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Rick Scott - Caricature
Florida Governor Rick Scott’s decision the other day to go along with the Medicaid expansion next year, after he had previously rejected it vehemently, has been widely interpreted as simply the latest event in a series whereby Republican governors are slowly seeing the handwriting on the wall and capitulating to the hated Obamacare, while also being motivated by one political factor or another; for example, Politico lays it to Scott’s sinking poll numbers.
But not so noticed are the conditions Scott was able to extract: his agreement is only for the first three years when the federal budget will pick up 100% of the cost, and, especially, all of these federal dollars will be privatized, pending, as HuffPo is careful to point out, approval by the Centers for Medicare and Medicaid Services. (Scott says his decision is made regardless of theirs, but I imagine he only says that because he’s confident they’ll approve the deal)
In the second most high-profile of these reversals, Arizona Governor Jan Brewer agreed in January to join the expansion, saying that the Affordable Care Act was the law of the land, like it or not. However, her acceptance was conditional in that, as a “circuit breaker,” Arizona will reduce the extra Medicaid enrollment the Act allows in proportion to reduction in the federal subsidy. This is the way to “keep Arizona tax dollars in Arizona,” as the Governor’s official website crows. Moreover, the program will be managed within a regime called the Arizona Health Care Cost Containment System, which appears Byzantine in complexity but, as the bottom line, entails entirely privatized care.
I have not studied the situation for the other states where Republican governors have agreed to participate, Michigan, Nevada, New Mexico, North Dakota and Ohio. (I leave that to someone more expert in this area than I am.) Yet it appears to me that what is going on is a movement to take advantage of the ACA as another means to funnel federal dollars into private industry (beyond what the non-Medicaid portions of the law already do), that is, into the kind of private firms that contribute to these governors’ campaigns.
There are more Republican governors who continue to reject participation than the seven that have now joined, but maybe that’s only because they haven’t figured out how to game the system yet.
43 Comments
If Republican governors and state legislators are having trouble figuring out that the Medicaid expansion is an opportunity for wealth extraction, they’re sure to have help figuring it out from
the President
and the insurance companies who plan to profit from it.
I don’t know what’s happening in other states, but in IL the Democratic governor is in favor of the expansion, and last I saw, the insurance and hospital companies were working to persuade any reluctant legislators.
Thank you so much, miI, I did not know of this policy change.
And aside from helping the states get more money from Washington, with the higher copayments, etc. it seems they are taking away from us patients with one hand what the “expansion” gives us with the other, eh?
As for the insurance companies, I think they smelled gold as soon as O put up his mandatory health insurance against Hillary’s voluntary plan in the 2008 primary campaign.
Heh, sorry pard, but you’ve got that exactly bassackwards.
Hillary’s plan was to have mandatory participation, while Obama’s did not, and in fact, Obama ridiculed the Hillary’s idea by saying “If mandating something worked, we could mandate an end to homelessness.”
I’m not going to waste my time looking for a link, because this is old news. If you’d rather not believe me that’s fine, as I was only trying to help you get the facts right.
I didn’t go out for a paper today, but let me add that on WaPo’s website the columnist Msnbc Contributor (Dana Milbank) is pushing the capitulation line big-time. Scott claims not not to be raising “a white flag of surrender” in agreeing to the expansion, MC acknowledges, but:
He then makes similar claims about Brewer and the governors of Ohio and Michigan.
Gotta love the “freedom” of the press.
I’m working from memory and you may well be right, OFG (especially since your own memory is good enough to supply an exact quote from O from over 4 years ago without “wasting your time” looking for links).
Let me rephrase: the insurance companies smelled gold as soon as expanded health coverage became an issue in the 2008 primary campaign.
That is correct. In fact, that was the deciding factor in my decision to register as a Democrat and vote for Barack Obama in the Democratic primary, so I remember that particular debate very well.
Saw it live, don’t you know.
lol
Sorry, my post sounded snippy when that wasn’t my intention.
I just suck at finding stuff on the web, that’s all. If I were one of those that could find links in fifteen or twenty seconds, I would, but I just always suck at it.
I doubt my “quote” was 100% accurate, but he said something along those lines. And I agreed with him. And it was on of the factors that made my mind up to support him over Hillary in the primary.
Who knew every word out of that assholes mouth was a lie??? I didn’t.
I do now. In 2012 I was proud to vote for someone that represented my interests and issues, Jill Stein.
pRick Scott is the de facto expert on stealing Medicaid/Medicare money. He holds the record for the largest fine in history for doing it, and possibly the most use of the 5th amendment in a single hearing (75 times) on that theft.
Here’s a link I found with the actual quote.
In Ohio, Governor Kasich SAYS he backs Medicaid expansion because he cannot in “good conscience” turn down access to health care for hundreds of thousands of Ohioans when it won’t cost the State of Ohio a dime for the first three years. He even quoted Jesus of Nazareth in saying that “how you treat the least of these(the people) is how you treat me.”
And besides, he argues, it would bring an additional 13 billion bucks over the next seven years or so that would go elsewhere if Ohio doesn’t have Medicaid expansion, so it’s just a good fiscal move.
The medical insurance lobby, the doctors, the nurses, the Democrats, and most of the local media, corporate and otherwise, like the idea. The Tea Party, OTOH, is apoplectic and threatening to primary any Republican legislator who votes for Medicaid expansion.
Kasich’s proposal also has an escape clause: if the federal government, ie Congress, doesn’t keep its promise for the high level of federal dollars in the future, then Ohio can bail from the program. The Tea Party laughs at that, thinking it would be impossible to do so if that happens because too many people would be dependent on Medicaid by then to make it politically feasible. That’s why they’re going full court press against the idea now.
I don’t know how much of the Medicaid money would or could be siphoned off by for-profit interests if Ohio does get Medicaid expansion, but I think I’ll find out.
More than likely, this part of Kasich’s budget will pass. He only needs about a third of the Republicans in the Legislature to back him to get it done.
As for Kasich’s real motives, I don’t know. I only know he’s been acting a lot more Eisenhower-like ever since he got his face slapped hard by the voters when Issue 2 got trounced.
Thanks for that info, JJ (here’s a link to the case I presume you mean), and especially for getting the discussion back on topic.
Thanks also to OB @ 6 and to OFG @ 7 and 9 for your clarifications. Mea culpa on who was for what in 2008.
I posted this little bit — out of a desire to correct certain impressions in these diaries — at dinner time last night and there were exactly 0 comments until noon today my time (two hours later than what the FDL system assigns in the bylines), and look where we are now. I love it!
Thanks, OB. Kasich looked like the 3rd most important case after Scott and Brewer when I was researching this thing yesterday, but I ran out of energy before getting to him.
The escape clause sounds a lot like Brewer’s “circuit breaker,” so there’s maybe a pattern, granted that Scott’s approach is to not even commit past the “100%” period.
You are certainly in a better position that I to find out about the privatization issue.
One aspect of this topic that hasn’t been brought up is that the expansion of Medicaid and Snap is an indicator of how our Capitalist system is failing at least for the 99%. If the account of private healthcare profiting from this expansion is true then Capital is even profiting of of its own failure, that’s truly sick.
It seems that most people have given up demanding or even talking about good paying secure jobs and accepted the downward spiral to Third World Status.
Good point, wow, at least insofar as Medicaid expansion is concerned. As for SNAP, that expansion was in 2009 and I’m not familiar with any more recent analysis of it (nor, for that matter, any analysis then, when I was almost entirely occupied with classical philology). Maybe someone would like to add some discussion of it?
Capitalism profiting from the failure of capitalism; what a concept.
I’m unsure of your pessimistic conclusion, though. Let’s see what happens this spring when the weather warms up.
Ol’ pRick should be long gone by the time 3 years runs out. He isn’t fooling anyone with his latest attempts to do the “right thing”.
The first thing pRick did when he took over was to refuse a 100% fed paid for light rail project claiming there must be hidden costs. That was the start of his plummet.
He then decided to drug rest everyone on public assistance. Oooops, turned out he owned the drug testing clinics (he transferred them to his wife when he was discovered). He was actually going to charge the victims for the test and then refund the money if they passed. The courts struck that down.
No one’s buying it.
Yes, we can always hope for a better Spring but even the word hope has lost much of its meaning.
I understand your desire to escape to the Classical Period since the one we inhabit is so depressing.
Snap benefits were already cut dramatically even while enrollment increased but JP Morgan is still reaping large profits from administering the card transactions. We’ll keep people alive with expanded Medicaid but we won’t feed them, I wonder how that will work out?
Thanks for the further info, JJ.
Now that you mention it I remember hearing about the drug test for people on assistance, but not that he or his wife owned the clinics — which tells you how deeply the MSM must have covered the story.
Thanks for the clarification about JP Morgan, wow.
I may have thought classics was an escape at one time, but if it worked perfectly I wouldn’t be blogging with FDL.
My escapes are less esoteric, including sci-fi and historical novels about the taking of the West. The problem with these is that there are too many correlations with the present.
I do have a question as to why you couched this diary in such a narrow partisan way and if this is really helpful? Some of the commenters broke from this track and pointed out that the Dem govenors are also feeding private interests with this largess. Democrats have rarely refused to spend, free money, for whatever cause so long as it’s someone else’s money. When the free money runs out I’m sure these Dem governors will be happy to have their state taxpayers take over this burden.
I certainly don’t dispute that the Dems are also gaming the system, wow, and the answer to your question is that the point of the post is to challenge the MSM notion that what the Rep governors are doing is capitulating to the Dems, an MSM notion that in this case is fostered precisely by the Dems to crow about their supposed victory (as the example of Msnbc Contributor noted @ 4 above bears out).
I would not have even written the piece if I had not sensed from their comments that some at FDL were also buying into the capitulation theory.
Quote is from that HP article you referenced. Does this mean that the law would have required single payer and now Great Scott has converted it to an un- insurance plan. Im confused.
If we had a decent political party, they would just federalize this program and make it like medicare.
Privatization of Medicaid pre-dates the ACA, in Florida and elsewhere. The ACA actually offers more opportunity to privatize that didn’t exist before.
What I’m reading about this current Florida “waiver” is that when states make this kind of change (in Florida expanding privatization to the whole state, instead of just part) they need to get the nod from HHS, but that’s just how I’m reading it, haven’t looked into the details.
Why in heavens name would they allow private insurance companies in this? They have all sorts of added costs, like income taxes, profits, exec pay, “admin” costs, lobbying costs and all sorts of crony costs, inability to negotiate effectively with providers etc. People on medicaid can’t pay insurance so that means it is part of the gov tax bill. And they wonder why healthcare cost is so expensive in this country? Everyday I find out just how screwed up the ACA really is.
and @ 23
I didn’t study the issue deeply enough to answer your question @ 21, bd12, figuring that they were just going to cave to Scott’s wish.
As for your question @ 23, I imagine the answer is because the insurance companies are lobbying them, Reps and Dems alike, to do so.
Thanks for your contributions at the beginning of this thread and here, miI. I did notice that Arizona’s Byzantine “AHCCCS” was fully privatized before the ACA.
I’m off to bed, folks, but feel free to continue this great discussion. I’ll check the thread in the morning.
For the same reason this ‘conservative’ Supreme Court approved the individual mandate, to force people to buy private health insurance through the exchanges ($$$$$), these republican governors are naturally going to play their part (i.e. jump on board with the Medicaid expansion).
They had to oppose it initially, to pacify their base, but they will try to convince their base that it’s important. But it doesn’t really matter what the republican base thinks, the last thing these governors are worried about is getting reelected. A governor’s salary is chump change up next to the dollars they’ll be getting from the health insurance industry and big pharma.
It looks like everyone went to bed when I did except for mt @ 27 above, who checked in 3 hours later (what a night owl). As for his point, I don’t disagree in general, although there are probably cases where the Guv is more interested in higher office than a lobbying career.
Now, wow @ 19 raises the point that the way this post is set up we tend to forget that Dem governors also funnel federal money into private industry. To redress the balance somewhat, here is some info for the state where I lived for roughly the first half of my 50 years in the Washington area, before moving downtown: Maryland.
Maryland is a so-called blue state, which really means that its state legislature is controlled by Democrats of the “blue dog” variety except for members from Baltimore and the Washington suburbs. It has alternated Rep and Dem governors for a while, and the current one is the latter, the liberal Martin O’Malley, a former Balto mayor who may have presidential ambitions.
O’Malley announced that the state would participate on the occasion of last summer’s “Roberts betrayal” whereby SCOTUS upheld Obamacare. What this means is that the patients coming in via the expansion will be enrolled in HealthChoice, a program which allows them to choose one from seven private “Managed Care Organizations,” such as UnitedHealthcare. There you have it.
Here is a complete list of where each state stands on the expansion, as of 4 days ago, including a map (which I tried to embed directly but couldn’t get it to work).
While the ACA requires an 80%-85% (depending on the market) medical loss ratio (percent of income that must be spent on medical care) for companies providing private insurance, there’s no requirement for Medicaid managed care providers, and only 11 states have their own requirement.
LINK
Well lets just say they are preserving the state based health insurance geographic monopolies with local hospitals. You know those tax exempt insurers who pay the providers, hospitals and the like outrageous markups on aspirin, knee immobilizers and all other sorts of things? It is a racket.
Concerning Scott, self interest and manipulation? Another election just around the corner. Like the late Sen. Arlen Specter, who switched political affiliations to help get: “Re-Elected.”
“In good conscience?” My ass…. No bolt of lightening could convert this guy………
That’s also good to know, miI; thanks.
So I guess you’re saying that the answer to bd12′s question @ 22 doesn’t really matter, right?
Fine, but I imagine bd12 would like a specific answer just so we can be formally accurate. As I said @ 25, I don’t have it.
“. . .the situation for the other states where Republican governors have agreed to participate, Michigan, Nevada, New Mexico, North Dakota and Ohio. . .”
————–
WSJ had a piece a day or two ago indicating that Ohio, at least, is a virtual clone of Florida insofar as a three year sunset trigger is concerned. The others bear scrutiny as well, no?
It might not be possible for HHS to leverage the maintenance of effort requreiment on these states to keep them participating, either, mindful of SCOTUS last June banning penalties against the recalcitrant states. Also hadn’t HHS told Arkansas it could opt out later, after opting in? Or was it a different state — a few months ago?
None of this bodes well. What tack is to be taken going forward?
I’m not sure it-s just Republican governors who are to blame. The “expert” drafters of the ACA could easily have anticipated the privatization of Medicaid care that would result. And we need to see what steps the Democratic governors will take (most likely, based on recent history, a watered-down version of privatization).
wow, he actually looks less like satan in that photo than he normally does. always remember to smile, folks. sometimes you can hide the evil that way.
I think the entire health care industry is a racket. By now we have all heard about the Times story and the CNN analysis. Imagine that poor bastard having to pay $474,000? Those little cups the pills come in are $12 each. Damn things are probably made for a penny each, if that. And when they come to test his glucose levels, it’s $39 each time. Well, shit lets test that around four times every day.
So now it seems the insurers are going to get into the medicaid racket.Poor people can’t afford the ridiculous cost so we get to pay the insurers, I guess. And guess what? We get to pay the exec and all their interest on debt and their profits and taxes. Plus whatever they and their cronies can rip us off for, you know like $12 pill cups. Nice racket. Al Capone missed a good thing here.
Oh great! That’s just another way to rip us off. As long as it is 80% of total, it’s all good. Lets make those pill cups $30 each. More profit.
Fuckers don’t even say “thank you, sir, you been good to me.”
Apparently our generous federal government doesn’t impose a medical loss ratio on Medicare Advantage or the Medicare Prescription Drug Program either, but the ACA provides that it can do so. The proposed rule is open for public comment until 4/16.
I support single payer. Yes lobbyist are protecting their turf. It is the republic which suffers from the waste and duplicative nature of the entire scenario. Cost containment is key and as I see wasting trillions of dollars driving, is the same type of protectionism for corporations tat we see in healthcare. Healthcare and energy screw us all. Monopolies in commerce and trade……
Considering the cost of all goods and services are transported, including medical supplies and everything else, the cost will only continue to go up as energy up……
So how old where you when diesel fuel was, 17 cents a gallon?
Spot on bluedot12.
I’ve been away from the thread for a while and won’t attempt to speak to all the comments that have come in in the interim. Thanks, all.
But as to cd @ 36, I point out that FDL has done a bit of a bait ‘n switch here: The photo they put up when they front-paged this diary is an actual photo, not the original caricature that appears above from the beginning on Friday night. Tsk, tsk.
Remember the MA BCBS Exec with the 11 million dollars golden parachute? Or the guy before at 8 million? Very nice for tax exempt not for profit public charities?
I call it corporate sodomy…..