Monday, September 29, 2014

Why the Moment of Truth is Coming for Red States that Rejected Obamacare

by Nomad

As more and more reports come in about the benefits of Obamacare, governors of Red States, some analysts predict, are soon going to feel the heat from the miffed voters.

Few could call Forbes a flagship of the liberal press so when it posts a negative article against conservative policy, it must send a few night-terrors into the sleep of Republicans.

Good News and Bad Tidings
Last week, for conservatives, Forbes was the bearer of bad tidings. Obamacare isn't so bad after all. and as the article says, for the governors of red states who had once been so quick to reject the Medicare expansion, things are going to get a little worrisome.
A new report showing the continued pileup of unpaid medical bills in states that didn’t expand Medicaid under the Affordable Care Act is escalating criticism on these Republican-led areas of the country to expand the health insurance program for the poor.
True, the report did come from the Obama administration who- conservatives would say- would have every reason to paint a rosy picture. Yet, sooner or later, the facts will spill out one way or the other. And the Obama administration's figures were bound to come under close scrutiny. 

Moreover, the figures from other sources are all pointing in the same direction. In spite of its rocky kickoff, Obamacare hasn't been the predicted disaster. The fears of socialized medicine, promoted by the likes of Sarah Palin, Louie Gohmert, Michele Bachmann, Betsey McCaughey, and last and not least, Rush Limbaugh were unfounded, especially when compared to the benefits to Americans. (They are still peddling their malicious nonsense, unchallenged by the media.)
The fear-mongering of "death panels" was well-financed, well-promoted poppycock for the low-information, hate-driven voter or the perpetually gullible.

The propaganda offensive nearly worked. Today, however, the Department of Health and Human Services report shows that the costs of uncompensated care are predicted to drop by nearly 6 billion.. this year alone.
“The projections . . . suggest that $4.2 billion of this reduction will come from the 25 states plus Washington D.C. expanding Medicaid as of the beginning of FY2014, representing a 25 percent reduction from baseline uncompensated care spending and 74 percent total savings.”
In short, millions of poor Americans- formerly uninsured- are now being covered by the expanded Medicaid insurance. Thanks to Affordable Care. The poor have been signing up in record numbers- again, contrary to the conservative forecast and in spite of obstacles put in their way.  Americans are finally getting the health insurance they need, that they can affordable and as citizens of a great nation, they deserve.

Good news for everybody?
Actually no. Not if you are on the wrong side of the fence.

Obamacare's growing success, both for low-income families and for the economy, is not good news for Republican-controlled states like Texas, Oklahoma, Florida, Kansas and most of the Southern tier states. 
Not. At. All.

Those 20 states used the  Supreme Court's ruling as a kind of loophole. The high court decision ruled that the federal government could not force individual states to participate in the Medicaid expansion- a key feature of the Affordable Care Act. 
It left that up to nation's governors and state leaders. 
As of August 2014, 27 states choose to join the Medicaid expansion and three were undecided.

The Forbes article points out:
The federal government traditionally picks up a little more than half of the cost of Medicaid. But funding under the health law is unlike past efforts to expand Medicaid in that the federal government will pick up the full tab this year as well as 2015 and 2016. The state gradually has to pick up some costs in 2017, but by 2020, the federal government is still picking up 90 percent or more of the Medicaid tab.
Case Study Texas: Rural Uninsured
According to the Forbes article, public hospitals in rural areas and inner cities where there are large numbers of uninsured residents will be particularly hard hit in these states. 
Before 2005, the uninsured rate was fairly evenly distributed between urban, suburban and rural communities. When the economy went belly up in the last year of the Bush administration, all that changed.
After the recession, the rate of people in rural communities without coverage jumped over 8 percent; now the percentage of people without health insurance in rural America is higher than it is in urban counties.
In fact there is now a higher percentage of people below the age of 65 with health insurance in rural America than in either the cities or in the suburbs. 

In Texas, officials and citizens in the rural communities are gradually waking up  to the problem.  

A former Lubbock County Judge Don McBeath offered his opinion of the health care problem in his community. McBeath is also the director for government relations at the Texas Organization of Rural and Community Hospitals, or TORCH for short.
In counties like Briscoe and Hall, 41 percent and 39 percent of their residents have no medical coverage. While the 25% statewide uninsured rate in Texas, in other counties such as Castro, Collingsworth, Gaines and Sherman, it’s at least 36 percent.

Despite the advent of Obamacare for the rest of the country, not much has changed in those communities. McBeath explained to reporter Enrique Rangel of Lubbock Avalanche-Journal that, with the high rate of uninsured people, most of whom are low-income, "the reality for all hospitals large and small is that they end up picking up the tab when the uninsured need medical care.”

Make no mistake, it is not only the uninsured who will suffer. Local taxpayers who will be paying the price for the high percentage of uninsured rural Texans. McBeath notes that “The taxpayers are picking up the tab,” with property taxes.

For rural Texas there's even more bad news. The insurance marketplaces which were mandated by ACA are hardly competitive.  

Across the state, there are dozens of different insurance companies participating, selling about 100 different plans. Residents of rural areas, however, are finding far fewer options to choose from. What does this mean? Less competition also means higher prices.

Critics in Texas accused the governor of trying to undermine the insurance marketplace. As one source reports:
At Perry's explicit insistence, the Texas Dept. of Insur­ance is doing its best to draft unnecessary and onerous regulations that will make it as difficult and expensive as possible for the navigators to do their jobs.
The Perry position had gone from rejection to obstruction and, critics of the governor say, attemptted sabotage.
*   *   *
Back in 2012,  Texas Governor Rick Perry took his stand, by proudly declaring that Texas- meaning Perry- had no intention whatsoever of participating in the Medicaid expansion. 
He appeared on Fox News and said:
"If anyone had any doubt, we wanted to put it clearly to bed that Texas wasn't going to be a part of expanding socializing of our medicine. So we're not going to participate in any exchanges. We're not going to expand Medicaid."
End of story? 
Well, that macho bravado might sound good in the Fox News studios. It's certainly music to the ears of the Koch brothers who has spend a fortune trying to destroying the Affordable Care Act. Even if it meant hiring Congressmen to shut down the government to get their way. 
But to rural Texans, Rick Perry was all but literally telling them to drop dead. 

Of course this could turn out to be Rick Perry's Texas-sized "oops" moment.

A Criminal Act
So no, it's not the end of the story. As the series of positive news about the savings and the benefits mount, Republican governors will soon have to explain their decision. They will have to give valid reasons for rejecting federal dollars that could have served their state and improve the lives of millions. 

In effect, the Supreme Court set a deep trap for Red State governors who, without proud arrogance, unhesitatingly and blindly tumbled into it. Texas governor was one of the more outspoken of the bunch. In October last year, he was upping the rhetoric to the point of utter nonsense.

According to right wing site, RealClearPolitics, Governor Perry told the assembly at a New Jersey campaign event (far from his own state, mind you):
“If this health care law is forced upon this country, the young men and women in this audience are the ones who are really going to pay the price."
Perry called the national health insurance plan a "criminal act" and that America was "mortgaging their futures."

Those are some pretty ironic statements coming from an indicted governor of the state which the Texas Medical Association has deemed "the uninsured capital of the United States."
Texas' uninsurance rates, 1.5 to 2 times the national average, create significant problems in the financing and delivery of health care to all Texans. Those who lack insurance coverage typically enjoy far-worse health status than their insured counterparts.
To the 6.3 million Texans, a figure which also includes 1.3 million children, Governor Perry, along with twenty or so other governors, has shown that, he is more than willing to mortgage their futures. Whatever plan for the future they ma have could easily be wiped out by an unexpected illness. 
What on earth could have induced the governor to put so many people's lives and futures at risk? Nothing but good old Republican conservative principles. 

Now even a conservative site like Forbes is beginning to ask questions that Red State governors would prefer to duck. Things are only going to get stickier when state residents realize how they have been shafted out of a perfectly sensible health care option that the rest of the country is now enjoying.