Category Archives: Health Care

Rollouts R Rocky

There is one lesson from the first chapters of Genesis that should have significance for legislators struggling with the expansion of Medicaid in Virginia.

The story goes that God created Adam and Eve and put them in a marvelous garden, where they should have been happy. Yet these perfect people in the marvelous garden responded to the temptation to eat the one thing they were not supposed to consume. They finally ate the forbidden fruit and God had to tweak his plan for them. It was rather a violent tweak, but it is not my story to edit.

Whether you take the story of Adam and Eve as metaphor or just the fair and balanced factual report of what happened, you should notice that one of the first ideas written down in human history and Christian scripture was that rollouts are rocky.

So just expand Medicaid. Or pass the Senate bill – that is better than nothing, and much better than two more years of study. The template is there, the money is there, and you aren’t going to do any better than God did in the first rollout. It won’t be perfect, but people will be able to go to the doctor when they are sick, and doctors and hospitals will be able to get paid. And that will be a good thing.

Having the Adam and Eve story to draw upon, we can possibly do a little better with the inevitable tweaking.

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Medicaid extension is needed in Virginia

On January 15, Consumers Union Advocacy sent me an e-mail asking me to contact my Virginia legislators about the Medicaid expansion provided for in Obamacare. Virginia’s Governor Bob McDonnell has stated he will not support the extension. I sent the letters, but I did not hear from the Governor or from Senator Bill Carrico. But I did hear back from Delegate Israel O’Quinn. He is concerned about the reliability of government, which I think is odd given that he is government. For what it is, our e-mail exchange:
Sent: Tuesday, January 15, 2013 9:01 PM
To: Israel O’Quinn
Subject: Bring our health-care dollars home!

Jan 15, 2013

Delegate Israel O’Quinn
General Assembly Building, Room 818
910 Capitol Square
Richmond, VA 23219

Dear Delegate O’Quinn,

I’m worried our state will lose out on billions of dollars set aside in health reform to extend coverage to all low-income working people in our state,  leaving our health programs continuing to struggle and missing out on huge economic stimulus and job growth.

Don’t trade Virginia’s health for political advantage. The Affordable Care Act lets our state take back tax money we’ve sent to Washington to extend health coverage to our residents earning little or no income. Say “YES” to this funding, so we don’t leave billions of our tax dollars in Washington and threaten the existence of our hospitals, as they would lose money to cover uninsured patients.

Additionally, this new funding amounts to enormous economic stimulus in the state. With the Federal government fully funding the cost of new Medicaid recipients for three years and then covering 90 percent or more of the cost each year after, we can expect to see a resulting expansion of health-care jobs in the state.

In good times or bad, it is your task to do what is best for the Commonwealth. We are still a part of the United States. Please do not deny our citizens the benefits of being Americans. I live in the Southwest, and believe me, RAM Clinics do not constitute health care. We live in a real world where real people need real health care. Please do not let this opportunity pass us by because of partisan bickering.

As you make difficult decisions during the legislative session, I urge you to support an extension of Medicaid for all low-income working families and others struggling to afford health care. It’s the right thing to do for residents, and it’s the right thing for our state’s economy and hospitals.

Sincerely,

Mrs. Sarah Williams

On the 17th, Delegate O’Quinn responded:

Dear Sarah:

Thank you for your message regarding Medicaid expansion in Virginia.  I appreciate you reaching out to us.

I am particularly concerned with issues related to access to healthcare for rural Virginians.  I genuinely appreciate the job our healthcare professionals in SWVA perform, but our residents often have to travel many, many miles to access a primary care physician or a hospital.  Thus, access to healthcare is certainly one of my top priorities.

My primary concern with Medicaid expansion is three-fold.  First, I am concerned about what happens if the federal government cannot meet its obligation for the match money they have promised.  Second, I am concerned what happens if the match money runs out or is done away with and Virginia is left with the entire tab.  Finally, it is no secret that Medicaid needs to be reformed in Virginia and we need to see a serious effort to that end before any expansion can work properly.  Medicaid continues to eat up a larger portion of our budget each and every year and that is concerning to me.

That being said, I want Southwest Virginians to have the best possible healthcare and I will continue to work to that end.

I appreciate your message and thank you for sharing you views.  While this topic will not come through a committee on which I sit,  I will certainly keep your comments in mind as we proceed forward.

Kind Regards,
Delegate Israel O’Quinn
Fifth District

I appreciate the response from Delegate O’Quinn. But the expansion of Medicaid is funded by the federal government 100% for the first three years and would never cost Virginia more than 10%, with 90% funding by the federal government, so I think his concerns about cost are unfounded. And also, hey, 30,000 jobs in Virginia, money for our doctors and hospitals, and medical care for our low-income population. And I do not understand why we need to reform Medicaid and get it perfect before we can at least give people something. So I wanted to share these concerns:

Dear Delegate O’Quinn,

Thank you for the response, and I believe it is vitally important for the access to medical care in SWVA to be foremost in our minds in this matter. Like many others who have dealt with health care concerns, I know that good primary care reduces costs over the long term by preventing many critical situations from developing.

With regard to the federal government living up to its promise of funding, we all have votes. We need to vote for people in federal office who will keep the promises. We are not a poor nation, we are not broke, but we distribute our money unwisely in expenditures that could be more economically and humanely managed by reasonable discussion. The true foundation of good government is reason exercised among reasonable people who look at proofs and likely outcomes.

As this focus on what is reasonable affects Medicaid, the most needed reform to the program — getting medical care to people who do not have it — is being facilitated at this time by the federal government. We need to snap that up and run with it. What great good we could do in the field for doctors and patients, all while we work on the policy questions! It is in my mind like first putting out the fire and then getting the appraisers and electricians and architects in to see what you need to do to fix the faulty wiring. People who disagree with me on literally everything argue compellingly for accepting this money and doing the expansion, notably Arizona’s Jan Brewer in her decision to expand Medicaid in Arizona.

This is money for Virginia hospitals and doctors that will permit them to do what they are trained to do and what we know they want to do. To turn it down because of a distrust of government is unwise. We vote. We are not a despotic regime, either at the local, state, or federal levels. People voted their trust in you, and you have become the “government” because of that trust.  We do need this money and the medical care it will provide, particularly here in SWVA. Our doctors and hospitals need it. I love the doctors who do volunteer services at RAM clinics, but I don’t want to see them doing that. I want to see them able to take care of people as they should be cared for. We need better, and this federal program extends our grasp.

Thank you again for your thoughtful response. I look forward to seeing you again here in Bristol.

– Sarah

I still expect that Virginia will turn down the federal funding and continue to enjoy RAM Clinics. In Virginia, we are so tough we don’t need health care, free is too costly if it comes from President Obama, and we know that it is better to get that faulty wiring fixed before we put out the fire.

Why I am pro-choice

The most emotionally powerful fiction in politics today is that pro-choice is the opposite of pro-life. These positions are not opposites. They are different, but not on the same continuum.

Pro-life is a choice. Pro-choice advocates respect an individual woman’s decision to have her baby – even if she can’t afford it, if she is too young or too old, if it is her husband’s child or if she doesn’t know the father, even if it is the child of her rapist. A woman may choose to have a baby even if she needs fertility treatment in order to conceive. She may choose to have her baby even if doing so will end her career, stop her education plans, and insure her a life of hard work and low wages, and even if the child will live in poverty, subsidized by welfare and taxpayer-funded services. A woman may choose to have her baby even if it will damage her health or kill her, and even if the baby has severe problems that will insure fetal death or a short, painful, and difficult little life. Pro-life is a choice even when it is based on religion, because the woman makes the choice within her own religious and moral understanding. That no one should – or even could – force a religious choice on another person is not only a democratic principle, it is a New Testament Christian principle that a person must freely choose to follow Jesus.

Pro-choice on the other hand is not a choice. It is the assertion that each woman has a right to make her own reproductive choice because it is her body. Abortion in the first trimester is a reasonable choice – not a good choice, but often the least bad one – and an individual woman should have the freedom to make that choice. The pro-choice position protects a woman’s right to a safe abortion as well as her right to have her baby. In China a national effort to control population growth resulted in women being forced to have abortions under a restriction that permitted only one child to a family. Life is complex and unpredictable, as are nations and legislatures. The only good reproductive rights law that any legislature can enact is one that recognizes the complexity of women’s lives and circumstances, their humanity, their love of life and of children, their freely-chosen moral and religious understandings, and their right to choose when and if they will become a mother.

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Ken Cuccinelli now says that Obamacare is fine

Virginia’s Ken Cuccinelli, a major force in bringing the constitutionality question on PPACA Obamacare, is now fine with the decision by Justice Roberts. He states that he did not consider the legal position that Roberts put forward in preserving the law. In an interview with The Washington Post, he said “That was not one of the combinations that were even in our top five. That permutation was one that we didn’t spend a lot of time thinking was a likely outcome.”

Why he didn’t think of interpreting the mandate as a tax is not clear, given that many in the GOP were crying that it was a tax. Perhaps he did not consider this interpretation because, if he had, he would not have had a basis for a lawsuit. The good outcome for Cuccinelli in forcing a ridiculous lawsuit into the Supreme Court is that it made his name among the radical right. Without Cuccinelli, perhaps there would have been no constitutional challenge — Lots of money saved, lots of stress averted — but not nearly as many people would know his name. It is difficult not to think he used his public office for political advantage. Regardless of the outcome or the merits of his lawsuit, his opposition to Obamacare kept his name in the national headlines effectively for over a year as a champion of the opposition to President Obama’s signature health care bill. Virginia taxpayers could wish he had thought about that permutation before filing the lawsuit and saved all that expensive ruckus.

Origins and consequences

Virginia’s Delegate Israel O’Quinn responded to my letter:

Thanks for your message. I can tell you for certain that not a single piece of legislation I filed was influenced by ALEC or any other national legislative organization. The bills I filed, and will continue to file, come directly from constituents or are items of interest for our region and/or Commonwealth.

He responded also on the matter of the economic impact of abortion-related bills, stating that “normal operating practice” is that every bill receives an economic impact statement. He said, “I’m not sure how your suggestion would expand that particular practice, but it is certainly a question for Legislative Services as I am not quite sure of the answer.”

I appreciate Delegate O’Quinn’s thoughtful response, which demonstrates that he is listening to voters. I am seeking the economic impact statements for the abortion-related bills in the Virginia legislature, and will post a link when I have that information. Updated Wednesday, April 4, 2012.
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Open and responsive government that takes care of business efficiently is what we need, and a citizen’s understanding of origins and consequences of bills before they become law is critical to this goal. Legislators also need to know where ideas come from and what their predictable consequences might be.

I recently sent a few comments to Delegate O’Quinn regarding the State Corruption Risk Report Card for Virginia. He responded that he too was disappointed, pointed out the problems of perspective in the report, and stated that he was committed to more open and accessible government in Virginia. I have no reason to doubt his commitment, and I hope that he will honor that as this legislature goes forward. I offered two suggestions for improving openness and accessibility in my letter back to him, reproduced below:

Dear Delegate O’Quinn:

Thank you for your response. I too was disappointed with this report card in Virginia, and while I agree that electing judges is not good, I believe we should have non-partisan judges. Judges should be committed to the equal and non-partisan administration of the law.

In the past — I am 67, so I have a lot of past — elections were partisan, and after the election legislators worked on substantive questions of the Commonwealth like infrastructure and improving the lives of citizens. I have recently been disappointed to learn that over 50 of the bills introduced in Virginia — including virtually all of the pro-gun, anti-woman, and public education assault legislation — were written by ALEC, and not by any Virginian at all. What does this say about us, about the neglect of the responsibility to govern among our elected representatives? Can we no longer govern ourselves? Are we enslaved to people we do not even know are controlling us?

As to suggestions for how to make government more open and accessible, I would appreciate the tagging of each piece of legislation that has been influenced by ALEC and an attached description of the ALEC recommendation that influenced the law on your website.

In an associated matter, I cannot tell you how disappointed I am with the frivolous agenda of the Virginia legislature in the current session, so demeaning to women. In the light of modern science and medicine, our legislators brought the debates of the 1500’s to 1700’s back to the floor. These debates are based on religion and on a pre-scientific understanding that men constitute humanity and are the generative force in procreation while women are “instrumental,” contributing nothing. Surely we are not going to be asked to accept that we are men’s tools for reproducing themselves, and that we have no rights to our own bodies.

The ancient nation of Israel in the Old Testament had birth control, but they had a need to increase population. Maximizing procreation was a practical matter for them, and their rules for sexual behavior did exactly that. The rules that were practical in their time are contrary to good sense for us. Neither the economy or the biosphere can sustain maximum procreation here and now. And making women primarily a means of reproduction by shaming, by limiting choices, or by limiting access to birth control is reprehensible.

It is even more onerous to understand women’s lives in this way when the rules you have made will affect only low-income to moderate-income women — wealthy women have always had access to safe abortions, and they always will have, law notwithstanding. If your daughter can afford two weeks abroad, she can go where the law is more sane and more humane, and return without the problem and without any record of ever having had the problem. Only poor and middle-income women are affected, and none of our families can afford to rear and educate 15 children.

As to suggestions for how to make legislation about reproduction more open and accessible, I would appreciate each piece of legislation regarding women’s reproductive rights to be accompanied by a published economic and environmental impact statement, showing 1) how it will impact the ability of young women to become self-sufficient and on their own economically, and 2) how it will impact the ability of parents to provide adequate medical care, living space, education, and recreation for their children, and eventually how the Commonwealth will generate jobs for a constantly booming population, maintain a safety net for those who are disabled or who become disabled, and care for them as they reach retirement age.

Thank you again for your response, and for the opportunity to share my concerns and suggestions.

Sincerely,

– Sarah

Mitt Romney’s pledge

Pro-choice, multiple choice, or pro-life, Mitt Romney rejects a hyphenated title. He pledges instead “to preserve and protect a woman’s right to choose.” This is not a label or a reaction to any endorsement. He has not changed his mind, and he will not change it. Listen to his statement:

Open letter to Senator Mark Warner

Dear Senator Warner:

As the text of S. 1247, a bill to develop and recruit new, high-value jobs to the United States, to encourage the repatriation of jobs that have been off-shored to other countries, and for other purposes. comes available, I will follow it closely. This is an important issue, and attracting “new, high-value jobs to the United States” is a number one priority. I hope that your bill has considered the environment in which jobs grow, one in which:

  1. people have economic security — money — and can purchase goods and services,
  2. the infrastructure will bear the weight of the commerce, and
  3. there is a rich culture to enjoy and opportunity for children and families.

Recent downturns and responses to them based on cuts in spending have reduced all three of these aspects of our economic environment. Above all, it is the responsibility of government to maintain a culture in which people enjoy living and have opportunity. Our corporate welfare focus is foolish. We need to build infrastructure, take care of the health care mess once and for all by extending Medicare to everyone who wants to enroll and supporting Medicaid. We need to defend — and extend — Social Security and restore the retirement age to a reasonable 62, which would open up opportunity for young people. Older people who can scarcely keep up the pace are now locked into jobs they are no longer able to do by the necessity to keep employer medical insurance and the prospect of poverty with reduced Social Security. Let older Americans retire and spend their retirement accounts and Social Security on travel and support for their children and grandchildren — something other than medical care — and the economy will turn around.

I look forward to voting for you again and again as our Senator from Virginia, and I hope I will get to vote for you for President in the future. Please understand that I do not want to take away from business, but business does not thrive except in a dynamic culture that produces demand for goods and services. Money trickles up, not down, and we know this every time we pay our credit card payment. If we keep cutting off our most vulnerable and forcing our middle class into poverty by low wages, expensive education, rising food costs, rising energy costs, abusive credit practices, and tax incentives to wealthy private corporations we will not survive.

For an economy to thrive, some of the money that goes up needs to be forced back down to the bottom so that it can recirculate. The way to do this is to collect taxes from the people who use our labor force and our infrastructure and our consumer base to become wealthy. The wealthy are not the source of jobs, they are the result of many people working to get by and to have a few dollars extra to take the family to the beach once a year and to carry smart phones in their pockets. The working people are the source of jobs and the source of wealth because they both do the work and generate the demand for goods and services. Infusing money at the top and asking corporations for the favor of a few jobs is utterly ridiculous.

I hope that your new bill considers the workers in the United States when you are thinking about jobs, because if our workers are not healthy and hopeful and do not benefit from their work we will not have an economy no matter how much money we give to corporations.

I hope also that you will see this message. I know that you receive many letters, but this message is clear. In the United States today we are seriously talking about taking out the foundations of the economy and trying to sustain the wealth at the top by giving more money to wealthy people. This is a third world solution, and we can do better.