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Ralph Northam pushes for Medicaid expansion in Virginia

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ashbird

@jouris, Thanks for both replies. My Reply button doesn’t work. Here's just to acknowledge their receipt and to say Thanks. In terms of being human, certainly we all make mistakes. Reagan had the maturity - you might say it was political foresight, either case or both, better to be like that or not - to stand up and say "I was wrong”, in front of millions of his allies and foes, albeit some of the wrongs could have been avoided had he been able to read faster and digest faster what he read (the point is he did read more than one book - the Holy one, and he was aware of more than one Amendment (the 2rd) in the US Constitution, not a deliberate/willful, or pretend deliberate/willful repugnant fool (this is a a malinger’s well-wrought trick - to feign mental incapacity so he could get away with murder, literally) . He was also natively smart enough not to hold himself hostage to an inflated ego or delusion of unprecedented "greatness". There is no character trait more self-defeating than this one. But our present administration under a leader like that indulges in it. Recall I said to you roughly a year ago we (the nation) were a long way from hitting bottom, and it is only until an "addict" hits bottom that change can be effectuated. America can be likened to an addict right now, looking for a "quick fix" for a self-inflicted (I would say half-imagined too) wound, and Trump is the "Fix" because he said he can "fix anything" (remember his campaign "promises"? It is noted the inauguration still is not the largest "in history", and he still hasn't disclosed his taxes." -> "I will disclose them when the Election is over."
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Yes, of course prevention is much much cheaper than treatment when a medical condition, once set, grows potentially to a monster pproblem. Medical care is expensive, extremely so, in America (that's a separate problem belonging to a separate fact-finding investigation) . In terms of the perspective of World Health, the concern of WHO and America’s own excellent Public Health Agency CDC (Center for Disease Control, excellent in terms of research and work in disease prevention), any endemic can potentially become a pandemic if not arrested early (and no border “wall” or military guards can stop the spreading of infectious diseases." But some people need to experience a fire literally burning their eyelashes before they will admit there is a fire. Nothing we can do except not be one of them.

Java Girl

Dear Economist,
When my friend, who was a full-tine student and a widow who suddenly found herself without insurance in Virginia when her husband died, tried to get Medicaid because she didn't qualify for the lower limits of Affordable Care (which is a misnomer since people who earn under the lower limit of the ACA, alias, Obamacare, cannot get coverage through ACA), she was told she had to be at least 65 years old to qualify for Medicaid in Virginia. She finally decided she would risk qualifying for Obamacare this year, but as for me, I still do not qualify since I am stll a full-time graduate student and have not been able to get health insurance that is less than $565 a month since I have been in grad school (studying Govt. & Law) since 2015, when Obamacare forced my insurer (Blue Cross/Blue Shield to drop my low-cost policy--$49 a month--that covered doctor visits and dianostics as well as urgent care). Obviously, if I earned less than $11,000 (the lower limit) last year and in each of the prior 4 years because I was a full-time graduate student, I could not qualify for ACA coverage (because I am pushed into the 'Medicaid' coverage level but do not qualify for that either in Virginia since I am under age 65 that is according to what my friend was told when she applied). However, since my friend told me that she was told that she had to be at least 65 to get Medicaid, this seemed like it had to be a misunderstanding since Medicare applies to those who are just a little older than 65. Why would that be the case? At any rate, I have been without any coverage for 4 years through no fault of my own since I am not able to work at al full-time job with benefits while going to law school.
Now, I have this question: What are those trying to get higher education to improve their situations to do because our politicians are fighting to keep out those who have no other option? If something like an accident happens to me, I will not be able to get treatment. I have to pay cash when I visit an eye dr. , for instance, or for urgent care. This has depleted me of funds I needed to live on to make it through grad school so that I can contribute to our society. There is no other option unless I go to a different university in a different state and I can't do that now. None of these so-called 'representatives' have to go without, nor their family members. It's time we got some true realists (real representatives) who understand the dilemma they are putting people, like my friend who is a widow, and like myself, still a full-time student here in Virginia. This is unacceptable treatment of US citizens who are trying their best to get ahead and then contribute to our society once we graduate. Come on, we are no slackers who want to live off the state forever. We just want to go on living while we are grad students in Virginia so we can get through grad school. Don't worry, we pay our university a lot here, so we are contributing to this state one way or another.

ashbird

Great post, @jouris.
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PS: I wasn't around to vote in the era of Ronald Reagan, governor or president. Watching old newsreels about the person, he was rather amiable, not taken to vulgarity, and it was said he read voraciously when he was in the White House, knowing he was a bit "deficient" in the department of leading a nation, and that leading America is not a TV show. And, of course, he was devoted to Nancy.

jouris in reply to ashbird

All true. But I think the absolute most critical way that he differed from what we see today is this: he wasn't afraid to learn from experience. And to be seen to have done so.
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He tried tax cuts, having been assured that the economy would pick up enough to end us up with an increase in Federal tax revenue. Didn't work. So Reagan up and increased taxes, to get revenue back up. A half dozen times! It required him to stand up and say "I was wrong." Picture Trump doing something like that. Ha!

ashbird

Perhaps a smidgeon of real life numbers and stats will serve to provide some background and context for an informed discussion on the subject, Left, Right, Conservative or Liberal.
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What MediAid is, who qualifies, are explained in details on the government’s (Fed and each state) website.
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According to Center of MediCare and MediAid services (CMS), Medicaid payments currently assist nearly 60 percent of all nursing home residents and about 37 percent of all childbirths in the United States. The federal government pays on average 57 percent of Medicaid expenses.
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Loss of income and medical insurance coverage during the 2008–2009 recession resulted in a substantial increase in Medicaid enrollment in 2009. Nine U.S. states showed an increase in enrollment of 15% or more, resulting in heavy pressure on state budgets. [Source: "Recession Drove Many to Medicaid Last Year" article by Kevin Sack in The New York Times September 30, 2010].
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The Kaiser Family Foundation reported that for 2013, Medicaid recipients were 40% white, 21% black, 25% hispanic, and 14% other races. [Source:
 Kaiser Family Foundation - Medicaid Enrollment by Race/Ethnicity for 2013-Retrieved January 13, 2018]
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With automation eliminating many traditionally blue-collar jobs, a trend not expected to reverse itself looking forward to the future, unless all of America wishes to go backward on the time line, this aspect of the country’s national healthcare is expected to face some steep challenges.
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Things as mundane as providing free vaccines for flu shots, pneumonia shots, whooping cough shots, for the particularly infirm and medically indigent (No they don’t give you Autism unless you are a Neo-Trumper). Oh! Just so there is no misconception or fear the rapists and robbers from down south and terrorists from MidEast are palming off free government benefits from CMS by living in bunkers below ground, Medicaid recipients must be U.S. citizens or legal permanent residents. There are additional eligibility requirements (again, info is all on CMS website). Poverty alone does not qualify someone for Medicaid.
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Many physicians do not accept Medicaid, the reasonable being the pay is pitifully small, so small they can’t allocate from it money to pay back the installments in their Med School Student Loan. A physician is not required by law to accept MediAid for services rendered. Many morally and ethically obliged. Some form their own practice groups to pool administrative expenses.
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The health on each continent on the surface of the Earth is of Global Concern. This is particularly true of infectious diseases. The transmission of some infectious diseases require physical contact, others, where the bacterium is air-borne (e.g. tuberculosis, the seasonal flu) require only breathing the same bacterium-ridden air).
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Margaret Chan* (*happens to be alumnus of same high school and friend), Director-General of World Health Organization (WHO), 2006-2017, said something about Global Health, the concern of WHO, which I thought makes sense:
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“Progress is not measured by national averages, but by how well the heath of the poor improves. If we miss the poor, we miss the point.” I add: Missing the poor also means the country can’t be that “great”. But of course, Americans can argue otherwise. It is a free country.
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jouris in reply to ashbird

Anyone who is even slightly familiar with medicine (not just you, but even folks like me with no medical background at all) is aware that prevention is vastly cheaper than dealing with problems after they happen. And that is, to an enormous extent, what Medicaid results in. Better care and cheaper care -- what's not to like?
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The only way slashing Medicaid makes financial sense (never mind medical or moral sense) is if you also require that emergency rooms leave anyone who can't pay to die on the street. Which (at least so far) the far right isn't willing to publicly advocate for.

jouris

Virginia Republicans might want to take a lesson for their compatriots in California. Moving ever further to the right in order to placate the base can be successful for winning nominations. But it is a solid lock to end you up holding no power in the state. Not the Governorship. Not the legislature.
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Even a conservative state (and remember, California is a state that elected Ronald Reagan Governor. Twice!) is not going to be willing to go as far as the extremes of the base demand. Either you educate them on how the real world works -- specifically that their views are simply not shared by a majority of the voting population. Or you figure out how to run the nominating process so that your party can nominate someone electable. The other alternative is irrelevance. Take your pick.

Hedgefundguy in reply to jouris

California has a different way of drawing districts than most states, correct?
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Kasich did an end run around the Ohio Legislature to expand Medicaid in Ohio.
John Kasich broke with the GOP on expanding Medicaid
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"There was one way around the legislature: the state’s Controlling Board, a seven-member panel created in 1917 and used to approve the spending of federal and state money."
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http://www.washingtonpost.com/sf/national/2016/01/05/deciderskasich
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There is a "bi-partisan" watered down redistricting proposal on Ohio's May primary ballot.
If it fails, the grass roots version will be on November's ballot.
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The inside story on Ohio’s redistricting deal
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"Three months later, the Fair Districts = Fair Elections coalition kicked off its effort for a 2018 ballot issue, and it eventually collected about 200,000 signatures. Some longtime reform advocates, such as Secretary of State Jon Husted, publicly suggested that Ohio’s congressional delegation should get behind a plan they could tolerate before they were forced to live with one they really didn’t like."
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http://www.dispatch.com/news/20180207/inside-story-on-ohios-redistrictin...
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NSFTL
Regards

jouris in reply to Hedgefundguy

California has a different way of drawing districts than most states, correct?
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Yup. We created (also by voter initiative) a non-partisan citizens' commission to do redistricting. And we have enough folks who are registered "independent" that it actually is non-partisan, rather than merely bipartisan. As a result, the number of safe districts (both state and Congressional) for either party are limited. There are still some, just because of the way voters are distributed, but nowhere near as many or as safe as there were before.
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When you fold in our top-two primary system, the incumbency edge has fallen substantially. It's still there, just nowhere near as big as it once was. (Now if only we could go back and eliminate term limits. They were an attempt to address legislators staying forever. But mostly what they have done is eliminate experience -- these days the folks most likely to understand how to get legislation done are lobbyists, simply because they are the only ones who stick around in the state capitol long enough.)