Saturday, November 19, 2016

Last Call For Dispatches From Bevinstan, Con't.

The people of Kentucky voted for Matt Bevin by a considerable margin last year, a man who promised to end Medicaid for 450,000 Kentuckians.  The only thing standing in his way was the Obama administration's Health and Human Services department, and Democrats in the Kentucky House.  Last week many of these same Kentuckians voted for, by an even larger margin, to get rid of both of those checks.

Now, some of them are worried they might lose their Medicaid.  They should be terrified.

For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America's poorest places, the Affordable Care Act was life altering.

The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.

"It's been a godsend to me," said the former Ohio school custodian who moved to Kentucky a decade ago.

Lockaby finally got treated for a thyroid disorder that had left her so exhausted she'd almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control.

But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state's Republican governor has submitted to the Obama administration.

I guarantee you Lockaby and her neighbors voted for Bevin last year and Trump this year.  And I bet that even if Lockaby herself did find it in her heart to vote for Jack Conway or Hillary Clinton, her neighbors saw the health care she was getting and figured she was one of those people who needed to be out there working like they are. They definitely voted for Bevin and Trump to take health care away from her. I'm willing to put actual money on the table that at least one of Frieda Lockaby's neighbors said "I know she's healthy enough to find a job, she's living off the government, and that's not fair.  That's why I voted for Trump."

Bevin has threatened to roll back the expansion if the Obama administration doesn't allow him to make major changes, such as requiring Kentucky's beneficiaries to pay monthly premiums of $1 to $37.50 and require nondisabled recipients to work or do community service for free dental and vision care.

Budget pressures are set to rise next year in the 31 states and the District of Columbia where Medicaid was expanded as the federal government reduces its share of those costs. States will pick up 5 percent next year and that will rise gradually to 10 percent by 2020. Under the health law, the federal government paid the full cost of the Medicaid expansion population for 2014-2016.

In a state as cash-strapped as Kentucky, the increased expenses ahead for Medicaid will be significant in Bevin's view — $1.2 billion from 2017 to 2021, according to the waiver request he's made to the Obama administration to change how Medicaid works in his state.

Trump's unexpected victory may help Bevin's chances of winning approval. Before the election, many analysts expected federal officials to reject the governor's plan by the end of the year on the grounds that it would roll back gains in expected coverage.

A Trump administration could decide the matter differently, said Emily Beauregard, executive director of Kentucky Voice for Health, an advocacy group that opposes most waiver changes because they could reduce access to care.

"I think it's much more likely that a waiver could be approved under the Trump administration," she said. "On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [Affordable Care Act] are repealed."

Lockaby is watching with alarm: "I am worried to death about it."

You should be. Donald Trump won every single county in Kentucky except for Fayette and Jefferson, where Lexington and Louisville are, respectively.  Trump won Clay County 87%-11%. They voted overwhelmingly to take everything away from those people.

It turns out "those people" are Frieda Lockaby herself.

They Livin' It Up In The Hotel Trumpifornia

About 100 foreign diplomats, from Brazil to Turkey, gathered at the Trump International Hotel this week to sip Trump-branded champagne, dine on sliders and hear a sales pitch about the U.S. president-elect’s newest hotel.

The event for the diplomatic community, held one week after the election, was in the Lincoln Library, a junior ballroom with 16-foot ceilings and velvet drapes that is also available for rent.

Some attendees won raffle prizes — among them overnight stays at other Trump properties around the world — allowing them to become better acquainted with the business holdings of the new commander in chief.

“The place was packed,” said Lynn Van Fleit, founder of the nonprofit Diplomacy Matters Institute, which organizes programs for foreign diplomats and government officials. She said much of the discussion among Washington-based diplomats is over “how are we going to build ties with the new administration.”

Back when many expected Trump to lose the election, speculation was rife that business would suffer at the hotels, condos and golf courses that bear his name. Now, those venues offer the prospect of something else: a chance to curry favor or access with the next president.

Perhaps nowhere is that possibility more obvious than Trump’s newly renovated hotel a few blocks from the White House, on Pennsylvania Avenue. Rooms sold out quickly for the inauguration, many for five-night minimums priced at five times the normal rate, according to the hotel’s manager.

To many of the guests at the reception Tuesday, accepting an invitation to tour the $212 million hotel and check out the $20,000-a-night, 6,300-square-foot “town house” suite seemed like a good idea. They spoke admiringly about the renovation and left with a goody bag of chocolates and a brochure. It listed the choices of accommodations and meeting rooms and expounded on the location’s “striking prominence” at historical moments such as the Inauguration Day parade.

“Believe me, all the delegations will go there,” said one Middle Eastern diplomat who recently toured the hotel and booked an overseas visitor. The diplomat said many stayed away from the hotel before the election for fear of a “Clinton backlash,” but that now it’s the place to be seen.

If Clinton, Obama, or any other Democratic president owned a hotel in DC, and still owned it after being elected president, it would be a wall-to-wall scandal for weeks, if nor months or even years that would be constantly brought up to bludgeon them for such an obvious "crony capitalism" move that you'd find in a fictional banana republic.  I know there are folks out there who are old enough to remember Jimmy Carter's peanut farm, for example.

For Donald Trump, having foreign diplomats stay in his hotel in DC is not even in the top 10 awful things he's done this week.

The Gaslight Express, Con't

Another day, another article on "Why White Voters Abandoned The Dems" and the answer once again is "Black Lives Matter".

Many of the voters in Rust Belt states who cast ballots for President Barack Obama in 2012 flipped parties and paved the way for a Donald Trump victory in 2016 because they felt "betrayed" by Former Secretary of State Hillary Clinton. At least, that's the takeaway from Chris Clayton, agricultural policy reporter for DTN.

"I was a little surprised," Clayton tells NBC News' Chuck Todd in the latest edition of "1947: The Meet the Press podcast." "It wasn't so much that she lost the rural counties - that was expected, but it was by how much she lost the rural counties." 
Hillary Clinton failed to earn enough votes to rack up an Electoral College victory in states like Iowa and Wisconsin that Obama won. According to Clayton, that's because many rural voters felt threatened by the increased prominence of organizations like Black Lives Matter; a fear that was reinforced by conservative news sources on cable television and talk radio. 
"Some of the negative [news] about Trump that may have been coming from other places [in the media] - they didn't see it," Clayton says. "They were really focusing on the negativity on Hillary Clinton." 
Clinton struggled with rural women in particular who felt a "great disdain" for the former First Lady - and they felt disrespected by D.C.-based media organizations that might have perceived them as being uneducated. 
"A lot of farmers - they might not have college degrees, but they are very astute business people," Clayton says. "They have to understand so many things to run the business that they do. To be continually portrayed as not that smart became very offensive to a lot of people."

Make no mistake: Black America and in particular Black Lives Matter is being set up as the scapegoat for why Clinton lost, and it will be the first thing that Chuck Schumer and his merry crew in the Senate will jettison their support for going forward.

When that happens, Democrats are going to have a real problem on their hands, not an imagined one.

So What Actually Comes After Obamacare?

There are a lot of theories on what happens to replace Obamacare when Republicans eagerly kill it next year, but they know that they own whatever remains.  Still, that has an actual process too, and Vox's health care writer Sarah Kliff goes over the various proposals.

If there’s one thing Republicans have been clear about for the past six years, it is that the top of their agenda includes repealing Obamacare. 
But Obamacare repeal would leave an estimated 22 million Americans without coverage and wreak havoc on the individual insurance market. It’s becoming increasingly clear that Republicans can’t just repeal Obamacare — they need to replace it with something. 
It turns out Republicans have a lot of choices: There are at least seven different replacement plans that Republican legislators and conservative think tanks have offered in recent years. I’ve spent the past week reading them, and what I’ve learned is this: 
  • Yes, Republicans have replacement plans. It is true that the party has not coalesced around one plan — but there are real policy proposals coming from Republican legislators and conservative think tanks. There is a base that the party can work from in crafting a replacement plan.
  • There is significant variation in what the plans propose. On one end of the spectrum, you see plans from President-elect Donald Trump and Sen. Ted Cruz that would repeal Obamacare and replace it with virtually nothing. On the other end of the spectrum, there are plans from conservative think tanks that go as far as to keep the Affordable Care Act marketplaces and continue to give low-income Americans the most generous insurance subsidies.
  • If we can say one thing about most Republican plans, it is this: They are better for younger, healthy people and worse for older, sicker people. In general, conservative replacement plans offer less financial help to those who would use a lot of insurance. This will make their insurance subsidies significantly less expensive than Obamacare’s.
  • Economic analyses estimate that these plans reduce the number of Americans with insurance coverage. The actual amount varies significantly, from 3 million to 21 million, depending on which option Republicans pick. They will near certainly provide more coverage than Americans had before Obamacare, but also less than what exists currently under the health law.
I’ve spent the past week talking to authors of Republican replacement plans, economists who support them, and economists who oppose them. I’m focusing here on the two plans that are likeliest to be the most influential in the coming replacement debate: Better Way, from House Speaker Paul Ryan (R-WI), and the Patient CARE Act, from Sen. Orrin Hatch (R-UT), who chairs the Senate Finance Committee.

Kliff goes on to explain the differences in these multiple plans, but on the spectrum that the GOP has, it's only a question of how much worse the replacement will be than the current Affordable Care Act. Paul Ryan's plan would eliminate health care coverage for at least 18 million people, and Orrin Hatch's plan would cause anywhere from 4 to 9 million people to lose coverage.

Other plans are either better or worse than this, but again, it's only a question of how many people lose coverage and all the plans get rid of the ACA's medical bankruptcy protection.  Nearly all the plans get rid of covering pre-existing conditions in some way as well.

In other words, it's a question of how badly this goes, and how quickly it happens.  If you thought Obamacare was bad, all the Republican alternatives are going to be worse.

But emails, right?
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