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.

Signed. Sealed. Delivered. For real

Whew. It's been a long fight, but the US Supreme Court announced today that it would not overturn the Affordable Care Act. As the New York Times reports,

Striking down the Affordable Care Act would have expanded the ranks of the uninsured in the United States by about 21 million people — a nearly 70 percent increase — according to recent estimates from the Urban Institute.

The biggest loss of coverage would have been among low-income adults who became eligible for Medicaid under the law after most expanded the program to include them. But millions of Americans would also have lost private insurance, including young adults whom the law allowed to stay on their parents’ plans until they turned 26 and families whose income was modest enough to qualify for subsidies that help pay their monthly premiums.

A ruling against the law would also have doomed its protections for Americans with past or current health problems — or pre-existing conditions. The protections bar insurers from denying them coverage or charging them more for it.

This is a big deal for me as I've put a lot of time in on this over the last 12 years, including street actions in support of its passage; bus rides to DC: probably dozens of op-eds; scary town hall meetings, including one where an ACA opponent heckled a priest during an opening prayer; pushing for Medicaid expansion in WV and other states; fighting off attempts to mess with Medicaid expansion; mobilizing to defend it in various ways after Trump's election; urging WV's senators not to undo it when that was a real option; and more. You can probably find scores of posts about it here. I'm also proud that the American Friends Service Committee was part of this effort from the beginning.

I'm hoping this settles things once and for all and that we can keep building out and expanding care, including expanding Medicaid in the twelve holdout states. It's probably no coincidence that eight of those states were part of the Confederacy during the Civil War. As I wrote here in 2014, there's a long and ugly connection between the legacy of racism and denying health care to millions of Americans of all backgrounds. I'm hoping this is a nail in that coffin.

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.

 

 

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.

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.

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.)

A belated birthday

Sometimes I miss a birthday by a day or even a few. Such is the case this time with the 10th anniversary of the signing of the Affordable Care Act. 

Personal note: I have put my time into that puppy, from supporting its passage, to pushing for Medicaid expansion to defending it from attacks. It was a far from perfect piece of legislation, but it was what we could get at the time.

Just for fun, below is an excerpt from a Goat Rope post I wrote at the time. The title was Signed. Sealed. Delivered.

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.

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.)

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.

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.)

A polite word for crash

West Virginia is a state that benefited more than just about any other from the expansion of Medicaid under the Affordable Care Act.

Thanks largely to it, our rate of uninsured West Virginians has plummeted. By 2016, it fell from 14 to 6 percent.

In a 12-month period, it covers 200,000 West Virginians. At any given moment, it covers around 175,000, nearly one in 10.

According to DHHR Secretary Bill Crouch, it made treatment for opioid addiction available to 50,000 people in desperate need of recovery.

It’s also been a boon to rural health care providers and helped preserve and create thousands of jobs in the health care sector.

In 2014, its first year of implementation alone, it reduced the cost of uncompensated care at 24 West Virginia hospitals by $264,829,374. Those are costs that weren’t be passed on to consumers in the form of higher costs.

The Republican-supported American Health Care Act, which passed the U.S. House in May, would phase out Medicaid expansion and mean a loss of Medicaid coverage to around 14 million Americans by 2026, according to the Congressional Budget Office.

The Economic Policy Institute estimates that these cuts would be a severe blow to our economy and could result in the loss of 23,000 jobs in West Virginia by 2022.

Given all this, it’s been a good thing that a few moderate Republicans in the U.S. Senate, including West Virginia’s Shelley Moore Capito, have spoken up in support of preserving Medicaid expansion.

Unfortunately, that might be changing.

According to The Hill, “GOP moderates in the Senate are open to ending federal funding for ObamaCare’s Medicaid expansion, but want a longer deadline for ending the additional funding than their leadership has proposed.”

These senators say they want “a significant glidepath” to end the coverage.

With all respect, I think glidepath is a polite way of saying plane crash.

Aviva Avon-Dine, of the Center on Budget and Policy Priorities, argues, “That approach would not preserve anyone’s coverage in the long run. It also would do next to nothing to preserve Medicaid expansion in the short run.”

According to one May poll, the House version is a little more popular than bubonic plague, with about one in five Americans supporting it. A more recent poll found that only 8 percent think the Senate should pass the House version.

But even a slower Senate version isn’t much more likely to receive public support.

According to the Kaiser Family Fund, “The vast majority of the public — including a majority of Democrats (93 percent), independents (83 percent), and Republicans (71 percent) — say it is important that states that received federal funds to expand Medicaid continue to receive those funds.”

The fate of a lot of people here and around the country is going to rest in the hands of a very small group of people. I hope that the lives and well-being of millions of Americans will outweigh political pressures and ideology.

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

Mother's Day action to protect health care

With the fate of millions up in the air with the attempted repeal of the Affordable  Care Act, West Virginians for Affordable Health Care and allies are organizing Mother's Day Medicaid Awareness events around the state:

Facebook Event Pages:

Charleston: https://www.facebook.com/events/1374037169351543/?ti=icl

Morgantown: https://www.facebook.com/events/777671539066178/?ti=icl
Beckley: https://www.facebook.com/events/174088976449675/?ti=icl

Shepherdstown: https://www.facebook.com/events/641000152769584/?ti=icl

There are also postcards (here and here) addressed to Senator Capito (R-WV. If you can't make it, feel free to print and send to these office locations (DC and local recommended) or just send an email.

Senator Capito's vote and influence will be critical to preserving and protecting Medicaid and other health care gains. Please be respectful but clear about your opposition to efforts to weaken health care coverage for West Virginians.

(Note: it's fitting that WV should act at this time since the Mother's Day holiday was born right here.)

"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.

A problem we don't need

Bo is all about health care.

According to the business website WalletHub, WV will be one of the states most impacted by the repeal of the Affordable Care Act. Not in a good way. Lots of people, including the participants in this press conference yesterday (which my dog attended), are speaking up about the issue and urging that the ACA not be repealed without a replacement that does no harm to the millions who benefit from the law-including around 225,000 West Virginians.

For more on the adverse impact of ACA repeal on WV's people and economy, check out this new and detailed report from the WV Center on Budget and Policy. And howl about it. This is a problem we really don't need right now.

This is what happens...

Sometimes it's hard not to say "No ****!" This might be one of those times. There have been a number of reports about how residents of the coalfields, many of whom supported he-who-must-not-be-named, are now in danger of losing black lung benefits.

Aside from black lung, the depressed areas of Kentucky and West Virginia are among those that have benefited the most from Medicaid expansion under the Affordable Care Act. Both states have seen huge drops in the number and percent of uninsured.

All that is up for grabs now, and much of it is likely to go down the drain. A major struggle is starting to take place to try to ensure that the ACA is not repealed without being replaced.

I think we may need a new rule: before sticking it to the man, we need to figure out exactly which man we're talking about. This time around, it seems like the man who got stuck is the one who works. The woman too.

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.

A little good news

I don't know about you, Gentle Reader, but I could use some of that. Here are two items.

First, it looks like 12,000 new and previously uninsured West Virginians signed up for health care on the exchange under the Affordable Care Act. That means there's about 37,000 getting care through the exchange with over 170,000 more getting care under expanded Medicaid.

Second, a judge actually acted with justice (!), siding with the Teamsters union which filed a rat-smelling lawsuit about how WVU may have played footsie with labor- hating  WV Republican legislators on a bogus "right to work for less study." With any luck, the public will get to read redacted emails that went back and forth between legislative leaders and...those people.

And here's a bonus item for cicada fans. Here they come!

Not so fast?

Even while congressional Republicans continue to talk about repealing the Affordable Care Act, aka Obamacare, some are starting to hesitate at the idea of taking way expanded Medicaid coverage from what probably amounts to millions of people.

WV Senator Shelley Moore Capito was even quoted saying this: “I am very concerned about the 160,000 people who had Medicaid expansion in my state. I have difficulty with that being included.” I'm glad she feels that way. I hope more people on her side of the aisle do as well.

I guess that amounts to good news these days.

THE LATEST EMBARRASSMENT TO WV? Maybe this.

MEANWHILE, BACK AT THE COURTHOUSE...the Don Blankenship case is up to the jury now.