#30000 Will Wait No Matter What Happens Today in Helena

by William Skink

James Conner, at Flathead Memo, is one of the few people writing about the actual reality of Medicaid expansion in Montana. He should be commended. And Montana Democrats should listen.

As it stands, the online Twitter hashtag #70000cantwait has become disingenuous. Politicians using this hashtag should stop using it, because the reality makes the use of it deceitful. Regardless of what happens today, tens of thousands of Montanans will continue to wait, and over a hundred thousand Montanans will be essentially taxed to cover 45,000 of the 70,000. From the link:

The Senate’s version of SB-405 provides health insurance for up to 45,000 of the 70,000 or so thought to be eligible for expanded Medicaid. It also slaps a de facto two percent income tax on all Medicaid recipients, including the poorest of the poor. It’s a mean spirited, teach the poor a lesson, piece of legislation. See my 18 March and 19 March posts for more details.

I commend the determination of the legislators who blasted the bill out of committee. I condemn the legislation into which they breathed new life. It violates the principle of first, do no harm.

It’s easy to focus on the disgusting antics of the Tea Party over this issue. The last few days have shown just how hard these soulless ideologues are willing to work to hurt poor people and kill job creation in Montana. It’s been dumbfounding to watch how this has all played out.

That said, if SB-405 passes today—and that’s a big IF—the de facto tax will have as-of-yet unknown consequences for the poorest in our state. Those consequences can then be used down the line by conservatives as proof that the expansion wasn’t worth it in the first place. And the half that won’t be covered, along with the 160,000+ people who will be taxed, will mean roughly 200,000 Montanans will be left behind and/or adversely affected by this “compromise” that Conner explains isn’t really a compromise at all.

Is it worth it?

While some Democrats are enjoying the media attention and retweeting accolades, health workers and social service providers should prepare for 2 more years of exacerbated struggle. I fear the situation on the ground won’t noticeably improve, and in some instances, may even worsen. 2% may not sound like a big number to most people, but for those barely hanging on, it could be hugely significant.

Knowing this reality, it’s difficult to be optimistic about the value of winning this political fight. I guess time will tell.

  1. steve kelly

    Another solution is always available in these situations: Let the people decide. The legislature could put the 70,000 option, or some more “universal” low-income option, on the general election ballot.

  2. So coal development doesn’t create jobs neither does pipelines or oil and gas development but Medicare expansion does?

    Reservation members get free health care and yet they’re the highest unemployment regions in our state.

    • lizard19

      your brain is clearly occupied territory.

    • JC

      You do realize the only reason we have carbon production-based jobs in Montana is because of federal subsidies and speculator loans? Oh yeah, I forgot that the speculators have left the Bakken and it is in a bust cycle now, waiting for a bailout from the feds and state. Unemployment is soaring.

      And you do realize that “Medicare expansion” will do nothing for the rez, as tribal members get shuffled on to the IHS first, not on to Medicaid? If you think Medicaid is bad healthcare, then you haven’t looked at the IHS.

      Playing loose and fancy-free with facts again today, Swede. your meme-fabricators must be working overtime, and laughing all the way to bank.

      • I remember all of you decrying the increase of crime associated with oil production. Having it both ways?

        Still the question remains. How does free health care increase job creation like Liz mentioned above?

        • JC

          What health care are you referring to as “free?” That health care we’re giving to legislators while they do the people’s company’s business?

          • Are our legislators given free health care? News to me.

            By the way is the avoidance of my questions a progressive trait?

            • JC

              Actually, with all of the drug addicts and alcoholics loosing their jobs in the Bakken, the crimes they commit will just be transported back to their communities of origin. Crime may go down in the Bakken, but it will rise in Billings.

              And legislators work for 90 days every other year. For that, they get two years’ health insurance, and a lot of other perks. That’s a free ride if ask me. From the Flathead Beacon:

              “Being a Montana legislator is part-time job. In fact, most legislators have other jobs. They work for the state 90 days every two years, in addition to interim committee meetings and possibly during a special session if one is called. They receive $82.64 per “legislative day” and about $110 per diem for every day they work. They also receive $887 per month for insurance, whether they work in that month or not.

              Even though they only work part time, legislators are eligible for the same benefits as full-time state employees. It’s a really good deal … at taxpayers’ expense. Each legislator receives a little over $10,000 a year for health insurance no matter how much they actually work. In addition, if they don’t want join the state plan, they can take that monthly amount and have it applied to an insurance policy of their choice.”

              Taxpayer-funded leeches, if you ask me.

              • Least they’re working. And the state receives part of their salaries back in taxes since most of them work or farm/ranch the remaining months.

                Does the HC bennie terminate when they leave office.

              • JC

                They work 90 days Swede for 2 years’ benefits. They work maybe a few more during off-session, if they are so inclined to “public service.” And why should working in their private lives allow them to continue to suck up public health care bennies?

              • On that we can agree. If you work you should get a HC benefit. If our legislators had to chip in more, weed out the deadbeats, write legislation that would encourage competition we’d all be better off.

            • JC

              Progressive trait? Hmmmm… you avoided answering my question to define “free health care.” The Medicaid bill in the Leg requires a premium, co-pays, and other out of pocket expenses. How is that “free?”

              Legislators, on the other hand, are given $887 dollars a month, whether they work or not, to purchase health insurance, or participate in the state plan. How is that not “free” for the majority of their term?

        • Under what conditions do you think it appropriate to deny health care to people, Swede?

          • Economic conditions mainly.

            Just an observation, do you see how I address questions directed at me?

          • Yes. You’re vague. “economic conditions” like what? Unemployment? Poor skills, low intelligence? Poor health? Birth defects?

            I’ll ask again in a different way: Which people should and should not have access to the health care system? I’m not asking about race or anything like that – just the general condition that you think should disqualify them.

            • Non access would include illegals, those refusing alcohol/drug treatment, the able bodied and perpetual welfare baby factories.

              Doctors/hospitals/staff should be allowed to write off services given freely to the poor and high risk HC Ins. could be purchased cross state lines without state interference.

              18T in debt should be a warning that we can’t afford additional services. Reduce the debt then add more benefits.

              • Fair enough. What about children of those refusing drug/alcohol treatment?

                Hospitals can “write off” services? Would they not go broke? Should they not be reimbursed?

                State lines: how do you answer the argument that cross-border insurance creates a rush to those states that mandate the least amount of coverage, creating an under-insurance problem?

                How do you answer the argument that countries with public systems have lower costs? Is that not a way to save money?

                How do you answer the question regarding debt owed the Federal Reserve via money creation – is it real debt?

              • JC

                Nobody is debating that debt is a problem, Swede. But where did that debt originate? And how much of the debt has been created by shifting public wealth (or future wealth redistribution through austerity programs) to the pockets of a small group of wealthy individuals?

                How much of the 18T debt (or smaller or larger depending on how you look at it) was created by the military-industrial complex in its hegemonic drive?

                And have you forgotten that the ACA was written so as to be deficit neutral? If you want to blame Obamacare for increasing federal deficits, then put up some real numbers.

  3. Write offs have limits. Religious organizations could take up the slack if permitted.

    State line under insurance didn’t happen with care ins..

    I’m not going to rehash public vs. private care unless you allow a third alternative comparison. Cash only with a catastrophic ins. rider.

    Debt is debt. Countries that have failed to repay debt have suffered economically.

    • Is religious orgs taking up slack also known as “hope?”

      Since you are aware of the under insurance problem, do you object if, in allowng yoru plan, we mandate minimum coverages?

      We have real systems, public and private in place, that can be compared. How do you compare real with hypothetical?

      When is it legitimate to write off debt? For instance, as JC says, the military ran up the deficit. Why should the health care system suffer because of that?

      • You of all people should know how efficient Catholic Charities can be.

        Ocare has min. demands, cancelled tons of existing plans.

        Study it. Give us 36-48 months to prove it works.

        Its a bitch being the world’s only super power. Most countries rely on us to provide the free flow of goods and services in some nasty places. That and being the world’s policeman. Many countries put what was once “protection money” into goodies.

        • Not a catholic. However, do you agree with the statement that “Hope is not a plan?”

          Are you possibly conflating Obamacare and public health care systems?

          So we are agreed that the military runs up our debt?

          • Hope is like smoking dope. Never asked about your current status just inferred your experiences.

            Ocare like public care set controls and parameters which often lead to inefficient ices.

            Of course the military runs up debt, but to the extent of 91.8 million out of the workforce? Lowest labor participation rate since 1978?

            • I see you are getting it From more than one direction. Just two more questions and I am done:

              A large portion of our country at any time has no regular income – these are children, stay-at-home parents, sick and disabled people, prisoners, and unemployed people. Are they included in our health care system? If so, who pays?

              You were vague again on Obamacare introducing inefficiencies into the system. I do not defend it, but can you be precise about the inefficiencies?

              • Charities pay, churches pay, Shriners pay, state and local govt. pay, Prisons (via state) pay, feds pay, Insurance cos. pay, go fund me pays, local fundraisers pay-my point is we should encourage and entice multiple payers whereas single payer makes it a crime to go outside the system and sometimes a crime to travel outside the respective country for health care matters.

                Ocare limits choices, so a plan that may have been more inefficient for you is not available. MT is one of the states which has experienced the largest increase in HC premiums. I swore off linking this post so I won’t refer to the graph I saw a few months back. Supplements allotted to low wage earners have lowered costs but working Montanans are feeling the brunt of these new rates.

                Then there’s the doctor choice issue. If you’re forced to change doctors after several years I can’t see where unfamiliarity breeds efficiency.

        • JC

          You do realize that one way to look at Catholic Hospital charity is that the money they use to subsidize charity care is “profit” from over charging insurers, the government, and cash customers?

          In essence, every dollar over cost that a Catholic hospital charges is a tax, some of which is redistributed to poorer people. Catholic (and other “nonprofit”) hospitals, by law, have to redistribute a percent of their profits to the communities they do business in.

          In this way, the state has relegated the business of redistribution away from the government to the church. I think that the secular among us would say that violates a basic tenet of separation of church and state. Why is it ok for the church to be the provider of last recourse (social safety net), instead of the state (which has a constitutional mandate to provide for the “general welfare” of the people)?

          Let the catholic church provide care for catholics. For the irreligious among us, let a secular provider of health care reign.

  4. @JC. Creating disincentives to work does more to create a gap between the upper and lower classes.

    Ocare will never be d/neutral.

    Every pie chart I see of the US budget shows Military spending as a smaller piece.

    • JC

      Your charts would show overt military spending. Look at DHS spending, and other hidden spending for real numbers.

      As to disincentives, the greatest disincentive is the lack of jobs. Your buddies at Breitbart stated that almost 93 million Americans are not participate in the country’s workforce. Why don’t they participate? No jobs.

      Why are their no jobs? Because the current “stimulus” policies of the fed printing money to buy up bad debt is just feeding bubbles and creating artificial wealth for the rich, none of which is “trickling down.”

      What you call “disincentives” is what others call the social safety net. And the oligarchs refer to the social safety net as that which keeps the peasants from revolting.

      Obama put that last point very succinctly when he told a bunch of Wall Street bankers (shortly after being elected the first time) that he was the only thing standing between them and the pitchforks.

      Take away the social safety nets, and the proles will revolt, and all wealth left in the country will be fair game.

      Restructure the economy so that those 93 million have access to capital for investment, and opportunities to compete fairly against the entrenched monopolies and oligarchies, then maybe capitalism can be made to be a bit less regressive.

      As it is now, the whole thing is heading for an implosion. And that 18T in debt will be meaningless in a post-capitalist world in total, perpetual depression.

      • And regulation, particularly in the energy sector has nothing to do with it.

        Open fed lands, offshore, permit logging, permit pipelines, ship natural gas, rescind coal regs, ship coal, build railroads (not speed rail), and see just how many people we put back to work.

        To me these restriction have more of an effect than your nemesis bankers.

        • JC

          I’d never support the government investing in or deregulating carbon-based energy forms.

          In your world, job creation takes the form of cleaning up pipeline spills, containing and cleaning up oil rig blowouts, building dikes around sea level coastal towns, relocating whole parts of the country to higher lands.

          Invest in non-carbon based forms of energy and see what happens. If we were to be able to generate commercially viable electricity from fusion, the world would change in an instant. The petro wars and petri-dictors would be a thing of the past. Geopolitics would no longer revolve around energy, or maintaining global hegemonies to monopolize energy markets. Debates over climate change would end. Health care debates like the one we are having now wouldn’t be necessary.

          Would not an energy future revolving around fusion not solve the worst problems plaguing mankind right now?

          • That’s open for debate. Combine the lasting environment effects of a few pipeline breaks to the Fukushima debacle.

            Not that I’d wouldn’t be for more fusion or solar or wind, I just want it all. Where it makes sense economically.

            • JC

              Why don’t you compare the effects of Fukushima with the impacts of the tar sands on canada, and native canadians?

              And comparing the effects of fission nuclear production accidents with fusion is a no-brainer. Fusion generates helium out of hydrogen. It is way cleaner than any other potential fossil or nuclear energy source.

        • steve kelly

          Please Swede, without demand no amount of supply will create any additional jobs. Subsidies distort supply and demand balance, keeping price artificially low. Oversupply can do little to reverse weakening demand.

      • By the way JC we tried accessing capital to the unemployed and downtrodden thru the Community Reinvestment Act.

        How’d that work out?

        • JC

          CRA? That is just trying to regulate private banks.

          Think about this: take all the QE money the Fed gives to banks to speculate and build bubbles in the stock, commodity and debt markets. We gave away over $4T in a trickle down gamble that has failed.

          What could those 92 million people have done if they were given a public mechanism to invest that sort of money?

          You see an economic problem and want to solve it by throwing money at the rich. I see economic problems and want to solve it by giving the poor access to our country’s incredible pool of wealth. That’s called “opportunity.”

          And now what does our country have as a result of QE? $4T in bad assets. And an artificial asset bubble that when it bursts will make the housing bubble bursting in 2008 seem like child’s play.

      • And to bring this discussion full circle has the “social safety net” out paced your expectations on our reservations?

        • JC

          A Political History of the Indian Health Service

          “One of the few bright spots to emerge from the history of relations between American Indians and the federal government is the remarkable record of the Indian Health Service (IHS). The IHS has raised the health status of Indians to approximate that of most other Americans, a striking achievement in the light of the poverty and stark living conditions experienced by this population. The gains occurred in spite of chronically low funding and can be attributed to the combination of vision, stubbornness, and political savvy of the agency’s physician directors and the support of a handful of tribal leaders and powerful allies in the Congress and the White House. Despite the agency’s imperfections and the sizeable health problems that still exist among American Indians and Alaskan Natives, the IHS is an example of one federal program that has worked.”

          My expectations of the obligations of the U.S. Government to the “social safety net” on the rez are far too voluminous to expound on here. Let me just paraphrase Micky Pablo at the ceremony for the 140th anniversary of the signing of the Hellgate treaty. Micky gets up to the podium, and holds the audience of hundreds of mixed tribal and non tribal attendees in his gaze, and opens with a joke in his deep booming voice:

          Q. What did native americans call this land before the white man came?

          A. OURS!

          Silence from some, laughter from others… then he went on to tell about the importance of treaties to the tribes, and their history.

          Manifest Destiny and the Monroe Doctrine will come full circle one day for “‘mericans.”

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