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People wait to receive a wristband number for medical treatment at the Remote Area Medical (RAM) clinic in Wise, Virginia July 20, 2012.  RAM clinics bring free medical, dental and vision care to uninsured and under-insured people across the country and abroad. The Wise clinic was the 647th RAM expedition since 1985 and drew 1700 patients from 14 states, organizers said.  REUTERS/Mark Makela   (UNITED STATES - Tags: HEALTH SOCIETY) - RTR359FS
Waiting for health care in Wise, Virginia.
There's a slim chance that a few more Republican states will decide to help their bottom lines by taking the federal government's Medicaid expansion offer. That's overall good news for the new law and for the nation's health, but the states that are still refusing have the populations who are most in need. Some of them also have the economies that could most use this boost.
Indiana and Oklahoma are eyeing alternative versions of expansion and were granted a one-year reprieve by the Obama administration to extend existing state health care programs while they think about it.

Virginia, where Democrat Terry McAuliffe is succeeding Republican Gov. Bob McDonnell, is considered a likely candidate to embrace expansion this year. In Maine, Democrats in control of the state Legislature are pressuring Republican Gov. Paul LePage to accept the Medicaid expansion this year, during his reelection effort. New Hampshire, too, where only a Republican-led Senate has blocked expansion, is considered a likely candidate to flip this year.

Governors in small, Republican-dominated states like Wyoming, Kansas and Utah say they’re keeping an open mind in 2014, despite their hatred for the overall health law. And in every undecided state, an unusual alliance of powerful hospital, business and religious interests has been leaning on Republican leaders to reverse course.

That leaves out the reddest of the reds—Idaho, South Dakota, Texas, Florida, and states in the deep south—in the "hell no" camp. Florida and Texas have the largest populations of uninsured, the largest populations that fall into the Medicaid gap. These states already have the high rates of poverty, great income inequality and what could be called health inequality as well.

It's one thing to talk about the statistics of the Medicaid gap, but the real story is the individual human suffering, multiplied by millions, of all those being left out. For a deep dive into what that actually looks like for the people living it, this story in The Atlantic about the Medicaid gap in Texas is a must-read. It examines the lives of real Texans trying to live with, or in one case die, with serious health issues and few places to turn. The most extreme Republicans governors and legislators are inflicting this on their own constituents, gleefully and completely needlessly.

Originally posted to Joan McCarter on Fri Jan 10, 2014 at 12:29 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (35+ / 0-)

    "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 Fri Jan 10, 2014 at 12:29:07 PM PST

  •  republicans assholery may have a silver lining.. (12+ / 0-)

    ..unless they get with it - and quick.

    If they continue to refuse to:

    Boost the Medicare reimbursement rate up from just $00.64 cents per dollar and expand Medicaid:

    Estimates from researchers at UTMB found that about 9,000 additional Texans will die each year because of the Medicaid gap. A New England Journal of Medicine study found that states that had previously expanded Medicaid saw a 6.1 percent reduction in the death rate among adults younger than 65.
    Texas republicans Rick Perry and the rest may end up speeding up their own loss of Texas as a RWNJ controlled state:
    ..though Medicaid is often derided as an expensive program, much of the charity care in Texas public hospitals goes uncompensated, so hospitals hike fees to make up the difference, and local residents see their property taxes and insurance rates rise.

     - emphasis added

    Especially when hospitals, a major part of Texas economy have been hurt by the GOP.

    And then people who have family or friends that live in states that have Medicaid expansion and have access to medical are for the first time in their lives - word will spread like wildfire

    A Blue Texas may be even closer to reality

    Thx Joan McCarter

    •  Shout out to Christie? (0+ / 0-)

      "The impediments to consensus are well known: ideology, personal political ambition, partisanship or score-settling. Identifying the roadblocks is not a challenge."

      Newly inaugurated governor McAuliffe

      http://www.washingtonpost.com/...

      In every deliberation we must consider the impact on the seventh generation... even if it requires having skin as thick as the bark of a pine. -The Great Law of the Iroquois

      by BrianCricketRakita on Sat Jan 11, 2014 at 10:18:26 AM PST

      [ Parent ]

    •  The problem is the people who should know don't (2+ / 0-)
      Recommended by:
      cocinero, FloridaSNMOM

      Day before yesterday while listening to a political scientist on the news who specializes in the study of voting patterns, he as asked what would be the best thing either party could do to mobilize voters and win elections.  His reply was interesting.  For the republicans he indicated that they should try to remain lucky that so many are completely oblivious to the differences between the two parties in terms of economic policy and to continue to obfuscate as much as possible.  For the democrats he suggested that they need to educate people more, especially the young and non-voting poor to the fundamental differences between the two parties.  

      It seems that with respect to health care, the focus of this discussion, this is a great place to start a serious and well coordinated voter and education drive.  However, the important point here is that the education and dialog needs to be directed to those not already paying attention.  We need new strategies, resources, and energies directed toward reaching out and educating the public at large, not just virtuous, but self directed dialog meant to keep the already committed fired-up.  Four areas that should be concentrated on are red counties in California with large populations of poor hispanics to turn the largest state totally blue thus getting rid of Darryl Issa and his ilk, and counties in southern Texas and in various suburbs and cities where large populations of hispanics reside.  Targeted areas of southern Ohio and Illinois, where there may be swaths of independents and moderate republicans that can actually be educated.

      It would be worth here revisiting some of the most recent election results precinct by precinct to identify the cross correlations between minority voters and the spread presidential and non-presidential election years so that the largest pools of potential democratic leaning voters can be identified for targeted education.  The plan needs to coordinate on the ground activism, with media of all kinds, print, TV, local cable, and internet so maximize exposure to those who need to get the information.  One way is for democrats to sponsor free local concerts, street theater, and other forms of entertainment to draw in those who seldom pay attention to the politics that most affect their own economic interests.   Activists and organizers will also need a website to coordinate such activities throughout the country, within specific regions, and to share ideas on what is working and what is not in reaching people, as well as to coordinate with voter registration efforts.

      •  I should have added (3+ / 0-)
        Recommended by:
        cocinero, FloridaSNMOM, DonnaSC

        that another idea might be for democrats to partner with health care providers pushing for more federal funding to set up free health care clinics in conjunction with the festivities so that the politics of health care can be more directly broached to those not paying attention, while also engendering positive feelings toward the party and to more visibly demonstrate the differences between the parties, both in terms of policy and compassion for the general welfare of the public.  This would do a lot to break the image of the democratic party as just a bunch of talking heads in Washington and various state houses, and on TV who don't do anything.  It would also provide great backdrops for democratic candidates to introduce themselves to the constituents of their districts.

        Another way is for party leaders to more visibly link the need to link environmental health with human health as a way of saving costs in a multitude of ways.  Come on folks, this is doable.

  •  North Carolina is holy hell. And you didn't (6+ / 0-)

    even mention it.

    When Governor Pat McCrory sits down in the next few weeks to consider his first year in office and gets around to listing his regrets about 2013 and his plans for 2014, both ought to start with the same thing, expanding Medicaid in North Carolina.

    McCrory and his Republican colleagues in the state House and Senate made the decision to refuse Medicaid expansion early in the 2013 legislative session despite compelling reasons for expansion, most importantly the opportunity to provide health care coverage for 500,000 low-income adults who are currently uninsured.

    The federal government would have paid the full cost of the expansion for the first three years and more than 90 percent of the tab after that.  Medicaid expansion would have brought in $13 billion dollars for hospitals over the next ten years and created as many as 25,000 jobs in the state, according to a study by the N.C. Institute of Medicine.

    But legislative leaders had already made up their minds before considering any of the facts. Their decision was motivated by ideology not policy disagreements. They dislike President Obama more than they want to help people who are uninsured be able to see a doctor.

    http://www.ncpolicywatch.com/...

    What we need is a Democrat in the White House. ~ expatjourno

    by ezdidit on Fri Jan 10, 2014 at 07:42:28 PM PST

  •  I WILL NEVER!!! (1+ / 0-)
    Recommended by:
    hadrons

    FEEL SORRY FOR PEOPLE WHO VOTE REPUBLICAN OR DO NOT VOTE.

    "ALL THAT YOU DO LET IT BE FOR THE GOOD OF ALL AND HURT NO  ONE. IF YOU WANT TO BE GREAT AMONG THE HUMAN RACE, LEARN TO HEAL."

  •  Yes as far as playing petty politics with peoples (8+ / 0-)

    lives goes, this is far worse than bridgegate.

  •  The gap hurts real people! (7+ / 0-)

    I live in Alaska, and while my husband gets care through the VA, I would have ended up in the gap, without some advice on how to avoid it. I lost my eligibility for COBRA insurance on January 1st, 2014, and originally I didn't qualify for an ACA plan because I should qualify for Medicaid. After spending a month applying for Medicaid, I was turned down because we are going back to college and are accepting financial aid. (Loans count as income. Sigh.)

    We were advised to go back and put in the loan amounts to qualify for ACA coverage, and get money back on our taxes at the end of the year, since loans aren't taxed as income. The Medicaid application process means I have 1 month with no coverage, but I at least can go to the student health office this month. If Alaska had taken the Medicare expansion money, I would have been covered, without a gap month and without paying premiums. Frustrating, but having ACA coverage is 1/3 of the cost of COBRA, for coverage with a maximum out-of-pocket, that is the same that our former deductible was. Our total healthcare costs, assuming we hit our maximum out-of-pocket, (I have pre-existing conditions that make it so that is a safe bet, since I hit it 7 of the last 10 years) when you include premiums, will still be just a little over half of last year's total medical cost. (And hopefully we will get even more back when we do our 2014 taxes.)

    I hope that more states expand Medicare, and if Repubs are refusing to do it, voters should let them try out the unemployment system. They might even get expanded Medicare, since most people/families on unemployment qualify for Medicare, once it is expanded! ;-)

  •  Because they're evil & they don't care (2+ / 0-)

    nosotros no somos estúpidos

    by a2nite on Sat Jan 11, 2014 at 04:16:42 AM PST

    •  That may be true but (1+ / 0-)
      Recommended by:
      FloridaSNMOM

      the real question is what are we going to do about it?

      I think we need to find imaginative and coordinated new ways to educate people to this fact, especially those who have been fooled by the "evil ones" and those who simply haven't paid attention.  Keep in mind that those who oppose providing affordable health care don't care if you are angry as long as you are ineffective.

  •  Because, it's obviously.... (1+ / 0-)
    Recommended by:
    i saw an old tree today

    what Jesus would do.

  •  At what point do we embrace two Americas? (1+ / 0-)
    Recommended by:
    a2nite

    Am I the only one looking at these reddest of red states, filled with a majority of self-destructive idiots that send us senators like Cornyn, McConnell, Rubio, and Cruz, and want to say FUCK THEM?

    I'm done.

    Let the red states sink into a pit or minimum wage jobs, no health insurance, poverty, lack of education, and the rest of the "free market libertarian dream" that these nitwits keep voting for.

    I realize that these states also contain millions of good people who vote for Democrats and want a better life, but my feeling is they should move to the blue states. I know not everyone can.  But at some point, I'm done caring about states so hung up on Supply Side Jesus that they cut off their own nose to spite their face.

    We can't save everyone.

    Lets take Blue State America into the 21st Century.  Lets build high speed rail, green jobs, reasonably priced healthcare for all, good public schools, paved roads, and infrastructure.

    Lets let the red states sink into a minority third world country status.

    I really don't care about them anymore.

    Fuck them.

    •  Well thanks (2+ / 0-)
      Recommended by:
      DaddyO, FloridaSNMOM

      guess I'll just sell my house, divorce my wife as she won't move, and high tale my ass to a blue state because I am unfortunate to live in a place you deem not worthy?

      If you are not the lead dog, the view never changes.

      by RepresentUsPlease on Sat Jan 11, 2014 at 12:19:36 PM PST

      [ Parent ]

      •  And that's what makes the ACA a success! (0+ / 0-)

        You think this is Russia? We can go wherever we want to go in this country--and you'd BETTER, because if you're poor, you HAVE to move to an ACA state to take advantage of this atrocity of a law.

        Just up and MOVE to Seattle or Bakersfield or Eugene or New Yawk City or...

        Because the ACA is FREEDOM, baby!

        "I feel a lot safer already."--Emil Sitka

        by DaddyO on Sat Jan 11, 2014 at 12:36:00 PM PST

        [ Parent ]

      •  It's not a place I deem unworthy (0+ / 0-)

        It's a place that has deemed itself unworthy.  

        If the majority of your state wants to destroy itself, yes you should move.

    •  Wow (1+ / 0-)
      Recommended by:
      FloridaSNMOM

      Spoken like a true Republican--about Democrats...let those latte liberals go to Hell. Let them change their gun laws. Let them allow their kids to smoke pot. Let their gays get married. But not HERE.

      Same message, other side, same inherent stupidity, same abandonment of a UNITED States of America.

      You might as well go ahead and give up, because THEY ALREADY HAVE.

      "I feel a lot safer already."--Emil Sitka

      by DaddyO on Sat Jan 11, 2014 at 12:38:57 PM PST

      [ Parent ]

      •  Totally ridiculous (0+ / 0-)

        Favoring focusing on building up blue states has nothing to do with "love it or leave it" republican fake patriotism.  I dn't even know what to tell you if you can't see the difference.

        My point is stop trying to force red states to help themselves.  They don't want to.  They're electing buffoons.  That's called democracy and they should reap what they sow.

    •  What you propose will not work (2+ / 0-)
      Recommended by:
      cocinero, FloridaSNMOM

      What you propose won't work, as it will simply leave the Senate full of red state senators, where there is already a structural imbalance between rural and urban areas that strongly favors republicans.  Health care is a natural wedge issue for democrats, which should be used to our advantage.  Yes, the red media has done a number on the minds of viewers, but a consistent, targeted education strategy can make people recognize their ways.  Keep in mind that we don't need to change the entire electorate, only mobilize the poor not voting and a small margin of voters who are persuadable.  

      Linking health issues to environmental health and both to agriculture and healthy living in pollution free environments is important, especially in rural states that rely heavily on agriculture.  The catastrophe unfolding in West Virginia is a situation that democrats should be organizing and educating on to capitalize on the chance to be seen as helping these people, rather than dismissing them and letting the GOP take them through the politics of divisiveness and despair.

      However, that said I do encourage blue voters who have been shunted into gerrymandered districts to move in targeted ways to "pink" or "purple" districts to make gerrymandering impossible in the future.

      •  You can't force red states to do anything (0+ / 0-)

        If you can't see them self destructing, I don't know what to tell you.

        Yes, I agree, we should try to advocate for blue candidates, especially in purplish states like Colorado and Virginia.  Those states are worth saving.

        But Florida?  Fucking Rick Scott?  Are you kidding me?  Texas?  Yes, I'll donate to Wendy Davis's campaign but get real.  Until the demographics change in ten years, you're wasting your breath.

        You can't force koolaid limbaugh-land to do the right thing.  Focus instead on building up the blue states.  

    •  Thanks a lot (0+ / 0-)

      are you going to send me and my family the money to move out of state? It would have to be somewhere out west, I and my daughter can't breathe up north in the cold. It would have to be somewhere where we know people or there was a very good bus system because we also can't drive. So how do you suggest we get to a 'blue state' in which I can have health care? Do I become a shut in in a northern city all winter? How then do I get to doctor's appointments?  Do I move to a city and an apartment across the country without knowing if it's accessible for my other half in his wheelchair and for our needs? What do we do? WALK there?

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Sat Jan 11, 2014 at 04:36:06 PM PST

      [ Parent ]

    •  Simple: we don't (n/t) (0+ / 0-)

      Procrastination: Hard work often pays off after time, but laziness always pays off now.

      by Linnaeus on Sat Jan 11, 2014 at 05:34:18 PM PST

      [ Parent ]

  •  South Dakota (0+ / 0-)

    republicans get a free ride, most of the poor here are Native Americans and they get the ACA through the tribes. Daugaard will never approve it as there are "only" 48,000 here that are effected. Sickening but true, most of that 48k will vote republican anyway.

    If you are not the lead dog, the view never changes.

    by RepresentUsPlease on Sat Jan 11, 2014 at 12:14:22 PM PST

  •  ? (0+ / 0-)

    How much will the federal government save by these states ignoring the needs of their poor?  Is it possibly enough to extend the 3 free years for the states in the expansion?

    Actions speak louder than petitions.

    by melvynny on Sat Jan 11, 2014 at 12:21:22 PM PST

  •  Don't forget Corbett's ugly "Healthy PA" proposal (1+ / 0-)
    Recommended by:
    FloridaSNMOM

    that might do more harm than good...http://articles.philly.com/...

    "Healthy PA is not Medicaid expansion. Healthy PA instead pokes so many holes in Medicaid law - 23 to be exact - that it is barely recognizable as Medicaid," said Sol B. Vazquez-Otero, senior mental health advocate for the Disability Rights Network of Pennsylvania, referring to the draft plan's 23 requests to waive various federal regulations.

    To be free and just depends on us. Victor Hugo.

    by dizzydean on Sat Jan 11, 2014 at 12:25:02 PM PST

  •  Republicans refusing to implement the ACA? (0+ / 0-)

    Oh, dear. Too bad NO ONE COULD HAVE FORESEEN such an UNPREDICTABLE turn of events.

    Too bad NO ONE in the Obama administration--including our incredibly intelligent President--could see this coming, when they laid down and completely gave in to GOP demands for a hybrid, socially impractical scheme of letting insurance companies get their every wish in the ACA.

    Too bad NO ONE could have foreseen how the GOP would fuck things up. Too bad NO ONE (except ATRIOS) saw that when the Dems committed to a SHITTY LAW, they would end up being BLAMED for the SHITTY LAW instead of taking CREDIT FOR A GOOD LAW--LIKE MEDICARE, SOCIAL SECURITY, UI, etc, every other surviving legacy from the New Deal that HELPS people and NOT corporations.

    And too bad we have Obama apologists refusing to acknowledge the train wreck that health care 'reform' STILL IS TO THIS DAY, thanks to their admonishments that the ACA is 'the best we can get right now'.

    Too bad. Too fucking bad.

    "I feel a lot safer already."--Emil Sitka

    by DaddyO on Sat Jan 11, 2014 at 12:32:42 PM PST

  •  I think that SCOTUS, in declaring the ACA (2+ / 0-)
    Recommended by:
    cocinero, RadGal70

    Constitutional but allowing states to opt out of Medicaid expansion found a way to save Roberts' "legacy" while still undermining President Obama and the Democrats.  Pretty smart of them, if one takes into account that like their fellow Republicans, the RW majority on the Court is perfectly willing to let thousands and thousands of ordinary Americans sicken and die unnecessarily as long as they can give Obama the finger.  Pathetic.  I'm not a believer in Heaven and Hell, but many of these GOP politicians and judges are.  I hope they like some really hot conditions; they've earned them.

    "It ain't right, Atticus," said Jem. "No, son, it ain't right." --Harper Lee, To Kill a Mockingbird

    by SottoVoce on Sat Jan 11, 2014 at 12:44:31 PM PST

  •  They're not the "hell no" states. They're the "go (2+ / 0-)
    Recommended by:
    cocinero, white blitz

    to hell" states.

    I'm in my 60s and I've never seen so much naked hostility to poor people as I see today.

    Of course, the best way to keep people at the bottom of the economic ladder from working together to better their lot is to get them fighting with each other.

  •  republican governors refusal to expand medicaid (0+ / 0-)

    picture this, republican governors consult with the grim reaper over medicaid expansion.  the most appropriate question to ask is ,even if you are a human being, and i use this term loosely, can a republican governor continue to refuse what is in the best interest of their constituents welfare?  

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