Bacon's Rebellion

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Virginia’s Medicaid Travesty

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by

Peter Galuszka
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medicaid1By Peter Galuszka

Some things never seem to change in the South and in Virginia, namely the idea among conservatives that the poor, notably African-Americans, are not worthy of help.

Such is the predicament faced Virginia and other states that have not expanded the federal Medicaid program to help the poor with health insurance just as the Affordable Care Act approaches.

Thanks to a bizarre turn of events, in states where Republican politicians have shunned the expansion of Medicaid, millions will be left uninsured although the point of ObamaCare is to provide health insurance for all, according to the New York Times.

That is because so many make too much to get Medicaid without expansion and make too little to qualify for federal subsidies under through health exchanges set up by ObamaCare.

This is the case in Virginia which has declined to expand Medicaid under pressure from conservative Republicans until “reforms” are accepted and put into motion at some distant point in the future.  As many as 400,000 Virginians may be caught in the vise.

“How can somebody in poverty not be eligible for subsidies,” a Virginia woman who lost her job in the health care industry told the Times, which found that the predicament tends to affect African-Americans and single mothers mostly in the South. Some 26 states have rejected expanding Medicaid. Many are in the South from Virginia to Texas and Oklahoma which have a large share of poverty and minorities.

Expanding Medicaid to families who make about $32,000 a year or 138 percent of the poverty rate has been a hotly contended issue in the gubernatorial race. Democratic candidate Terry McAuliffe says that Medicaid must be expanded since it would help lower income citizens and create jobs.

Republican candidate and Attorney General Kenneth Cuccinelli has fought Medicaid tooth and nail since he took office in 2010. In fact, Cuccinelli has made fighting alleged “fraud” in Medicaid a cornerstone of his accomplishments as the state’s top legal officer. He has gone so far as to propose setting up an armed flying squad of Medicaid fraud investigators.

It is a strange notion since Medicaid fraud is not exactly rampant in the state and the perpetrators tend to be doctors, nurses, accountants and ambulance company officials who are not likely to store automatic weapons in their offices.

The General Assembly this year agreed to consider expanding Medicaid after a lengthy review. Del. Steve Landes, a Republican, has said that the issue is not likely to move forward in the near future, according to the Washington Post.

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25 responses to “Virginia’s Medicaid Travesty”

  1. larryg Avatar
    larryg

    Well.. I’d say something but I’m on probation from HillcityJim and others to limit my views lest they piss others off….

    😉

  2. Neil Haner Avatar
    Neil Haner

    Cooch’s fight against Medicaid Fraud is about as worthwhile an expenditure of the Right’s time and effort as the movement against Voter Fraud. Take that as you will…

    McAuliffe better be using this as his vehicle to drive the election home. Thanks in no small part to the GOP’s “brilliant” stand against Obamacare, but also equally thanks to the timing of the 10/1 rollout of the Exchanges, the ACA and its effects are now front and center in the consciousnesses of the American, and Virginian, electorate.

    This “coverage gap,” as the media has termed it, is very real. And the unwillingness of Republicans to close this gap, rightly principled or not, plays absolutely God-awful in the eyes of the public. McAuliffe and his team need to be hammering the Republican ticket with this in at least half of their mailings and ad buys over the next month, because it’s going to be as good a motivator for the D’s base to get out to the polls as anything that’s come up this year.

    That lower-income voter shrugs at an ad about Cooch’s defense of the out-of-state Energy company. But tell them that his agenda is going to stand in their way of qualifying for health insurance? Yeah, that’ll get them in line on 11/5.

  3. James A. Bacon Avatar
    James A. Bacon

    Let me save readers the trouble of reading Peter’s blog post. Here is the substance boiled down to nine words: Republicans oppose expanding Medicaid because they hate black people.

    This is what constitutes liberal “thought” these days. It would be one thing if Peter acknowledged Republican concerns about the impact of Medicaid expansion on the state budget, fraud and the entitlement trap and then explained how those concerns were not valid or were outweighed by other considerations. But, no, he goes straight for the ad hominem attack. In a word, Republicans are morally depraved. There is nothing worth discussing, nothing worth debating, nothing to compromise over.

  4. larryg Avatar
    larryg

    the opposition to Medicaid expansion – that form the support for the GOP – do those folks get health care subsidies from the government?

    How many of the folks who support the GOP position – receive no govt subsidies for their health care?

  5. TMT Avatar
    TMT

    Let’s see. It would be good for Virginia to expand Medicaid cuz liberals like to give away other people’s money in a compassionate way. My understanding is that, if a state signs up, it cannot ever cut back. So, what’s the problem?

    North Carolina has a $330 million Medicaid shortfall. http://charlotte.cbslocal.com/2013/05/22/nc-medicaid-shortfall-now-330-million-plus/ The state had to cut back on other programs to fund the difference, including paying $132 million to the Feds. Oh No!!! Obama says money goes from Uncle Sam to the states.

    What are the long-term consequences of expansion for Virginia? Who cares? We want to be compassionate.

    Larry, are you suggesting that the fed’s contribution to federal employees’ health insurance is somehow a government subsidy? Why isn’t it part of their compensation?

    1. larryg Avatar
      larryg

      TMT –

      no.

      I’m asking if people with employer-provided insurance essentially get tax credits because it is not taxed?

      and I’m asking if Medicare folks get about $5,000 a year in subsidies?

      don’t both of these groups get essentially credits and subsidies ?

      I’m not arguing that everyone should get them.

      I’m just trying to understand how people who themselves get $5K in direct subsidies are opposed to others getting them.

      How can the same folks who say people should not get “free stuff” themselves are getting “free stuff”?

      Isn’t that a bit hypocritical?

      1. TMT Avatar
        TMT

        Larry, there’s no unequal treatment of anyone similarly situated. Every person who gets medical insurance at work doesn’t pay taxes on the employer’s premiums. From the overpaid CEO to the mail room clerk. All are treated alike.

        Ditto for Medicare. Ever since LBJ got the bill passed in the 60s. The billionaire is treated the same as the minimum wage retiree. In fact, higher income people have to pay more from some items. There is no unequal treatment.

        Of course more low income workers would likely have medical insurance from work if there weren’t so many illegal workers putting downward pressure on compensation. But some argue it’s racist not to open our boarders. If we had real tort reform, more low income workers would likely have medical insurance from work. But Obama’s party takes in millions from the plaintiff’s bar, And if we repealed the law prohibiting people from buying insurance across state lines, more low income people could afford insurance. But that won’t expand the federal bureaucracy.

        1. larryg Avatar
          larryg

          you’re making excuses here for injustice rather than advocating a remedy.

          people who get tax-free insurance are getting a credit – a credit that the uninsured don’t get for their expenditures….unless they can itemize and many cannot..

          why not let them have a refundable credit on page 2 of the 1040?

          I can give you a dozen different remedies here to make it more just and fair rather than make excuses for it.

          People on Medicare get 5000 subsidies EVEN iF they have 85K in income.

          how in any reasonable world is that fair when we don’t give anything close to that to the uninsured?

          How many seniors would be “uninsured” guy if it were not for Medicare to start with. They not only get guaranteed insurance that cannot discriminate on pre-existing conditions – they get a $5000 subsidy.

          why do you justify it on other grounds like illegals ?

          ObamaCare effectively repeals the state line issue and the GOP could have done that a LONG TIME AGO and DID NOT –

          BECAUSE – and you know this guy – they are OPPOSED to the Fed Govt doing this.

          let’s be honest.. please…they could have done this under Bush and they could have made it a true legislative alternative to ObamaCare a long time ago and in EVERY one of the 40 REPEAL-only votes.

          1. TMT Avatar
            TMT

            Larry, America has never been about treating everyone equally with respect to outcomes. It’s about treating similarly situated people equally. You want to ignore the fact the Internal Revenue Code treats medical insurance the same for every single employee. Congress never intended the law to force employers to provide medical insurance. Obamacare does that, and it’s costing people work hours and pay.

            The same holds true for Medicare. Everyone is treated the same. Congress passed the law to deal with people 65 and older. It doesn’t address people under 65. I think that, over the years, there have been proposals to expand Medicare for some people under 65, but it’s been rejected.

            Our constitution and laws don’t require equal outcomes. They don’t require people who are not situated the same to be treated the same. People under 65 don’t have to be treated the same as people over 64 for Medicare purposes. What is required is that all people over 64 are treated the same. That’s the law. That’s fair treatment.

            Take two kids who show up for high school in Fairfax County one morning. The first one’s parents live and pay taxes in Fairfax County. The second one’s parents live and pay taxes in Prince William County. FCPS will let the first one in and turn the second one away. But we have 16 year olds. They are not be treated the same, but they are not situated similarly.

            There is nothing in our laws or constitution that says health care is a right. Ditto for housing, clothing, automobiles, air quality, proximity to parkland, a job, etc., etc., etc. I don’t see where this right to equal results for heath care arises. I don’t buy your logic.

            If some individuals get to proclaim new rights, don’t the rest of us also? Joe claims he has a right to health care. Ann claims she has a right not to pay for Joe’s health care. Who wins? No one. That’s why we have a system of government and laws.

          2. larryg Avatar
            larryg

            TMT – we’re NOT talking about equal outcomes.

            we’re talking about discriminatory treatment of people with regard to health insurance and health care.

            we treat different classes of people – differently.

            we give seniors a 5K subsidy and we refuse to give the poor a 5K subsidy for the same thing.

            please tell me how this is “equal”?

            what exactly justifies given one group of people a 5K subsidy and not another?

            that’s not arguing for equal outcomes guy.

            that’s asking why the two classes of people are not treated the same long long before the outcomes… On group keeps their assets after expensive medical care and the other group goes bankrupt after the very same illness.

            how do you justify that?

          3. TMT Avatar
            TMT

            I think we will need to agree to disagree. I don’t see any unlawful or unconstitutional discrimination. Similarly situated people are treated the same. There is no existing right to health care. Even the Warren Court didn’t invent that one.

            A state could amend its constitution to grant such a right. Congress or the states could initiate an amendment to our Constitution that would establish this right. But it wouldn’t pass.

  6. TMT Avatar
    TMT

    A bit more from the Tar Heel State. State lottery funds are taken from education to fill other budget holes. In 2010, the legislature, then controlled by Democrats, shifted lottery money to fill a Medicaid gap. Looks like the GOP is following the trend.

    Could this happen in Virginia?

  7. Peter Galuszka Avatar
    Peter Galuszka

    Rather lame dismissive effort Jim.

    Why not read the Times? The story was the lead on the front page in big type. I am not making the stuff about the South and blacks up. You want it both ways — to be a “conservative” on spending and personal responsibilty why being some kind of New Age Libertarian sensitive to diversity.

    No can do Jimbo. Can’t pee down both legs.

    1. Neil Haner Avatar
      Neil Haner

      Peter

      I don’t think Jim is arguing the point that the “coverage gap” affects the poor, and as a result, blacks disproportionately. That’s obvious, measurable fact.

      His objection is that you casually assert Republicans refuse to close this gap through Medicaid expansion because, and for no bigger reason than, they don’t like black people.

      “the idea among conservatives that … African-Americans, are not worthy of help”

      Your words, not mine.

      TMT points out lots of great reasons, none of them tied to race, than many conservatives are against the expansion. I can’t speak to every Republican everywhere, I refuse to paint anyone with broad-brush strokes, but there are plenty of rationale arguments against the expansion than many color-blind conservatives can stand behind in arguing against the expansion.

      The people flying the confederate flag along I-95 in Chester? Racists. The people concerned about adding massive obligations to already strained state budgets? Not racist. Pigeon holing every conservative as a racist just makes you sound as paranoid as Kanye “George Bush hates black people” West.

      1. Neil Haner Avatar
        Neil Haner

        Ugh, I can’t type today. My apologies for spelling and grammatical errors.

      2. larryg Avatar
        larryg

        When people who have income of 85K a year can buy health care that cannot deny pre-existing conditions for $100 a month – and the GOP is worried about others getting something they don’t deserve – it IS a bit whacko though.

        and the irony here is that the additional subsidy given to the same folks to help them cover the 20% co-pay – was taken away and give to ObamaCare to help pay credits …..

        yet the GOP says nothing about any of this – just deny helping one group of people even 1/5th as much as others are being helped.

        In fact some in the GOP proposed getting rid of the 5K subsidies for the first group and all hell broke loose and they backed off of it…

        the problem is we do not have a level playing field for everyone.

        they are winners and losers created by govt that grants tax preferences, subsidies and credits to one group and not the other – and by coincidence the “other” group just happens to be the poorest of the poor.

        Now is that really a coincidence?

        I agree – this is not about race.. but unfortunately the party that grants special consideration to one group and not the poor also seems to have racists in their ranks – that they tolerate and make no attempt to rid the party of.

        1. TMT Avatar
          TMT

          Larry, again you are comparing apples and oranges. Every employee with medical insurance from work is treated alike for tax purposes. Ditto for everyone 65 and older on Medicare is treated alike.

          1. larryg Avatar
            larryg

            they’re treated alike within their specially treatment groups.

            why are they special treatment groups that get de-facto credits and subsidies and yet we oppose similar equivalent credit/subsidy treatment for the poor group?

            why is that? How is that just?

          2. larryg Avatar
            larryg

            TMT – I’m saying this with due respect guy. I mean no disrespect to you as a person.

            but HOW do we JUSTIFY the different treatment of GROUPS in our society on something as basic and vital as health care?

            How in the world can we justify giving de-facto tax credits worth thousands of dollars to those with employer-provided, give guaranteed insurance to people who make 85K a year for 100.00 a month and then have ‘nothing left over’ to give equivalent credits/subsidies/benefits to the poor?

            It would be EASY to do – it could be done like the earned income credit. You don’t get the credit unless you work but if you work and are low income, you get the credit.

            Why can’t the GOP support that?

            how do we, in good conscience support the status quo on this?

            It’s a terrible injustice to people who are being overtly discriminated again – because they are poor.

            We won’t even give them the same equivalent benefits that we give to those with employer-provide health insurance or seniors.

            We are, in effect, after granting subsidies and credits to those who are not poor – .. we are after we do that – “too poor to help the poor”.

            Anyone with a scintilla of fair play and justice should want this fixed.

            my views.. no disrespect to anyone.. I respect others views even if I do not agree.. but I WILL make as strong a case as I can.

  8. Peter Galuszka Avatar
    Peter Galuszka

    Hey Bacon!
    Lest you think this idea of the South and GOp and hurting the poor is entirely my idea, I confess it is not! Here is a NYT editorial. I am copying the thing you you see see that I have company:

    EDITORIAL
    A Population Betrayed
    By THE EDITORIAL BOARD
    October 3, 2013
    It is outrageous that millions of the poorest people in the country will be denied health insurance because of decisions made mostly by Republican governors and legislators. These people will neither qualify for their state’s Medicaid program for the poor nor for subsidized coverage on new insurance exchanges that are being established in every state by the health care reform law.

    Their plight is a result of the Supreme Court’s decision last year that struck down the reform law’s mandatory expansion of Medicaid and made expansion optional. Every state in the Deep South except Arkansas has rejected expansion, as have Republican-led states elsewhere. These 26 states would rather turn down incredibly generous federal funds that would finance 100 percent of the expansion costs for three years and at least 90 percent thereafter than offer a helping hand to their most vulnerable residents.

    As Sabrina Tavernise and Robert Gebeloff reported in The Times on Thursday, two-thirds of the country’s poor, uninsured blacks and single mothers and more than half of the uninsured low-wage workers live in those states. The reform law originally sought to help poor and middle-income people through two parallel mechanisms. One was a mandatory expansion of Medicaid (which in most states cover primarily children and their parents with incomes well below the poverty level) to cover childless adults and to help people with income levels above the poverty line. Those with slightly higher incomes would be eligible for federal subsidies to buy private policies on the new insurance exchanges.

    That approach fell apart when 26 states decided not to expand Medicaid, at least for now. There is no provision in the law to provide health insurance subsidies for anyone below the poverty line because those people are supposed to be covered by Medicaid.

    The Times report, based on an analysis of census data, found that eight million Americans who are impoverished and uninsured will be ineligible for help of either kind. To add to the insanity, people whose incomes initially qualify them for subsidies on the exchanges could — if their income fell because they lost a job — end up with no coverage at all.

    There are no easy solutions to the difficulties wrought by the Supreme Court decision and the callousness of state officials who seized on that opening to victimize the poor.

    States like New Hampshire, Ohio, Pennsylvania and Tennessee that are still flirting with the idea of expansion should do the right thing and expand. States that have adamantly refused to expand should relent and take the generous federal funds. And if Congressional Republicans ever give up on their obsession to destroy the health reform law, Congress could surely find ways to make certain that the people most in need of help get it.

    1. TMT Avatar
      TMT

      I notice the “Editorial Board” neglected even to identify any of the bona fide economic issues associated with expansion or the fact a state cannot alter its program if it expands it. But we did get some substitutes for thought and analysis — outrageous, for the poor, incredibly generous federal funds, insanity, difficulties wrought, callousness, victimize, do the right thing, expand, obsession. Wow! What analysis!

      This brings me back to the papers my kids did in Sophomore English class at FCPS. They had to argue a position. Funny, they and their classmates would get dinged if they didn’t have facts and analysis to support their positions. I guess the NYT Editorial Board would have flunked Sophomore English in Fairfax County. Am I surprised? 😉

    2. James A. Bacon Avatar
      James A. Bacon

      Peter, no question, you are a New York Times kind of guy. You think just like them! … But that doesn’t make you right!

  9. Peter Galuszka Avatar
    Peter Galuszka

    TMT,
    Full disclosure, I have done free lance assignments for the NYT. I am obviously in their pocket.

    1. TMT Avatar
      TMT

      Peter, my points remain. There is no economic analysis in the NYT editorial – just a lot of empty words. And if my kids would have turned in that piece for Sophomore English, they would have flunked.

  10. larryg Avatar
    larryg

    Here’s a proposal.

    everyone gets the same deal on health care.

    employer provided gets their tax free
    medicare gets their subsidies
    and the poor get the equivalent.

    if we don’t want to pay more – overall – then we adjust each group to allow the 3rd group that currently gets no preferences – to get equal ones.

    Why, for instance, should employer-provided have one income cap and Medicare another and MedicAid yet another – which is totally less favorable than the other two?

    what kind of a just society do we have when we give different groups different preferential treatment on health care?

    If we can give Medicare folks 5K in subisides why can’t we give MedicAid folks the same?

    if we dont’ want to increase the over all then why not adjust the Medicare Income threshold to be more like the MedicAid income threshold ?

    why should Medicare folks get 5K of subsidies even if they make 85K income and MedicAid have to make no more than 1/10th that amount to qualify ?

    how is the current system fair and just?

    how can anyone support such a system that is so unfair and unjust?

    How can the GOP support such an unfair and discriminatory system?

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