6472.

To his credit, Senator Joe Manchin is the only member of WV's delegation who has come out in favor of preserving the gains of the Affordable Care Act.

24 million

The nonpartisan Congressional Budget Office just did the math on the proposed bill to "replace" the Affordable Care Act. The short version: 24 million more uninsured Americans over 10 years.

From the NPR report:

Just over 28 million Americans were uninsured in the first half of 2016, according to the latest data from the Census Bureau. The CBO estimates that in 2026, that number would remain barely-changed under current law — there would likewise be 28 million uninsured Americans if the Affordable Care Act, also known as Obamacare, remained in place. 

However, 52 million would be uninsured under the American Health Care Act, which is the first step in the Republican repeal-and-replace plan.

Some of that would come from eliminating the individual mandate. However:

...a big chunk of that increase in the uninsured comes from Medicaid, as the Republican bill rolls back the Affordable Care Act's Medicaid expansion. In 2026, 14 million fewer people would be enrolled in Medicaid under the GOP health care bill, accounting for half the total increase in uninsured.

CBO also estimates the Republican bill would cut the number of employers who cover workers by eliminating the employer mandate.

Any way you cut it, this would be a disaster for West Virginia and millions of people across the country.

But don't worry, rich folks and drug companies will get a huge tax cut. That's all that matters, right?

"They'd better start digging graves"

As I mentioned last week, a co-worker and I have been interviewing people who received coverage through the Affordable Care Act. Some of these got it at no cost through Medicaid expansion while others purchased it on the exchange. Some people were on oxygen, in wheelchairs, or both.

Again, the takeaway message was that even those who don't like some parts of the law or who have complaints about the cost agree on this: don't just take it away.

We had some intense conversations and lots of memorable moments, but one thing someone said stuck in my head: "If they get rid of it, they'd better start digging graves 'cause they're gonna be burying people."

Let's hope--and work hard to make sure--it won't come down to that.

Talking ACA

I spent the day talking with several West Virginians who were impacted by the Affordable Care Act. This included someone who received coverage through Medicaid expansion, some who purchased health care on the exchange, and someone who works in a primary care center.

Their experiences varied widely. Based on what I heard now and in the past, it's pretty clear that those who gained coverage through Medicaid expansion (around 200,000 in WV in a typical year) really like it and are grateful for it.

It's a bit more complicated for those who gained coverage by purchasing it on the exchange, some of whom had life-threatening illnesses. Two out of three of the people I spoke with were concerned with premiums and deductibles which increased, often dramatically, even as their incomes stayed the same.

One thing everyone agreed on was that they needed the coverage they had and that repeal of the ACA without a replacement--preferably a better, more affordable one--would only make the situation worse. There was also zero interest in health savings accounts-- mostly because there was little or nothing to put in them.

Lots more on this to come.

Some good news, with an example of misinterpretation of the obvious

Let's start with some good news: last week, the Charleston Gazette-Mail reported that the number of uninsured West Virginians has fallen below 10 percent, thanks largely to Gov. Tomblin's decision to expand Medicaid back in the year of grace 2013. That decision alone has brought coverage to 165,000 West Virginians.

The Daily Mail side of the editorial pages thinks this is a bad thing because it presumably disincentives work. That might be the case if employer-provided health insurance was the norm. Apparently the editorial writer didn't get the memo that employer-provided health insurance is declining and never was an option for millions of US workers. Another memo that was apparently lost would have explained that you have to work to qualify for the expanded Medicaid program.

On the road again

Last weekend marked a welcome milestone. A bit shy of four weeks after having arthroscopic knee surgery I ran, sort of, my first post-op 5K. I was really slow but it was nice to be in motion again.

Jogging had been out of the question this summer due to persistent knee pain. Other favorite activities had to stop too, like jumping rope, kicking a bag and sparring. Karate became pretty much impossible towards the end. I tried to make do on a bike but it just wasn't the same.

One thing that made the run more special was the fact that I completed it with my 7 year old grandson, who ran every step of the way. In fact, the little bugger finished ahead of me.

I think I can still take him in karate though.

YOU PROBABLY ALREADY KNEW THIS, but the price of health insurance is going through the roof.

THE MORAL ARC THING. As far as I can tell, the moral arc of the universe swings around randomly (in fact, "moral universe" seems like an oxymoron, but here is an interesting alternative perspective.

WHAT DO YOU SEE? Human perceptions of race vary with perceptions of social status--and vice versa.

GOAT ROPE ADVISORY LEVEL: ELEVATED

Poor us

The Census Bureau released its poverty data this week and the results were pretty much what you would expect with a persistent recession and/or a very weak recovery further weakened by the phasing out of Recovery Act programs. Without the latter, things would have been much worse.

For an overview, here are the comments of Robert Greenstein of the Center on Budget and Policy Priorities and here's an article about the situation in West Virginia.

OKAY, LET'S LOOK AT SOME BUGS. Having satisfied my duties as a social justice blogger, I now suggest you check out this Wired Science post which shows close up pictures of scary monsters. Fortunately, these monsters are way smaller than we are.

GOAT ROPE ADVISORY LEVEL: ELEVATED

May Ceiling Cat be with you

Wu is a true believer.

Off and on lately, Goat Rope has been monitoring the progress (perhaps regress would be a better term) of the Conservative Bible Project, which is attempting to remove its "liberal bias."

(It might be easier with different deities.)

Anyhow, a friend was chasing down related links and came across yet another endeavor, the "lolcat Bible Translation Project," which attempts to translate the same into "kitty pidgin," i.e. the imagined language of cats.

Maybe I've been living under a rock, which is a separate issue, but this was new to me. I've seen some of the lolcat pictures but it never occurred to me that someone would try this. I can't say I've read the whole thing, but I did check out Genesis and the Sermon on the Mount.

Here are the first few lines of the creation story, in which Ceiling Cat makes the world:

Boreded Ceiling Cat makes the world.

1 Oh hai. In teh beginnin Ceiling Cat maded teh skiez An da Urfs, but he did not eated dem.

2 Da Urfs no had shapez An haded dark face, An Ceiling Cat rode invisible bike over teh waterz.

3 At start, no has lyte. An Ceiling Cat sayz, i can haz lite? An lite wuz.4 An Ceiling Cat sawed teh lite, to seez stuffs, An splitted teh lite from dark but taht wuz ok cuz kittehs can see in teh dark An not tripz over nethin.5 An Ceiling Cat sayed light Day An dark no Day. It were FURST!!!1

The website also contains such items as proofs for the existence of Ceiling Cat.

El Cabrero is not officially sanctioning or recommending this version as canonical. However, the picture of Ceiling Cat making the world is worth a look.

Flying Spaghetti Monster, watch out!

MEANWHILE, Bigfoot fans are searching for Sasquatch in WV's Dolly Sods.

MISMEASURING THE ECONOMY. GDP (gross domestic product) can be a misleading measure, according to top economists.

ALL FRINGE, NO BENEFITS. A new report from the Economic Policy Institute shows the continuing erosion of employer-provided health insurance.

COAL CONCESSIONS. The Senate climate change bill has some, but it's unclear whether these will be enough to garner coal state support.e

SICKNESS UNTO DEATH. What would a day be without pondering Kierkegaard and spiritual despair?

HURTS SO GOOD. This item discusses how athletes can deal with the pain of exertion. I've tried some of these tricks and they seem to help.

GOAT ROPE ADVISORY LEVEL: ELEVATED