Former Arkansas surgeon general brags on Medicaid expansion

I have written often about the Affordable Care Act not being fully implemented since 15 states have not expanded Medicaid. Rather than repeat my arguments, let me reference the attached editorial written by Dr. Joe Thompson, the former Surgeon General of Arkansas, which I read in Friday’s The Charlotte Observer. The reason for their interest is North Carolina has a Democrat governor working with a Republican majority General Assembly and the issue of Medicaid expansion is of importance. The editorial is entitled “Medicaid expansion works in deep red Arkansas. It would work in North Carolina too.”

“My home state of Arkansas is unusual among Southern states in having adopted Medicaid expansion early and in our own fashion.

I was Arkansas’ surgeon general in 2013 when the state first faced the question of whether to expand Medicaid. Like North Carolina now, Arkansas then had a Democratic governor and a Republican-controlled legislature. Fortunately, we avoided an impasse; lawmakers on both sides of the aisle came together to approve an innovative alternative to traditional Medicaid expansion that provides private health insurance coverage to about 250,000 people earning up to 138% of the federal poverty level.

The effect on Arkansas’ uninsured rate was swift and dramatic. A 2015 Gallup report showed that since Arkansas’ Medicaid expansion program took effect in January 2014, the state’s uninsured rate had been cut roughly in half, dropping from 22.5% to 11.4% ― the biggest reduction in the nation.

According to the U.S. Census Bureau, Arkansas’ uninsured rate was 8.2% in 2018. North Carolina’s was 10.7%, the ninth-highest rate in the nation. Arkansas’ reduced uninsured rate led to a 55% reduction in uncompensated-care losses at hospitals. This has been especially important for rural hospitals, which treat many low-income patients.

Since January 2010, only one rural Arkansas hospital has closed for financial reasons. In the five neighboring states that have not expanded Medicaid, more than 50 rural hospitals have closed, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

Expanding Medicaid also has helped stabilize Arkansas’ health insurance market, improve competition and control premiums. Since 2014, at least three insurers have offered plans through the Health Insurance Marketplace in each county in the state. The competition encourages low rates: In 2014, 38 states had marketplace premiums lower than Arkansas’; today, only six states have lower premiums.Medicaid expansion has brought billions of new federal dollars into Arkansas’ economy: $1.7 billion between January 2014 and June 2015 alone, according to the Kaiser Family Foundation. Arkansas also is saving money because some individuals previously covered under traditional Medicaid, which in Arkansas is 30% state and 70% federally funded, are now covered under Medicaid expansion.

The federal government currently is paying 93% of Medicaid expansion costs and will pay 90% in 2020 and thereafter. A consultant told a legislative task force in 2016 that Medicaid expansion would save Arkansas $757 million between 2017 and 2021.Thirty-six states have now decided to accept Medicaid expansion.

Arkansas has become a firmly red state, but it has reauthorized its Medicaid expansion program with a supermajority vote every year because of the demonstrated benefits to the working poor, the economy and the health care infrastructure. Last year, Arkansas added a work and community engagement requirement that currently is blocked by a federal judge’s order, but however that issue ultimately is resolved, it is clear that Medicaid expansion has had tangible, positive results. There’s a reason the number of states rejecting it continues to shrink each year.

Joe Thompson, MD, MPH, is president and CEO of the Arkansas Center for Health Improvement. He was Arkansas’ surgeon general under Republican Gov. Mike Huckabee and Democratic Gov. Mike Beebe.”

In spite of efforts to naysay it, hobble it and kill it, the Affordable Care Act is stabilizing some. It needs more stability and Medicaid expansion would help in the remaining 15 states. I have also advocated the US government paying back the money they withheld from insurers causing some to leave the market, inviting those companies back to the market. I have also advocated the reduction of the Medicare eligibility age from 65 to age 62 or even 60. And, where options don’t exist, Medicare could be offered as an option for younger adults.

What frustrates this retired benefits manager, consultant and actuary is the fact people getting harmed by decisions to harm the ACA is not a major factor. There is too much focus on winning an argument that people getting screwed does not seem to matter. Please help make it matter. Even as we speak, the eating away at the edges of the ACA could lead the Supreme Court to rule it unconstitutional. If this occurs it would be a damn shame.

Immortality in crosswords

It is often said you can’t live forever, but in crossword puzzles that is not entirely true. With the right name, you will be recurringly remembered. It is not necessarily the most famous names that come up. It is the names with at least a couple of vowels.

UMA Thurman is a popular actress, but her first name is even more popular in crossword puzzles.

ERMA Bombeck was a witty columnist and author. But, her first name lives on.

ENYA is an enchanting Irish songstress, but her solo name appears often.

Herman Melville’s most famous novel is “Moby Dick,” but in crossword puzzles “OMOO” beats it hands down.

Melville’s more read novel does show up, but its tormented Captain AHAB is the answer to many a puzzle question.

ALMA Gluck was a famous actress, but her first name lives on in puzzles. The same goes for IDA Lupino.

While Charlie Chaplin was the star, his last wife OONA is very popular in crosswords with three vowels.

Several deities appear with some frequency – ODIN, HERA, OLAF.

Even a pair of tennis playing sisters will periodically come up – SERENA and VENUS.

Finally, while he was most famous for playing Obi Wan Kenobi, ALEC Guiness lives on with the crossword Force.

This is by no means an exhaustive list. If you do crossword puzzles, please share a few of the names you use with some frequency.

You have to be carefully taught

On the news today, I saw the UK Labor Party has been accused of having a few anti-Semites. Not to be outdone, the UK Conservative Party has been accused of Islamophobia. And, as I wrote last week, hate crimes are on the rise in the US largely due to a rise in white nationalists who feel more empowered these days.

People are not born hating. They have to be taught. Richard Rodgers and Oscar Hammerstein wrote a key song in the musical play and movie “South Pacific” called “You have to be carefully taught.” The lyrics are noted below, but I wanted to mention the context of the play first.

“South Pacific” is a play about the idiocy and harm of bigotry. It was written in the 1949 as a clever metaphor to address the Jim Crow period in the US. Rodgers and Hammerstein knew they had to use a different setting to get their point heeded.

These lyrics are powerful. Please let them sink in as we all need to counter bigotry and racism we see and understand some of our own prejudices.

“You’ve got to be taught to hate and fear,
You’ve got to be taught from year to year,
It’s got to be drummed in your dear little ear
You’ve got to be carefully taught.

You’ve got to be taught to be afraid
Of people whose eyes are oddly made,
And people whose skin is a diff’rent shade,
You’ve got to be carefully taught.

You’ve got to be taught before it’s too late,
Before you are six or seven or eight,
To hate all the people your relatives hate,
You’ve got to be carefully taught!”

Let’s use this Thanksgiving to be thankful for and embrace our diversity. In fact, the first Thanksgiving brought two different groups together.

A few funnies

Comedian Tom Arnold was asked a question on “The View” that was personal and evolved out of the table conversation. “How long does it take for sex at your house?” He responded to the surprise of others, “Thirty minutes.” When questioned, he said “Yea, 5 minutes for foreplay, 5 minutes for sex and twenty minutes to get the pillows off the bed.”

On the CBS TV show “Mom,” the mother and daughter were sharing a bedroom. The daughter got up, went to urinate and came back to bed. The mother said “You didn’t wash your hands.” The daughter replied testily “I didn’t touch anything!”

One of the funniest, recurring lines was provided by the oldest of three brothers when they arrived at the inn on The Bob Newhart Show. Larry would say “This is my brother Daryl and this is my other brother Daryl.” The two Daryl’s never spoke on the show. Newhart often let his ensemble cast get the limelight on his two long-running shows.

A real life funny happened to one of my close friends and his wife. He got a call from his mother-in-law who was very worried about his wife. Mom had been talking to daughter and the phone went silent. My friend rushed home to see if there was a problem. He walked in and found his wife on the couch taking a nap. Waking her, she saw the phone on her chest and exclaimed, “Oh my God, I fell asleep on Mom!”

The funniest movie line was saved by Rob Reiner for his mother in “When Harry met Sally.” After Sally vividly and audibly demonstrates to Harry in a cafe how a woman can fake an orgasm, Reiner’s mother who observed all of this responded to a waiter “I’ll have what she’s having.”

Please feel free to add any funny stories or jokes from real life or TV, movie or theater performances.

Per Reuters – More foreign firms halted U.S. deals amid Trump administration scrutiny: report

Last week, Alexandra Alper of Reuters Financial News shared findings within a concerning report. The “report released by the Committee on Foreign Investment in the United States (CFIUS), shows that foreign companies abandoned roughly 14 percent of U.S. investments that were investigated by CFIUS in 2017 ‘in light of CFIUS-related national security concerns.’ The percentage in 2018 was 11 percent.

Those figures were sharply up from the period immediately before Trump took office. About 4 or 5 percent of such transactions probed by the committee were dropped annually from 2014 to 2016, the report showed. The Committee, led by the Treasury Department, reviews foreign investment in the United States for national security issues.”

I have raised this issue previously – when any entity makes it more burdensome to deal with, other entities will explore other options. The tariff wars are causing suppliers and customers to find other avenues. John Deere sales are down in the US, but up in South America as more agricultural products are being bought there.

On foreign investment, if we have companies jump through too many hoops, they will take their money elsewhere. These are headwinds to our economy and our growth has been softening.

Coupled with overall global softening, it should give us concern.

Letter to editor – as a Republican, I won’t follow blindly

A letter to the editor in my paper today was entitled “As a Republican, I won’t follow blindly.” The following are his first two paragraphs:

“Why are American citizens turning a deaf ear to the obvious wrongdoings of the president of the United States.

As a registered Republican, I am appalled that my fellow American citizens aren’t ashamed of the total disregard for the truth that is being emitted from Washington.”

This emperor has no clothes. He is also a national security risk as he belittles and embarasses an ally in need of our help for personal gain.

Travel safely and sanely

As we head into my favorite holiday week, the weather is starting out on a less than friendly basis. So, please take extra care to travel safely and reach your family destinations. I can assure you the interstates and airports will be crowded and at a standstill at times. If you look in the dictionary I-95 is code for stationary and an airport is a gathering place.

So, to manage expectations consider the following. First for flyers:

– you will wait in airports and have a hard time finding a parking space,
– your plane will be delayed and may be canceled, and
– your plane will be crowded.

How you let this affect you is your ball to play. You can let it bother the heck out of you or you can take it in stride. As I waited for my checked bags once, a woman commented on how calm and relaxed I was. I was sitting with a book and was waiting for the bags to come in. My standing up at the carrousel was not going to make them come faster.

Now for the drivers:

– you will be accompanied by many drivers on the road,
– you will come to a halt due to accidents and rubberneckers, and
– you will get irritated on occasion with fellow passengers.

How you let this affect you is your ball to play. Following distance is our friend. Rest areas break the monotony. Listen to your kids play lists – I had a ball with my kids doing this as they take pride in sharing. Find those side roads to avoid only interstate driving.

Please travel safely (and sanely). Giver everyone a hug for me when you get there. Happy Thanksgiving.

We must ask more why questions

We have a national security issue which is right in front of us. I sent the following to my Congressman and select Senstors. Please feel free to use and adapt.

We are not asking enough why questions.
– why is the president running a shadow diplomacy with Rudy Guiliani, who has not been vetted by the Senate?
– why does the president ignore the seasoned diplomats and intelligence officials to chase conspiracy theories postulated by editorialists on Fox?
– why are diligent, experienced, courageous and honorable public servants focusing on helping Ukraine gain better footing, when the president is so focused on his campaign?
– why is there obstruction of documents and witnesses? The president cries foul, but he is blocking witnesses. He can’t have it both ways.

As an independent and former Republican voter, I am deeply concerned by what has transpired in the White House with Ukraine. I am also concerned by an over zealous protection of someone who needs greater scrutiny, not less. I fully support the impeachment hearings. What witnesses are testifying under oath at great risk is very troubling.

It is also troubling that Devin Nunes is leading the GOP efforts. He cited on Thursday a partisan report that GOP Senator Richard Burr asked Nunes and Speaker Paul Ryan not to release as his Senate committee did not agree with its conclusions. Plus, we cannot forget that he had to step down as Chair of this committee as he informed the White House what they were investigating. So, I must confess I feel he lacks credibility and that is unfortunate.

Help us Americans get to the bottom of this.

The torch passes to us

Our friend Jill wrote an excellent post (see link below) called “Why do we need bigotry?” In the comments, she and I discussed the passing of Holocaust survivors, at a time when white nationalism is on the rise along with hate crimes.

The torch passes to new generations to speak the hard truths about history:

– the Nazi movement purposefully captured Jews, intellectuals, gypsies, homosexuals and expunged multiple millions of human beings calling them less than human. This is genocide.

– the American settlers committed genocide, as well, on Native Americans first claiming rights to land and killing the Native Americans when they rose up in protest.

– Slavery has never been right dating back to the bible. It matters not who is being enslaved. It is wrong. Watching the movie “Harriet” about Harriet Tubman, the cumulative asset value of the slaves could exceed the value of the land, which is why people wanted to maintain this sinful way of life.

– Then, there are the enslavements and genocides around the world and over history. Sometimes the enslavement is tying low wage jobs to people at risk. This is economic slavery. This occurs today in the US and other countries and is not restricted to the Jim Crow period. Whether it is sex trafficking or suppressed migrant workers, it is wrong.

– Finally, we had the Lavendar Scare in the US, where homosexuals were fired from government jobs, even if they were highly proficient and experienced. This is after Brit Alan Turing helped shorten WWII, but had to hide that he was gay. He was arrested and humiliated before he died after being outed after the war.

Bigotry is not right. It is also unwise. If people are treated as possessions or suppressed then their intellectual capital cannot be allowed to flourish. Countries that suppress women and girls are competing in a world with half of their talent.

Let me leave you with the key line from Oscar Hammerstein in “South Pacific.” “You have to be carefully taught, by the time you are seven or eight. You have to be carefully taught to hate the people your parents hate.” Bigotry is not DNA driven. It is taught.

Why Do We Need Bigotry?

True story example

One of the underlying themes of the Ukraine issue is the undercutting of diplomats doing a job without bothering to tell them what is going on without their knowledge. Setting aside the abuse of power and possible criminal activities, what the president did is just a poor leadership practice. A true example that happened to me might help illustrate this point.

I was client manager on a client relationship with a dear long term client. The client was looking to outsource some major internal work, which my company only did a small part. My client was asking me to help them source other providers, so I started to pull together a team to do so.

Without telling me, my company agreed to partner with a larger company to offer a proposal for the outsourcing. After pulling together a team, I was apprised at the last minute we were actually bidding on the project I was going to help source. Really? So, I apprised my client of the conflict of interest and we suggested he consider a competitor for the sourcing work.

None of this had to happen. My company could have told me up front what was going down without me being embarassed. Plus, it embarassed our bidding partner as they got wind of my sourcing efforts. And, it embarassed my main contact.

This came down from the top. In my or any business, you don’t leave your people hanging. You arm them with information and tools to do the job. You want people to have your back, not go around you snd not tell you they are so doing.

This is what was done by the US president to his diplomats in the field dealing with Ukraine. They were playing a hand they were dealt, but were not informed Rudy Guiliani was playing at another card table.

I have said before, not standing up for your people is poor leadership. So, is not informing them of what is happening. But, it does not just affect us. Ukraine and others wonder “who speaks for America?” Who does?