MOMocrats™

HHS to Review Health Care Regulations

This morning Deputy Secretary Bill Corr released a statement announcing the Department's plan to retrospectively review existing health care regulations. Regulatory review is about as much fun as filing taxes while undergoing a root canal... an unmedicated root canal. But the Administration's willingness to undertake such a painstaking process is yet another sign of their commitment to providing all Americans with healthcare that is economical, efficient, and, most importantly, effective.

Regulations are the flesh on the bones of law. After Congress passes a law, executive branch agencies are left to formalize specific requirements. For example, the health reform law talked about creating accountable care organizations but the small details were announced late this spring by HHS. How much detail? Try 429 pages of proposed regulations to clearly outline the plethora of requirements for such organizations.

Of particular interest to me is the interplay between Medicare (which typically covers older adults and some persons with disabilities) and Medicaid (which typically covers low-income children and their parents and people in institutional-level care, such as nursing homes). As our population ages, we'll have more people eligible for   Medicare and Medicaid. In theory, whatever isn't covered by Medicare should be paid by Medicaid. In reality, these programs don't always play nicely since what Medicare covers differs from what is covered by Medicaid.

Even more complicated and increasingly common are people who have private insurance or military benefits and are eligible for Medicaid. Trying to coordinate benefits between private insurers, especially those not covered by the complex ERISA rules, and Medicaid is becoming a time suck for states.

The attention to telemedicine is interesting too. Historically, Medicaid and Medicare refused to pay non face-to-face services. In the last few years that has changed and some states are using telemedicine to overcome health care shortages -- an area that is also under exploration as it has been three decades since we first defined "shortage area."

I think it is excellent that the administration is undertaking this project in light of so many regulations to come: final regulations for ACOs, regulations on the basic benefit package, etc. Attention today will prevent confusion and lawsuits later.

FY2012 Budget Battle: The Opening Salvo

This morning Rep. Paul Ryan (R-WI) released a template for the FY2012 Budget Resolution. If The Path to Prosperity is, as the GOP promises, the road to restoring America's promise I encourage you to think about another road.

That is a picture taken during the Dirty Thirties, when our breadbasket crumbled. In the early 30s people turned their faces west. They did find work in California, though mostly as migrant laborers, picking fruit and harvesting lettuce. A few years later FDR would begin his New Deal of recovery, relief, and reform. Three decades on, the Great Society programs would reinforce our social safety net.

Mr. Ryan's budget doesn't even take pains to pretend to leave the safety net in place. Instead, he places all of us in the cradle of laissez-faire economics. The cradle metaphor isn't misplaced here, as it is children who are likely to suffer the most in Mr. Ryan's economic vision.

Food Aid

Mr. Ryan would turn the Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps) into a block grant (more on that in a minute). In 2015, when the economy is once again hale and hearty, benefits will be contingent on either holding a job or enrolling in job training.

This is replay of the 1994-5 debate on welfare reform, which required women to go to work. In general, I have no objection to requiring able-bodied adults to work given proper support. That means child care subsidies, food aid to cover the transition from cash assistance to full employment, transportation and housing subsidies, and so on. If we truly want women – and it is mostly women – to be self-sustaining, we must offer educational opportunities that end in a skilled job with family-supporting wages. How does Mr. Ryan intend to enforce a work or training requirement when very young children are in the home? Or if we have a double-dip recession and unemployment remains high?

Does Mr. Ryan not know that many food aid recipients are employed? They have minimum or low-wage jobs and, assuming a family of three, make less than $1,526 per month -- a couple grand more a year than a full-time, minimum wage worker would earn. Does he not know that increasing numbers of retirees -- again mostly women without pensions and with low Social Security benefits -– rely on SNAP? Will he require the elderly to work? And what about our service men and women who use food aid to make ends meet? Will they too have to get better jobs?

Medicaid

Medicaid is the health insurance program for America's poorest and most needy. The majority of beneficiaries are children and the elderly. I know that will surprise many, who think of it simply as program for the very poor. But Medicaid is much more restrictive than many imagine.

In general, states are only required to cover children (including those in foster care), pregnant women, low-income disabled persons, low-income adults with dependent children, and the elderly who have exhausted their savings and are in nursing homes. Childless adults, even those with incomes far below the poverty line are not automatically eligible for Medicaid.

Mr. Ryan, and Republicans in general, have argued that Medicaid is too expensive. Yes, it is expensive precisely because it is the payer of last resort. Children on Medicaid receive EPSDT services, aimed at preventing health problems. Children on Medicaid are sometimes medically complex and receive SSI income for extreme low birth weight or other serious maladies. Medicaid recipients under 22 or over 65 may be eligible via the need for inpatient mental health care. Elderly in a nursing home who have run through all their savings become eligible; Medicare doesn't cover long-term care. Medicaid is expensive precisely because it operates as a safety net and covers services unavailable via private insurance or Medicare.

Mr. Ryan argues about Medicaid's quality of care, pointing out that the health outcomes of beneficiaries is poor. He must have skipped the public health literature for the last decade or so. Medicaid beneficiaries are poor. Many rely on food aid and while I've save you a retread of Michael Pollan, our agricultural policies mean that healthier food is often more expensive. They are more likely to live in areas with high lead levels. More likely to live in areas too remote or unsafe to exercise. More likely to suffer stress. I recommend he look into the social determinants of health before commenting on Medicaid outcomes. Medicaid is not magic. It cannot heal all comers and then offer a ride home on a unicorn; it is limited medical benefit for people who have concomitant health challenges and outcomes to match.

Yes, Medicaid is straining states' budget and yes, reimbursement is too low to attract enough providers, particularly specialists. But block granting doesn't automatically solve those problems, nor does it solve the GOP favorite claims of fraud, waste and abuse. It just gives states the ability to hold the purse strings.

Mr. Ryan and almost every other R want to convert federal entitlement programs like Medicaid and Medicare to block grants. Block grants are Beltway-speak for bucket of money. Entitlement programs like Medicaid impose requirements and limits on the states to receive money (Rs call this bureaucracy). Do the limits impinge upon states' flexibility? Yes of course. Which is why the federal government allows demonstration projects and waivers – Section 1115, 1915(b) or (c) or some combination thereof, 1915(i). There are optional coverage services to be included or waived.

To simply gut the Medicaid rules that have guaranteed coverage for the most vulnerable citizens and instead hand governors a check is wrong. Mr. Ryan may decry the social safety net, thinking it is becoming a “hammock, lulling able-bodied citizens into lives of complacency and dependency” but I wonder how that image squares with the reality of Medicaid: a child, a pregnant woman, a bed-bound senior, or a disabled adult.

There are other changes in the budget. Ending Medicare for those under 55. Lowering corporate taxes from 35% to 25%. (I'd support that one, if it meant companies actually paid federal taxes.) Cutting federal workers salaries and benefits.

Mr Ryan may pretend that his budget represents some grand vision for America's future. But in truth it is the plan of someone who read too much Horatio Alger and Ayn Rand, of someone who has never lived in Section 8 housing, of someone who does not know hunger, of someone who never had to take their kids to mall to get warm in the winter, of someone who enjoys their comfortable, government-provided chair atop the House Budget Committee.

Blocking Governor Jerry Brown's Budget for California: David Koch's Americans For Prosperity, and Supermajority Rules

Support the MOMocrats! We get a small bonus when you click & sign the petition. Sign up to five times & you'll help keep sharp, witty, and on-point political news and commentary from women front and center!

 

UPDATED TO ADD:

Governor Brown withdrew from discussions with the GOP Assembly and Senate members when it became clear that they delivered a list of 53 demands, many of which had nothing to do with the budget, at the very last minute.

WE STILL NEED TO VOTE.

+++++++++++++++++++++++++

Almost 50,000 58,000 citizens can use a petition to call for a vote that will let them keep taxes at the existing level for five years, and 55% of the state's voters approve of raising corporate taxes, but only a handful of Republican legislators are required to block the vote and thwart the democratic process.

What's wrong with this picture? California's "supermajority" rule--with aid and comfort from the astroturf organization Americans for Prosperity, that's what. This, from a state Republican party that was delivered a shellacking in 2010 with no wins in important state seats and LOSSES in the State Senate and Assembly.

The Right Priorities For Our Working Families by Sen. Kirsten Gillibrand

The 2010 election was a mandate for one thing: creating jobs and strengthening our economy for the long term. I heard that message loud and clear from New York families in every corner of our state, and I am working with my colleagues in Congress on solutions that will help create good-paying jobs and get the economy moving again for everyone.

But, instead of focusing on rebuilding the economy, House Republicans have unleashed an extreme ideological attack on America’s women and working families with HR 1, the first bill they introduced this Congress.

The House-passed bill slashed critical funding for prenatal care, including $750 million from nutrition programs for pregnant women and infant children.

It denies more than 5 million American women access to breast and cervical cancer screenings that could potentially save their lives.

Their budget cuts affect early childhood education deeply—cutting over $1 billion from Head Start, and nearly $40 million from child care, depriving nearly 370,000 children from the early learning needed to put them on a path to a bright future.

And despite the overwhelming demand from the American people for Democrats and Republicans to work together to invest in job creation policies, House Republicans slashed nearly $1.5 billion from the job training programs we need to prepare America’s workforce for the jobs of today and the high-tech jobs of tomorrow.

But, more than these dollar figures and the irresponsible budgeting and priorities from Republicans, this debate is about the working families who rely on these resources to make ends meet each day. From the single mother who will no longer be able to provide nutritious meals for her young children to the young woman in who will no longer have access to the early cancer screenings that could save her life to our children who will never walk through the doors of a university years from now because the doors to early education are being closed to them today. We cannot slash and burn our way to a healthy society and a thriving economy.

These are the wrong priorities for New York and the wrong policies for America.

Instead of marginalizing women, Congress must get to work on policies that can foster job creation and fuel economic growth. I have a range of proposals that can help get us there.

I have authored legislation that empowers more women and minority-owned businesses with the resources to help guide these budding entrepreneurs to be leaders of our economy, opening up access to the credit they desperately need to get their businesses off the ground.

I have also authored legislation to support the increase of young girls and minorities in the fields of math and science to generate the leaders we need in emerging high-tech industries that will be the future of our economy.

I’m fighting to make child care more affordable for working parents so they can continue working and advancing their careers, closing wage gaps that for too long have held women back from the fair economic opportunities they need.

And, as our troops return home from Iraq and Afghanistan, and our women veterans become one of the fastest growing segments of the homeless veteran population, I’m partnering with businesses and working to provide them with tax credits in exchange for hiring recent veterans so our heroes have better access to good-paying jobs after serving our country.

These are the priorities that I am urging my Republican colleagues to join me on. And we can all do our part—because this debate isn’t just happening in the halls of Congress. It’s happening in each and every one of our communities, at kitchen tables and living rooms, in our schools and in our churches. It’s up to all of us to get off the sidelines and join the effort to protect our families and the resources that keep our communities safe, healthy and thriving.

We will not stand for this attack on America’s women and working families.

It’s time to focus on real solutions that will create jobs and build our economy for real strength and stability—not just for the fortunate few but for every American.

State Education Funding in Crisis: Missouri Risks Its Future

Even as Congress debates on whether to proceed with more than $4 billion in education funding cuts proposed this in year's federal budget bill, states across the U.S. continue to slash local education funding in the name of balancing struggling state budgets.

As mentioned in our latest MOMocrats MOMochat podcast on Blog Talk Radio, in Missouri, Governor Jay Nixon -- a Democrat -- recently proposed millions of dollars in cuts to state education funding, including $39 million in cuts to scholarships and financial aid for college students, a seven percent cut in general funding to state universities (which will result in the elimination of up to 116 degree programs), a $4 million cut to the Parents as Teachers early childhood education program, and a myriad of other cuts at every education level.

GOP Budget Wars on Reproductive Health

What's happened to the whole Republican "the economy and jobs are our first priority" mantra from the 2010 elections? Eric Cantor can say it all he wants, but that isn't making it true. Instead of jobs, conservatives are once again focused on our lady parts. While I am sort of getting used to the new TSA pat downs, I have to draw the line when it comes to the government getting its hands on my privates.

The GOP is focusing on the budget, but not for creating jobs -- they are trying to impact substantive issues through bills that control spending, as they recently did in their (thankfully) failed attempt to redefine rape in the "No Taxpayer Funding for Abortion Act." It initially called for limiting the availability of Medicaid funds for abortion only to women who had been "forcibly" raped.

Since the original passage of the Hyde Amendment in 1976, no federal taxpayer funds have been available to cover the cost of abortions through Medicaid except in instances of rape, incest or if the life of the mother is in danger. The forcible rape exception, introduced by Representative Chris Smith (R-N.J.), didn't explicitly spell out in the bill what that meant, but a variety of organizations, including NOW and EMILY's List, believed it would exclude victims of statutory rape, date rape, rape victims who initially said "no" but weren't able to fend off their attackers, and women who feared for their lives unless they acquiesced to a rapist's demands.

Ronald Reagan at 100: I Remember His Presidency...Well Enough to Skip the Hype

 

Grenada...does anyone even remember the tiny Caribbean island we invaded in the 1980s to keep Cuba from going all Communistic? The one that had a population of 100,000 at the time?

I didn't think so. The people at The Reagan Library are hoping that people born after 1980 don't remember either. Which is why they're so eager to push St. Ronnie. The man already has an airport that had a perfectly good name, Washington National, re-named after him instead, and TWO frickin' postage stamps in the past 6 years. Enough is enough.

Watch This, Congress. Then Extend the Damn Unemployment Benefits, Now.

Why is this even being debated? When unemployment is high, Congress has always voted to extend unemployment insurance for those unlucky people who have been laid off.

What's different about this Congress? The numbers of Republicans who I seem to recall campaigned with slogans like "Country First," but are now dragging their feet on a yes vote for the extension of unemployment. Who are these petty, greedy people who are simultaneously holding up other business in Congress for a tax cut that only millionaires will enjoy?

Call them now and give them a piece of your mind: 877-662-2889. Pass unemployment benefit extensions, NOW.

 

Cynematic blogs at P i l l o w b o o k.

A Word On Bi-Partisanship

Man, who ever thought it would be so hard being in charge?  Seriously.  It's become quite apparent that the Democrats have a serious case of minority-party PTSD as, with the exception of a hand full of brave souls, they seem capable of doing little more than cowering in the corner while Boehner and McConnell continue to steal their lunch money.

And all the while the drumbeat of criticism levied at President Obama about his push toward "bi-partisan" solutions has grown louder as even reasonable minded Democrats seem about ready to abandon this presidency and resign themselves to handing the keys back over to the GOP.  I'll admit, I'm on that ledge.  But let's consider this.  What if bi-partisanship is not about Republican support, but about trying to wrestle in the remaining Reagan Democrats in Congress?

Look at who is consistently blocking Democratic initiatives, for example.  Ben Nelson (D-NE) is a perfect case study.  Now, as a Nebraskan I can speak a bit to Nelson and he is a classic Nebraska Democrat.  If the Republicans were not so blatant in their racism he'd (and most his voters) would be Republicans.  Same with Evan Bayh.  Unless the Democrats were to get real comfortable with the idea of passing every piece of legislation via reconciliation (which would be far too brass-knuckled for the delicate constitutions of Democrats), President Obama needed to find a way to maintain 60 votes, and keep up appearances of Democratic unity.  That's a political quagmire if one ever existed.

But so what?  What do we do now that the Republicans control the House and have pledged to block every piece of legislation the Democrats introduce (save, of course, tax cuts, OBVIOUSLY).  Do we let them, as some on the left have suggested and let the American people see them for the obstructionists that they are?  Sounds tempting, but I'm starting to think that's too sophisticated for our current political media and most voters.  Sigh.

Or, do we take the tactic of our President and work to get SOMETHING passed, knowing that something is better than nothing and it is easier to build on legislation than to pass it?  That's what we did with health care reform and financial services reform.  It's also what we did with civil rights legislation.  Our first Civil Rights Act was pretty meager.  Over time it got better.  I suspect the same will be true with the Affordable Care Act, presuming the Democrats (and a few sane Republicans) find the will to beat back the impulse to cave to the quick and conservative-media driven narrative that the bill is garbage.

So, I guess what I'm saying is let's not give up, no matter how dark and how cold our political climate may be right now.  And lets resist the urge to punish one man for the failings of Congress and keep in mind that legislative change happens incrementally, and often is a process of two steps forward, one step back.  We'll get there, and President Obama can still bring us there, but not if we expect miracles and victories at every turn and in every year.

Another Economic Meltdown: new 1099 rule hurts small business -- badly

The new 1099 rules are a major pain for all small businesses. I foresee major fees and rate hikes as a result. And it may be enough to put many small businesses...out of business.

Let me explain.

I'm a small business owner. A little over five years ago I made it official: I filed articles of incorporation, did due diligence on my business name, invested money in legal and business advisors, got my EIN, opened a business account and got business credit cards.

I've been careful to use my business cards for all business expenses. I mark all receipts, attach to expense reports, include in my business accounting software, file under Reimbursed or Not Reimbursed (because it matters for taxes), and so forth.

I've managed to make it and be profitable despite a tanked economy. I know that my success helps in rebuilding our economy.

But now, I'm deeply concerned that my success is at major risk.

New 1099 rules may put me out of business.

And it's not just my problem, it's yours, too -- it's the problem of every single independent contractor, consultant, small business owner, blogger (yes BLOGGERS)...anyone who does any business and receives money, which includes goods, for services.

Reuters' Lauren Young and Amy Feldman explain:

The new rules on 1099 forms, which were attached to the health care bill and are set to go into effect in 2012, call for all businesses, no matter how small, to file 1099 forms for goods as well as for services. That sounds like a technicality, but it’s got small business up in arms.

Here’s why it matters, and what you need to know.

What exactly is the rule, anyway?

The new rule requires all business to file 1099 forms for goods as well as services, if those goods cost over $600 annually (the current threshold). It also gets rid of the distinction between corporations, which previously did not need to receive 1099s, and unincorporated entities, which did. The rule is slated to go into effect in 2012.

So...WTF? How did this happen?