Archive for the ‘Affordable Care Act’ Category


I’m having a hard time letting this one go. After Liz’s recent post on the seeming opening up of the Missoulian’s editorial page to some forward-thinking words about beginning a community dialog on mental illness, now we have outright lies and opinion masquerading as fact to continue that discussion.

I guess a bone tossed to the left deserves a bone tossed to the right, eh? Such be “balance” on the Missoulian’s editorial page. So what’s got me so ruffled? Well State Sen. Fred Thomas from down the Bitterroot seems to have been parroting some rightwing blather about Medicaid.

I get all of the outrage against Obamacare. I’ve railed against it since it became clear that Max Baucus was going to give us one of his uniquely dysfunctional American “solutions” to the lack of access to health insurance that the poor, the lower middle class, and those with preexisting conditions have.

But I’ve always maintained that through all of the ideology and desire for a workable single payer system, that Obamacare could be considered a good thing when people actually got some insurance that could help them get access to health care. To the degree that it had a positive effect on people’s health and lives, it might a good thing. We could sort out all the ideology and politics and disinformation later. I guess it’s time to let the sorting-out begin.

So when the Missoulian opened the discussion about mental illness, of course, one of the topics has to be the impact of expanding Medicaid to impoverished and homeless populations. But when Sen. Thomas wrote up his opinion piece tirade justifying the Montana Legislature’s denial of Obamacare’s Medicaid expansion using a bunch of lies instead of facts, well, I guess the Missoulian isn’t too concerned about fact-checking it’s “dialog” about mental illness.

Sen. Thomas goes off in two main directions justifying his and the Legislature’s actions: 1) using a study of Oregon’s recent Medicaid expansion and 2) the budgetary impact on Montana State’s fiscal status. I’m not going to get into the debate over the scientific study, as that is well trodden territory (dkos and wonkblog have both taken it on, as have right wingers).

There’s much to debate about Medicaid and how it could be improved, but there is no debate about the difference between being poor and not having any health insurance or Medicaid, or having Medicaid. Any who would suggest that poor people are better off without having some form of access to health care via either Medicaid or private insurance are just pissin’ in the wind.

Suffice it to say that the study’s positive findings (i.e. decreased incidence and severity of depression in those who were newly enrolled in Medicaid for 2 years) have a great impact on the mental illness conversation. If the study would have looked at other forms of mental illness, I’m sure it would have found that a poor and/or homeless person who had mental illness that received Medicaid coverage would have better outcomes, and decreased incidence of symptoms.

Afterall, if you are bipolar or schizophrenic, and living under a bridge not only will you not get diagnosed, you wouldn’t be able to pay for your meds anyways, and get ongoing treatment (and no, Partnership Health in Missoula County does not offer any form of robust mental health services for free, nor does a short stint in the Providence Center’s Mental Health Unit provide comprehensive ongoing care for those without insurance or Medicaid).

Untreated mental illness is one of the largest contributors to both addiction and homelessness in our communities. To the degree that poor individuals with mental illness and/or addiction get meaningful access to either health insurance or Medicaid, they can get treatment that will begin to lessen their burden on our community and their families and they can start contributing to society.

But it’s the point that Sen. Thomas made about the Medicaid expansion’s funding under Obamacare that is such a blatant lie. Here’s what he had to say:

Potentially a far larger problem with the Obamacare Medicaid expansion was the hole it would blow in our balanced budget. Currently the revenue of the state of Montana is estimated to grow by $318.8 million from the current biennium to the next. So we expect to have $318.8 million more in 2014-15 than 2012-13. This is what provided the revenue to increase our local school K-12 funding, university system and health and human service programs.

The Obamacare Medicaid expansion is expected to cost $179.3 million in the biennium of 2018-19 and $281.7 million the next.

If we were to have expanded Medicaid, we would have committed up to 88 percent of the current revenue growth to this Medicaid expansion cost. That would have eliminated the funding increases we were able to provide for our local schools, university system and health and human services.”

What Sen. Thomas ignores is the FACT that when a state expands its Medicaid services to people under the poverty line (or 138% of poverty at the highest level), the federal government picks up the entire tab for 3 years, and during the period from 2014 – 2022 picks up a total of 93% of the cost. After 2022, the states will be responsible for only 10% of the cost of Medicaid.

So his argument against the State’s expansion of Medicaid largely rests on either an inability to understand the basic facts surrounding Medicaid expansion costs, or a desire to just use lies to justify his and the Legislature’s actions and ideological biases. Neither of which gives him the credibility necessary for the Missoulian to offer him a bunch of space to offer up a pack of lies.

It will be interesting to see how this “conversation” about mental illness and Medicaid plays out in the Missoulian, given that they have set up ground rules where opinion masquerades as fact, and the role of the media is to let a discussion as important as one about mental illness, poverty and homelessness be conducted in a fact-free environment.


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