Tag Archives: medicaid

This GOP Presidential Candidate Is Trying to Destroy Planned Parenthood. Now Planned Parenthood Is Fighting Back.

by FinlayBales Posted on August 26, 2015

Mother Jones

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Planned Parenthood in Louisiana is asking a federal judge to halt presidential candidate and state Gov. Bobby Jindal’s efforts to cut Medicaid funding for the health care organization, arguing that the cut would hurt nearly 6,000 low-income women, men, and teens who access the group’s services each year.

Referencing the series of attack videos that depict Planned Parenthood officials in California and other states discussing fetal tissue donation, Jindal earlier this month directed the state’s department of health to terminate Planned Parenthood’s contract with Medicaid, saying the organization was not “worthy of receiving public assistance from the state.”

Planned Parenthood Gulf Coast, which operates clinics in New Orleans and Baton Rouge, does not offer abortion services in Louisiana. It does, however, provide physical exams, breast cancer screenings, and testing for sexually transmitted infections to 10,000 people each year, 60 percent of whom are enrolled in Medicaid.

In a lawsuit filed Tuesday, lawyers for the health care organization wrote that those patients will be cut off from health care access as early as next week, causing them “significant and irreparable harm,” unless the court blocks Jindal’s decision. Medicaid payments to Planned Parenthood, which totaled nearly $730,000 last year, are set to end September 2 unless the court steps in.

A key issue is whether cutting off Planned Parenthood’s Medicaid funding is legal. This month, the federal Centers for Medicare & Medicaid Services (CMS) warned Louisiana that terminating Medicaid provider agreements likely violates a federal rule requiring Medicaid beneficiaries to be able to obtain services from any qualified provider.

The point of that provision, according to CMS, is to “allow Medicaid recipients the same opportunities to choose among available providers of covered health care and services as are normally offered to the general population.”

Louisiana isn’t the only state to cut funding for Planned Parenthood: Alabama, Arkansas, New Hampshire, and Utah have taken similar steps. And Republicans in Congress tried, but failed, to push through a bill to slash $500 million in federal funding.

Jindal is also one of a handful of Republican governors who have launched investigations into state Planned Parenthood affiliates in the hopes of finding criminal activity related to the sale of aborted fetal tissue. Those investigations, many of which are taking place in states that don’t have fetal tissue donation programs, have so far turned up nothing. The investigation in Louisiana, however, has put on hold the construction of a third Planned Parenthood clinic, which was approved by the department of health earlier this year after months of pushback.

But coming out swinging against the country’s largest women’s health care organization hasn’t translated to a more successful presidential campaign for Jindal. He was one of two sitting governors who did not get to participate in the first prime-time Republican debate this year because the forum was limited to the top-polling candidates. National polls have consistently put him in the low single digits.

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This GOP Presidential Candidate Is Trying to Destroy Planned Parenthood. Now Planned Parenthood Is Fighting Back.

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In Shocking News, Scott Walker’s Health Care Plan Screws the Poor

by ForrestTrujillo Posted on August 19, 2015

Mother Jones

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This is going to be the most anticlimactic blog post ever, but can you guess how Scott Walker’s health care plan compares to Obamacare for the poor? And how it compares for the upper middle class and the wealthy?

Damn. You guessed. But just to make it official, here are a couple of charts that show how the subsidies in the two plans compare at different income levels. I used the Kaiser calculator to estimate Obamacare subsidies and Walker’s written document to calculate tax credits under his plan. The chart on the left shows a 3-person family with 30-year-old parents. The chart on the right shows the same thing with older parents.

And have no fear: I chose $30,000 as the minimum income level because most families below that level qualify for Medicaid. And you guessed it: Walker’s plan slashes Medicaid too. So the poor and the working class get screwed by Walker no matter what their income level is.

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In Shocking News, Scott Walker’s Health Care Plan Screws the Poor

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Puerto Rico Crisis Goes From Bad to Worse

by AYZShantell Posted on August 5, 2015

Mother Jones

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Puerto Rico’s economic crisis has only gotten worse in the month since Gov. Alejandro García Padilla told the New York Times the island’s $72 billion in debts was “not payable.” Earlier this week, the island missed a key bond payment, making history and setting the stage for a bruising and protracted battle with creditors. There are many reasons Puerto Rico finds itself in this quandary, including its murky political status, and the situation seems to be deteriorating as time goes on.

Here are the direst problems facing Puerto Rico—and the impact they could have on the upcoming presidential election:

Default: In June, when García Padilla called on Congress to pass legislation that would allow Puerto Rico to get its debt in order under the US bankruptcy laws that apply to the 50 states, the idea that the island would default on loan payments was mostly theoretical. That’s not the case anymore. The island’s government paid just $628,000 of a $58 million debt payment due this week, triggering the first default since the island was taken over by the US in 1898. No state has defaulted since Arkansas failed to make its bond payments during the Great Depression in 1933.

The default complicates an already complicated situation. Since current law doesn’t allow Puerto Rico to authorize its cities and publicly owned entities to seek bankruptcy protection through the courts, the island’s government has to negotiate with each of its lenders individually. As anybody who has ever borrowed money knows, interest rates go up when your credit goes down. Puerto Rico’s default, without any congressional intervention to change the bankruptcy laws, will likely lead to much more expensive borrowing in the future. “The default is consistent with our belief that Puerto Rico does not have the resources to make all of its forthcoming debt payments,” Moody’s Investors Service Vice President Emily Raimes said in a statement this week. “This is a first in what we believe will be broad defaults on commonwealth debt.”

No Help From Congress: When American cities and political entities such as towns, water districts, counties, and publicly run corporations face similar financial problems, they reorganize their debt under Chapter 9 of the US Bankruptcy Code. Detroit, which filed for bankruptcy in 2013, is perhaps the best-known example of this, but according to Governing magazine, it has happened nearly 50 times in the US since 2010. Federal bankruptcy law specifically excludes Puerto Rico, which means that the island’s government is forced to negotiate directly with a range of lenders, all of whom have different requirements and some of whom recommended closing schools, cutting university subsidies, and firing teachers to repay the debt.

Pedro Pierluisi, Puerto Rico’s non-voting representative in Congress, has more than once introduced legislation that would allow Puerto Rico to be treated like the states when it comes to US bankruptcy laws, but it has gone nowhere. More recently, Sens. Chuck Schumer (D-N.Y.) and Richard Blumenthal (D-Conn.) introduced an identical bill to Pierluisi’s, but some Republicans continue to oppose the idea on the grounds that it’s a backdoor bailout, so any relief coming from Congress is unlikely.

Medical Issues: Puerto Ricans face a host of problems as a result of the economic implosion, but a looming health care crisis might be the most serious. As the New York Times reported over the weekend, Puerto Rico is bracing for large cuts to a Medicare program called Medicare Advantage, which is being pared back under the Affordable Care Act. The result is that tens of thousands of Puerto Ricans are expected to face higher copays, reduced services, and a shrinking network of already stressed doctors. Puerto Rico’s Medicaid program, which serves nearly 1.6 million people, is also in danger of running out of federal grant money by the end of 2016. If the financially strapped government can’t come up with funding, as many as 900,000 people could get dropped from the program, according to the Times—and funds are hard to come by these days.

The lack of Medicaid funding is partly responsible for $25 billion of the island’s $73 billion debt burden, because the government has had to borrow to make up Medicaid funding gaps. Puerto Ricans pay Medicare taxes (along with many other federal taxes), but the federal government’s funding to the island is capped, forcing Puerto Rico to try to make up the difference.

All of this helps explain the mass exodus of doctors from the island, who are leaving at a rate of about one per day for work in Florida, New York, or other states. The rate is expected to climb, further exacerbating the health care woes of a place that already has too few doctors serving the population.

The Effect on Mainland Politics: Doctors aren’t the only ones abandoning the island. As US citizens, Puerto Ricans can freely move to the US mainland, so now, there are more Puerto Ricans living on the mainland than on the island. The growing number of Puerto Ricans moving to the US, mainly Florida, will likely play a big role in the coming presidential election. As the Washington Post reported last week, politicians hoping to win Florida will face problems if they don’t have Puerto Ricans backing them up at the polls. “Puerto Ricans are the swing voters in the swing region of a swing state,” former Puerto Rico Secretary of State Kenneth McClintock told Mother Jones in July. “So, come March of next year, the presidential primaries in Florida will be very important in terms of what is done with Puerto Rico in the future.“

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Puerto Rico Crisis Goes From Bad to Worse

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John Roberts Just Saved the Republican Party From Itself

by TristanFrank Posted on June 25, 2015

Mother Jones

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The Supreme Court’s Thursday ruling, written by Chief Justice John Roberts, that upheld a core tenet of the Affordable Care Act is good news for the millions of Americans whose health insurance was on the line. But it’s also, in a strange way, good news for a completely different group: the Republican politicians who have all but called for Obamacare to be shot into space on a rocket.

Had the court gone the other way, gutting federal subsidies while leaving the shell of the law on the books, congressional Republicans, as well as GOP governors such as Scott Walker and Chris Christie, would have been put in the uncomfortable position they’ve managed to avoid since Obamacare was signed into law—having to fix it. The Associated Press outlined Walker’s dilemma neatly on Wednesday:

About 183,000 people in Wisconsin purchase their insurance through the exchange and nine out of 10 of them are receiving a federal subsidy, according to an analysis of state data by Wisconsin Children and Families. The average tax credit they receive is $315 a month.

Health care advocates who have been critical of Walker for not taking federal money to pay for expanding Medicaid coverage have also called on the Republican second-term governor to prepare for the subsidies to be taken away.

And many of those Wisconsonites enrolled in the federal exchange are there because Walker put them there. As Bloomberg’s Joshua Green noted in a prescient piece in March, Walker booted 83,000 people from the state’s Medicaid program and put them on the federal exchange instead. That’s not the kind of crisis you want to be dealing with in the middle of a presidential campaign—or ever.

Conservatives would have been thrilled with a ruling in their favor on Thursday. But Roberts’ decision spares Walker and his colleagues from what would have come next, and frees them to continue lobbing rhetorical bombs at the law they’re now stuck with. As previous generations of Washington Republicans can advise, it’s much easier to go to war if you don’t need a plan for how to end it.

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John Roberts Just Saved the Republican Party From Itself

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Will Supreme Court Uphold Obamacare Subsidies On Same Grounds It Struck Down Medicaid Expansion?

by NicholeAuricht Posted on June 22, 2015

Mother Jones

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Back when the Supreme Court ruled on NFIB vs. Sebelius—the original Obamacare case—there were two basic parts to the opinion: The individual mandate was upheld and the Medicaid expansion rules were struck down. Most liberals thought the reasoning behind the Medicaid decision was absurd, but I didn’t. I found it quite plain and persuasive. Basically, Congress had told the states that if they didn’t accept the Medicaid expansion, they’d lose all Medicaid funding. But states are supposed to have a legitimate choice about whether to accept new government programs, and this clearly didn’t give them any real choice. No state can afford to lose all its existing Medicaid funding. Congress had set things up so that technically each state had a choice, but it was really no choice at all. In practical terms, every state had to accept the expansion, and this was constitutionally unacceptable.

Two liberal justices agreed with this reasoning, as did the five conservative justices, including Anthony Kennedy. Over at the New Republic, Simon Lazarus notes that during oral arguments in the latest Obamacare case, Kennedy suggested a similar dynamic was at work. The plaintiffs were arguing that the text of the law clearly stated that federal subsidies were available only to states that set up their own insurance exchanges. The problem here is that without subsidies Obamacare is not only useless, but could severely damage the existing insurance market in a state:

Such a threat, he observed, could amount to unconstitutional “coercion” to pressure states to set up exchanges. If this is Justice Kennedy’s take, his most likely outcome would be to adopt an alternative interpretation that avoids having to face the constitutional issue. The Obama administration’s interpretation—that the ACA prescribes credits for customers on all exchanges, whether state-run or federally facilitated—fits that bill.

….Previously, only one case had invalidated a law under a coercion theory like the one Kennedy advanced—NFIB v. Sebelius itself. Then, the Court held unconstitutional the ACA’s method to incentivize states to expand Medicaid coverage to all adults up to 138 percent of the Federal poverty level. If they declined, states risked losing federal financial support for their pre-existing Medicaid programs, on average over 10 percent of state budgets. That, seven justices agreed in two separate opinions, was a bridge too far. Chief Justice Roberts, joined by progressive Justices Breyer and Kagan, ruled that this “financial inducement” amounted in effect to “a gun to the head . . . so coercive as to pass the point at which pressure turns into compulsion.”

Why were both sides caught off-guard by Kennedy’s attraction to extending the NFIB coercion holding to King, but this time for the benefit of the ACA? The reason, I suggest, is a deep bipartisan cynicism about the Court’s “federalism” jurisprudence….What that cynicism seems to have missed is that, as an ideological matter, Justice Kennedy takes very seriously what he repeatedly lauds as the “federal balance.”….In sum, Justice Kennedy might well see King v. Burwell more as an opportunity to advance his federalism ideology, than as a second shot at vindicating the Republican political priority of crippling Obamacare, for which he showed evident sympathy three years ago.

Interesting. Both Kennedy and Roberts could see this case as a way of gaining bipartisan support for a ruling that saves Obamacare but further entrenches the view of federalism stated in NFIB. They might both consider that worth it. While we all twiddle our thumbs waiting for the decision in King v. Burwell to be handed down, it’s an interesting possibility to ponder.

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Will Supreme Court Uphold Obamacare Subsidies On Same Grounds It Struck Down Medicaid Expansion?

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NYC Doctors Allegedly Used Free Shoes to Lure Homeless Into Medicaid Fraud

by OpheliaP67 Posted on April 1, 2015

Mother Jones

Nine New York City physicians and 14 other medical workers have been charged with fraudulently billing Medicaid $7 million dollars in expenses for homeless and poor patients whom they convinced to undergo unnecessary medical testing in exchange for free shoes, Reuters reports.

Brooklyn District Attorney Ken Thompson said in a statement: “These defendants allegedly exploited the most vulnerable members of our society and raked in millions of dollars by doing so.”

The doctors allegedly offered the “guinea pigs”—as the medical workers referred to the homeless and poor patients they recruited from shelters and welfare centers—a free pair of kicks if they produced a Medicaid card and agreed to have their feet examined. Prosecutors said that in some cases the patients underwent unneeded physical therapy, extensive testing that sometimes lasted days, and were given leg braces and other pieces of equipment they had no use for.

Daniel Coyne, deputy Medicaid inspector general for investigations, told Reuters that by getting the arbitrary testing, the patients’ actual medical problems could have gone untreated.

If convicted, the doctors face up to 25 years in prison.

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NYC Doctors Allegedly Used Free Shoes to Lure Homeless Into Medicaid Fraud

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A Baton Rouge ER Is Closing Because Bobby Jindal Won’t Accept Medicaid Expansion

by JaiFitzGibbon Posted on February 9, 2015

Mother Jones

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Louisiana’s capital city is losing one of its emergency rooms:

The Baton Rouge General Medical Center-Mid City will close its emergency room within the next 60 days, a victim of continuing red ink and the Jindal administration withdrawing the financial support that kept it open.

….The General’s Mid City campus suffered a financial hit as a result of the April 2013 closure of the LSU Earl K. Long Medical Center….More and more poor and uninsured patients from the low-income neighborhoods of north Baton Rouge ended up at the Mid City hospital, which was the next-closest facility.

Mid City hospital reported losses of $1 million a month as more and more patients who could not pay arrived. Losses jumped from $6 million to $8 million annually from 2009 to 2012, then up to $12.5 million in 2013, according to Baton Rouge General. Last year, the facility lost $23.8 million.

The nearest ER for residents who are currently served by Mid-City is now 30 minutes further away, and it’s a certainty that people are going to die because of this. But what’s the real story behind this closure? Shouldn’t the expansion of Medicaid be offsetting the increased losses on uninsured patients?

You bet it should. And it would, if Bobby Jindal were willing to accept Obamacare’s offer of virtually free Medicaid expansion. But he’s not, and that means Baton Rouge is losing one of its central emergency rooms and more people will die who otherwise could have been saved. That’s some nice work, Bobby. Michael Hiltzik has more details here.

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A Baton Rouge ER Is Closing Because Bobby Jindal Won’t Accept Medicaid Expansion

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Wyoming Is Thinking About Accepting Medicaid Expansion After All

by FloridaBirchell Posted on August 26, 2014

Mother Jones

Michael Hiltzik passes along the news that Wyoming’s governor is the latest traitor to the cause of denying health care to poor people no matter what the cost:

The reason for Wyoming’s wavering is clear: It’s money.

The Health Department says Medicaid expansion could save the state $50 million or more if it expands the program, for which the federal government will pay at least 90%. Meanwhile, Wyoming hospitals say they’re losing more than $200 million a year in uncompensated care for people without insurance.

The state Legislature has rejected the expansion, but Republican Gov. Matt Mead has been saying it’s time to pack up. He’s entering negotiations with the feds for a way to expand Medicaid next year, covering as many as 17,600 low-income residents.

I imagine that before very much longer, most of the other Midwest holdouts will go ahead and accept Medicaid expansion too. That will leave only the hard-core holdouts of the Old South, where the poor are apparently especially undeserving. I guess there must be some kind of difference between poor people in the Midwest and poor people in the South. I wonder what it could be?

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Wyoming Is Thinking About Accepting Medicaid Expansion After All

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Inside Alaska’s New "War on Women"

by BradyKhanx Posted on March 7, 2014

Mother Jones

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On Wednesday, a Republican state senator in Alaska took to the floor to explain that the government should not pay for family planning services for low-income women, because anyone can afford birth control. “Even the most sexually active folks don’t need to spend more than $2 or $3 a day for covering their activity,” state Sen. Fred Dyson (R-Eagle River) said. He explained that it’s easy for women to get access to birth control in Alaska, given that they can get it delivered via Alaska Airlines’ express delivery program.

Dyson was talking about birth control as part of the debate on a controversial abortion bill. He is one of six Republicans senators cosponsoring the fast-moving bill, which would stop low-income women in the state from using Medicaid to fund abortions, except in the cases of rape, incest, or to “avoid a threat of serious risk to life or physical health of a woman.” The bill outlines a list of 22 conditions that would qualify a woman for a Medicaid-funded abortion, such as risk of coma or seizures. Under Alaska law, since 2001, a woman could still only use state Medicaid to pay for an abortion that was “medically necessary”—but the definition was left up to the woman and her doctor. Critics of the bill say that the bill’s new definition is much more restrictive. (Last year, more than 37 percent of abortions reported in Alaska were covered by Medicaid.) Recently, Alaska’s Department of Health and Social Services tried to enforce the same restrictions contained in the bill, but Planned Parenthood sued the state over that decision. A court put the regulations on hold as the case unfolds. If this bill passes, it is expected to be challenged as part of that lawsuit. And it’s expected to pass—Alaska has a Republican majority in the House, and Republican Gov. Sean Parnell opposes abortion.

Democrats in the state have been trying to limit the bill’s effects on women, successfully adding an amendment to this bill last year that would have allowed at least 14,000 low-income Alaskans without children to get their family planning services—including STD testing and birth control—covered by Medicaid. (Right now, Alaska has chosen not to accept money through the government’s Medicaid expansion.) But in February, the House Finance Committee stripped the amendment from the bill. State Sen. Berta Gardner (D-Anchorage), who proposed that amendment, says that if the state really wants to prevent abortions, lawmakers should focus on giving women access to birth control. “We know that the best and most efficient way to reduce abortions is to ensure that all women have access to contraceptive services. We do not understand the opposition to doing this,” Gardner says, characterizing the Republican opposition as part of “the continuing war on women.”

Debate has been ongoing about the bill, and whether the birth control amendment should be added back in. At a Senate floor meeting on March 5, Dyson explained that low-income women don’t need their birth control paid for, because it’s already easy to get: “No one is prohibited from having birth control because of economic reasons,” he said, arguing that women can buy condoms for the cost of a can of pop and get the pill for the price of four to five lattes each month. He added, “By the way, you can go on the internet. You can order these things by mail. You can make phone calls and get it delivered by mail. You all know that Alaska Airlines will do Gold Streak, and get things quickly that way.” (When reached by Mother Jones, Dyson says that he was referring to the fact that even women in tiny villages in Alaska can get their prescriptions delivered.)

Dyson’s “latte” estimate is correct for the cheapest brands of the generic birth control pill—but it doesn’t take into account the cost of doctor’s visits to get a prescription, and alternative methods, such as IUDs. Additionally, according to our own birth control calculator, small co-pays on birth control add up to big expenses for women who don’t have insurance, not including the costs of a doctors’ visit associated with getting birth control. For example, a 25-year-old woman without insurance who takes the birth control pill until she hits menopause (estimated at age 51) will end up spending about $150 a month, or $46,650 over her child-bearing years (about $8,290 with insurance). Dyson told Mother Jones, “My guess is that most of those women, if they weren’t able to pay, their partner would be able to. I don’t see the costs being that big of an issue, in reality.”

According to the National Institute for Reproductive Health, uninsured women are less likely to consistently use birth control due to high costs, and low-income women are four times as likely to have an unintended pregnancy than their higher-income counterparts. (The Obama administration’s birth control mandate, which requires private insurers to cover family planning services, is changing that—it has increased the percentage of women who currently don’t have to pay for the pill from 15 percent in 2012 to 40 percent in 2013.)

“It is frankly shameful for Sen. Dyson to claim that low-income people are buying lattes instead of birth control,” says Jessica Cler, a spokeswoman for Planned Parenthood Votes Northwest. “It’s truly puzzling that Dyson and his like-minded colleagues, including Gov. Sean Parnell and Lt. Gov. Mead Treadwell, think that they are responsible for making the personal medical decisions of Alaskan women.”

Dyson disagrees, adding, “I don’t think public money ought to be paying for Viagra, either.”

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Inside Alaska’s New "War on Women"

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CBO Gives Flunking Grade to Republican Plan on Obamacare Mandate

by AlisonEnticknap Posted on February 26, 2014

Mother Jones

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“Ouchy ouchy,” says Ed Kilgore today. “No conservative love for CBO this week, I suspect.”

There was plenty of conservative love for the CBO last week, of course, because they estimated that an increase in the minimum wage might reduce employment. This week, however, the subject is a conservative plan to eliminate the Obamacare requirement that employers with health plans cover everyone working more than 30 hours a week. Republicans have been bellyaching forever that this is going to cause employers to reduce hours in order to get workers just under the 30-hour minimum, thus causing enormous pain to hardworking real Americans throughout the country. There’s not much evidence that this is actually happening, but whatever. They want to get rid of the 30-hour mandate anyway.

Sadly, the CBO’s opinion of a Republican bill to do this was not good. The bill would reduce the number of workers covered by employer healthcare by about a million people; increase use of Medicaid and CHIP; and increase the budget deficit by about $74 billion over ten years.

That’s some bill. I think Kilgore is right that Republicans aren’t going to be giving the CBO a lot of love this week.

UPDATE: And while we’re on the subject, Republican attacks on Obamacare just generally don’t seem to be doing well lately. In the latest Kaiser survey asking Americans if they want to keep Obamacare or repeal it, the keepers are ahead by a margin of 56-31 percent. That’s up from last year, when they were up by only 47-37 percent. Greg Sargent has the deets here.

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CBO Gives Flunking Grade to Republican Plan on Obamacare Mandate

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