PLUNKETT: Dems latest Medicaid proposal: A lemon by any other name.

BY: B. Keith Plunkett @Keithplunkett
The Democrats offered their alternative to Medicaid expansion yesterday by proposing a bastardized version of ObamaCare for Mississippi that will tax businesses and kill job creation at the very time it is needed most. The end result, despite what they say, will be an expansion of Medicaid, and the poor health outcomes that come with it.

According to the sponsors, the proposal is much like one proposed in Arkansas. The Natural State has proposed taking federal dollars for Medicaid expansion and instead using them to subsidize those potential beneficiaries into a state based insurance exchange. The Federal Department of Health and Human Services Director Kathleen Sebelius has given the Arkansas proposal her initial blessing, as the Obama Administration looks for any way to dangle an evermore irresistible carrot in front of states not anxious to jump into bed with a federal partner fully expected to renegotiate the contract through constant regulatory changes.

Hurry Up and Sign Here.

There are several things wrong with this latest Democrat proposal that all lead back to the same question for Mississippi: What the hell is the rush?

It feels a lot like a pressure sales pitch from a used car salesman trying to sell a lemon to a unprepared and uniformed customer. It doesn’t pass the smell test.

It’s Not Private Insurance

The proposal offers enticing and hypnotic terms conservatives like to hear like “private” and “market”. But, beware the poisoned apple. The Dems deal does have elements of private insurance. However, it is still Medicaid expansion money, and still legally part of the Medicaid program. That program as it currently stands is rife with fraud, abuse and government regulations that restrict choices and coverage to the needy, and result in most cases in health outcomes worse than those with no insurance at all.

References to “managed care” and “private insurance” in this new proposal are window dressing for a federal program that will come back to roost later with more regulations and restrictions, much as is the case with the current Medicaid program. Are we really going to trust the federal government enough to partner with them in building on such a cracked and shifting foundation?

The feds have already changed the original intent by writing tens of thousands of pages of new regulations not authorized in the law. There are several lawsuits in play that could affect whether much of the regulatory bait and switch is legally allowed.

We should be talking about reforming Medicaid first.

With all the “what ifs” floating around there is one thing and one thing only Mississippi legislators have full control over and can do right now. There are several options to reform Medicaid and see a significant cost savings AND better health outcomes for those on the program.

Florida has a pilot program in play in three of its most populous counties that has already saved the state $118 million, and led to better outcomes for those in that states program. When fully implemented it will save an estimated $1 billion dollars that Florida will reinvest into the program to continue reform.

Those same reforms in Mississippi would realize savings of around $250 million here.

Getting the Cart Before the Horse

If this new proposal isn’t Medicaid expansion, as Democrats say, then why aren’t we dealing with reauthorization of Medicaid first? Isn’t that the most pressing need? Is the drive to expand care to a couple hundred thousand people worth jeopardizing the needs of 700,000 needy that are already on Medicaid?

In case the Democrats forgot, July 1st is D-Day for the blind, disabled and elderly currently relying on the program for their care. The “D” stands for “Democrats Did Deny” those most in need a voice while they played politics for the Obama Administration. If they don’t change course, they will watch as their handiwork results in nursing homes across the state dealing with how to care for patients without funding.

Conservatives must hold the line and fight against the tax increase.

Behind the facade of Democratic rhetoric, this is nothing more than a political game. It’s not really about health coverage or health access. If it were, then Democrats would have already reauthorized the program and looked closer at reforms. This is about expansion of a government program that doesn’t work well for anyone except government lobbyists and those who can pay them the most. It certainly doesn’t help the beneficiaries or the doctors.

According to ObamaCare rules–again, rules the feds keep changing–exchanges are supposed to cover people between 100 percent and 400 percent of the federal poverty level. Medicaid expansion is to cover between 0 to 138 percent. There is an overlap of coverage for those who fall into the 100 percent to 138 percent range. If the state accepts the federal dollars for this proposal, we’ll be putting that overlap group into a state-exchange. Why not let them go into a federal exchange, and let the feds take the full responsibility? Why invest state money into a program the federal government will control anyway?

According to the ObamaCare law, and a source of another legal challenge, the IRS can ONLY tax small businesses the $2,000 per employee and force the individual mandate through a state based exchange. The reason for the lawsuit, filed in Oklahoma, is that the IRS has overstepped its authority by ruling on it’s own that it can tax businesses regardless of what the law says. But, that is not settled.

This Democrat proposal releases the state from that protection and opens the floodgates to taxing small businesses in Mississippi out of existence, and the jobs they provide right along with them.

The end result is that more people end up on Medicaid anyway as they lose their job and the coverage they currently have.

Pay no attention to the man behind the curtain.

The Congressional Budge Office estimates 100,000 Mississippians of the 300,000 the expansion would cover already have insurance through an employer, meaning we’ll be pulling people into a government system that don’t need it, and the numbers the pro-expansion forces are giving us are not what they seem. Either way, the projections for voluntary participation are so bad the federal government is now spending millions to advertise and entice people to join the program.

Without the participation of a skeptical public the whole house of cards comes tumbling down. The only way Democrats can make the program work is through a combination of enticement and force. It has become very obvious that anything state officials can do to keep Mississippi out of this debacle, then the better off we are on the other side of this nightmare.

Democrats are fond of saying this is the law of the land, and rejecting it is futile. Ever wonder why they have to keep repeating that?

Give the public the ability to purchase insurance across state lines, give them the incentive to start Health Savings Accounts, make Medicaid a truly block grant program to the states that offers innovation and, for godsakes, reform the program to do away with fraud and abuse and save the money that is already there to be saved. Those are ideas that put power in the hands of people.

Expanding government, taxes and control is proven time and again to be a drag on innovation and service. You need only look to the current Medicaid program as a perfect example.

About Keith: Keith Plunkett has worked on communications issues with a range of public officials from aldermen to Congressmen, and a variety of businesses, governmental agencies and non-profits. He serves or has served as a board member of several non-profit, civic and political organizations. Contact him by going to HorizonMediaMarketing.com or follow him on Twitter @Keithplunkett

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Ethics Commission’s June 14 ruling could give House Republicans votes to reauthorize Medicaid.

It is anticipated that Gov. Phil Bryant will call a special session – probably in mid -to- late June – to take up the issue. An Ethics Commission ruling on whether a legislator can vote because of a possible financial conflict could affect the outcome of the special session. Ethics Commission opinions are advisory, but provide legal protection for public officials who follow them.

During the regular session, Democrats blocked Medicaid legislation, saying they wanted to be able to offer an amendment to expand the program to cover those earning up to 138 percent of the federal poverty level as allowed under the federal Affordable Care Act. Republican Speaker Philip Gunn, R-Clinton, refused to allow the minority Democratic Party to offer that amendment.

Democrats were able to block the legislation because a number of Republicans did not vote due to conflicts of interests.

If a more precise ruling from the Ethics Commission allowed more members to vote, it could impact the legislation in a special session.

Read More

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House Republicans waiting on ethics ruling to push for Medicaid vote.

(Gov. Phil Bryant said Monday) while Democrats are holding the legislature hostage, some Republicans are working around that stalemate. The group is pushing for a vote on the current Medicaid System.

“That could happen as early as next week. If not there are six members of the House of Representatives all Republicans that are asking as to whether or not the ethics commission will allow them to vote. They have some concern. So we feel like it’s important for every member to have the opportunity to vote,” said Bryant.

According to the governor, the Ethics Commission could look at the group’s request sometime around June 14.

Read More

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Rep. Bobby Moak on Medicaid expansion: “All Democrats want is a vote.”

Over 600,000 Mississippians on Medicaid are at risk of losing their health benefits if the

legislature does not reauthorize Medicaid by July 1st.

House Democratic leader Bobby Moak says Governor Bryant is threatening there will be no special called session to vote on Medicaid reauthorization or expansion. Moak says the Department of Health and Human Services in Washington confirms that federal health funds will be cut to states that don’t expand Medicaid.

“For the Governor to think the law of the land will not be enforced is a fallacy,” Moak says. “All Democrats want is a vote.”

Rep. Bobby Moak says, “Lets have a vote on expansion. Allow us the opportunity to express our vote to protect our hospitals throughout this state. Now, they like to say look you Democrats don’t have enough votes to pass the expansion measure. Well, to that I say ‘tell me what the vote number is.’ Look into your crystal ball because I don’t know what it is. Put it out there on the floor, lets have a vote, and if we lose we’ll vote to reauthorize Medicaid.”

Moak says he hopes Governor Bryant will step back from the issue, call a special session, and allow Medicaid expansion to be properly vetted.

Read More

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• Plunkett: DSH payments will never be cut. Dems should vote to reauthorize Medicaid now. (mississippipep.wordpress.com)
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MS House Dems meet with Federal HHS officials to gather info for “alternative” Medicaid legislation

Last week, state Reps. Cecil Brown, D-Jackson, and Robert Johnson, D-Natchez, traveled to Washington to meet with officials of the Department of Health and Human Services.

“They clearly want to work with Mississippi officials and are willing to consider options,” Brown and Johnson said in a statement. “We intend to spend the next couple of weeks working on some alternative legislation that we would seek comments from them and that we would propose during any special session.”

Brown and Johnson said they hope Bryant agrees to work with them on compromise legislation to continue the current Medicaid program and expand it to include 300,000 additional low-income working Mississippians.

But Bryant blames Democrats for the stalemate.

The Mississippi Hospital Association has come out in support of expanding Medicaid.

Gwen Combs, vice president of policy for the Mississippi Hospital Association, says MHA estimates state hospitals will see a reduction of 75 percent, from $198 million to $50 million, in 2014 federal fiscal year in Medicare cuts to hospitals prior to Medicaid cuts taking effect.

Read More

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Plunkett: Media attempting to ride to rescue of Mississippi Democrats with new Medicaid narrative.

BY: B. Keith Plunkett @Keithplunkett
Democrats have been flailing around looking for any and every reason to remain relevant in a Medicaid debate that, except for their obstructionism in the Mississippi House, passed them by weeks ago.

House Democrat leader Rep. Bobby Moak’s latest attempts, with the help of long time Representative Cecil Brown, has been to paint Medicaid expansion as a jobs program. It’s the latest argument in an ever-changing and undisciplined message from Democrats.  Before, it was about rural hospitals closing due to the loss of federal money, and before that it was about hospitals losing their good credit ratings. Both of the latter arguments have been disproven. The argument as it relates to job creation is, at best, speculative.

Besides attempts during the legislative session to organize rallies in conjunction with the Mississippi Hospital Association to support expansion of the program–a strategy that did little more than trot out examples of the very reason the Medicaid program is in the terrible shape it is in–there has been nothing consistent about the Democrats message. Chairman of the Democrat Party Rickey Cole hasn’t been seen publicly commenting on it in over a month.

But, never fear. The cavalry is coming.

Two analysis articles written by the Associated Press and another by the Northeast Mississippi Daily Journal are attempting to give Dems a hand in rewriting the script with a “one-two punch”.

The AP analysis attempts to recognize a tremor in the political steadiness of Republicans. The Daily Journal editorial tries to help the Democrats refocus the argument on the wretched plight of the impoverished masses.

Back in 2006, the AP welcomed a new director who made it perfectly clear that in order to compete, the news organization would have to be more of an advocate for causes. This latest article appears to fit well within that organizational reboot.

In short, the AP analysis tries its dead-level best to show that Governor Phil Bryant’s latest comments, that he would attempt to run the Medicaid program, is a crack in the Republican foundations, an example of “veering from the script.”

The AP analysis said:

Beyond the cloudy legality of the Republican’s claim, it turns away from the clear-as-glass GOP strategy of blaming Democrats for voting against the program and causing a calamity where 640,000 Mississippians wouldn’t have health care coverage come July 1.

Those GOP positions, repeated over the last two months, appeared aimed at ratcheting up pressure on members of the House Democratic minority. The idea is that some would give in and vote to reauthorize the state-federal health insurance program for the poor without insisting on expanding Medicaid to cover additional people. The plan appeared to be to build the pressure into June and then for Bryant to call lawmakers back for a special session, with the threat of the program’s imminent collapse teetering over Democrats’ heads.

But if it’s Bryant’s position that he can keep Medicaid going even if the Legislature doesn’t act, why say it out loud? It’s likely to encourage some Democrats to keep fighting.

There’s a couple of problems with the AP’s attempt at encouraging the Democrats to continue this political game: Democrats DID vote against reauthorizing the program. And, this WILL be a calamity for the 641,194 needy Mississippians who now rely on Medicaid.

A precursory read of Governor Bryant’s comments show a man frustrated with those two facts, and one who cares about the elderly and disabled who the Democrats are willing to “toss out in the street.”

The man said he cares enough to do everything he can and that is a political weakness? Sorry, that boat doesn’t float.

Like Reading Mississippi PEP’s Original Content? Help Us Keep It Coming.

The Daily Journal editorial attempts to pick up the other side of the argument; that no one is speaking for the people who need Medicaid.

They write the following:

So far, little has been said about the consequences for the program’s 640,000 current clients.

Politics so far trumps patients – those 640,000 people who are primarily the disabled, poor pregnant women, poor children and the elderly.

The additional 300,000 who would be eligible under expanded coverage aren’t in the equation except as a footnote about uncompensated care provided by hospitals already hard-pressed to stay financially afloat.

That is a complete fabrication, and the Editorial Board at the Daily Journal knows it. The Governor’s office released a well-publicized list of the services that would end for Medicaid patients come July 1, and has clearly discussed with the media that the needs of those currently on the program should come first.

Finally, the Daily Journal pushes another fallacy on it’s readers. The opinion of the Editorial Board is that if it weren’t for the hard headedness of Gov. Bryant there COULD be a compromise in Mississippi along the lines of the Arkansas’ model.

In that instance, the Governor of Arkansas cut a deal with the US Dept. of Health and Human Services Director Kathleen Sebelius to take the Medicaid expansion money and apply it to private insurance through a state-run insurance exchange.

The Daily Journal Editorial board says:

Mississippi has a health insurance exchange constructed and ready to be implemented, but Gov. Bryant, in a disagreement with statewide elected Insurance Commissioner Mike Chaney, refused to take the necessary steps, and the federal Department of Health and Human Services disallowed the exchange.

Chaney moved to create the state exchange on the premise that it would be better for the state to run its own exchange than to have the federal government do it for us.

There’s been no compelling argument to the contrary; Bryant’s decision was clearly political.

Again, that’s a load of crap.

There are plenty of compelling reasons not to have a state-based health exchange under ObamaCare, but the main one is the job-killing taxation that only comes with a state-based exchange. The IRS ruled that it could tax companies and implement the individual mandate regardless of whether there was a federal exchange or a state exchange. But, that is outside of the way ObamaCare was written and a lawsuit filed in Oklahoma last week is meant to get to the bottom of it.

In December of 2012, Commissioner Chaney heatedly debated some of these finer points with me on a statewide radio telling me I was wrong because “the IRS already ruled on that.”

But, the lawsuit clearly shows this is not settled, and much of the wheeling-and-dealing of the Obama Administration to arm twist states into expanding Medicaid may in fact turn out to be completely unenforceable and unworkable.

The ObamaCare law, and the Medicaid expansion that is a foundational piece of it’s implementation, is unsettled. Until the time that we can know for sure whether the federal government has the constitutional authority to cut DSH payments to hospitals, for example; or if the IRS rulings will stand up to the latest lawsuit over whether they now have carte-blanche authority to make law and tax individuals without prior approval of Congress, there simply is no reason to move ahead with this liberal experiment.

In the meantime, Mississippi Medicaid patients are about to lose services. That is the one thing Mississippi has control over right now, and where the focus of lawmakers should be.

About Keith: Keith Plunkett has worked on communications issues with a range of public officials from aldermen to Congressmen, and a variety of businesses, governmental agencies and non-profits. He serves or has served as a board member of several non-profit, civic and political organizations. Contact him by going to HorizonMediaMarketing.com or follow him on Twitter @Keithplunkett

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Pender: Gov. taking Medicaid message to the streets.

Gov. Phil Bryant on Tuesday was in Brookhaven, touring a nursing home, pleading his case on Medicaid with workers and patients — something he plans to do across the state in the next few weeks.

Taking it outside the capital and to the streets — that’s a political move out of former Gov. Haley Barbour’s handbook. It’s notable that the first stop on his Medicaid Mystery Tour was in the backyard of House Democratic Minority Leader Bobby Moak, his chief opponent in the Medicaid standoff.

But Medicaid expansion opponents are doing the same thing, with a “Bridging the Gap Statewide Listening Tour” recently kicked off in Hattiesburg and headed to Tupelo and Oxford.

Bryant is also saying that if lawmakers can’t reach agreement and reauthorize the Medicaid program — without expanding it — by July 1, then he’ll try to run it by executive order, something Democrats have said for months he cannot legally do, since the Legislature hasn’t reauthorized or funded the program for the coming year. Expect litigation, if that comes to pass.

via Read More.

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Division of Medicaid preparing to notify beneficiaries of loss of coverage.

“I think it’s required 30 or 45 days before the July 1 deadline,” longtime state Rep. Bobby Moak said last week of recipients being notified.

State Attorney General Jim Hood said a 2004 federal court opinion mandates that proper notice be given to Medicaid recipients prior to the end of services because of a lack of funding.

“The Mississippi Division of Medicaid continues to hope the Legislature can reach a resolution regarding our reauthorization and funding prior to July 1,” said Medicaid spokeswoman Erin Barham. “However, if that is not the case, we are currently reviewing guidelines regarding the procedure for notifying interested parties of potential impacts. Although we are aware of the situation, when we have more direction we can provide additional information.”

Lawmakers failed to pass reauthorization and funding for Medicaid during the regular session that concluded April 4.

Democratic lawmakers and Republican legislative leaders are trading blame for who is responsible for the stalemate.

“Gov. Bryant regrets the situation Democrats have created by voting several times to withdraw funding and authorization for Medicaid services provided by Mississippi’s nursing homes, hospitals and other facilities,” spokesman Mick Bullock said last week. “He has repeatedly stated that when Democrats are ready to fund and reauthorize the current Medicaid program, he will call a special session so Mississippi can continue providing services to children, pregnant women and aged, blind and disabled adults.”

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AP: Freshmen legislators make their mark on education.

(Rep. Charles) Busby was tapped by leadership to carry the charter school bill in the House, and made the most of his opportunity. Though Democrats baited him in committee and during more than seven hours of debate on the House floor, Busby never lost his temper and was generally in command of the details of the legislation.

Other House Republican freshmen have also been influential on education matters, including Rep. Brad Mayo of Oxford and Rep. Pat Nelson of Southaven. Mayo carried other education bills this year. Nelson has played the role of maverick, serving as one of the chief vote-counters among charter school opponents in the 2012 session.

Pascagoula has a double dose of high-profile Republican freshmen, because Sen. Brice Wiggins also found success in the 2013 session as the Senate sponsor of an effort to create a limited state-funded prekindergarten program for the first time.

Another GOP newcomer, Sen. Angela Hill of Picayune, sponsored the bill that’s meant to improve literacy instruction in early grades and would flunk third-graders who couldn’t read on at least a basic level.

For other new Democrats, it’s harder to make an obvious mark, with the party in the minority in both chambers. The most vocal leaders among Democrats in the House have all been veterans. Some new Democrats have shown signs of promise, though, including Rep. Kevin Horan of Grenada, a former prosecutor.

Read More

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Plunkett: Wicker’s got some splainin’ to do.

BY: B. Keith Plunkett @Keithplunkett
Senator Roger Wicker will be a guest on the JT show on Supertalk FM at 11:00 AM on Monday.

Wicker is taking considerable heat from Second Amendment proponents for voting against a filibuster on Thursday. Wicker said he voted to end the filibuster because he supports a vote that would put all Senators on record regarding the Second Amendment.

Here are a few comments we have received at Mississippi PEP:

“Here’s the thing about rights. They’re not supposed to be voted on. That’s why they call them rights.”

“Politicians who try to play both sides of the fence and have no backbone must be voted out.”

“I just got off the phone with Senator Roger Wicker. Basically, Wicker left me with the impression that we who are upset with his vote are wrong and he is right. He said that we need to move on from here. I feel that he has no concern about the Constitutional Principles but yet he said that he believes in the same principles as we do… I told him that if that was true then he would not have voted today the way he did… He started to get short with me as I was expressing my concerns to the point he responded with talking points instead of relevant responses. If there was any respect for him as a Senator before, it is gone now.”

“The thing that gets me, is why does he want to know where the Democrats stand? Ummmmm, we know where they stand, and that’s more gun control. It seems Sen. Wicker has a silly argument there.”

From a readers letter to Wicker: “My family supported you in the past. Now, I can’t think of very many things that you can do to regain my confidence.”

I can’t say I disagree with any of the statements. You don’t debate a right. Period. It’s not debatable. It’s ours. You can’t take it away.

Playing the vote off as a parliamentary tactic to get others on the record seems too smart by about half. Gun owners in Mississippi don’t care too much for DC tricks when it comes to this.

It may be an understatement to say that the Senator is going to have a hard time with callers tomorrow. You can bet I’ll be listening.

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