Category Archives: Entitlements

An Alternative to Expanding Medicaid: Expanding Free Clinics

Del. John M. O'Bannon III

Del. John M. O’Bannon III

by James A. Bacon

With all the bad press that Virginia’s Medicaid program has been getting recently, the prospect of the General Assembly enacting an expansion of the health care entitlement in 2016 are just about nil. First came a report last month that the state wasted $21 million last year paying Medicaid benefits to recipients who no longer qualified. Then the McAuliffe administration revealed that the state share of funding Medicaid is forecast to surge in the next two-year budget cycle, boosting the annual cost from $7.9 billion in fiscal 2015 to $9.3 billion in fiscal 2018.

That’s without expanding Medicaid as allowed for in the Affordable Care Act. While the federal government has covered 100% of the cost for an introductory period, state governments will have to begin paying a share of the cost beginning in the next fiscal year, eventually topping out at 10% of the added spending.

Virginia Republicans have held fast against expanding the entitlement. Their primary argument has been one of fiscal responsibility: Every state dollar spent on Medicaid is one less dollar that can be invested in K-12 schools, higher education, and other pressing state needs. But Medicaid doesn’t exist in a vacuum. It needs to be seen against a larger backdrop of reforming a largely dysfunctional health care system and a tattered social safety net.

Yesterday I sat down with Del. John O’Bannon, R-Henrico, a practicing physician who happens to be vice chair of the House Health, Welfare and Institutions Committee, to discuss the wellness (or lack of it) of Virginia’s health care system. The thrust of my questions was this: It’s all very fine to oppose Medicaid expansion on fiscal grounds, but the health problems of poor and near-poor Virginians are real. What do Republicans propose as an alternative?

His answer comes in two parts. First, the General Assembly has steered more funds into the state’s mental health programs and into free clinics. Said O’Bannon: “We’re for strengthening the safety net.” But he prefers programs that Virginia can control without federal interference or that leverage private-sector philanthropy. Second, the state should do more to promote competition and transparency to contain medical costs and improve outcomes for all Virginians, including the poor. In this post, I’ll focus on the first approach.

In the current fiscal year, the General Assembly approved $125 million in new safety-net funding for mental health, free clinics and Federal Health Centers.

Of that amount $96 million is dedicated to SMI mental health, which, with an equal match from the feds, should treat 20,000 people with serious mental illness. (SMI stands for Serious Mental Illness.)

The balance of the new funds supports free and affordable clinics, which provide physician care, x-ray services, lab services, immunizations, preventive services, prescription drugs, and some dental care to Virginians lacking other health care coverage. According to FreeClinics.com, there are 254 clinics in the state of Virginia. Some clinics are federally sponsored Community Health Centers, which may charge patients a fee, depending on income, while others are entirely free. While coverage does not extend into every nook any cranny of the state, it is extensive. In Southwest Virginia, the mobile Health Wagon fills in some of the gaps by providing care services to residents of 11 counties.

State funds complement charitable donations and professional time contributed by doctors, nurses and other volunteers, while the Virginia Health Care Foundation works with pharmaceutical companies to contribute prescription drugs.

Although free/affordable clinics do provide primary health care to hundreds of thousands of Virginians, the health safety net is “stretched as never before,” states the website of the Virginia Health Care Foundation. “Free clinics reported up to a four-month wait for patients seeking a first appointment. Some have instituted lotteries to determine who can receive care. Other clinics are simply unable to accept new patients because of capacity and/or resource limitations.”

As imperfect as the safety net may be, Virginia’s dense network of free/ affordable clinics is “unique” in the country, says O’Bannon. By comparison, he says, Maryland doesn’t have a single free clinic. Instead of expanding Medicaid, with its arbitrary rules and fiscally unsustainable cost, Virginia should focus on strengthening its home-grown institutions that are inherently closer and more responsive to the community.

Memories of a Klan Rally

KlanersBy Peter Galuszka

I was looking through a some old clips today and spotted this Golden Oldie that ran in the Jan. 30, 2000 edition of BusinessWeek magazine where I worked for about 15 years. Bloomberg now owns rights to it and I hope they don’t mind me re-running it.

Mindful of the lofty rhetoric one reads on this blog about being Southern and symbols, I thought this might be an interesting read about how nothing is sacred. Not the Confederate Flag. Not even Stonewall Jackson.

It also shows how little things change. The flag and statues of Confederate generals are still flashpoint issues and people like GOP presidential candidate hopeful Donald Trump are running around making offensive statements about Mexican immigrants. (For the record, the late U.S. Sen. Robert Byrd of West Virginia had been a Klan member early in his life and he later renounced his membership).

The Ku Klux Klan rally I covered was on Nov. 6, 1999.

Here goes:

Letter From West Virginia

The High Price of a Klan Rally

Studying me solemnly from across his desk, Thomas A. Keeley sighs and says in his West Virginia twang: “I have to take care of my people.” I kid Tom that he sounds like the sheriff who was battling coal-company thugs in the 1988 movie Matewan. Tom grins. He puts up with me, since we go back 35 years–to grade school here in Clarksburg, a town of 18,000 nestled in the hills of central West Virginia. Today, Tom, as president of the Harrison County Commission, is the county’s top elected official, and I’ve come to find out how he intends to take care of “his people” in what could be one of the biggest crises Clarksburg has ever faced.

In two days, the Knights of the White Kamellia, one of 55 units of the Ku Klux Klan, will hold a rally on the front steps of the Harrison County Courthouse in downtown Clarksburg. The Klan picked the spot because of its dramatic statue of Confederate General Thomas J. “Stonewall” Jackson, born in Clarksburg in 1824. The Klan figures that Stonewall, riding north against the Yankees, will make a dandy prop for its November rally. So will the 70 state troopers, city police, and county deputies who will be providing the security. The Klan believes that the police presence not only will make it appear to be an oppressed group but will also increase the media coverage.

The city-county expense for the Clarksburg rally will be about $50,000–pin money compared with what 40 cities spent in 1999 hosting the Klan. Security at Cleveland’s August rally ran $600,000, although only 21 Klansmen showed up. But Harrison County is in the heart of the Appalachian poverty belt, and it desperately needs the money for other things. The hamlet of Marshville, for example, badly needs help, since its groundwater has been polluted by coal mines. “It’s costing us a lot of money to accommodate a bunch of white-trash bigots, and you can quote me on that,” says Tom, leaning back in his rumpled suit.

But he doesn’t have much choice. Not only is the Klan making noise, but a far more dangerous ultra-right-wing group is also active locally: the Mountaineer Militia, a cabal of heavily armed survivalists ready to fight what they consider excessive federal power. Militia members from the Clarksburg area hatched an Oklahoma City-style plot in 1996 to bomb the new $200 million FBI fingerprinting center in Clarksburg. The installation employs 3,000. After the FBI infiltrated the group, five men were convicted or pleaded guilty to explosives charges; one was convicted of selling blueprints of the center.

IDENTITY CRISIS. Taking a cue from New York Mayor Rudolph Giuliani, who has also had to deal with a Klan demonstration, Tom is forbidding the wearing of masks at the rally, figuring that fewer Klansmen will show up if they are not able to keep their identity secret. At this point, nobody is sure who they are. The only known Klansman is Cletus Norris, who wrote Tom the letter announcing the rally, using a post office box in Grafton, 20 miles to the east. Norris is a former road worker, once employed by the city. The next day, as I drive to Grafton in search of Norris, I try to recall if the Klan had been active when I lived here back in the 1960s.

In the Deep South at that time, the Klan was bombing black churches and killing civil-rights workers. But from what I remember, not much happened here. Besides, Klansmen in these parts traditionally weren’t so much antiblack (there were few blacks here) as anti-Catholic. That was in reaction to the Italian immigrants who streamed into the area in the 1800s to build the Baltimore & Ohio’s main line to St. Louis, taking jobs away from Protestant backwoods types. The animosity was resolved naturally over the years as boy met girl and both defied ethnic hostility. Today, largely due to intermarriage, 40% of local folk are of Italian descent.

As luck would have it, driving down a Grafton street, I spot a parked gray Dodge pickup with bumper stickers bearing Confederate flags and the slogan, “Racial Purity Equals American Security.” Bingo! I walk up the crumbling concrete stairs to a yellow clapboard house and knock on the door. A slim man with a reddish-blond beard answers. “I am the Grand Dragon,” confirms Cletus Norris. He invites me to sit in the warm autumn sun on the front porch of his parents’ house. The experience is unnerving because for an hour, this 33-year-old is talking softly, pleasantly, almost seductively, but is expounding truly hateful ideas. At one point, Norris asks gently, “You aren’t Jewish, are you?” I reply: “No, but I am Catholic.” Norris says: “That’s O.K.”

A Klansman for five years, Norris claims his group is peaceful and interested only in protecting white rights. “Our rally,” Norris reassures me, “will set a lot of minds at ease. They’ll listen to us and see that we’re just normal Christian men.” Their agenda? “By the year 2040, we will be outnumbered by the combined nonwhite races of this country, and whites won’t get a fair shake.” The message is spreading through cyberspace. “We have some people in Europe and Australia, thanks to the Internet,” he says, as he hushes a dog barking inside the house. Norris insists he doesn’t hate blacks, only “race-mixing.” As for Mexicans, the border to the south should be closed. And Jews? “Christ didn’t have one good thing to say about the Jews.”

Later, I contact Mark Potok, editor of The Intelligence Report of the Southern Poverty Law Center, a Montgomery (Ala.) nonprofit that tracks hate groups. He says Klan membership is static at about 5,000, but that 200,000 belong to other hate groups: Membership in those groups is increasing 25% a year.

PEPPER GAS. The following day–rally day–the police are nervous. Clarksburg looks as if it’s occupied by an invading army. Police vehicles include a bomb disposal truck. There are SWAT teams wearing black Wehrmacht-style helmets and face masks. “If things really get out of hand,” says policeman J.P. Walker says at a press briefing, “you’ll hear a siren, and then you’ve got 10 seconds until the pepper gas goes off.” The rally site has three fenced-in pens–one for Klan supporters, one for the press, and one for protesters. Participants must go through detectors, and attendees can’t bring in anything more than a car key.

Right on time, Norris, head up and confident-looking, dressed in white robe, leads the Klan parade out of the courthouse onto the front plaza, right past Stonewall. He is followed by eight Klansmen and two Klanswomen in brightly colored robes and hoods–no masks. About 150 protesters and 20 supporters shout insults at each other. “This country will go down the tubes,” shouts Norris, but he is barely heard above the noise because Tom won’t allow loudspeakers. When a rumor sweeps the crowd that one Klanswoman is a local English teacher (which turns out to be false), she yells good-naturedly: “There’ll be a test Monday morning.”

After two hours without incident and only one arrest–for disorderly conduct–the Klanspeople are escorted to a city parking lot, where they get into three cars, with Missouri, Ohio, and Virginia plates. Norris announces that a rally the next day in Fairmont, 20 miles north, has been canceled. Is that because the mayor refuses to provide security, I ask? “No, we just don’t want to make a nuisance of ourselves,” Norris says. The irony of that is not lost on one police officer. As he waves to the departing caravan, he mutters: “Goodbye, you sons of bitches–and to think I had seats on the 50-yard line at the West Virginia-Virginia Tech game today.”

By Peter Galuszka; Edited by Sandra Dallas

Taking The Statues Down

stalin By Peter Galuszka

In 1993, I was stumbling along the rough concrete sidewalks of Alma Ata, then the  capital of the former Soviet Republic of Kazakhstan. I was late for an interview with an official of what was now an independent nation rich in oil, natural gas and uranium.

The street map I had was old. I stopped a Kazakh woman in a kerchief and asked, “Is this Lenin Street?”

“Not anymore,” she replied. “It is Apple Street.”

Therein lies a small history lesson. Every human society, it doesn’t matter, where undergoes a major reassessment of how its humanity squares with its history.

The former Soviet Union is an excellent example. Its architect, V.I. Lenin, was a brilliant organizer but a killer. Josef Stalin murdered at least 20 million (who’s counting?) during the Great Purge and later in the war against Hitler.

Time and again, the old USSR and now the Russian Federation would undergo a change in leadership and the statutes would come down. They did when Stalin died in 1953 in Eastern Europe. Russians were shocked when new chieftain Nikita Khrushchev gave his liberal-minded “Secret Speech” in 1956 denounced Stalin. When another liberal, Mikhail S. Gorbachev, came to power in 1985, he pushed the national conversation even further.

By that time, I was reporting there for an international magazine. I visited a tractor factory in the town of Vladimir in 1987. Its very bright deputy director who would go on the Harvard Graduate School of Business, smirked uneasily when he said the factory was still named after Andrei Zhdanov.

He didn’t need to mention that Zhdanov was a Stalin thug who oppressed artists like Anna Akhmatova and Dmitri Shostakovich. He also was instrumental in starting the great purge of the 1930s during which 1.5 million people were imprisoned and more than 680,000 were shot.

The old statues really started to come down after the Soviet Union fell apart in 1991. The Zhdanov plant got a new name (although the way things are going under Vladimir Putin, the statues are starting to go back up).

So, what’s may point? That all societies need to air their history and their myths – including the ones that white Southerners have clung to for yours. Are some so arrogant as to claim they are above what other nations undergo?

Mother Jones, one of my favorite magazines, has story listing just how many streets, schools and public buildings are named after dubious characters. In Jacksonville, Fla., they renamed a high school named after Nathan. Bedford Forrest, a lieutenant general in the Confederate Army and founder of the Ku Klux Klan. North Carolina has renamed school facilities named after former Gov. Charles Aycock, a white supremacist.

And for the truly strange, look no farther than Richmond. The Martin Luther King Jr. Middle School is on a street named after John Singleton Mosby, a famous Confederate cavalry raider.

Tobacco Commission: Six of Eight Projects Fail

The old logo

The old logo

 By Peter Galuszka

Down Danville way, of eight companies that have received money from the Tobacco Region Opportunity Fund (the old, embattled tobacco commission) only two have managed to fulfill contractual obligations to create jobs and help the local economy.

According to a report by Vicky M. Cruz in the Danville Register & Bee, the six firms that have failed to meet their obligations mean a loss of 1,340 potential jobs and $63 million in local investment. It also means that Danville owes the tobacco commission $5.47 million.

Here’s a list of the companies.

The tobacco commission has been around since 1999 to supposedly help residents in the tobacco growing areas of the state move into non-leaf related jobs. The money came from the huge multi-billion dollar Master Settlement Agreement between four cigarette companies and 46 states that had sued them over health concerns.

The tobacco commission has been a bit of a sham. Money has been doled out without checks on how it was spent or how successful projects have been. A former director ended up in prison for siphoning off funds. A state audit has been ultra-critical of the fund, which figured in the political corruption conviction of former Gov. Robert F. McDonnell and his wife.

Last month, Gov. Terry McAuliffe renamed the fund, appointed a new director and changed its board. The cases reported by the Register & Bee obviously date before the reforms. Let’s hope they work.

(Hat tip to Larry Gross).

New Film Documents Horrors of Coal Mining

blood on the moutain posterBy Peter Galuszka

Several years in the making, “Blood on the Mountain” has finally premiered in New York City. The documentary examines the cycle of exploitation of people and environment by West Virginia’s coal industry highlighting Massey Energy, a coal firm that was based in Richmond.

The final cut of the film was released publicly May 26 at Anthology Film Archives as part of the “Workers Unite! Film Festival” funded in part by the Fund for Creative Communities, the Manhattan Community Arts Fund and the New York State Council of the Arts.

Directed by Mari-Lynn Evans and Jordan Freeman, the film shows that how for more than a century, coal companies and politicians kept coal workers laboring in unsafe conditions that killed thousands while ravaging the state’s mountain environment.

As Bruce Stanley, a lawyer from Mingo County, W.Va. who is interviewed in the film and has fought Donald L. Blankenship, the notorious former head of Massey Energy, says, there isn’t a “War on Coal,” it is a “war waged by coal on West Virginia.”

When hundreds of striking workers protested onerous and deadly working conditions in the early 1920s, they were met with machine guns and combat aircraft in a war that West Virginia officials kept out of history books. They didn’t teach it when I was in grade school there in the 1960s. I learned about the war in the 1990s.

The cycle of coal mine deaths,environmental disaster and regional poverty continues to this day. In 2010, safety cutbacks at a Massey Energy mine led to the deaths of 29 miners in the worst such disaster in 40 years. Mountains in Central Appalachia, including southwest Virginia, continue to be ravaged by extreme strip mining.

As Jeff Biggers said in a review of the movie in the Huffington Post:

“Thanks to its historical perspective, Blood on the Mountains keeps hope alive in the coalfields — and in the more defining mountains, the mountain state vs. the “extraction state” — and reminds viewers of the inspiring continuum of the extraordinary Blair Mountain miners’ uprising in 1921, the victory of Miners for Democracy leader Arnold Miller as the UMWA president in the 1970s, and today’s fearless campaigns against mountaintop-removal mining.”

The movie (here is the trailer) is a personal mission for me. In 2013, after my book “Thunder on the Mountain, Death at Massey and the Dirty Secrets Behind Big Coal,” was published by St. Martin’s Press, Mari-Lynn Evans called me and said she liked the book and wanted me to work with her on the movie project. She is from a small town in West Virginia a little south of where I spent several years as a child and thought some of my observations in the book rang true.

I drove out to Beckley, W.Va. for several hours of on-camera interviews. Over the next two years, I watched early versions, gave my criticisms and ideas and acted as a kind of consultant. Mari-Lynn’s production company is in Akron and I visited other production facilities in New York near the Brooklyn Navy Yard.

Interesting work if you can get it. My only forays into film making before had been with my high school film club where he videographed a coffin being lowered into a grave (in West Virginia no less). I was greatly impressed when I saw the movie at its New York premiere.

Mari-Lynn and Jordan have been filming in the region for years. They collaborated on “The Appalachians,” an award-winning three-part documentary that was aired on PBS a few years ago and on “Coal Country” which dealt with mountaintop removal strip mining.

They and writer Phyllis Geller spent months detailing how coal companies bought up land on the cheap from unwitting residents, hired miners and other workers while intimidating them and abusing them, divided communities and plundered some very beautiful mountains.

Upper Big Branch is just a continuation of the mine disasters that have killed thousands. The worst was Monongah in 1907 with a death toll of at least 362; Eccles in 1914 with 183 dead; and Farmington in 1968 with 78 dead (just a county over from where I used to live).

By 2008 while Blankenship was CEO of Massey, some 52 miners were killed. Then came Upper Big Branch with 29 dead in 2010.

At least 700 were killed by silicosis in the 1930s after Union Carbine dug a tunnel at Hawks Nest. Many were buried in unmarked graves.

While state regulation has been lame, scores West Virginia politicians have been found guilty of taking bribes, including ex-Gov. Arch Moore.

The movie is strong stuff. I’ll let you know where it will be available. A new and expanded paperback version of my book is available from West Virginia University Press.

Blankenship is scheduled to go on trial on federal charges related to Upper Big Branch on July 13.

Using Big Data to Lift Americans out of Poverty

Senior person hands begging for food or helpWe’ve reached a dead end in the debate over poverty here in the United States. Liberals and Democrats say that all we need is to throw more money at the program, as if the trillions we’ve spent over the past 50 years were not enough. Conservatives and Republicans, while great at dissecting the failure of Great Society anti-poverty programs, don’t have much to offer in their place. No one, not even mean, skin-flinted conservatives like me, want to slash benefits willy nilly. No one wants a country in which poor children starve or poor sick people die from a sudden retraction of the safety net.

Is there a third way? Perhaps. From the small but magnificent country of New Zealand (run by the conservative National Party) comes a new idea: using Big Data to target welfare dollars where they are most needed. Allegheny County, Pa., (which includes Pittsburgh) is hiring a Kiwi pioneer in the field to apply the same approach to the American welfare system. Maybe Virginia should consider doing the same.

Writes Josh Eidelson with Bloomberg:

In 2010, when [New Zealand] Minister of Finance Bill English first convened a policy group to review welfare spending, government statistics showed half the 4,300 teenage single mothers receiving benefits in that country were likely to remain in the welfare system for 20 years, at a total cost of about $264,000 each. The government responded with $23 million to assign individual case workers to help teenage mothers finish school and find work. Now, after four years, the number of teenage single parents on benefits has dropped to 2,600.

Using data from welfare, education, employment, and housing agencies and the courts, the government identified the most expensive welfare beneficiaries—kids who have at least one close adult relative who’s previously been reported to child safety authorities, been to prison, and spent substantial time on welfare. “There are million-dollar kids in those families,” English says. “By the time they are 10, their likelihood of incarceration is 70 percent. You’ve got to do something about that.”

What works in a small, homogeneous country like New Zealand may not translate well to a large, multicultural country like the United States with a culture of inter-generational poverty and dysfunctional governance institutions. But, then, it’s just possible that the Kiwi model will work here. Given our impotence in combating poverty in the U.S., we don’t have anything to lose. If we frame the initiative as fiscally conservative (no one is asking to spend more money or raise taxes) and as pragmatically effective (we succeed at actually lifting at-risk people out of poverty), using Big Data to combat poverty would at least be a political winner.

— JAB

Private Immigrant Jail May Face Woes

Farmville jail protest

Farmville jail protest

By Peter Galuszka

Privatization in Virginia has been a buzzword for years among both parties. In this tax-averse state, contracting off public functions is seen as a wise and worthy approach.

But then you get debacles such as the U.S. 460 highway project. And now, you might have one brewing down in Farmville.

The small college town is in Prince Edward County, which gained international notoriety from 1959 to 1964 when it decided to shut down its entire school system rather than integrate. Many white kids ended up in all-white private schools and many African-American children were cheated out of an education entirely.

About six years ago, another creepy project started there – a private, for-profit prison designed exclusively to imprison undocumented aliens. It’s a cozy little deal, as I outline in a piece in Sunday’s Washington Post.

Farmville gets a $1 per head, per day (sounds like slavery) from the U.S. Immigration and Customs Enforcement agency. Immigration Centers of America, the private firm run by Richmond executives Ken Newsome and Russell Harper, gets profits. Then, in turn, also pay taxes to Farmville and the county.

The ICA facility, whose logo includes an American flag, pays taxes as well and provides about 250 jobs locally. The project even got a $400,000 grant from the scandal-ridden Virginia Tobacco Indemnification and Community Revitalization Commission for water and sewer works.

What might sound like a no-lose operation, except for the mostly Hispanic inmates who might have entered the country illegally, overstayed their visas, or had other bureaucratic problems, may face problems.

The census now at the jail is about 75 percent of what it could be. President Obama has issued an executive order that could free some five million undocumented aliens. It is being challenged by 26 states but Virginia Atty. Gen Mark Herring has filed an amicus brief in favor of Obama.

So what happens to Farmville if Obama wins? It could affect 96,000 aliens in Virginia. Could there someday be no prisoners? Wouldn’t that be too bad for Farmville?

Recent history is instructive. Back in the 1990s, Gov. George Allen, a conservative darling, was pushing private prisons in Virginia as he successfully got rid of parole in part of his crime crackdown. Slave labor was part of the deal.

Executive Intelligence Weekly wrote in 1994:

“Slave labor in American prisons is increasingly being carried out in what are called “private prisons.” In his campaign to “reform” Virginia’s penal laws, Gov. George Allen pointed to prison privatization as the wave of the future, a moneymaking enterprise for the investor, and a source of good, cheap labor for Virginia’s municipalities. Indeed, after taxes, pay-back to the prison, and victim restitution are removed, the inmate earns an average of $1 per hour in these facilities.”

Well guess what happened. Allen pushed for more public and private prisons. They were overbuilt. Demographics changed. Crime rates dropped. Prisons had to be shut down.

So, if immigration reform ever comes about what happens in Farmville? Don’t forget, the private jail came at a time when a construction boom, especially in Northern Virginia had drawn in many immigrants especially from Latin America. Their papers may not have been in order.

Neo-racists like Corey Stewart, chairman of the board of supervisors of Prince William County, ordered a crackdown on brown-skinned people who spoke Spanish. But when the real estate market crashed, fewer Latinos arrived. And, if they did, they avoided Stewart’s home county.

Wither Farmville?