Who Is Being Intransigent Now?

Medicaid reform? We don't need no stinking Medicaid reform.

Medicaid reform? We don’t need no stinking Medicaid reform.

by James A. Bacon

Let me get this straight. Virginia Democrats in the General Assembly are saying that they will not pass a state budget until they get Medicaid expansion?

“We won’t vote for a budget — and I can’t be emphatic enough — we will not vote for a budget, nor will the governor sign a budget that doesn’t have some form of expansion,” Senate Democratic Leader Richard L. Saslaw, D-Fairfax, said during a brief conference call. So reports the Times-Dispatch.

The only possible conclusion to draw from that statement is that the Dems are willing to shut down state government (and much of local government) in order to get their way. Hmmm… Who does that sound like? Oh, I don’t know… maybe Congressional Republicans in the debt-ceiling debate with President Obama? The same Republicans whom the Dems denounced as maniacally irresponsible and willing to destroy the country in order to save it?

I’ve heard a lot of reasons why state Dems support Medicaid expansion: The money would come from Uncle Sam, it would expand health coverage for thousands of Virginians and it would pump up the state’s economy. These are not unreasonable arguments.

Here’s what I have not heard: why Democrats refuse to join with Republicans in pushing for Medicaid reforms. If Governor Terry McAuliffe and other Dems joined Republicans in petitioning the Obama administration, there is every reason to think the state could get the waivers and exemptions they’re asking for. President Obama has waived just about every other provision of Obamacare, why not this?

I truly don’t understand why the Dems can’t join the GOP in presenting a united front to extract Medicaid reforms from the Obama administration. They’ll get what they want, an expanded Medicaid program. It’ll just be a little leaner and more fiscally sustainable than what they’re asking for now. Are they really willing to shut down government over that? Who are the intransigents now?

16 Responses to Who Is Being Intransigent Now?

  1. not a good strategy for the Dems, I agree. But it downright partisan dumb on the GOPs part to not take Fed money (that we have paid for) for one thing while taking it for other things…

    I don’t see us telling the POTUS to “defund” govt-spending NoVa and Hampton because they are contributing to massive debt…

    I don’t see the GOP urging reform of Medicare because it’s going to blow up the deficit and debt…

    I don’t see us turning down highway money or education money.

    so the GOP is basically engaging in – in your face Partisan stuff that will end up – if they are successful – with us losing funding for our urban core and rural hospitals ( Obamacare takes away the disproportionate share subsidy that keeps these hospitals open).

    what is the “plan” from the GOP to deal with this?

    are we going to replace the lost Federal funds with State funds?

    this started with the GOP saying – “we will not compromise on the MedicAid Expansion”.. nothing.. NADA.. it’s will not be discussed … we will just walk away.

    right?

    and we are currently what, 48th in the funding of MedicAid – and we are demanding “reform”?

    so now it’s a game of chicken… which may end up with the Dems getting the lions share of the SLIME.

    so we rank 48th in MedicAid and the GOP is demanding “reform” before we do the expansion?

    methinks.. there is an odor to the actual motivations…

  2. One set of rules. The Rs are squawking now, but pushed it several years ago. The Ds screamed bloody murder when the Rs in Congress did this last fall, but now are doing the same thing in the GA.

  3. You missed the key phrase: “…some form of expansion.” That doesn’t necessarily mean the full program.

    This isn’t just another federal welfare program any more. Medicaid goes back to LBJ but now this is Obamacare. The GOP rhetoric is about opposing the expansion of Obamacare. Just this session, and for many recent years, Republicans in the legislature have bragged about creating more and more intellectual disability (ID) and development disability (DD) waivers, meaning Medicaid slots for families with very much similar incomes to the families they are now standing firm to keep out. The only difference is these waivers are limited in number and for some reason those cases are ruled to be “deserving”. But clearly some Medicaid expansions are acceptable.

    Right now both sides are showing off for their base ideological voters and the vast majority of Virginians are not paying any attention. If the General Assembly gets to July (or June even) without a budget, the public pressure to pass something will be enormous on both parties, and the blame for failure will fall on both parties. If the General Assembly does put out a bill, Medicaid expansion or not, the Governor will not veto it.

    • we are ALREADY PAYING for the folks who would be “covered” by the “expansion”

      it’s not a question of paying or not but how do we?

      do you want to continue to pay ER-type prices for non-urgent Medical care and/or let chronic conditions fester until they become horrendously expensive – and then we pick up the tab?

      do you really think it’s okay for Va to not have some kind of aid for people who work full-time and/or are veterans?

      do you hear the part about removing the Federal subsidies for hospitals that treat the poor and uninsured? Are you okay with rural and urban core hospitals closing or reducing their services to those who are uninsured?

      where is your ideology about government do you deal with these issues?

      rhetoric won’t do it. This is why you have hospital administrators from around the Commonwealth getting in touch with Richmond about what the “plan” is if the disproportionate share payments go away.

      what is that plan?

      partisan opposition won’t fix it.

      people are getting on disability in any way they can. they are getting on Medicare (if you get disability, you get Medicare) anyway they can.

      you can say you don’t want no more stinking government welfare plans but you can’t make the poor and uninsured disappear or keep from having to pay for them.. so what is the plan?

      so a simple question to you Breckindridge. Would you repeal EMPTALA?

      would you make it legal for hospitals to turn away people?

  4. “Here’s what I have not heard: why Democrats refuse to join with Republicans in pushing for Medicaid reforms. ”

    Hmm where to start?

    The Dems have joined in with some Rs about offering to do yet another audit of how Medicaid is used in the state. No dice from the Howell types.

    The Dems have suggested going with a proposal by some Rs about a private “Marketplace Virginia” concept to help the near poor buy insurance. No dice.

    McAuliffe has pitched approaching Medicaid expansion as a two year pilot program. No Dice.

    Meanwhile, you suggest that the Dems are refusing to go with Medicaid reforms, you never say what they are. Are we supposed to know? Want to clue us in?

    Damn, I’d love to be your copy editor.

    • the problem with the GOP is they want to live in a world that subsidizes the “makers” and penalizes the “takers”.

      it’s a comic-book, sound-bite type world.

      Now that we’ve subsidized the heck out of the middle class with employer-provided and Medicare, – we cannot “afford” the same kinds subsidies for the others. we make the cut when you work full time and do not get employer-provided. How convenient.

      the funding for the Medicaid Expansion comes from taxes on employer provided, some higher dollar medical appliances, moving the itemized threshold for health costs from 7.5% to 10%, cutting the disproportionate share Federal subsidy, and transferring the Medicare Advantage subsidy.

      the sound-bite folks don’t care about this. it’s about the way it “feels”, and it feels like more free rides for folks who don’t deserve it.

      right?

    • From the attachment to Bob McDonnell’s letter to Kathleen Sibelius: Five Tenets of Medicaid Reform

      – Deliver all Medicaid services through an efficient, market-based delivery system.
      – Establish provisions to reduce financial burdens to Virginia.
      – Maximize tools currently available to the Commonwealth, such an 1115 waiver or other appropriate vehicle to achieve administrative efficiency and implement initial payment and delivery reforms.
      – Achieve greater flexibility by pressing for Congressional action to change Title XIX of the Social Security Act as amended by the Patient Protection and Affordable Care Act. (Virginia seeks to drive behavior through value-based purchasing and restructure benefit and service delivery design.)
      – Achieve commitment from stakeholders for broad-based, long-term, statewide reform.

      It is the conceit of many Dems and liberals such as Larry G that Republicans have no reform proposals of their own, that all they want to do is oppose Obamacare. That makes for a nice narrative. But all you have to do is read a little to see that it is total nonsense.

      A more realistic narrative is that Dems are not interested in any “reform” to the healthcare system that does not give more power to the state and the political class and they bury any effort to take healthcare in any other direction.

  5. Here’s what the Hospital in Fredericksburg would like to do with the uninsured who show up at the ER.

    They’d like to treat them for their urgent problem – but then refer them to the local Community Clinic for their chronic problems – but they cannot because the clinic is maxed out and cannot take those who do not qualify anyhow – so they want to use the MedicAid Expansion to build more capacity for the clinic and hand off the uninsured to the clinic and a cadre of local doctors who support the clinic.

    there are a number of ways forward – I’d say ways forward that are more cost-effective, and based on conservative principles of helping those that need help but doing it in a fiscally responsible way.

    there is no excuse for the BUTTS who can’t seem to find in their opposition repertoire, anything beyond just opposition.

    were the do da are the leaders of the Conservatives to provide THEIR path forward rather than just having opposition to others paths?

    every since the Heritage Foundation and Newt Gingrich proffered their alternative to Hillarycare – an individual mandate – the GOP has been devoid of concurrence among themselves for many of the serious issues of our time – including health care.

    Massachusetts figured out a way to provide all of their population with some level of health care.

    All Virginia can do is blame their own feckless irresponsibility on Washington.

    • If there are cost savings from the reduction of uncompensated care of the uninsured, why aren’t those cost savings being funneled back (by statute) to those who pay those costs in higher taxes and insurance premiums? The Governor’s plan does set aside $200 M from cost savings – a start. But what about the alleged cost savings for the insured? If Dominion’s imposes a higher rate than is later justified before the VSCC, customers get refunds. Why won’t the Medicaid expansion supporters do the same in the statute?

      Are there real savings? Did McAuliffe promise the health care industry that no premium reductions would occur? Pass along the savings, by putting the providers at risk and I’ll support expansion.

      • re: cost savings

        TMT – they’re cutting the disproportionate share subsidy – that’s a real saving.

        but how do you get “proof” ahead of time with ANYTHING that is attempting to save money especially with something as health care?

        but this is a relatively simple idea – get sick people to see a primary care physician instead of an ER doctor.

        it won’t happen overnight as we have entire generations of people who have been doing this and had no realistic way to do anything else.

        it’s DUMB for us – through subsidies to ERs and cost-shifting for those who have insurance to be paying to see ER doctors when we ourselves pay less money to see primary care physicians rather than specialists or ER docs.

        I’m open to other approaches.

        I’d gladly entertain better ways to do this – and that’s the frustration. We basically have not only opponents but opponents with no other alternatives .. just opposition and, in effect, continuing support for an unacceptable status quo.

        this is coming from people who say they are fiscal conservatives.

        fiscal conservatives are pragmatic types who know that we cannot get a perfect system but they always seek more cost-effective systems even if they are still not “perfect”.

        today’s environment is opposition and nothing else.

        that’s not fiscal conservatism.

  6. The RPV talks about The Virginia Way and claims that Medicaid reform should precede expansion because that is the Virginia Way.

    I love all this talk about “The Virginia Way”. Let’s talk about Virginia. Let’s make the comparison between the Virginia Way and alternatives clear. Let’s compare Virginia to … let’s see … Massachusetts.

    We all know Massachusetts is a liberal utopia with so-called RomneyCare and Medicaid expansion. However, Massachusetts also has the best public schools in the United States (Virginia was recently rated as #11 by the WSJ).

    But, at what price?

    The “Virginia Way” is conservative, fiscally responsible, low tax, small government. Right?

    No. Not right.

    People in Virginia pay MORE in state and local taxes than people than residents of “Taxachusetts”!

    http://wallethub.com/edu/best-worst-states-to-be-a-taxpayer/2416/#complete-rankings

    The Virginia Way?

    The Virginia Way is citizens putting up with the gross incompetence and culpable negligence of our political class. The Virginia Way is to stand idly by and watch as the same liars, cheats and thieves who refused to implement ethics reform now claim they will reform Medicaid. The Virginia Way is to have the least competitive state legislative elections in America along with the 5th worst gerrymandered state in America.

    The Virginia Way – Are you kidding me?

    The Virginia Way should be the “before” picture for state government.

    • Virginia has a multitude of options that they can pursue and yet they have chosen none – not now, not in the past.

      MedicAid in Va is almost dead last in costs and denies coverage to full-time employed people who do not have any insurance like Mercedes Harris.

      at the same time, they allow middle-class citizens in Va to use MedicAid to pay for nursing care for people trying to preserve their assets so their kids can inherit them.

      so much for the “they don’t deserve entitlements” mentality.

      Many states are much tougher on that.

      so we have options in Va for MedicAid reform already – have had it for some time, and we have chosen to not pursue them and now make it the excuse for not expanding and reforming – as if you can’t expand until you reform.

      it’s just more opposition for partisan opposition sake – combined with feckless ineptitude and really, willing self ignorance … and that’s the real Virginia Way.

  7. James
    What you have written about Medicaid reform is impenetrable gibberish and when I click on the link to McDonnell’s letter I go nowhere. Can you translate this into English?

  8. It does not work? Damn sounds like obama’s first website”!!!

  9. Pingback: Who Is Being Intransigent Now? » Jefferson Area Tea Party

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