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Map showing status of Medicaid expansion in the states as of August, 2013.

Where congressional Republicans have had limited success in doing serious damage to Obamacare, John Roberts' Supreme Court might just succeed. That's because their ruling that states could refuse to expand Medicaid under the law will leave many uninsured people just that: uninsured. That's because there's a gap in the income levels set between Medicaid eligibility under the law, and when federal subsidies kick in. In the 26 states that have so far either refused the expansion or not decided, as many as two in five uninsured adults fall into that gap, according to a new study from the Commonwealth Fund.

Between 2010 and 2012, nearly one-third (32%) of U.S. adults ages 19 to 64, or an estimated 55 million people, were either continuously uninsured or spent a period of time uninsured. Data from the 2011 and 2012 Commonwealth Fund Health Insurance Tracking Surveys of U.S. Adults show that people with incomes below 133 percent of the federal poverty level (i.e., the level that will make them eligible for Medicaid in 2014 under the Affordable Care Act) were uninsured at the highest rates. Yet, fewer than half the states are currently planning to expand their Medicaid programs, because the 2012 Supreme Court decision allows states to choose whether to expand eligibility. In those states that have not yet decided to expand, as many as two of five (42%) adults who were uninsured for any time over the two years would not have access to the new coverage provisions in the law.
What's more, those states that are refusing the expansion have the most uninsured, the survey found. "[I]n the 26 states that have said they are not expanding or are undecided, nearly three-quarters (72%) of adults with incomes below 133 percent of poverty in one or both of the two years spent a time uninsured over the two-year period." That's opposed to 61 percent of those surveyed in the states that will be expanding Medicaid.

The survey identified another problem for low-income Americans trying to get health insurance under the new law in the refusing states—fluctuating incomes. Twenty-nine percent of the surveyed population had income levels that fluctuated enough in those two years to change their eligibility for subsidies. So one year they could qualify, the next year they could lose the subsidy, fall into the gap, and lose insurance altogether. There's a fix, Commonwealth says, for both of these problems, but it's an unlikely one since it requires Congress.

Congress needs to pass a bill to expand the subsidy program, allowing adults below the poverty line who are not eligible for Medicaid to get the subsidy. As long as we're asking the Congress to do this, we might as well be asking the Congress to make a real, substantive reform by opening up Medicare to these people. Neither is likely to happen as long as Republicans control the House of Representatives. The solution is going to require organizing at the state level to both pressure governors and legislatures who have refused the expansion to change their minds, either by lobbying or by ousting them in 2014.

Originally posted to Joan McCarter on Mon Sep 09, 2013 at 09:17 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Good idea, but dream on.... (1+ / 0-)
    Recommended by:
    MGross

    "Congress needs to pass a bill that pass a bill to expand the subsidy program, allowing adults below the poverty line who are not eligible for Medicaid to get the subsidy."

    This is like the US going to the UN Security Council over Syria with Russia and China with their automatic veto power. Neither is gonna happen.....(revised health care bill or agreement among the US, China and Russia on response measures to chemical weapons).

    •  frame it as a win for the R's (0+ / 0-)

      Expanding the subsidy program is effectively allowing red state vetoes of Medicare to privatize health care for those recipients instead -- shrinking the dream of "Medicare for all" and instead increasing the flow of tax dollars to private insurance companies. This has been a Republican goal for decades in different guises.
      Personally, I want to see us move little by little toward single payer/Medicare for all. But if we on the left are instead prepared to settle for an interim goal of getting more people insured, we could play a mind game with the R's on this one. We amp up the call for expanding Medicare and trumpet loudly that we don't want more government money going to private insurance companies, and let R's run with that to, in their minds, give D's and Obama a black eye. Result: gap is filled in Obamacare.
      From the start, R's should have dealt with Obamacare by declaring victory as the D's adopted conservative ideas. This would at least hand them a fig leaf. Not sure whatever cool heads are left in that party have enough sway to get the party to run with it, though.

  •  The solution is Congress? (4+ / 0-)
    Recommended by:
    ferg, BachFan, mspicata, 714day

    Oh, we're okay then.  Those guys are great.

  •  OK... (3+ / 0-)
    Recommended by:
    grubber, ferg, blukat

    But how does this 'wound' Obamacare?  The states that expand will thrive while the states that don't will not.  What am I missing here?

    “Socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires.” - John Steinbeck

    by RichM on Mon Sep 09, 2013 at 09:24:52 AM PDT

    •  Yeah, she didn't really tie that in, did he? (0+ / 0-)

      At the risk of putting words in the diarist's mouth, it could happen a couple of ways:

      1 - Federal contribution for Medicaid expansion starts at 100% then phases down... potentially costing states who opted in a lot of money... eventually.

      2 - States with functioning expansions attract a disproportionate amount of people who are large net drains on finances due to their medical conditions.

      That's... all that's coming to mind.  Anything else?

    •  There will still be (7+ / 0-)

      a lot of uninsured people. Which is what the law was trying to fix.

      "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

      by Joan McCarter on Mon Sep 09, 2013 at 10:54:13 AM PDT

      [ Parent ]

    •  Anger management (4+ / 0-)

      Person A in State X is covered by Medicaid, Person B with identical income in State Y isn't.  Person B isn't going to be pissed at their state and vote to change things, they're going to be mad at Obamacare taking their tax dollars and giving it to Person A.  

      We do not forgive. We do not forget. The whole world is watching.

      by Tracker on Tue Sep 10, 2013 at 11:14:16 AM PDT

      [ Parent ]

    •  The question is.... (8+ / 0-)

      how many of those who find themselves in states which don't extend coverage, get active enough to pressure their legislators and governors to provide it?

      Here in PA, Gov. Corbett has so far refused, but his popularity ratings, heading into next year's re-election cycle have been very rocky and not improving.  Opposition ads against him began running soon after he took office and have continued on and off since then.

      And he is under mounting pressure to act:

      A signal that the Corbett administration may be softening its position on Medicaid expansion under the Affordable Care Act is a step in the right direction of helping low-income working Pennsylvanians.
      Administration officials plan to spend this week talking with state legislators about options for expansion in the context of broader changes for the existing Medicaid program, which provides health care coverage for poor families.
      Of course it also appears that Corbett may try and tie conditions to extending any coverage.
      But Public Welfare Secretary Beverly Mackereth last week softened the "no, no, no" position. She said the administration has been studying the Medicaid system and that Mr. Corbett would like to see, among other things, requirements that recipients who are unemployed prove they are looking for a job and that recipients be charged co-pays for some services.
      With every day that PA citizens find themselves unable to avail themselves of coverage under Obamacare, you an be sure that proponents of the program will be asking why Corbett wants to keep them from getting it.  He's vulnerable and he knows it.

      Free markets would be a great idea, if markets were actually free.

      by dweb8231 on Tue Sep 10, 2013 at 11:14:44 AM PDT

      [ Parent ]

    •  It wounds it because the program must have.... (3+ / 0-)

      .....the program's success is built on increasing the number of insured people nationwide. The more people who remain uninsured, the more dysfunctional the health care "system"will remain. That will make people unhappy. When people are unhappy with the health care system, they will vote Republican. They will do so even when it is hazardous to their health.

      If you hate government, don't run for office in that government.

      by Bensdad on Tue Sep 10, 2013 at 11:14:46 AM PDT

      [ Parent ]

  •  Congress will not pass a bill that helps the ACA (3+ / 0-)
    Recommended by:
    blueoregon, ahumbleopinion, 714day

    The administration of ACA in red states will be very diffiocult if not impossible.

    I still don't understand what this will do in the 2014 mid-terms.  And I hope that Obamacare shines in blue states. In California, a leading Obamacare implementation state, it will be difficult enough to implement it.  I see the ACA as a step on the direction to Single Payer.

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Mon Sep 09, 2013 at 09:24:58 AM PDT

    •  I think the effect in 2014 is pretty simple. (5+ / 0-)

      Right now, the Democrats own the ACA, 100%.  People here can scream all they want about Republicans refusing to make it better, but the bottom line is that, as far as the country as a whole is concerned, the law we now have was passed on a purely partisan basis, so Democrats own it.  

      If the ACA is seen overall as successful, it's a win for Democrats in 2014.

      If the ACA is seen as creating problems, it's a loss for Democrats in 2014.  

      And, really, I don't see the logic behind the notion some have that, "If the ACA doesn't work well, that will move the country closer to single payer."  Here's what the country will see if the ACA doesn't work well -- Democrats had their shot at fixing health care, and the ACA is what we got.  Why would the country trust them when they say, "we messed things up with the ACA, so trust us with single payer -- we'll get it right this time."  

      I think that the fortunes of Democrats in 2014 are going to depend a lot on how the country perceives the effectiveness of the ACA.  

    •  Politically (2+ / 0-)
      Recommended by:
      Shockwave, ColoTim

      I think the backlash will (hopefully) be at the state level primarily.

      I'm not sure that as a single issue it will have much effect in the congressional midterms.

      "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

      by Joan McCarter on Mon Sep 09, 2013 at 10:55:50 AM PDT

      [ Parent ]

  •  Ya think that when people in the red states (4+ / 0-)

    realize that in voting Republican, they might be voting for their death, they might change their votes?

    Nah, too much to ask for.  Death is a small price to pay to avoid being controlled by a socialist, communist, Nazi, Kenyan, negro, Stalinist, Chicago politician.

    •  Not when their state reps, the repubs, (3+ / 0-)

      and their news media keep telling them, "we kept Obamacare out of our state, and look how it's failing.",
      Low information voters are going to be kept low information by their msm because the republican party has so much vested in their remaining so.

      "Truth catches up with you in here. It's the truth that's gonna make you hurt." - Piper Chapman

      by blueoregon on Mon Sep 09, 2013 at 09:39:18 AM PDT

      [ Parent ]

      •  Right, there are ads on the radio in MO (6+ / 0-)

        right now from some conservative shill group using Utah senator Mike Lee's voice, warning how "Obamacare is going to make you leave the doctor you like and send your health costs through the roof. Call now and sign our voice petition to urge Congress to repeal Obamacare."

        My son is one of those people in the gap. Working 30 hrs a week for a small business at $10 an hour, he can barely pay his bills much less buy insurance. We NEED the Affordable Care Act to be implemented by all states in the way it was attended.

        •  It's even worse... (0+ / 0-)

          I had the misfortune to hear one of these anti-ACA ads and in it there was an older lady saying, "I'm afraid I won't be able to go to the doctor of my choice" and other scary bogeyman-type things. So apparently, it's not necessary to find something actually wrong with the law, just something that somebody, somewhere, is afraid might happen, even if no such inference can actually be drawn from the text of the law itself (death panels, anyone?).

    •  Nah. (3+ / 0-)
      Recommended by:
      BachFan, never forget, annan

      PA isn't entirely red, and look what we got stuck with. Far too many here vote GOP b/c their parents and grandparents did...no other logic to it whatsoever.

      I have begun to believe that GOP voters are brainless.

      Irony takes a worse beating from Republicans than Wile E. Coyote does from Acme. --Tara the Antisocial Social Worker

      by Youffraita on Mon Sep 09, 2013 at 09:39:30 AM PDT

      [ Parent ]

  •  I"m not clear on why it's (4+ / 0-)
    Recommended by:
    flatford39, BachFan, Kimbeaux, blukat

    wounding Obamacare - By leaving people uncovered? How can that be blamed on Obamacare when those states REJECTED coverage for those citizens. Also most of the articles I have read about this seems to indicate that it was the Governors in those states who rejected the expansion by executive fiat - I don't recall hearing about it being debated in the statehouses.

    Those Governors will have actual deaths on their hands due to their rejection of healthcare and I really do not think that I am guilty of hyperbole. Those Governors felt that their political grandstanding was more important than actual lives.

    Many of those states border states which accepted the expansion. Look at Maine for God's sakes! Maine has rampant poverty and I think is second in the nation for households needing food stamp assistance. This will be an excellent time for Maine to vote out their idiot Republicans and start to install some pols with some conscience and humanity.

    “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

    by Phoebe Loosinhouse on Mon Sep 09, 2013 at 09:36:57 AM PDT

    •  In OH, the Republican governor pushed for (1+ / 0-)
      Recommended by:
      annan

      Medicaid expansion because he is a money Republican.  He has been blocked so far by the true Tea Party believers in the legislature.  We are still hoping for a way around them, but it is a delicate operation when dealing with hateful fools with so much power.

      “The future depends entirely on what each of us does every day.” Gloria Steinem

      by ahumbleopinion on Mon Sep 09, 2013 at 10:01:49 AM PDT

      [ Parent ]

    •  It is wounding the program itself, (6+ / 0-)

      preventing it from functioning as intended in many states. Whether it wounds Democrats in the mid-terms is a separate question. Much depends on the reaction of people who sign up on the exchanges starting in October, and get insured in January.

      Ceterem censeo, gerrymandra delenda est

      by Mokurai on Mon Sep 09, 2013 at 10:57:21 AM PDT

      [ Parent ]

    •  Keeping people uninsured (10+ / 0-)

      perpetuates the problems that Obamacare is intended to, at least partially, solve. Primarily, the high costs of providing emergency care to millions of uninsured.

      Politically, it's going to take a lot of work to pin the failure on the obstruction for voters who are not as attuned to politics as your average Kossack. They're going to see that Obamacare isn't working like it's supposed to and they or people they know are still uninsured. Are they going to dig deeper to find out who to blame it on? I doubt it.

      "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

      by Joan McCarter on Mon Sep 09, 2013 at 10:59:41 AM PDT

      [ Parent ]

      •  Did I read somewhere here a while ago (1+ / 0-)
        Recommended by:
        ColoTim

        that the Administration was going to mount a campaign in the states that have refused to expand that makes it perfectly clear why there are no state exchanges?  I might be confusing this with the issue of state exchange vs. the federal exchange, but it still seems like an opportunity to place the blame directly on those responsible.

        The most violent element in society is ignorance.

        by Mr MadAsHell on Tue Sep 10, 2013 at 11:22:41 AM PDT

        [ Parent ]

        •  Most of the Republican governors were banking (2+ / 0-)
          Recommended by:
          Brooke In Seattle, Mr MadAsHell

          on Obamacare being ruled unconstitutional in total by the USSC and they weren't in position to implement a state exchange once the law was upheld.  So not only do they not get input this year, but they get what they wanted least - the federal government setting up the exchange for them.  They have nobody to blame but themselves for the mess they are in, but that's not going to stop the Republicans.  They're doing everything they can to cause the failure of Obamacare because they will then say they were right all along, even though there will be plenty of evidence in those blue states that if they had chosen to implement the Medicare expansion and the state exchanges, their people would have been much better off.  The people of those states won't hear that lesson, however, because their government and their media will promote failure, not success.

    •  We need as many people as possible signing up (0+ / 0-)

      for the exchanges or the ACA won't work well for anyone.  If not enough sign up at all, it might really wound it.  If people fall in a gap and have no subsidy, they might decide it is better to just pay the small fine.

      There are several ways this could hurt.

  •  Coverage Gap (2+ / 0-)
    Recommended by:
    judyms9, Mr MadAsHell

    Joan, thanks for highlighting this important issue. It's one of the biggies and we can turn it to our advantage.

    So I've been thinking about the coverage gap at the bottom. First of all, it wasn't intentional.

    The original idea was that people under 133% of the poverty line may be too poor to participate in the ACA even when subsidized after you factor in all costs including premiums and out-of-pocket expenses. So the Medicaid expansion was designed to fill the gap.

    But Medicaid has earned a bad-rap as being filled with moochers, freeloaders and losers, so it was politically naive to expect red-state polls to expand it in the current climate.

    So what are we left with? As I understand it, the details are still being worked out. Things are still fluid at both the state and federal level.

    We need to get the word out loud and clear: this is not acceptable!

    How about this? Many of the people caught in the coverage gap are freelancers and solopreneurs - both young and old - people who are creating new jobs in a bad economy.

    Many, if not most, would be appalled to be cast into Medicaid.

    These folks are doers with fluctuating income, the very people who could use government help as they reshape our economy from the bottom up. Where are the subsidies for these start-up? The invisible start-ups who will play a huge role in reshaping our economy over the next 20 years. Free Enterprise! ;-)

    We can turn this to our advantage!

    "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

    by annan on Mon Sep 09, 2013 at 11:17:30 AM PDT

    •  Coverage Gap versus Medicaid Gap (2+ / 0-)
      Recommended by:
      judyms9, Mr MadAsHell

      We need to focus on the coverage gap that hits hard-working, "free-enterprising" entrepreneurs, solopreneurs and start-ups who have fluctuating and hard to verify incomes.

      Of course it also hits other low wage, part time workers, but that's not my focus. If we call the same gap a Medicaid Gap that brings to mind an entirely different "undeserving" demographic. Not my belief, but one that is rampant in the red states who are perpetuating the problem.

      My 2 cents: let's all start calling it a coverage gap to avoid triggering the bigots.

      "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

      by annan on Mon Sep 09, 2013 at 11:27:14 AM PDT

      [ Parent ]

      •  You're correct about everything herein, annan. (1+ / 0-)
        Recommended by:
        annan

        People struggling to cling to the economic ladder rung they're on don't want to be lumped together with those who can't or won't climb the ladder.  We had the Keough Plan rather than Social Security for some of this same group.  If a coverage gap had a specialized name for the soloists, freelancers and others and was administered through the Social Security Administration rather than local public assistance offices, it would have strong appeal.  This is the group of people who couldn't quit low-paying, deadend jobs because they would lose health care benefits that they may have needed for a sick spouse or child, and it would allow them to strike out on their own to be their own AC/Heating services, solo plumbing contractors, electronics repair people, etc.  And administering out of the SS office puts this part of the program closer to Medicare--for all.

        Building a better America with activism, cooperation, ingenuity and snacks.

        by judyms9 on Tue Sep 10, 2013 at 11:25:58 AM PDT

        [ Parent ]

    •  "Appalled to be cast into Medicaid"? (2+ / 0-)
      Recommended by:
      Brooke In Seattle, alice kleeman

      I'll go tell my son he should be appalled and not happy he's getting the treatment he needs.

    •  Agree with one addition (1+ / 0-)
      Recommended by:
      annan
      The original idea was that people under 133% of the poverty line may be too poor to participate in the ACA even when subsidized after you factor in all costs including premiums and out-of-pocket expenses. So the Medicaid expansion was designed to fill the gap.

      But Medicaid has earned a bad-rap as being filled with moochers, freeloaders and losers, so it was politically naive to expect red-state polls to expand it in the current climate.

      I believe it was the Supreme Court ruling that opened the door for individual states to decline the additional federal medicaid money.

      This portion of the ruling will cause heartache for individuals, and might more generally raise questions related to other federal programs that are mandated for the states.

    •  can't rec (1+ / 0-)
      Recommended by:
      annan

      You are so right anon. We need to fight back. I don't understand how someone who cared enough to get it passed can't get out and fight for it. Why are the Republicans getting the last word?

  •  Please rebut this extreme cynicism (4+ / 0-)
    Recommended by:
    Whatithink, judyms9, ColoTim, Stude Dude

    1. The fascists are against the ACA because they are ultimately regional dictators with tenuous control.

    Digression: the only downside to the ACA is in comparison to single payer. The present system wastes $800 billion a year. The ACA will, if it is successful, waste only $700 billion - "saving $100 billion". But republicans cannot make that argument. Once the ACA is implemented it will have visible benefits and its only downside will appear to be a benefit.

    If the fascists allow the ACA to be fully implemented in their states the public will like it and they will lose control. They cannot prevent this from happening, but they can, and are, slowing the process by limiting the benefits of the ACA as much as they can.

    2. Corporate Democrats like the ACA because it protects the insurance companies from single payer. There are two possibilities: a. the ACA "succeeds" (ie. it only wastes $700 billion instead of the present $800 billion, while providing its medical advantages) Politicians will then say, "Single payer? But we went through hell for the ACA and it's working!" or b. "Single payer? But we went through hell for the ACA and it failed!" (Single payer just failed in the CA legislature, where it had passed before in a less Democratic environment.)
    To look at the ACA as a stepping stone to single payer is pollyannish; horribly, the only hope for single payer in this generation is if the ACA fails and Vermont's single payer succeeds enough to force CA to see the light.

  •  I live in west Texas and can see New Mexico from (6+ / 0-)

    my house. I wish I lived 3 miles further west.

  •  sidebar: (0+ / 0-)

    Senator Mike Lee: Don't Fund Obamacare

    http://en.wikipedia.org/..._(U.S._politician)

    Senator Michael Shumway “Mike” Lee (born June 4, 1971 is a lawyer and the junior United States Senator from Utah.
    http://www.youtube.com/...

    The American people know the system is rigged against them and they want us to level the playing field. That's our mandate. That's what we're here to do. ~ Senator Elizabeth Warren, AFL-CIO convention

    by anyname on Tue Sep 10, 2013 at 11:15:57 AM PDT

  •  If TX is not expanding, then why is Rick Perry (3+ / 0-)
    Recommended by:
    judyms9, defluxion10, Fury

    groveling for $100 million of federal money?  Sort of like flipping you off with one hand while the other is in your pocket

  •  One thing we have seen is that the ACA (3+ / 0-)
    Recommended by:
    ferg, True North, defluxion10

    over the course of this summer is that it has reached the local level.  It's very tangible to people all across the socioeconomic spectrum. It's not like the defense budget or education budget.  Americans love comparison shopping and they see what goes on in other states.  When some states succeed and others fall behind, there is a political dynamic in this country that focuses the issue at a state level and the discussion becomes centered around 'why aren't we like State x?' as opposed to 'I hate the Federal government'.

    There will be red state holdouts, but that won't hurt the ACA or the Democrats.  It will be a motivator and organizing tool to turn a lot of red states blue.  

    Global Shakedown - Alternative rock with something to say. Check out their latest release, "A Time to Recognize": Available on iTunes, Amazon, Google Play, Spotify and other major online music sites. Visit http://www.globalshakedown.com.

    by khyber900 on Tue Sep 10, 2013 at 11:24:45 AM PDT

  •  its amazing isn't it (1+ / 0-)
    Recommended by:
    judyms9

    we have one half of our political mix entirely devoted to undermining any semblance of positive reform, while at the same time convincing a sizable portion of the people reform is intended to help that all this self-destruction is a good idea.

    our politics is a zero sum game now. progress is seen as a loss by conservatives and those that underwrite them. and they'll never stop trying to find a way to turn their losses into gains.

    everybody who ever wonder why domestic reforms are so hard or who jumped all over Obama for not getting stuff like a public option should remember this. there is nothing more difficult in our modern political life than trying to fashion progressive policy reform.

  •  The other thing to note is that within these (4+ / 0-)
    Recommended by:
    ferg, Chas 981, True North, defluxion10

    states there will be a functioning exchange.  The working poor may not be able to use it because of cost and the Medicaid funding gap, but a lot of middle class Americans living in these states will be able to use the exchange and will see the financial benefits, coverage benefits and flexibility.  That will spark a debate within each of these states that will localize the issue and the Democrats will have a clearer message to deliver to people.  This is an election winner for the Democrats.

    Global Shakedown - Alternative rock with something to say. Check out their latest release, "A Time to Recognize": Available on iTunes, Amazon, Google Play, Spotify and other major online music sites. Visit http://www.globalshakedown.com.

    by khyber900 on Tue Sep 10, 2013 at 11:26:48 AM PDT

  •  NC Refusal Closes Rural Hospital (2+ / 0-)
    Recommended by:
    judyms9, Fury

    http://www.wral.com/...

    RALEIGH, N.C. — A small community hospital in eastern North Carolina is closing after state officials declined Medicaid expansion under the federal Affordable Care Act.
    Meanwhile.....

    http://www.wral.com/...

    RALEIGH, N.C. — An employee of state Department of Health and Human Services Secretary Aldona Wos' husband landed a lucrative contract that puts him among the highest-paid workers at the department.
    State records show the health agency paid Joe Hauck more than $228,000 for work done from late January through August to advise the secretary on "strategic planning, reorganization and policy issues.".... Hauck's resume lists no prior experience in the field of health care,

    Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

    by bernardpliers on Tue Sep 10, 2013 at 11:28:36 AM PDT

  •  Virginia (1+ / 0-)
    Recommended by:
    True North

    I thought Virginia accepted Medicaid expansion ('with variation") in the Transportation bill that passed earlier this year.  Did that not happen?

    http://www.timesdispatch.com/...

    Democrats *do* have a plan for Social Security - it's called Social Security. -- Ed Schultz

    by FredFred on Tue Sep 10, 2013 at 11:36:34 AM PDT

  •  Roberts: I have a scheme! (1+ / 0-)
    Recommended by:
    yoduuuh do or do not

    You have to wonder whether Roberts actually had this outcome in mind when he "bravely" back Obamacare but somehow managed to find making the Medicaid extenion mandatory invalid.  Taken in consideration of the indirect but de facto invalidation of the voting rights act, it seems like Roberts's rulings are as conservative as was feared but cloaked in Machiavellian subtlety.  


    My country, right or wrong; if right, to be kept right; and if wrong, to be set right.—Carl Schurz
    "Shared sacrifice!" said the spider to the fly.—Me

    by KingBolete on Tue Sep 10, 2013 at 12:41:04 PM PDT

  •  Frankly (0+ / 0-)

    I don't care. The people in those states chose their government, they need to live with it.

  •  Done under Reagan-a variation of this: (2+ / 0-)
    Recommended by:
    Nance, Fury
    Congress needs to pass a bill to expand the subsidy program, allowing adults below the poverty line who are not eligible for Medicaid to get the subsidy.
    There is already a model-a blueprint in existence- albeit one that is specific to a particular population.

    In 1982 Medicaid policy fundamentally shifted to allow people with significant health care needs and disabilities to receive care at home.

    Over the past thirty one years, the ‘Katie Beckett Waiver,’ a Medicaid program, has provided over a half million children with disabilities the chance to live at home with their families and participate in their communities instead of living in hospitals and institutions.

    Established in 1982 under the Tax Equity and Fiscal Responsibility Act (P.L. 97-248), the Katie Beckett/TEFRA Medicaid Program permits a state to ignore income eligibility for children up to 19 years of age who qualify as disabled individuals under §1614 of the Social Security Act.

    General historical overviews:

    http://mchb.hrsa.gov/...

    http://parenting.blogs.nytimes.com/...

    My child was one of the over half a million children with disabilities served under this law.  In a republican run state that is currently "opting out" (or posturing) of the Obamacare medicaid expansion.  

    31 years this program has existed & been utilized by  states who opted in-saving these states untold dollars amounts.  

    Seems to me, the KB/TEFRA Waiver could serve as a blueprint/example....along with the Reagan fingerprints surely would appeal to some.

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