Category Archives: Medicaid

Good Friday Report

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I apologize for not posting yesterday. I had a dental appointment and didn’t get home until late in the day.

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For millions of Christians, today is a day of remembrance. Some ignorantly claim it’s a celebration. It is not. It’s an acknowledgment of debt to one who paid all for all of us. The celebration is on Easter. The unchurched and ignorant dcann’t discern the difference between the two days.

This blog, however, is political rather than religious. In many cases, the two views are in alignment. In one such arena is the choice of mass welfare. On one hand many claim that we should support those in need. I doubt anyone would argue against that. However, many of those in ‘need’ are not. They are in a situation of their own making and refuse to extricate themselves from that situation. They depend on the largess of others while doing nothing to better themselves, to remove themselves from a life of parasitism. Generations subsist in such environments and blame others for their own failings.

Those of us of a conservative bent prefer to help those who are willing to accept that help to better their livelihood, to better their skills in search of employment, to work, study, learn, to educate themselves so they need not be dependent on the charity of others. We had a small victory in the Missouri Senate this week. An attempt to extend dependency in Missouri, to bolster the cult of parasitism failed in Jeff City.

Missouri Senate defeats proposal to expand Medicaid

Mar 31, 11:33 PM CDT

JEFFERSON CITY, Mo. (AP) — Missouri senators have defeated a proposal to expand eligibility for Medicaid.

The Senate on Tuesday voted 25-9 against the measure.

Democratic Sen. Paul LeVota proposed adding the amendment to a bill that would ensure the state continues to receive certain funding for Medicaid.

The vote follows rallies in the Capitol and across the state calling on lawmakers to debate expanding the joint federal and state health care program for low-income residents.

States can receive additional funding for raising eligibility under Democratic President Barack Obama’s health care law.

But Missouri’s Republican legislative leaders have called the measure a nonstarter.

This amendment should be a nonstarter. The democrats ignore one extremely important proviso of Obama’s assistance—it’s temporary. And when the subsidies expire, Missouri will be left holding the bag for ALL the costs of the medicaid expansion. Why? Because Medicaid is a primary component of Obamacare. The feds, by themselves, cannot pay for the enormous costs of Obamacare. They need to steal from us to do so…one way or another. Expanding medicaid is one such scheme.

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Kansas Governor Sam Brownback signed legislation yesterday permitting concealed carry by Kansas residents without a permit. Existing Kansas concealed carry permits will still issued as before to allow Kansans to carry out-of-state where the Kansas CCW permit is recognized.

A similar bill has been filed in Jefferson City. It too would allow concealed carry without a permit while retaining the existing CCW permit structure. The bill was filed late in this year’s session but it is being sponsored by well-known supporters. The bill, along with allowing CCW on public transportation was heard in committee this week.

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In local news, the liberals in Kansas City, lead by Mayor Sly James, are proposing to raise the city’s minimum wage to $15 and hour. Seattle did so last year and the results are in—restaurants are failing and closing all over the city. Sly James would like to do the same to Kansas City—kill jobs and close businesses.

Many of Kansas City’s business owners are unaware of this proposal. During my visit to the dentist yesterday, he said he had just given his assistant a raise to $9 and hour. I told him that soon he’d have to raise her to $15 an hour if Sly James had his way. He was unaware that could happen. He’s a small businessman employing just three people. Wages and salaries are a significant portion of his business expense. A sudden increase in his cost of doing business could put him in dire constraints!

He asked if they knew of the consequences of such an increase. “How could anyone be so stupid?” he asked.

And stupid it is. The increase wouldn’t hit just the food industry. It would affect many small businesses like my dentist as well as large organizations…like the Kansas City School District.

Many (most?) of the school districts para-professionals are only paid $8-9 and hour. They would be affected too and the increase would bust the already horribly large school district budget. According to the Kansas City district’s payroll data, the increase of the minimum wage would affect 1,447 employees of the district who are currently paid less than $15 and hour. How many of these employees would have to be laid off?

This situation is what we’ve come to expect from the incompetency of the left. Money appears whenever they want it from an overflowing pot of money that is magically extracted from…somewhere. Taxpayers however, know who is the source of this rapacious demand for more and more money—democrats.

 

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A paradigm shift?

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I didn’t watch Obama last night. I wasn’t interested in listening to his pontifications and lies. Listening to the top-of-the-hour news this morning, I was vindicated in skipping Obama’s brag fest.

Instead, I went to a small meeting to listen to a friend who is a political activist and heads a state-wide organization. I’d rather listen to him than Obama.

I’ve heard my friend speak before. He’s always been knowledgeable and has numerous inside contacts in Jeff City. He original topic was the upcoming legislative session in Jefferson City. I was particularly interested in HB 188, a bill designed to attack grassroots organizations, like the Western Missouri Shooters Alliance, by forcing them to disclose their membership lists and donors.

That was his intent. And…he did cover a few of the items coming forth in Jeff City. We were a small group last night. Many of the usual members didn’t come. Some are snowbirds and were out-of-state in more warmer climes. When questions started from the floor how we, as individuals, could be more effective lobbying in Jeff City, his planned talk went out the window.

In retrospect, the diversion was good. He explained the legislative process that many did not understand. How opinions of legislators can be changed. He cited the successful veto-override effort for SB 523 in the last session. We discussed various techniques how individuals can influence legislators…and how some tactics, yelling at staffers over the phone, can back-fire.

The discussion spread far and wide and as I listened I began to hear an underlying concept, something I’d heard from others outside Missouri…the federal government is becoming irrelevant. Every new tyranny from Washington has an opposite and equal reaction within the states. The result of the reaction is more ‘nullification’ bills being filed in state legislatures. More states joining the Convention of States movement. More states resisting, and in many cases, succeeding, edicts being issued from Washington.

Prior to the Civil War, an individual’s primary loyalty was to his state. After that war, a person’s loyalty, supported strongly by the triumphant North, was to the country as a whole and to the central government. That viewpoint has continued until Obama was elected. (For some, it was earlier but I’ll not argue the point.)

What I am hearing from many across the country is a return to the primacy of state loyalty. The growing view that it must now be the states who defend their citizens from the tyrannical acts of the central government. It matters not the issue, be it education and common core, the EPA and water-rights, Obamacare and the forced expansion of medicaid, or the failure to secure our borders. Here, there, people’s loyalties are shifting and I don’t yet think the liberals have noticed. Yet.

I’m of two minds on this paradigm shift. I was born, as was my wife, in Illinois. I have relatives who live in the oppressive state, still. But, I’m glad my wife and I left over forty-five years ago. Missouri is now my state, my home, and I’m proud of it and our ‘Pub controlled legislature.But I’m still loyal to the nation as a whole—not the FedGov, but to the United States. I once swore an oath to defend the nation and the Constitution. I’ve not recanted that oath. But the Constitution no longer rules the federal government. Loyalty to the Constitution is not loyalty to the FedGov.

Note above, I said ‘Pub controlled state legislature, not conservative controlled. Not all of the ‘Pubs in Jefferson City are conservatives. It’s a work-in-progress to change them to conservatives…or replace them with conservatives.

I’m sure the libs will call those who have shifted their primary loyalty to their states racists, fascists, Nazis, the usual liberal diatribe. They overlook one central fact: conservatives can live quite well without the federal government in their lives. The liberals and social parasites, cannot. That, perhaps, may be the real divide within this nation.

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Friday Follies for November 14, 2014

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I haven’t used the ‘Follies’ headline for awhile. I do so when there are a number of items appearing on the ‘net but none worthy for a longer post nor discussion.

We won the mid-term ten days ago. We should be celebrating but we’re not. Why? Because we are watching the Washington GOP leadership selling us down the river0—again. The day after the election, McConnell tells a reporter he will not use Congress’ more potent weapon, the power of the purse. “We won’t shut down the government!” he declares meaning he will continue with the stream of CRs and upholding Harry Reid’s plan for funding everything we’re against—Obamacare, Dodd-Frank, open border, and governmental tyranny across the nation.

“Throw the bum out!”  Too late, McConnell has been re-elected as Majority leader. Boehner was re-elected Speaker of the House with only three dissenting votes.

McConnell chosen as next Senate majority leader, Boehner re-elected as House speaker

WASHINGTON –  Kentucky Sen. Mitch McConnell joined House Speaker John Boehner of Ohio on Thursday at the pinnacle of the congressional and Republican power structures in Washington — two establishment deal-cutters, each on occasion frustrated by the other’s inability to rein in their party’s most zealous ideologues.

The pair, formally selected Thursday to lead their party’s new majority control of Congress, will be charged with guiding Republicans on Capitol Hill for the final two years of President Obama’s presidency. Their success or failure could determine whether the GOP can take back the White House in 2016.

McConnell, 72, is taciturn and rarely cracks a smile. “Why don’t you get a life?” he joked to photographers trying to snap photos of him after he was unanimously chosen by his Senate GOP colleagues Thursday to serve as the new majority leader starting in January.

The article blathers on here, if you’ve the stomach to read it.

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For some good news, Sullivan has been declared the winner in the Alaska Senate race. Begich continues to wallow in his fantasy and has not, as far as I know, conceded the race. No class. A common fault of democrats.

Sullivan brings up the number of GOP Senators to 53. The last race still to be determined is Cassidy vs. Landrieu in Louisiana. Landrieu is pushing the Keystone Pipeline bill in an attempt to gain votes but it doesn’t appears to have helped.

‘Her campaign is running on fumes’: Final Senate race looks to be a Louisiana laugher as internal polls show GOP’s Bill Cassidy opening up 16-point lead over Sen. Mary Landrieu

  • Poll commissioned by GOP candidate’s campaign shows massive advantage leading up to Dec. 6 runoff 
  • Win by GOP Rep. Bill Cassidy would bring total Republican pickup to a whopping 10 seats
  • Landrieu is hoping a long-awaited vote on the Keystone XL pipeline will improve her fortunes
  • Poll was leaked in Washington to send a message to energy lobbyists who think she can prevail
  • Survey is an ‘automated’ phone poll that Landrieu’s campaign considers less credible than traditional surveys conducted by voice
  • ‘Her campaign is running on fumes,’ the pollster told MailOnline 

Democratic Senator Mary Landrieu is trailing her Republican challenger by a giant 16-point margin in a runoff for one of Louisiana’s two U.S. Senate seats, according to poll results obtained by MailOnline.

The survey, commissioned by GOP Rep. Bill Cassidy’s campaign, was leaked to media in order to fire a shot over the senator’s bow and send a signal to energy lobbyists that her ship is taking on water.

It suggests that Democrats’ worst fears have been realized even though Landrieu edged Cassidy by 1 percentage point on Election Day.

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A second Republican candidate, Rob Maness, won 14 per cent of the vote on Nov. 4, enough to deny them both the 50-percent showing required to avoid a December 6 runoff. 

Now Maness has endorsed Cassidy, helping him erase his 1-point deficit with Landrieu and adding far more.

Cassidy is ‘trying to shut K Street down for Mary’ by selectively releasing the polling data, a source close to his campaign in Louisiana told MailOnline.

‘The energy folks, the lobbyists, keep trying to say she has a chance to win. That’s why it was leaked.’

Landrieu has lined up for what Republican Capitol Hill aides are calling the ‘Hail Mary XL,’ a legislative strategy to save her Senate seat by winning a vote to approve the Keystone XL pipeline, which would bring 700,000 barrels of oil daily from the Canadian province of Alberta to the Gulf coast.

From the information I’ve been able to gather, Landrieu is toast. Cassidy will bring the total number of GOP Senators to 54. It would be nice if McConnell would use that number as leverage dealing with Obama and the democrats but my expectation for that is…nil.

One question I have…why do we see these breaking news stories in the UK Daily Mail instead of a US news outlet? Our country is in sad shape when we have to use foreign sources for news here in the US.

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I wrote yesterday about the push to expand Missouri’s medicaid using the three-year funding promised as part of Obamacare. What the advocates for that expansion don’t bother to tell you is that the state would be responsible for the added ocsts after that third year. Why is Jackson County and Truman Medical Centers in such dire straits? Increased cost of medical care compounded by the cost of complying with federal regulations.

Those increased cost are having another negative medical impact—rural hospitals.

Rural hospitals in critical condition

Rural hospitals serve many of society’s most vulnerable.

Jayne O’Donnell and Laura Ungar, USA TODAY

RICHLAND, Ga. — Stewart-Webster Hospital had only 25 beds when it still treated patients. The rural hospital served this small town of 1,400 residents and those in the surrounding farms and crossroads for more than six decades.

But since the hospital closed in the spring of last year, many of those in need have to travel up to 40 miles to other hospitals. That’s roughly the same distance it takes to get from Times Square to Greenwich, Conn., or from the White House to Baltimore, or from downtown San Francisco to San Jose.

Those trips would be unthinkable for city residents, but it’s becoming a common way of life for many rural residents in this state, and across the nation.

Since the beginning of 2010, 43 rural hospitals — with a total of more than 1,500 beds — have closed, according to data from the North Carolina Rural Health Research Program. The pace of closures has quickened: from 3 in 2010 to 13 in 2013, and 12 already this year. Georgia alone has lost five rural hospitals since 2012, and at least six more are teetering on the brink of collapse. Each of the state’s closed hospitals served about 10,000 people — a lot for remaining area hospitals to absorb.

The Affordable Care Act was designed to improve access to health care for all Americans and will give them another chance at getting health insurance during open enrollment starting this Saturday. But critics say the ACA is also accelerating the demise of rural outposts that cater to many of society’s most vulnerable. These hospitals treat some of the sickest and poorest patients — those least aware of how to stay healthy. Hospital officials contend that the law’s penalties for having to re-admit patients soon after they’re released are impossible to avoid and create a crushing burden.

“The stand-alone, community hospital is going the way of the dinosaur,” says Angela Mattie, chairwoman of the health care management and organizational leadership department at Connecticut’s Quinnipiac University, known for its public opinion surveys on issues including public health.

The closings threaten to decimate a network of rural hospitals the federal government first established beginning in the late 1940s to ensure that no one would be without health care. It was a theme that resonated during the push for the new health law. But rural hospital officials and others say that federal regulators — along with state governments — are now starving the hospitals they created with policies and reimbursement rates that make it nearly impossible for them to stay afloat.

Low Medicare and Medicaid reimbursements hurt these hospitals more than others because it’s how most of their patients are insured, if they are at all. Here in Stewart County, it’s a problem that expanding Medicaid to all of the poorest patients -– which the ACA intended but 23 states including Georgia have not done, according to the federal government — would help, but wouldn’t solve.

“They set the whole rural system up for failure,” says Jimmy Lewis, CEO of Hometown Health, an association representing rural hospitals in Georgia and Alabama, believed to be the next state facing mass closures. “Through entitlements and a mandate to provide service without regard to condition, they got us to (the highest reimbursements), and now they’re pulling the rug out from under us.”

For many rural hospitals, partnering with big health systems is the only hope for survival. Some have resorted to begging large hospitals for mergers or at least money to help them pay their bills. But Douglas Leonard, president of the Indiana Hospital Association, said these days, “I’m not sure they can get anyone to answer the phone when they call.”

The article continues at the website. Obamacare does not just increase the cost of an individual’s medical care, it also reduces the reimbursement of those services to hospitals and physicians. In the end, we all suffer. The institutions with tighter cash flows are hit first and worse.

A new push for Obamacare in Missouri

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The new push is medicaid expansion, a part of Obamacare. Missouri has been successful pushing back on this part of Obamacare but that hasn’t deterred the big-city progressives. Their newest tactic is to hire a former ‘Pub state senator, Charlie Shields, to be their front-man in their continued search for more money.

In Kansas City, the issue is the failing Truman medical system, two publicly funded hospitals with a track record of failure. Jackson County hopes their new man will succeed when their democrat puppet didn’t.

Hospital CEO Contends With Medicaid Conundrum

Former Lawmaker Needs to Prod Legislature Into Expanding Federal-State Health Plan or Face Losses

By Anna Wilde Mathews,
https://trumed.org/images/news/WSJ_Shields.jpg

Charlie Shields, CEO, Truman Medical Centers

KANSAS CITY, Mo.—The future of Truman Medical Centers, a two-hospital safety-net system here, depends on the state legislature—and no one understands that better than its new chief executive, Charlie Shields.

Mr. Shields, a genial 55-year-old, spent 20 years as a Republican lawmaker, ending up as the leader of the Missouri Senate before term limits forced him to step down. In 2010, he became chief operating officer of one of Truman’s hospitals, and in July he succeeded longtime Truman CEO John W. Bluford III.

Now Mr. Shields, whose office décor includes a collection of elephant statues, must press the legislature’s current Republican leaders to accept the Affordable Care Act’s expansion of Medicaid, the federal-state insurance for low-income people. Expanded Medicaid would be a financial lifeline for Truman, which is losing money as it cares for a large population of uninsured patients.

Mr. Shields said he tells lawmakers he understands their situation: “I’ve been in your shoes. I’ve made these tough decisions.” Indeed, he voted for a major retrenchment of Missouri’s Medicaid program in 2005, when about 100,000 people were cut from the rolls. He said the move was difficult but necessary amid a budget crunch, and that he always aimed for it to be reversed when there was funding to do so.

Today, Mr. Shields argues, with federal money available because of the health law, the expansion makes sense. Under the law, the U.S. is supposed to pay the full cost of Medicaid expansion through 2016, and then a share that will phase down to 90% in 2020 and beyond.

Still, he acknowledged the political challenge for Republicans who don’t want to be seen as endorsing a law that is unpopular with many constituents. In polling performed by the Kaiser Family Foundation between January and October of this year, 34% of Missouri residents favored the law, while 52% viewed it unfavorably.

As a middle ground, Mr. Shields said, lawmakers could craft a “Missouri-specific solution” that could potentially occur under a federal waiver, and “there are a lot of things that would work” as a structure for expanding coverage.

You can read the rest of the column at the WSJ website.

Perhaps what Mr. Shields needs to do is to explore something different, something Jackson County progressives would never consider. He has a reasonably conservative history during his time in the Missouri Legislature. With that history, he may be open to something radical like—privatizing the Truman Medical System, privatize both hospitals.

If the county is unable to manage these two hospitals and keep them in the black, perhaps it is time to pass them on to an organization who can. There are numerous hospitals and hospital organizations across the country who are privately owned and not only stay in the black, but actually make a (horrors!) profit.

When a CEO in a business can’t make his company profitable, the stake-holders have two choices, get rid of the CEO and hire one who can succeed, or close the doors. That truism holds true for publicly owned institutions as well.

The progressive’s solution is more taxpayer money in the form of expanded medicaid included in Obamacare. Missouri has rejected both realizing that within a few years, if that, it would be the state would who be picking up the tab for the increased expenditures of medicaid—money the state does not have unless something else is cut equally. Stealing from Peter to pay Paul is not a viable solution for Missouri.

Government, like all of us, must learn that the public money-well is not bottomless.

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Poorhouse or Deathhouse?

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A 19th Century Poorhouse
County Poorhouses were common when I was growing up in southern Illinois.  There was one just on the outskirts of the Franklin County Seat, an old multi-storied house dating back to the Civil War.  It was rumored to have belonged to a slave-owner who went south to fight for the Confederacy and never returned.  I don’t know the truth of that but it’s a good story.

In the 1950s, these homes were more like today’s medicaid-funded nursing homes.  The social safety-net so beloved by FDR had shifted responsibility for caring for the indigent, poor and the terminally ill from kith ‘n kin and church to government.  Before FDR, even in the midst of the great depression, folks were cared for by their their families, local churches and, as last resort, the county government.  The families, churches and local governments took personal care of those needed assistance.  They were kith and kin.

By 1953, all that had changed.

My paternal grandfather was a cantankerous old coot.  He was a miner and had outlived many of his contemporaries and most of his enemies.  During the 1920s and 30s, he was a union organizer during the union/mine owner wars of Williamson and Franklin counties. Many folks around Benton, IL had long memories.  While no one was angered enough to “disappear” Grandpa, he wasn’t being cut any slack either.  Of his immediate family, Dad was about the only one who could put up with Grandpa for any length of time.

From time to time, one of Dad’s sisters would take Grandpa to live with them.  These “visits” didn’t last long and within a week or so, Dad would get a call to come and get Grandpa.
One winter not long after we’d moved out to the farm, Grandpa was living with one of my aunts, the mines were on strike—again, and Dad had gone to Chicago to find work until the strike was over.  Mom was teaching school and I stayed with my maternal Grandmother until I was picked up at the end of the day.  
My Aunt threw Grandpa out of their house and called Dad to come get Grandpa—but no one was home. (I’m not even sure we had a phone at that time.) With no one to take Grandpa, my Aunt called the Sheriff and told him to take Grandpa to the Poorhouse.  
The Poorhouse,at that time, was funded by the county and the county filed for Guardianship of those in the poorhouse. That allowed them to seize any assets the poorhouse residents may have, such as pension and social security checks and any property they owned.  The first inkling Mom had of what had happened was the arrival of the Sheriff at the farm with an eviction notice.  
When we lived in town, Mom and Dad lived in Grandpa’s house with Grandpa. Dad’s mother had died just before I was born and when I came along, Mom and Dad wanted a larger place. After a few years, Grandpa sold his house and the money used to help buy the farm along with money saved by Mom and Dad.  
My Aunt told the Sheriff that Grandpa owned the farm.  Not so. The farm was in Dad’s name, not Grandpa’s.  It took a bit of work for Dad’s lawyer (who was also the County State’s Attorney) to get things straightened out.  In the meantime, Grandpa was stuck in the poorhouse.

Nursing homes today, even the badly operated ones, are worlds better than the poorhouses of the 1950s.  Today, there is state and in some cases federal oversight.  Some nursing homes are excellent, some are marginal.  It was different in 1953.

Expense control was a prime consideration then as it is today.  Any surplus by the poorhouse was absorbed into various pockets.  Cost was controlled by limiting services and controlling resources.  (Sound familiar?) There were no nurses available to care for the sick residents. There were no dietitians overseeing the menus. There was no law nor regulations governing cleanliness and vermin control.

I was only four years old when we went to get Grandpa at the poorhouse. I still remember. 
He was in a room on the third floor with 15 to 20 other old men. The room, by today’s standards, would be small for a double room in any nursing home.  He was tied to the bed. He kept trying to escape, we were told, so they tied him up. If Grandpa got away, no more money for the County.

Grandpa, in his 80s at the time, was quite vigorous.  When we lived in town, he would take me to a local greasy-spoon, a walk of a couple of miles, where he’d spend an afternoon with some friends.  

Dad had to carry him down to the car.

He hadn’t eaten for a couple of days, nor was he allowed to go the outhouse.  There was no indoor bathroom. He’d laid in filth for several days.

Dad cleaned him up when we got to the farm. Mom’s mother came out to help take care of Grandpa for a couple of weeks but Grandpa Miller wasn’t in too good a shape either.  My sister was at college. She came home to help at the end of her term.  By summer, Grandpa was able to walk on his own, but he never fully recovered and died the following year.

While Grandpa had a number of enemies, including, I later discovered, the County Sheriff, he also had a number of friends.  The Sheriff lost his next election.  It was too late for Grandpa. He died before election time came around.  The Manager of the poorhouse departed that summer taking all the money in the poorhouse account and the county closed the place.  Not being cost-effective would be the term today.

I still remember Mom calling the poorhouse, the Death-house.  She wasn’t alone.  I remember hearing the term a decade later when I was in High School and the place was torn down. Whoever was there for any length of time, died.  Usually, it was someone who had no family nor friends.  Someone alone.  Care had to be managed and resources were limited.  Those sentiments have resurfaced again during this last year.  It’s now known as Obamacare.

I’m glad poorhouses no longer exist.  I hope to Heaven I’ll never have to go to a nursing home.  

Is today’s use of nursing homes better than being cares for by family and friends?  I don’t know.  I do know that anything would be better than resurrecting Death-houses.

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