Baton Rouge, La., is about to lose a crucial hospital emergency room because the administration of Gov. Bobby Jindal (R) has refused to expand Medicaid under the Affordable Care Act, and won’t put up funds to keep the facility open, Michael Hiltzik noted at the Los Angeles Times (2/6).

The scheduled closure of the emergency room of Baton Rouge General Medical Center-Mid City means patients needing emergency treatment will have to travel as much as 30 minutes longer to reach the nearest ERs.

The ACA was designed to encourage states to expand Medicaid — almost entirely at federal expense — as a means of cutting the uncompensated medical care hospitals had been forced to provide for low-income individuals and families. Much of that care has been customarily delivered through the ER.

In the expectation that Medicaid would pick up the slack, the ACA reduced so-called disproportionate share hospital payments, which went to hospitals serving a large number of the uninsured. So institutions in states that have refused to expand Medicaid, like Louisiana, have faced a double-whammy — they still have to serve a large number of uninsured patients, but they have less money to do so.  

The ACA has reduced uncompensated care costs across the board — by $5.7 bln in fiscal 2014 compared with what they would have been otherwise, according to the Department of Health and Human Services. But most of that effect is seen in Medicaid expansion states. The crisis has continued for hospitals in non-Medicaid expanding states. The problem is so acute that the Tennessee Hospital Assn. offered to pick up the state’s cost of expansion. That wasn’t enough: Conservative Republicans who dominate the state legislature on (2/4) voted in a Senate committee to kill a compromise plan by Republican Gov. Bill Haslam (R) to expand Medicaid to cover more than 250,000 low-income uninsured adults.

In Baton Rouge, the Mid City ER, which recorded 45,000 patient visits last year, started facing a crisis in 2013, when it inherited the case load from the closure of LSU’s Earl K. Long Medical Center, which handled charity ER cases. According to the Baton Rouge Advocate, Mid City’s losses were projected to hit $25 mln to $30 mln this year. The Jindal administration last year stepped in with a promised infusion of $18 mln, but has withdrawn further support. Now the ER is set to close within two months.

Since the beginning of 2010, 48 rural hospitals, with more than 1,600 beds, have closed or stopped providing emergency services through January 2015, according to data from the North Carolina Rural Health Research Program.

Georgia alone has lost five rural hospitals since 2012, and at least six more are teetering on the brink of collapse, USA Today reported (11/12/14). 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 but the plan depended on expansion of Medicaid to cover the working poor who make less than 138% of the poverty level and don’t get health insurance from their jobs. When the Supreme Court in 2012 ruled that states could opt out of Medicaid expansion, even though it was paid almost entirely by the federal government, many Republican governors and legislative leaders took the opportunity to sabotage President Obama’s signature health care reform.

Critics say the ACA is also accelerating the demise of rural outposts that cater to many of society’s most vulnerable, because the law penalizes hospitals that have to re-admit patients soon after they’re released — which often include the sickest and poorest patients who are least aware of how to stay healthy, USA Today reported.

KOCHS BACK ATTACKS ON MEDICAID. The Koch brothers have made stopping Medicaid expansion under Obamacare a top priority for their state efforts. It worked in Tennessee, where the state’s chapter of Americans Prosperity backed the legislative effort to stop Gov. Bill Haslam’s effort to expand Medicaid to provide health care for 280,000 working-poor Tennesseans. The Kochs’ allies did it in Wyoming, too, where the state Senate (2/9) rejected a plan that Gov. Matt Mead (R) had been pushing. But not all states are as receptive to their interference, Joan McCarter noted at DailyKos.com (2/9). In Montana, a Koch road-show against Medicaid expansion was greeted by some well-informed and angry Montanans.

Americans for Prosperity has been having “Healthcare Town Hall” meetings around the state, trying to relive the glory days of August 2009 recess when they terrorized politicians and citizens alike with stories about death panels and the evils of affordable health insurance. They decided to have one in Kalispell targeting Rep. Frank Garner (R), who has refused to sign their pledge to vote against Medicaid expansion.

The Flathead Beacon reported (2/6) that Garner wasn’t invited, but he made the eight-hour round trip from Helena to attend the meeting and took umbrage with post cards that read, “Tell Frank Garner to stand with us and vote no on ObamaCare’s expansion in Montana.”

Garner’s presence had a chilling effect on the AFP presentation, which was frequently derailed by laughter, booing and shouting from audience members who overwhelmingly expressed support for Garner, Tristan Scott reported in the Beacon.

“I promised the people here when I ran that I would listen to you and not out-of-town special interests,” Garner said to raucous applause. “If every time they want me to sign a pledge card and I don’t do it they are going to rent a room and have a meeting, then this is going to get real expensive. Cause I’m not signing the pledge card.”

Any sense of order the meeting maintained at the beginning broke down toward its end, with audience members shouting questions and accusations, interrupting AFP State Director Zach Lahn and defending Garner, Scott reported.

“You have pissed me off,” one man told Lahn. “Character assassination does not go down well in Montana. If he has to take a pledge then I want it to be the Pledge of Allegiance, because they don’t represent you, they represent me.”

EMPLOYED WHITE SOUTHERNERS MOST AT RISK IN O’CARE CHALLENGE. If the US Supreme Court accepts the right-wing argument in the King v. Burwell lawsuit that a typographical error is grounds to strike down tax credits for people buying health insurance on federal exchanges, about 8.2 mln Americans in 34 states could lose their coverage under the Affordable Care Act. Most of the people likely to be affected are white, employed, and low- to middle-class. They also are concentrated in a single region of the country: the South, Michael Ollove noted at Stateline (2/10).

Health insurance rates in those states are expected to rise by as much as 35%, which may make coverage unaffordable even for those who don’t qualify for tax credits. Some believe that if the tax credits are disallowed by the Supreme Court, the underpinnings of President Barack Obama’s signature health care law would collapse.

“Estimates of insurance rates are highly speculative given the many moving parts of the system that affect costs and premiums. But still: that’s a lot of impact, with a lot of it clearly concentrated in the white working class voters of red states,” Ed Kilgore noted at WashingtonMonthly.com. “Maybe Republicans can convince these folk to blame it all on Obama, but they’d better lie convincingly.”

However, Ian Millhiser noted at ThinkProgress.org (2/10) that the plaintiffs may fail to satisfy one of the most basic tests of a lawsuit: that the plaintiffs are hurt by the action at issue. The Competitive Enterprise Institute found four plaintiffs, but reporting by the Wall Street Journal and Mother Jones, however, indicate that the plaintiffs in King are not actually injured.

According to a declaration filed by a senior official in the Department of Health and Human Services, two of the four plaintiffs are exempt from the consequences of not buying health insurance regardless of whether they receive a tax credit, because the cost of the cheapest plan will exceed 8% of their income even if they do receive a tax credit, which would make them exempt from the penalty for not buying insurance. Additionally, while plaintiff Brenda Levy projected that she would earn as much as $43,000 in 2014, reporting by the Wall Street Journal suggests that her income may actually be “less than $10,000.” If her income is that low, she would also be exempt from the law’s consequences for people who do not buy health insurance. That leaves one more plaintiff, Douglas Hurst, a veteran who may be entitled to enroll in a veterans health plan, which would take care of the insurance requirement.

GOP HEALTH PLAN—SAME OLD SAME OLD. After six years of complaining about the Affordable Care Act, Republican leaders announced that they were finally ready to get serious about crafting a health care plan of their own.

“To significant fanfare, Senate Intelligence Committee Chairman Richard Burr (R-N.C.), Senate Finance Committee Chairman Orrin Hatch (R-Utah), and House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) announced last week they had a ‘new’ health care plan they were each proud to present. And while they received the headlines they wanted, Dana Milbank reported in the Washington Post that the eagle-eyed press secretary for Democrats on the House Ways and Means Committee noticed that the Republicans had lifted the thing — right down to quotes in the news release — from the rollout of the same proposal a year earlier.

“In other words,” Steve Benen noted at MaddowBlog.com (2/9) “the GOP lawmakers couldn’t be bothered to come up with a more credible policy solution — and they couldn’t be bothered to write a fresh press release while touting their ‘new’ plan.”

The Center on Budget and Policy Priorities noted the plan would:

• Result in millions of people losing their existing coverage through the marketplaces and Medicaid by repealing all of health reform’s coverage expansions;

• Make coverage unaffordable for substantial numbers of low- and middle-income individuals through changes that would significantly raise their premiums, deductibles, and co-payments, likely adding millions of people to the ranks of the uninsured and underinsured;

• Eliminate or significantly weaken health reform’s consumer protections and market reforms, especially for people aged 50-64 and many people with pre-existing health conditions, thereby placing 50-64 year-olds with modest incomes and people with serious medical conditions at risk of facing high insurance premiums they may not be able to afford;

• Leave states with shortfalls in federal Medicaid funding that could cause many poor beneficiaries to become uninsured or underinsured over time; and

• Jeopardize employer-based coverage for some people who work at firms with fewer than 100 employees.

There is no Congressional Budget Office score on the Burr/Hatch/Upton report, and there probably won’t be, Benen noted, because the sponsors almost certainly don’t want to hear what the CBO would have to say.

“So why should you care? Because this woeful package is emblematic of the Republicans’ broader dilemma: they can’t get health care reform right because they don’t want to make the kind of choices necessary to create a sound system.”

WHO WOULD TRUST REPUBLICANS WITH THE ECONOMY AGAIN? Kevin Hassett, a conservative economist who has advised GOP presidential nominees John McCain and Mitt Romney, explained to the Washington Post (2/6) what the Democratic message will be in 2016: “When Hillary Clinton runs, she’s going to say, ‘The Republicans gave us a crappy economy twice, and we fixed it twice. Why would you ever trust them again?’”

Hassett added, “The objective for the people in the Republican Party who want to defeat her is to come up with a story about what’s not great” in this recovery, especially wage growth, he said.

Ed Kilgore noted at WashingtonMonthly.com (2/10), “Wow, no kidding, Hillary Clinton should say that. It would almost fit on a bumper sticker, and with a few photos would make killer text for a 30-second ad.”

HALF OF AMERICA IS STILL BROKE. The US economy is on a tear, as third-quarter economic growth was the strongest in 11 years, and the stock market is up 10% for the year, but Paul Bucheit noted at CommonDreams.org (2/9) that, despite the jubilant headlines, “Half of our nation, by all reasonable estimates of human need, is in poverty.” Examples he cited:

• More than half of householders have no money for unexpected bills. A recent Bankrate poll found that almost two-thirds of Americans didn’t have savings to cover a $500 repair bill. A Pew survey found that over half of US households have less than one month’s income in readily available savings, and all their savings, including retirement funds, amounted to only about four months of income.

• Between 2007 and 2013, median wealth dropped 40%, leaving the poorest half with negative wealth (because of debt).

• The cost of living has surged as income has fallen. Food costs have doubled since 1978, housing has more than tripled and college tuition is 11 times higher. The cost of raising a child increased 40% between 2000 and 2010. But median household income has been going down since 2000, as 95% of the post-recession income gains have gone to the richest 1%.

• According to the Federal Reserve Bank, there have been job gains at the highest paid level — engineering, finance, computer analysis; and there have been job gains at the lowest paid level — personal health care, retail, and food preparation.  But the jobs that kept the middle class out of poverty — education, construction, social services, transportation, administration — have seen a  decline since the recession, especially in the Northeast. At a national level jobs gained are paying 23% less than jobs lost.

Finally, over half of public school students are poor enough to qualify for lunch subsidies. There’s been a stunning 70% increase since the recession in the number of children on food stamps. State of Working America reported that almost half of black children under the age of 6 are living in poverty.

OBAMA READIES HIS VETO PEN. On the eve of our press run, the House passed a bill (2/11) ordering approval of the controversial Keystone XL pipeline, which would carry Canadian tar sands oil to Port Arthur, Texas, to be refined and exported, with little economic gain for the US to counter the risk of environmental damage. The vote was 270-152, as 29 Dems voted for it and one Republican voted against. It’s the same bill passed 62-36 by Senate and it is headed for a presidential veto, Meteor Blades noted, adding that there aren’t enough votes in either chamber to override that veto.

STEIN MULLS ANOTHER GREEN RUN FOR PREZ. Dr. Jill Stein, a Massachusetts physician, announced (2/6) that she is considering making another race for president. At a news conference at the National Press Club in Washington, D.C., Stein said she is “testing the waters” and forming an exploratory committee to seek the Green Party nomination for President. She received 456,169 voters, for 0.36% of the total, in the 2012 election. See Jill2016.com.

POLS START LINING UP FOR 2016. If Dems want the House back anytime soon, they’ll need to unseat Repubs like Michigan’s Tim Walberg (R-Mich.) who David Nir at DailyKos.com (2/10) described as a “Club for Growth dystopian” who sits in a suburban district that Barack Obama narrowly won in 2008 (51-47) and lost in 2012 (51-48).

Democrats have landed a legitimate recruit in the battle to reclaim the House with two-term state Rep. Gretchen Driskell’s announcement (2/9) that she’d take on Walberg.

In 2012, Driskell knocked off a Republican incumbent in very swingy 52-47 Obama district, and prior to that, she served for over a decade as the mayor of Saline (pop. 8,810), Nir noted. “A race for Congress is a different beast altogether, but that’s why it’s good to see Driskell getting such an early start.”

Among potential Senate races, in California Republicans acknowledge that they only have a slim chance to flip the seat that Barbara Boxer is giving up, but state Assembly member Rocky Chavez seems to be emerging as a consensus pick, and the Los Angeles Times reports that he’s meeting with national party officials. “Chavez has a good profile as a Hispanic veteran, and the Senate race could at least set him up for something down the line,” Nir noted. Among the others mulling a bid is teabagging former Assembly member Tim Donnelly. Nir noted that Democrats would love to use the far-right Donnelly as a foil in downballot races, and he’d give his party a headache if he ran.

In Illinois, Democratic Rep. Robin Kelly says she’ll make a decision on a bid against GOP Sen. Mark Kirk by early June. Three other members of the House are also looking at bids: Bill Foster, Tammy Duckworth and Cheri Bustos. Kelly is the only one among that group who has run statewide before, losing 50-45 to Republican Dan Rutherford for treasurer in the GOP wave of 2010. In year-end financial reports, Kirk reported $2 mln cash on hand, while Duckworth and Foster reported $1 mln each, Bustos $135,000 and Kelly $122,000.

In Kansas, teabagger physician and social media aficionado Milton Wolf, who came fairly close to unseating Sen. Pat Roberts in last year’s Republican primary, is hinting that he might challenge Sen. Jerry Moran (R) in 2016 instead of going after Rep. Kevin Yoder (R). Wolf told the Kansas City Star that “[a]nybody who wants to step up and save our country would have much more opportunity to do that from the Senate than the House.” He also took aim at Moran for helping save Mississippi Sen. Thad Cochran during his primary runoff against challenger Chris McDaniel in 2014.

Though the final quarter of any even-numbered year is often a snoozy time for fundraising—after all, who wants to start raising money right when people feel so tapped out right after an election, particularly during the holidays?—Senate candidates don’t have the luxury of waiting around. Roll Call has compiled a chart of fourth quarter fundraising numbers for every incumbent senator up for re-election in 2016, as well as members of the House who are also considering bids (or at least have gotten Great Mentioner treatment). Among the laggards are Sens. John Boozman (R-Ark), with $268,000 in cash on hand (but no apparent challengers); James Lankford (R-Okla.), $323,000, with no immediate challengers; Mike Lee (R-Utah), $367,000, and no apparent challengers; David Vitter (R-La.) with $41,000 while Rep. John Fleming (R-La.) has $1 mln; Sen. Ron Johnson (R-Wis.) has $606,000, but Rep. Ron Kind (D-Wis.), who is considering a Senate race, has $1.46 mln in the bank.

In potential gubernatorial races, in Indiana, former Democratic US Rep. Baron Hill is considering running for governor in 2016. Hill said he’ll make a decision “probably in the spring, or no later than the summer.”

Republican Gov. Mike Pence is expected to decide if he’ll run for re-election or seek the White House around that time. Hill sounds ready to run against Pence, but he’ll almost certainly have a better shot if this is an open seat, Nir noted. Former state House Speaker and 2012 Democratic gubernatorial nominee John Gregg is also considering a bid, though he hasn’t been raising much money in preparation.

In Oregon, Democratic Gov. John Kitzhaber come under fire for work done by the first lady, Cylvia Hayes, as a political consultant on clean energy issues. The state’s largest newspaper, the Oregonian, in an editorial called on him to resign, but Nir noted, “Whether any conflict-of-interest laws were violated will probably need to be sorted out by the state’s ethics commission (and ultimately, the courts), not only because Hayes is continuing the career she had before Kitzhaber became governor, but also because Hayes and Kitzhaber aren’t married, and the legal question hinges on whether or not they’re considered a ‘household.’”

Kitzhaber has requested that state Attorney General Ellen Rosenblum (a fellow Democrat) begin an investigation. Meanwhile, two members of the campaign of Dennis Richardson, the Republican who lost to Kitzhaber in the 2014 election, have announced that they’ll begin the recall process, though any recall can’t begin in earnest until Kitzhaber has been in office for six months (meaning July). Even then, they’ll have a steep hill to climb, needing to collect 220,000 signatures in 90 days, which is 15% of all votes cast in the last gubernatorial election.

Richardson wouldn’t be able to immediately gain from the efforts, though; if Kitzhaber leaves office either due to resignation or recall, Secretary of State Kate Brown, also a Democrat, would become governor until a special election could be held in November of 2016.

KOCHS ALREADY HAVE RAISED $249M FOR POLITICAL TAKEOVER. At their retreat in southern California in late January, billionaire industrialists Charles and David Koch and 450 of their donor-allies announced plans to spend $889 mln over the next two years to influence state and federal elections and shape the national discourse. The money would go to bankrolling political activity, funding think tanks and academic research, and fueling grassroots organizing efforts around the country—all in support of the Kochs’ pro-business, free-market-centric ideology. That eye-popping, nine-figure goal made national headlines, but what wasn’t reported was that the Kochs and their allies were already well on their way to banking that huge amount of money. Andy Kroll reported at MotherJones.com (2/10) that donors at the Palm Springs confab pledged $249 million toward funding the Koch brothers’ grand plan, according to two sources with knowledge of the fundraising haul.

RAUNER ATTACKS ILLINOIS UNIONS. New Illinois Gov. Bruce Rauner (R) dramatically escalated his war against labor unions (2/10), issuing an executive order that allows public employees to opt out of paying “fair share” fees that support collective bargaining. The move threatens to further erode the power of the labor movement, which has been particularly embattled in its former Midwestern strongholds.

Rauner, a billionaire former private equity executive who ousted Democratic Gov. Pat Quinn in November, is pitching his executive order as a strike against coercion and corruption.

“Forced union dues are a critical cog in the corrupt bargain that is crushing taxpayers. Government union bargaining and government union political activity are inexorably linked,” Rauner said. “An employee who is forced to pay unfair share dues is being forced to fund political activity with which they disagree. That is a clear violation of First Amendment rights — and something that, as governor, I am duty-bound to correct.”

Under the theory that all who benefit from a contract should help pay the costs of collective bargaining, current law in Illinois states that while workers may choose not to join a union, they must pay fees to help fun collective bargaining and contract negotiations.

Rauner’s administration calculates that of 46,573 state workers covered by collective bargaining, 6,580 are not union members; they pay, on average, $577 in yearly fees.

Seeking to pre-empt a legal challenge to his order, Rauner retained former US Attorney Dan Webb of the white-shoe law firm Winston & Strawn to ask for a declaratory judgment in federal court that the fair share provisions are unconstitutional. The Supreme Court ruled last year that workers who are not “full-fledged public employees” can’t be forced to pay union fees; Rauner contends that the court’s decision supports his position.

In 1977, however, the Court affirmed mandatory fees, ruling that they were constitutional as long as they weren’t used to fund political activity, including lobbying and candidate contributions. Accordingly, public employee unions in Illinois do not use fair share fees to support political endeavors, despite Rauner’s suggestions to the contrary. A spokesman for AFSCME, the largest public employee union in the state, told the Chicago Sun-Times that AFSCME does “not include any fees for contributions related to the election or support of any candidate for political office.”

With Rauner at the helm, Illinois joins other Midwestern states that have been battlegrounds in fights over workers’ rights and union power in recent years. Wisconsin Gov. Scott Walker sounded a dramatic salvo in 2011 with his ultimately successful push to strip most public employees of collective bargaining rights. Ohio Gov. John Kasich signed a similar bill, although it was overturned by voters in a November 2011 referendum. The following year, Michigan Gov. Rick Snyder signed legislation making his state — once the backbone of the auto industry, powered by a vibrant labor movement — a right-to-work state.

Rauner’s anti-union campaign also occurs amid a grim national context for the labor movement. In 2014, the nationwide unionization rate dipped to 11.1%, from 11.3% in 2013. At midcentury, the rate stood at nearly 35%.

At 15.1%, Illinois’ unionization rate still outpaces the national average, and public employee unions show no sign that they’re willing to acquiesce to dispiriting nationwide trends. (Luke Brinker, Salon.com)

OIL WORKERS STRIKE EXPANDS. The United Steelworkers strike against the oil industry has expanded, as 1,400 workers at two BP oil refineries in Ohio and Indiana walked out (2/8), citing unfair labor practices and dangerous conditions, including leaks and explosions. They join nearly 4,000 workers who began striking (2/1), ThinkProgress reported (02/08):

The first nationwide strike by oil refinery workers since 1980, the addition of BP’s Whiting, Ind., refinery and the company’s joint-venture refinery with Husky Energy in Toledo, Ohio, brings the total number of plants with strikers to 11, accounting for 13% of total US oil refining capacity. The original strike included workers in California, Kentucky, Texas and Washington.

The USW called for the strike after talks broke down with Shell Oil, which is leading the industry-wide bargaining effort. It comes at an already tumultuous time as plummeting oil prices have given rise to a heated debate over the future of an industry that relies on extracting cheap and plentiful resources from the ground. This precipitous drop in crude oil prices by over 60% since June has caused companies to lay off workers and delay plans for expansion; what they see as the most painless means of avoiding profit cuts. The strike is not expected to impact gas prices.

USW International President Leo W. Gerard said the oil industry is long overdue in addressing many of the issues that directly impact workers’ health and safety.

“Management cannot continue to resist allowing workers a stronger voice on issues that could very well make the difference between life and death for too many of them,” said Gerard.

TENNESSEE WELFARE DRUG TESTS FIND 37 USERS. Less than one quarter of 1% of Tennesseeans who applied for public assistance flunked a drug test in the first six months of the state’s experiment with drug screenings for welfare recipients, according to recently released state figures.

Out of more than 16,000 applicants from the beginning of July through the end of 2014, just 37 tested positive for illegal drug use, or 0.23%. It contrasts sharply with the state’s overall 8% rate of drug use. Across the country, states that implement drug tests for low-income families have found that economically vulnerable people are less likely than the general population to use drugs. Utah spent $30,000 on tests that caught just 12 drug users, for a positive rate of 0.2% of total benefits recipients, compared to 6% of all state residents who use drugs. Before a judge ruled Florida’s drug testing system was illegal, it had turned up a drug use rate of just 2% among public assistance users, compared to 8% of its total population.

Twelve states have enacted laws requiring drug screening and testing of welfare applicants despite all the evidence and expert testimony against the practice. Texas lawmakers are hoping to start mandatory drug tests for the Temporary Assistance for Needy Families; their law would impose a three-strikes rule for drug testing, under which anyone who tested positive a third time would be permanently ineligible for the federal aid program. Maine is launching its own drug testing system for welfare early this year. Wisconsin Gov. Scott Walker (R) wants to drug test everyone who gets food stamps or jobless insurance money. Montana lawmakers have proposed a drug testing scheme this year, and El Paso County, CO has instituted a testing system. (Alan Pyke, ThinkProgress.org)

From The Progressive Populist, March 1, 2015


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