GOP assault on health care in rural Nevada

There’s a tendency to see social needs as an element of urban living in major cities like New York City, Los Angeles and Chicago, and rural poverty as something that happens in Appalachia.  This perspective obfuscates two features of life in Nevada.  For all intents and purposes Nevada is an urban state.  Not only is Nevada “urban” it is getting more so.  In 1970 about 80.9% of Nevada residents lived in urban areas, in 1990 the percentage was 88.3, and as of 2010 the percentage was 94.2% [ISU.edu]

By contrast, New York state as of 2010 was 87.9% urban, and Illinois 88.5% urban, while Nevada is closer to California’s 95% urban population. [ISU.edu]  However, to perceive rural Nevada as a wonderland of “freedom” and rugged individualism is to miss some crucial figures describing life in the “cow counties.”

For example, Pershing County has an 18.3% poverty rate; the US poverty rate is 12.7% [census] but the county does support a critical care hospital with a skilled nursing facility  with a maximum capacity of 25 residents.  The county’s population also includes 11.1% disabled people under the age of 65.   Given these figures, perhaps some politicians would like to explain why slashing Medicaid now and all but eliminating the national program by 2027 would be a good idea for Pershing County, Nevada.

Neighboring Humboldt County has a lower poverty rate, at 9.4% and a lower rate of disabled individuals under the age of 65 at 8.3%, but reducing the Medicaid program would have a deleterious effect on its 53 bed hospital, with an ICU, Obstetric services, and skilled nursing facility for 30 residents.  What effect of cutting Medicaid might be seen in the county’s ability to care for its aging population, including its hospital’s plans to incorporate a “memory care services unit” in its offerings?  [hgh] Recall that some 60% of all skilled nursing home residents get their health insurance coverage from Medicaid.

More populous Elko County has a poverty rate of 9.9% and an 8.4% rate of individuals with disabilities under the age of 65.  The county is home to a short term acute care hospital with 59 beds, and a resident center for 110 people needing skilled nursing care.   Again, if 60% of those SNF residents rely on Medicaid for their insurance coverage then cutting funds in 2027 then 66 families will be under increased pressure to find suitable and appropriate care for elderly family members.

Now, consider that Nevada is an urban state, and that should the Republicans get their wish for a capped Medicaid system of block grants then the state would be tasked with allocating increasingly spare resources to maintain nursing home and hospital facilities statewide.  Given the 2.115 million people in Clark County contrasted with the 52,168 population of Elko County, the 6,650 in Pershing County, and the 16,842 in Humboldt County — where are the monetary resources likely to go?

If Congressman Mark Amodei (R-NV2) and Senator Dean Heller are truly representing the needs of rural Nevada, then offering platitudes about “freedom,” “free enterprise,” and “individual initiative” are a poor substitute for enacting legislation to maintain and improve the health care facilities and the insurance availability to those facilities for northern Nevada rural citizens.

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Filed under Amodei, Health Care, health insurance, Heller, Medicaid, Nevada politics, Politics

It’s not over until the fat lady sings adios to the current Congress

This is your Monday morning reminder that Republican attempts to kill the Affordable Care Act and Medicaid aren’t history.  The Graham-Cassidy Bill, which would mean a net loss of coverage for 243,000 Nevadans, still lives, and at long as it does so we have to keep those phone lines busy.

Please let Senator Heller know that his latest attempt to foist off a “Repeal and Replace” effort onto Nevadans is actually worse than his last performance on behalf of the Senate’s “skinny bill.”

“Graham-Cassidy’s impact on coverage in 2027 would be similar to that of the Obamacare Repeal Reconciliation Act (ORRA), the so-called “repeal and delay” bill that the Senate failed to pass in July. Under both the ORRA and Graham-Cassidy, these three major policies would be in effect a decade from now:

  • Repeal of the mandates for individuals to obtain health insurance coverage and large employers to offer insurance

  • Elimination of subsidies for nongroup health insurance

  • Elimination federal funding for the ACA’s Medicaid expansion” [CAP]

No individual or employer mandates to stabilize the insurance market, no assistance for those trying to find insurance in the private market, and the loss of Medicaid assistance for working Americans.  And, why all of this effort?

The Republican plan to lower taxes for those in the top 1% of American income earners won’t “add up” without cutting help for average Americans under the ACA and without pulling the rug out from under those (including retirement center residents and children) who are insured by Medicaid.

Senator Heller can be contacted at:  202-224-6244; 702-388-6605; and 775-686-5770

You may also want to thank Senator Catherine Cortez Masto for her support of Nevada families who rely on the ACA and Medicaid for their health care insurance needs.  202-224-3542; 702-388-5020, and 775-686-5750.

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Filed under Health Care, health insurance, Heller, Medicaid, Politics

Yes, It’s About Race Relations

No matter how much the current president and his supporters want to make #TakeAKnee about “the flag,” and “the military,” it’s not about those two sacrosanct topics — it is all about the tendency of white controlled police departments to shoot first and take questions later when an African American is shot and killed.

In 2017 there have been 721 individuals shot and killed by police officers.  Certainly, not all of these people have been black, and not all have been unarmed.  However, there’s another layer to these numbers: justification.  In several highly publicized incidents (witness Michael Brown, Tamir Rice, John Crawford III, Walter Scott) few officers have been held accountable for their actions; Walter Slager’s guilty plea in the Walter Scott case being a notable exception.  Philando Castile, was recorded in his dying moments, and yet the officer was acquitted on all counts.   It appears, and appearances are important in the cases, that all an officer must do is to testify that he or she feared for her safety.  Shoot first, and take questions later.

Police apologists cry “Blue Lives Matter,” and the more radical among them shout “All Lives Matter,” but then that’s the point of “Black Lives Matter;”  the slogan Black Lives Should Matter Just As Much As Any Other Lives is entirely too long to fit on a T-shirt.

And #TakeAKnee is about Black Lives Matter.  There’s an interesting thing about African American protests — by white lights there’s never been an appropriate way for them to protest.  When a crowd is predominantly white the media describes it as a protest as they did during the Women’s March, however when the crowd is predominantly black media contributors seem to be on edge waiting for the first rock or bottle to be thrown.  Some police departments, like the St. Louis PD, helpfully provide photos of the bottles they’ve collected and tweet the number of officers injured — no mention is made of the types of injuries incurred.

When the crowd is predominantly African American if they move then they must be blocking traffic, or impeding commerce.  If they don’t move (such as in a sit-in) then they must be an “unauthorized” gathering.  If they boycott businesses then media commentators often find it necessary to observe they “are hurting themselves.”  Only recently have cable news outlets invited non-white commentators to opine on the activities of black activists.   It’s encouraging to find at least a few broadcasts willing to engage commentators who do more than wag their heads and fingers at protests.

The entire idea of a protest is to gather attention, thus no one should be surprised when NFL players seek to capitalize on TV coverage of #TakeAKnee.  However, the current administration appears to believe that African American players and their allies should only do this on their “own time.”   Worse still is the willingness of the President to politicize and re-imagine the protests into a “counter culture” narrative.  The tweeter-in-chief decided at 3:44 am on September 24th that the #TakeAKnee protests were about “flag and country.”  And some of the commenters duly chimed in.   This technique has a long and rather sordid history.

People who protested Jim Crow laws were derided as Un-American, or as tools of the Communists, those who would desecrate the efforts of the military to defend our freedoms in World War II.  Those who protested the Vietnam War were also disparaged as “unpatriotic,” unworthy of the sacrifices made in the last great War.  The racist technique of choice in contemporary times is to conflate the “anti-racists” with the “anti-military” and the “anti-flag” elements of their imaginations, and first discount and then disparage efforts to improve life in America for all its citizens.

The flag is a very convenient icon, but that’s all it is, an icon.  Yes, it’s flown by those who fought in World War II, Vietnam, and in the Middle East; but it’s not the reason the veterans fought…not to defend The Flag, but to defend American values, their comrades in arms, and not least, the Constitution of the United States.   Perhaps this is the time to remember that President Dwight Eisenhower had another flag flying contingent march into Little Rock, Arkansas, with about a thousand members of the 101st Airborne to put down white inspired riots that Governor Faubus refused to control. Federal marshals assisted in the integration of the University of Mississippi, and the Alabama National Guard was employed by President Kennedy to integrate the University of Alabama.  Reverend Martin Luther King, Jr. marched to Montgomery under the protection of federalized National Guard units. [ChiTrib]

Yes, the flag flew over Okinawa and Normandy — but it also flew over Huntsville, Oxford, Little Rock, and Montgomery.  Those attempting to appropriate the flag to promote their own racial and political views would do well to remember the same flag flew to enforce civil rights laws and rulings.  And, racial view are important.

The current occupant of the White House has been quick to condemn any and all attacks by Muslims, both real and fake, however all but silent on the activities of white nationalists.  Remember when he tweeted about the death of Richard Collins III who was stabbed to death in a hate crime in Maryland?  I don’t either.  Recall when Timothy Caughman was killed by a white supremacist in New York City? I don’t remember a tweet-storm after that tragedy.  Then, there was a firebomb tossed into a mosque in Minnesota, a member of the administration described this as a fake attack.   And then there was Charlottesville.

Who on this earth, who sentient enough to recall that World War II was fought against Nazis and white supremacists in Europe, could possibly say there were “some fine people” marching near a Virginia synagogue in a replication of a Nazi torch parade?

So, whatever the Tweeter-In-Chief might have to say, the current #TakeAKnee protests aren’t about the flag — they are about a system that minimizes the accountability for the deaths of African Americans.  They aren’t about the U.S. Military — they are about policing systems and institutions that give every appearance of disparaging the lives and rights of those for whom the flags flew in Huntsville, Oxford, Little Rock, and Montgomery.

We can only hope the Tweeter-in-Chief gets the message from the National Football League this weekend.  However, I’m not holding my breath.

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Filed under media, Politics, racism

GOP: Poor Excuses and Paucity of Empathy

By all accounts the Graham-Cassidy+Heller version of health care destruction would yield a net coverage reduction for 243,000 Nevadans. Overall it would mean a 31% cut in Medicaid for children — that’s right — children.  There’s another 15% cut for services for people with disabilities.  And what’s the rationale for this atrocity?

(1) Because we promised!  This is probably the silliest reason to do anything ever.  I may have promised to offer someone a ride to go shopping, but if there’s a blizzard on the way then it’s downright stupid to “keep the promise.”

(2) Because Obamacare is failing!  And why would that be? Because Republicans refused to make some simple fixes (risk corridors, risk sharing, and reinsurance) and the individual health insurance is unstable.  It’s a classic case of tossing the baby out with the bathwater.  Or, of finding some perfectly “fixable” problems with a law and using those to rationalize pitching the entire thing.  Head UP: They’ll try this same approach with the financial sector reforms in the Dodd Frank Act.

And then there’s the part the Republicans aren’t talking about.

(3) Because they’ve wanted to get rid of Medicaid, Medicare, and to privatize Social Security from time out of mind.

This comment sums up the situation:

“The two keys to the Republican attitude are money and ideology. If you view the modern G.O.P. as basically a mechanism to protect the wealthy, Medicaid is an obvious target for the Party. The program caters to low- and middle-income people, and its recent expansion was financed partly by an increase in taxes on the richest households in the country.”

The concept can’t be articulated more simply or directly.

Then there are the sputtered talking points, common among Republican politicians and supporters to hike around the obvious but unspoken issues they have with the Affordable Care Act.

If we don’t pass this we’ll have socialized medicine.  Please.  Even Single Payer (or Medicare for all) isn’t socialized medicine.  Medicare insurance is used to pay PRIVATE providers for medical treatment.  This obviously isn’t a nationalized medical service plan.  Only by artificially conflating medical insurance with medical services can anyone assert that this is “socialism.”

There are no guarantees in life.  So if a family in Minnesota who has a child with muscular dystrophy may be required to pay higher premiums that’s the way the markets work.  It doesn’t get more morally bankrupt than this — especially since the current system does guarantee coverage for families with chronically ill children.

This issue is long past being a public policy issue, it has devolved into pure politics in which ‘points’ are scored by a party desperately hoping to cut taxes for its most generous donors at the cost of Americans’ health care.

So, every few weeks we’ll have to call our Senators to beg them not to destroy the Affordable Care Act and Medicaid for ourselves, our families, our friends, our neighbors, and our fellow citizens.

Call Senator Heller at his Las Vegas Office 702-388-6605; his Reno Office 775-686-5770; or his DC Office 202-224-6244. 

You may also want to call Senator Cortez-Masto to thank her for her support of health care access for Nevadans. 202-224-3542; 702-388-5020; 775-686-5750.

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Filed under Health Care, health insurance, Heller, nevada health, Nevada politics, Politics

It’s Official: GOP Hates Women — Scamcare Edition

In case there’s anyone left who thinks the Republican Party is representing the needs of women in this country, the contradiction is right in front of us in the form of the Graham-Cassidy+Heller (tagging along) bill.

Amy Friedrich-Karnik, senior federal policy adviser at the Center for Reproductive Rights, pointed to a statistic from progressive think tank the Century Foundation that estimates 13 million women will lose access to maternity care services if the ACA is repealed. Friedrich-Karnik explained that the bill also blocks Medicaid patients from using Planned Parenthood, which bars access to essential preventative care like birth control, cancer screenings, and STD testing and treatment. “It also slashes Medicaid overall and into the future, and so really impacting particularly low-income women and women of color who rely on Medicaid broadly for their health care,” she said. According to the Kaiser Health Network, Medicaid pays for nearly half of all births in America and covers family planning services for 13.5 million women. [Jez]

Not only is the bill a golf ball shot to the back of the head for Nevada women, it could cost the state some $250 million in funding:

Specifically, the proposal would eliminate the marketplace subsidies and federal dollars that states that chose to opt-in to Medicaid expansion under the ACA, like Nevada, currently receive, replacing them with block grants to be doled out to states, which would be left with the responsibility of deciding how to spend that money. It also converts almost the entire Medicaid program to a per capita cap, under which the federal government would set a limit on how much it reimburses states per enrollee, and allows states to waiver certain provisions from the ACA that require insurance companies to cover certain services and bars them from placing annual or lifetime caps on coverage. [NVInd]

Got that? Nevada gets a per capita cap, AND insurance corporations could refuse to cover pre-existing conditions, maternity care, family planning, women’s health care services, AND the corporations could revert to that wonderful old scam — the lifetime limit on coverage.  This isn’t as bad as the former “skinny” bill — it’s worse.

Senator Heller might have wanted to give this version some thought before he inked his name on the paperwork to co-sponsor the bill, but he didn’t.

It’s understandable that Nevadans are tiring of calling, writing, and sign making, but if Republicans are nothing else they are persistent.  They’re counting on public apathy, ignorance, and fatigue.  Not this time. Not on American health care. Not on our watch.

Senator Heller’s Washington DC office number is 202-224-6244.  Calls are tallied, and at some point the number of calls opposing this iteration of scam-care needs to impinge on the amount of money Republicans are counting on from the Koch Brothers and other right wing radicals.

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Filed under Health Care, health insurance, Heller, Medicaid, nevada health, Nevada politics, Politics

This Isn’t Normal And We Can’t Let It Be

In 1830 the United States had a total population of 12,806,702 spread among 24 states. New York City was our largest urban area with 202,589 people, Baltimore was second with 80,620. [Cen]  There was nothing about the American economy, which lurched from crisis to crisis during the 1830s, that would cause European powers to see the US as a power player:

“During this time, English traders could not collect on their sales in America, and many of them went bankrupt. Cotton mills closed in England, and American planters saw their markets disappear. By the summer of 1837, business was paralyzed, and it was not until the early 1840s that a semblance of confidence in business was restored.” [RU.edu]

We’re not, obviously, in the same category as we were 180 years ago, but we aren’t on the trajectory we were following a matter of months ago.   This, for Americans, isn’t normal.  Out of the economic and social debris of the American Civil War came an industrial nation,  fully prepared to compete with European nations, far ahead of some nations in terms of industrialization, financial markets (not that we were free from speculation and its results), and growing into importance as a world leader.  After booms and busts, periods of isolationism and nativism, and two world wars the US emerged as a super-power.  By 1953 President Dwight Eisenhower could say,”Whatever America hopes to bring to pass in the world must first come to pass in the heart of America.” [NA]

Former General Eisenhower had another line which should resonate with us today: “Now I think, speaking roughly, by leadership we mean the art of getting someone else to do something that you want done because he wants to do it, not because your position of power can compel him to do it, or your position of authority.”  [NA]

A Quick Review 

Other presidents following in this tradition sought to use American leadership in this manner.  President Kennedy’s foreign policy problems were legion, but he did manage to take a step towards arms control in the Limited Test Ban Treaty.  Lyndon Johnson’s presidency is associated with the Vietnam War, however during his tenure the US negotiated the Outer Space Treaty with the Soviet Union and the Nuclear Non-Proliferation Treaty.  President Nixon followed through with the SALT talks and the ABM Treaty.  President Gerald Ford signed the Helsinki Accords.  President Carter is remembered for the Camp David Accords. President Reagan changed the SALT formula to the START format: Strategic Arms Reduction Talks, and the tension evident in 1983 ended with Reagan’s trip to Moscow toward the end of his term in office. President George H.W. Bush managed to steer a steady course when relations with China threatened to implode over Chinese reactions to popular demonstrations, and his careful commentary in the wake of the collapse of the Soviet-era regime in Germany is said to have mitigated the reaction of hardliners in Eastern Europe.  President Bill Clinton pursued what he called his Policy of Enlargement, i.e. a policy based on promoting democracy and human rights abroad.  President George Bush’s foray into Iraq has encumbered the US with several foreign policy challenges, as did Clinton’s failure to deal assertively with Rwanda, however it would be remiss to omit Bush’s initiatives to deal with global HIV/AIDS programs and treatment.  The presidency of Barack Obama included negotiations concerning climate change (Paris Accords) and the limitations on the Iranian weapons program.

However mixed the policies and results of American world leadership since the Eisenhower Administration one aspect has remained fairly constant.  Every president has sought to get someone else to do what we want because they want to do it.  This was normal American foreign policy.  Until now.

America First America Alone

The first speech was a clear signal:

“President Trump’s speech Friday will go down as one of the shorter inaugural addresses, but it will also be remembered for its populist and often dark tone.“From this day forward,” Trump said at one point, “it’s going to be only America first. America first.” Trump appears to have first used the phrase last March in an interview with The New York Times when he denied he was an isolationist. “I’m not isolationist, but I am ‘America First,’” he said. “So I like the expression. I’m ‘America First.’” [Atlantic]

He appears to understand the dark origins of the America First movement, but adds a transactional element to the implied isolationism:

“Not isolationist, but I am America First,” he said. “I like the expression.” He said he was willing to reconsider traditional American alliances if partners were not willing to pay, in cash or troop commitments, for the presence of American forces around the world. “We will not be ripped off anymore,” he said.”[NYT]

He may like the expression, but it is irrevocably associated with the infamous Lindbergh Speech delivered on September 11, 1941:

“The three most important groups who have been pressing this country toward war are the British, the Jewish and the Roosevelt administration.  Behind these groups, but of lesser importance, are a number of capitalists, Anglophiles, and intellectuals who believe that the future of mankind depends upon the domination of the British empire. Add to these the Communistic groups who were opposed to intervention until a few weeks ago, and I believe I have named the major war agitators in this country.”

Putting America First, Lindbergh rushed past the fact that the British were  blitzed in the Summer and Fall of 1940, and the Jews were the subject of Nazi genocide.  His rationale was that neither the British nor the Jews were “American” and therefore they were promoting their interests at the expense of American interests.  At the time Lindbergh delivered his speech in Des Moines the British weren’t fighting for their empire — they were fighting for their existence; and, the Jews were fighting for their lives.  Given this context, the expression “America First” should have been assigned to the great trash heap of really bad phrases, however in Trumpian terms it’s a banner to be waved in front of our adversaries, and unfortunately our allies as well.  This isn’t normal.

Normal recognizes that Article 5 of the NATO Treaty states an attack on one ally means an attack on all — no strings, no demands for payment, no second guessing — as when it was invoked after September 11, 2001 on behalf of the United States.  It is not normal to address a gathering of NATO allies and delete a reference to the article.

Normal recognizes that voluntary accords such as the Paris Climate Agreement aren’t binding, but do express the aspirations of the global community toward adopting policies and practices which do not impinge on the health of our shared planet.  It is not normal to unilaterally discard an agreement most of the changes to which (from the Kyoto version) were made at American insistence.

Normal recognizes that the deployment of U.S. forces around the world is a deterrent to adventurism and the disruption of financial and commercial functions in the global domain.  It is not normal to view these expenses as being “ripped off” by other nations.  It is truly beyond normal to decry these expenses and then advocate for a $700 billion increase in the U.S. military budget.

Normal recognizes that not everyone gets exactly what is wanted from any international agreement, but that small steps can often lead to greater improvements.  The SALT talks begat the START talks and the START talks begat a nuclear non-proliferation treaty.  It is not normal to demand that the treaty with Iran contain precisely what the American government wants when it wants it — without securing international agreement as to the terms of the specific treaty.

Normal recognizes that it is necessary for a nation to be perceived as cooperative and willing to be held to one’s word.  It is not normal to have allies questioning whether or not the U.S. will sustain its support for NATO, cooperate with global initiatives on trade, health, and climate change, and keep its word concerning threats to global peace.

Normal recognizes that the foreign policy of other nations, such as Russia, is not in alignment with American interests.  Normal recognizes that the creation of a “Russian Century” is not in the best interest of the United States.  It is not normal to have an American president deny or try to minimize the significance of a Russian assault on American democratic practices and institutions.   It is not normal to have an American president omit reference to what is occurring in the Crimea, in Ukraine, and along the borders of western Europe.

The United States of America cannot allow the abnormal to become the new normal.

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Filed under Defense spending, energy policy, Foreign Policy, Politics

It’s Always About the Girls?

ESPN’s Jemele Hill posts her truth:  Donald Trump is a white supremacist.  What do we get from the lectern in the White House? This is a “fire-able offense.”  Hillary Clinton goes on her book tour.  What do we get?  She’s blaming every one but herself — when in fact she admits some 35 mistakes for which she took responsibility.  What does the occupant of the White House do?  He re-tweets a bit of anti-Semitic commentary with a GIF of Hillary Clinton being hit with a golf ball.  It would be tempting to oversimplify this, but there is a pattern:  Women being hit, women being fired, or women being otherwise assaulted or attacked is acceptable. There’s a word for this — misogynist.

These would be part of the background noise associated with the current administration, except that the misogyny is part of the administration’s policy, witness the Department of Education’s reversal of Title IX protections for those who report campus assaults.

“Perhaps it should come as no surprise that this latest undermining of survivors’ rights is taking place under the administration of a president who has bragged about sexually assaulting women. An administration in which the acting assistant secretary of education for civil rights, Candice Jackson, suggested, in July (she later apologized), that for “90 percent” of campus sexual assault allegations the complainants regretted having sex, but weren’t actually sexually assaulted.” [WaPo]

So, are we surprised that the Department of Education is dialing back the protections for assault survivors on college campuses?  If we are we shouldn’t be.  The signals have been there all along.

We couldn’t really miss the images of the President barging ahead out of a vehicle, leaving his wife to exit on her own, or the images of him climbing the steps to Air Force One again leaving his wife to mount the stairs without assistance.  Or, images of him holding the umbrella over his own head, leaving his wife to stride in his wake perhaps hoping to get some protection from the rain.  If he will treat his wife with this casual disregard, what can we expect of his attitude toward women he doesn’t know?  Why would we be surprised if he tweets a GIF showing a woman being hit by a golf ball?

So, what do Jemele Hill and Hillary Clinton have in common?  One’s black, the other is white.  One is an experienced politician, the other is a sportscaster and analyst.  One was born in 1975, the other married Bill Clinton in 1975.  One attended Michigan State University, the other attended Wellesley.  What makes them targets from the White House lectern?  They are women.

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Filed under Politics, Women's Issues, Womens' Rights