No more Texas governors for president

“Next time I tell you someone from Texas should not be president of the United States, please pay attention.” - Molly Ivins
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Posts tagged "medicaid"


July 30, 1965. LBJ signs the Medicare and Medicaid Bill (official name: Social Security Amendments of 1965) at the Truman Library in Independence, Missouri. President Harry S. Truman is seated next to him. Others looking on include Lady Bird Johnson, Vice President Hubert Humphrey, and Bess Truman. After the signing and the presentation of the first Medicare cards, LBJ gives one of the bill-signing pens to Truman. 


July 9, 1965. The Medicare/Medicaid bill passes the Senate: LBJ declares it a “great day for America.” It has already passed the House, on April 8. 

The support of Rep.Wilbur Mills (D-Arkansas), chair of the powerful House Ways and Means Committee, was crucial to the passage of Medicare. Mills, above with LBJ in 1966, was the one who combined elements of various plans into a “three-layer cake” that ultimately became Medicare/Medicaid. Read Mills’ oral histories here

Here is a conversation from March 23 between LBJ and some of the key players, including Mills, discussing discussing their strategy, the opposition from the American Medical Association, and how much the healthcare plan is likely to cost. 


Lots of jobs and fewer snakes.

I love you, Jon Stewart.


Stephen Ansolabehere looks at polling data on Americans’ budget priorties (Boston Review, September/October 2012)


David Brooks in today’s New York Times commits the standard error of pundits who want to appear neutral but know the Romney-Ryan plan would be a disaster for America. He asserts that Ryan makes a serious effort at entitlement reform. “If you believe entitlement reform is essential for national solvency, then Romney-Ryan is the only train leaving the station.”


Ryan “reforms” Medicaid by destroying it – cutting the federal contribution by some $800 billion and then continuing the cuts after the first ten years until federal spending is a small fraction of what it is today, and handing it over to the states, which can’t possibly keep the program going.  

Ryan “reforms” food stamps by slashing them – reducing the federal contribution by around $125 billion and then, beyond the first decade, essentially ending the program altogether.

He “reforms” Medicare by substituting vouchers that can’t possibly keep up with the rising costs of health care.

Originally he wanted to “reform” Social Security by turning it into private savings accounts whose value would rise or fall at the whim of the Wall Street casino. (Now he doesn’t suggest any reform of Social Security. )

You want real entitlement reform? President Obama has begun it. Rational people would make sure he gets a second term to:

Use the government’s huge bargaining clout in Medicare and Medicaid to push down drug costs and the costs of medical providers, and to shift from a fee-for-services system to a payments-for-healthy-outcomes system.

Then allow anyone of any age to join Medicare so all Americans can get affordable health care.

Fold food stamps and other programs for the poor into a single enlarged Earned Income Tax Credit  — a monthly cash grant that’s inversely related to income.

Save Social Security by eliminating the ceiling on income subject to it. (Now, income over $110,100 isn’t touched.)

These are real reforms. Ryan isn’t an entitlement reformer. He’s an entitlement destroyer. And in an era of rampant economic insecurity, Ryan’s destruction would cause American families even greater hardship.


Does Paul Ryan agree with Todd Akin’s rape comment?


Earlier today, Missouri U.S. Senate candidate Rep. Todd Akin (R-MO) claimed that “legitimate rape” does not often lead to pregnancy because “the female body has ways to try to shut that whole thing down.” This is not the first time the biologically challenged senate candidate tried to minimize the impact of rape. Last year, Akin joined with GOP vice presidential candidate Rep. Paul Ryan (R-WI) as two of the original co-sponsors of the “No Taxpayer Funding for Abortion Act,” a bill which, among other things, introduced the country to the bizarre term “forcible rape.”

Federal law prevents federal Medicaid funds and similar programs from paying for abortions. Yet the law also contains an exception for women who are raped. The bill Akin and Ryan cosponsored would have narrowed this exception, providing that only pregnancies arising from “forcible rape” may be terminated. Because the primary target of Akin and Ryan’s effort are Medicaid recipients — patients who are unlikely to be able to afford an abortion absent Medicaid funding — the likely impact of this bill would have been forcing many rape survivors to carry their rapist’s baby to term. Michelle Goldberg explains who Akin and Ryan would likely target:

Under H.R. 3, only victims of “forcible rape” would qualify for federally funded abortions. Victims of statutory rape—say, a 13-year-old girl impregnated by a 30-year-old man—would be on their own. So would victims of incest if they’re over 18. And while “forcible rape” isn’t defined in the criminal code, the addition of the adjective seems certain to exclude acts of rape that don’t involve overt violence—say, cases where a woman is drugged or has a limited mental capacity. “It’s basically putting more restrictions on what was defined historically as rape,” says Keenan.

Although a version of this bill passed the GOP-controlled House, the “forcible rape” language was eventually removed due to widespread public outcry. Paul Ryan, however, believes that the “forcible rape” language does not actually go far enough to force women to carry their rapist’s baby. Ryan believes that abortion should be illegal in all cases except for “cases in which a doctor deems an abortion necessary to save the mother’s life.” So rape survivors are out of luck.

One thing that hasn’t been getting nearly enough attention is that Ryan has been a front-line General in the GOP War on Women. He’s as far right on women’s health as anyone — which means, as is demonstrated above — that he’s as far right on the issue of abortion as Todd Akin. So it wouldn’t be at all unfair to get a statement from Ryan on whether he agrees with his former legislative partner that only women impregnated by rape are those who weren’t actually raped at all (Akin now claims he “misspoke,” but hasn’t said his statement was inaccurate).

Does Ryan believe that a women can’t get pregnant from “legitimate rape” or is he willing to let the wingnut base down on this one?


Paul Ryan is the reverse of Sarah Palin. She was all right-wing flash without much substance. He’s all right-wing substance without much flash.

Ryan is not a firebrand. He’s not smarmy. He doesn’t ooze contempt for opponents or ridicule those who disagree with him. In style and tone, he doesn’t even sound like an ideologue – until you listen to what he has to say.

It’s here — in Ryan’s views and policy judgments — we find the true ideologue. More than any other politician today, Paul Ryan exemplifies the social Darwinism at the core of today’s Republican Party: Reward the rich, penalize the poor, let everyone else fend for themselves. Dog eat dog.

Ryan’s views are crystallized in the budget he produced for House Republicans last March as chairman of the House Budget committee. That budget would cut $3.3 trillion from low-income programs over the next decade. The biggest cuts would be in Medicaid, which provides healthcare for the nation’s poor – forcing states to drop coverage for an estimated 14 million to 28 million low-income people, according to the non-partisan Center for Budget and Policy Priorities.

Ryan’s budget would also reduce food stamps for poor families by 17 percent ($135 billion) over the decade, leading to a significant increase in hunger – particularly among children. It would also reduce housing assistance, job training, and Pell grants for college tuition.

In all, 62 percent of the budget cuts proposed by Ryan would come from low-income programs.

The Ryan plan would also turn Medicare into vouchers whose value won’t possibly keep up with rising health-care costs – thereby shifting those costs on to seniors.

At the same time, Ryan would provide a substantial tax cut to the very rich – who are already taking home an almost unprecedented share of the nation’s total income. Today’s 400 richest Americans have more wealth than the bottom 150 million of us put together.

Ryan’s views are pure social Darwinism. As William Graham Sumner, the progenitor of social Darwinism in America, put it in the 1880s: “Civilization has a simple choice.” It’s either “liberty, inequality, survival of the fittest” or “not-liberty, equality, survival of the unfittest. The former carries society forward and favors all its best members; the latter carries society downwards and favors all its worst members.”

Is this Mitt Romney’s view as well?

Some believe Romney chose Ryan solely in order to drum up enthusiasm on the right. Since most Americans have already made up their minds about whom they’ll vote for, and the polls show Americans highly polarized – with an almost equal number supporting Romney as Obama — the winner will be determined by how many on either side take the trouble to vote. So in picking Ryan, Romney is motivating his rightwing base to get to the polls, and pull everyone else they can along with them.

But there’s reason to believe Romney also agrees with Ryan’s social Darwinism. Romney accuses President Obama of creating an “entitlement society” and thinks government shouldn’t help distressed homeowners but instead let the market “hit the bottom.” And although Romney has carefully avoided specifics in his own economic plan, he has said he’s “very supportive” of Ryan’s budget plan. “It’s a bold and exciting effort, an excellent piece of work, very much needed … very consistent with what I put out earlier.”

Romney hasn’t put out much but the budget he’s proposed would, according to the Center on Budget and Policy Priorities, throw ten million low-income people off the benefits rolls for food stamps or cut benefits by thousands of dollars a year, or both.

At the same time, Romney wants to permanently extend the Bush tax cuts to the wealthy, reduce corporate income taxes, and eliminate the estate tax. These tax reductions would increase the incomes of people earning more than $1 million a year by an average of $295,874 annually, according to the non-partisan Tax Policy Center.

Oh, did I say that Romney and Ryan also want to repeal President Obama’s healthcare law, thereby leaving fifty million Americans without health insurance?

Social Darwinism offered a moral justification for the wild inequities and social cruelties of the late nineteenth century. It allowed John D. Rockefeller, for example, to claim the fortune he accumulated through his giant Standard Oil Trust was “merely a survival of the fittest… the working out of a law of nature and of God.”

The social Darwinism of that era also undermined all efforts to build a more broadly based prosperity and rescue our democracy from the tight grip of a very few at the top. It was used by the privileged and powerful to convince everyone else that government shouldn’t do much of anything.

Not until the twentieth century did America reject social Darwinism. We created a large middle class that became the engine of our economy and our democracy. We built safety nets to catch Americans who fell downward, often through no fault of their own.

We designed regulations to protect against the inevitable excesses of free-market greed. We taxed the rich and invested in public goods – public schools, public universities, public transportation, public parks, public health – that made us all better off.

In short, we rejected the notion that each of us is on our own in a competitive contest for survival.

But choosing Ryan, Romney has raised for the nation the starkest of choices: Do we want to return to that earlier time, or are we willing and able to move forward — toward a democracy and an economy that works for us all? 


This is a cross post from ThinkProgress.

Texas has the worst health care in the nation, with more 25 percent of Texans - 6.2 million people - uninsured. And last month, Texas became the largest state whose governor has committed to turning down the Affordable Care Act’s Medicaid funds or establish a health insurance exchange. According to a new analysis by the Center for American Progress, Republican Gov. Rick Perry’s decision is especially harmful to Latinos, who make up 18.7 percent of Texas’s population.

A full 38 percent of the nonelderly Latino population in Texas is uninsured, compared to 17 percent of white Texans and 26 percent of Texans of color. Austin’s Center for Public Policy Priorities found that expanding Medicaid would immediately insure 2 million Texans, and this would provide health care to hundreds of thousands of Latinos and address health problems particularly harmful to Latinos.  

Latinos are significantly less likely to receive preventative care than other groups. Latinos are also more likely to have chronic diseases such as diabetes. Latino women contract cervical cancer at twice the rate of white women, further highlighting the need for better preventative care in the Latino community. Read More

Hospitals supported the Affordable Care Act because it contained a trade-off they could accept: The law would provide coverage to millions of uninsured people, even as it cut government payments to hospitals.

If the Legislature goes along with Gov. Rick Perry’s decision to reject much of the coverage expansion, Texas hospitals will face the prospect of huge Medicare and Medicaid funding cuts without as many new paying customers. The Medicaid expansion would provide insurance to as many as 1.7 million low-income Texans who are currently uninsured, according to the Urban Institute.

The coverage expansion “is something we were really banking on because of the 27 percent uninsured rate in the state of Texas — closer to 30 percent in North Texas,” said Steve Love, president and chief executive of the Dallas-Fort Worth Hospital Council. “It’s going to have an impact on all hospitals in North Texas.”

The health law, mostly upheld last month by the Supreme Court, cuts $155 billion in rising Medicare payments to hospitals over 10 years. Texas’ share of those cuts is roughly $14 billion, Love said.

Those cuts began in 2011 and will grow larger in the latter part of the decade.

The Medicaid expansion would have patched that hole — and then some. While the state would have faced additional costs — which Perry emphasized on Monday — the federal government would have sent about $112 billion to Texas to fund the Medicaid expansion.

“We are taking a whack off the bottom line currently, so no coverage expansion hurts that,” said John Hawkins, senior vice president for government relations at the Texas Hospital Association. “Given the fact that we lead the nation in the number of uninsured, we have the most exposure.”

The Medicaid expansion is scheduled to begin in 2014. As enacted, it would expand Medicaid to cover adults who earn up to 133 percent of the federal poverty level.

The federal government would fund the cost of expansion for the first three years. The state’s contribution would top out at 10 percent in 2020.

Separately, the law called for health insurance exchanges to provide coverage to people whose incomes are too high to qualify for Medicaid. Nearly 3 million Texans would qualify for subsidies that help fund that private coverage.

If Texas indeed skips the Medicaid expansion, the biggest losers are likely to be urban hospitals such as Dallas County’s Parkland Health & Hospital System. Urban hospitals, often supported by taxpayers, serve a role as “safety net” hospitals for uninsured patients who seek routine care in emergency rooms.

According to the PwC Health Research Institute, public hospitals could see their revenues decline if states such as Texas choose not to expand Medicaid. The public hospitals also face a cut in funding from a program known as “disproportionate share,” which boosts payments to hospitals that treat large numbers of Medicaid patients.

Texas hospitals received $957 million in Medicaid disproportionate share payments in 2011. Some, but not all, of that funding will be reduced as the Affordable Care Act is implemented over the coming decade.

Even so, public hospitals can’t shift their costs to private payers, because they don’t treat as many privately insured patients, said Bruce Siegel, president and chief executive of the National Association of Public Hospitals & Health Systems.

“There aren’t a lot of places where safety net hospitals will be able to turn,” Siegel said. “The options are going to be either find new sources of funds, that could be local or state [taxpayers], or cut back on services.”

Yes, this first assumes that Rick Perry even thinks, but please read on - it’s a bad outlook for Texans.

But while Perry denounces the Affordable Care Act’s “one-size-fits-all requirements,” others in Texas say that the state’s citizens and its health-care industry stand to lose because of the dilly-dallying over health reform.

Perry may not like the idea of expanding Medicaid, a key part of the health-care law, but his state relies heavily on the care provided to citizens through the state and federal health program. Texas tops the nation in the number of citizens who are uninsured—25 percent, or more than 6 million people—and a study by the Agency for Healthcare Research and Quality recently ranked the state’s care level the lowest in the nation. Some studies show that without the Affordable Care Act, the number of uninsured Texans could climb all the way to one third of the population.

Health care is one of the state’s biggest industries, and hospitals in Texas are likely to push hard in the coming months to get the Lone Star State to take Obamacare into its warm embrace. Those benefits to the state are compounded by the fact that many of Texas’s neediest could become eligible for care unavailable to them now, due to the state’s unusually steep restrictions on Medicaid eligibility. Under the health-care reform law, Medicaid will be extended to all citizens with annual incomes under 133 percent of the federal poverty level.

The Affordable Care Act is supposed to go into full effect in 2014, but Perry says he will not implement the expansion of Medicaid or creation of a state health-care exchange prescribed by the law. Other Republican governors, including Louisiana’s Bobby Jindal and New Jersey’s Chris Christie, have said they will also oppose implementation of key portions of the bill in their states.

[I]f there’s any state that knows the woes of Medicaid and Medicare, it is Texas. The same Texas Health and Human Services report issued in 2007 found: “Today, care for uninsured Texans too often takes place in hospitals and emergency rooms—the most expensive points in the healthcare system. The cost of that care is passed on to local governments and those with private insurance.” And in 2012 the state still can use more help funding its existing Medicaid program. Earlier this year, state HHS Commissioner Tom Suehs said the program would see a $15 billion to $17 billion shortfall when it comes up before the legislature again in 2013.

Which means a Medicaid crisis in Texas was likely in the works with or without Obamacare. But some experts say the $27 billion over 10 years that Perry says the expansion will cost his state doesn’t reflect reality. A report by the Center for Public Policy Priorities, a nonpartisan think tank based in Austin, found in June of this year that Texas will reap $20 billion in new federal funds a year under the health-care reform law, $13 billion of which will go to residents of the state living at or below the poverty line. Medicaid coverage expansions planned for 2014 will be mostly covered by the federal government, the report found. According to the CPPP, 20 federal dollars would be returned to the state in health care for every $1 its citizens put in.

One result of so many Texans going without health insurance has been the cost to hospitals and the state government represented by uncompensated-care charges—treatment costs incurred by a hospital that have to be picked up by someone other than the patient. According to a report by the Texas Health and Human Services Commission, hospitals in the state recorded $11.6 billion in uncompensated-care costs in 2006. That amount rose to more than $13.6 billion in 2008, and would continue to spike without reform.

Hospitals incur uncompensated-care costs when they treat uninsured patients who cannot pay for the services themselves. The number of people in Texas who ring up uncompensated-care costs in is particularly high because of the unusually steep restrictions the state places on Medicaid—12 percent of the poverty level for an unemployed parent—said John Holahan, director of the nonpartisan Urban Institute’s Health Policy Center.

A report prepared by the Urban Institute for the Kaiser Commission on Medicaid and the uninsured found that Medicaid enrollment in Texas would increase by 45.5 percent under the Affordable Care Act. According to the report, only 3 percent of the tab would be picked up by Texas. Holahan said that all in all, Texas would either see no net change to its bottom line or could wind up saving money as more people either ensure through a state exchange or get coverage under Medicaid.

That’s in line with research done by January Angeles and Matthew Broaddus of the Center on Budget and Policy Priorities, who found that the federal government would be footing most of the bill for the Medicaid expansion, as well as increased mental health coverage, across the United States.

“Currently Texas received about one of every 17 federal dollars that go to Medicaid,” Broadus said. “If you look at federal dollars that will go to the Medicaid expansion in the first six years of the program, Texas would receive one of every nine dollars.”

Health officials in Texas say the effect that health-care reform could have on uncompensated-care costs would benefit their health facilities. At the same time, they say, procrastination by Governor Perry could hurt Texas’s vital health sector.

In a statement Monday, Texas Hospital Association President Dan Stultz said, “With a strained state budget, it’s hard to imagine addressing the uninsured problem in Texas without leveraging federal funds, which will now go to other states that choose to expand their Medicaid program.”

“Our sense is that any time that you can find ways to get more people coverage so that they can get the proper care for themselves and their families is preferable than for them to be uninsured,” said Jesus Garza, president of the Seton Healthcare Family, a network of 31 health-care facilities spread through central Texas. “The fact is that you have a lot of working people in Texas who for one reason or another can’t afford health insurance and so don’t have it.”

As for the governor’s argument that the federal government is trying to force an unwieldy system on Texas’s citizens, Garza said disagreement over whether his patients would be better served by a state- or federal-run insurance exchange doesn’t concern him.

“I think those are political judgments,” Garza said.

There are some ways in which Texas has already seen the benefits of the Affordable Care Act. Data compiled by the U.S. Department of Health and Human Services show that as of December 2011, 357,000 previously uninsured young adults between the ages of 19 and 25 were allowed to stay on their parents’ health insurance coverage because of the Affordable Care Act.

The Texas Department of Insurance also has received a $1 million grant to coordinate efforts among state agencies toward building a state insurance exchange—which Perry now says he’ll oppose.

Looking at the dollars, Perry’s decision to fight the Affordable Care Act is a fiscal mistake for Texas, said John Holahan. “Ideologically it might make some sense,” he said, “but I don’t think the economics of it work.”


What happens if a state opts out of Medicaid, in one chart

If governors opt their states out of the health law’s Medicaid expansion — as many are now threatening to do — it’s the poorest Americans who would find themselves getting the rawest deal.

(via motherjones)

Tell me again why this is bad? :)

Tell me again why this is bad? :)