Good News Everybody

New Hampshire is the latest state to get on board with Medicaid expansion.  They still will need approval of a waiver from Health and Human Services, but the New Hampshire government is extremely likely to ask for an Arkansas style “private option” waiver.  HHS has been willing to grant those waivers as long as there is no poor shaming involved.

Via TPM:

The GOP-controlled New Hampshire Senate approved a privatized plan for expanding Medicaid under Obamacare Thursday, opening the door for the state to become the latest to adopt the expansion…

The Democratic-controlled House is expected to approve the plan, and Democratic Gov. Maggie Hassan has expressed her support. About 58,000 New Hampshirites are expected to gain coverage under the expansion.

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55 replies
  1. 1
    Yatsuno says:

    What’s the point of expanding coverage for the poors if you can’t shame them? I don’t like this option because it ends up more expensive and I get the feeling they get shoved onto shitty narrow networks with little coverage.

  2. 2
    c u n d gulag says:

    WTF – NO POOR-SHAMING?!?!?!?!?!?!?!?!

    That’s mostly what our Conservative sociopaths live for – to kick-down!!!!!

    Of course, the only other thing they live for – is to kiss-up!!!!!!!!!!!!!!!!!!!!!!!!

  3. 3
    Rob in CT says:

    Yay. I have a family member up their (brother in law) for whom the ACA is a serious improvement. He’s already signed up, I assume via the federal exchange.

    He probably makes enough he doesn’t qualify for medicaid, but it’s nice to know that it’ll be there if his income drops.

  4. 4
    boatboy_srq says:

    @Yatsuno: @c u n d gulag: Signs of hope that New England’s GOP haven’t all fallen victim to the Teahad.

  5. 5
    Chyron HR says:

    Stay tuned for Paul Ryan’s scathing rebuttal, “Good news, everyone! I’ve invented universal SOUL care!”

  6. 6
    Rob in CT says:


    Via Charlie Pierce’s blog… Wayne LaPierre, everyone:

    “We trust what we know in our hearts to be right,” he said. “We trust our freedom. In this uncertain world, surrounded by lies and corruption everywhere you look, there is no greater freedom than the right to survive and protect our families with all the rifles, shotguns and handguns we want. We know, in the world that surrounds us, there are terrorists and there are home invaders, drug cartels, carjackers, knockout gamers and rapers, and haters and campus killers, and airport killers, shopping mall killers, and killers who scheme to destroy our country with massive storms of violence against our power grids, or vicious waves of chemicals or disease that could collapse our society that sustains us all.”

    You gotta be f*cking kidding me. In a sane USA this guy would be a lone crackpot ranting on a street corner.

    The stupid, it hurts.

  7. 7
    Omnes Omnibus says:

    @Rob in CT: .

    We know, in the world that surrounds us, there are terrorists and there are home invaders, drug cartels, carjackers, knockout gamers and rapers, and haters and campus killers, and airport killers, shopping mall killers, and killers who scheme to destroy our country with massive storms of violence against our power grids, or vicious waves of chemicals or disease that could collapse our society that sustains us all.”

    TL:DR version: I am scared of everything.

  8. 8
    Tissue Thin Pseudonym (JMN) says:

    @Yatsuno: I don’t like this option, either but, much like the ACA writ large, it’s better than not covering them at all.

  9. 9
    dedc79 says:

    @Chyron HR: And Ryan’s actual speech was even worse than what was previewed:

    He then told a story of a “young boy from a very poor family” who received free lunches at school “from a government program.”

    “He didn’t want a free lunch,” Ryan insisted. “He wanted his own lunch, one in a brown paper bag, just like the other kids.”

    “He wanted one, he said, because he knew a kid with a brown paper bag had someone who cared for him. This is what the left does not understand.”

  10. 10
    Tommy says:

    @Omnes Omnibus: How about it. I thought Republicans were manly men, not scared of anything. That is a long list of things to be scared of. I like to joke I often don’t even lock my front door. So can we restrict guns where I live, you know just a little.

  11. 11
    Trollhattan says:

    I liked Coscarelli’s headline over at NYMag: “Old White Guys Pose With Big Gun: Welcome to CPAC 2014”

  12. 12
    Gin & Tonic says:

    @Rob in CT: He came close, but whiffed. No “precious bodily fluids.”

  13. 13
    KG says:

    @Omnes Omnibus: there’s a lot of courage in an empty bottle of whiskey and a six shooter.

    @dedc79: oh, for fuck’s sake…

  14. 14
    Gypsy Howell says:


    Oh, he’s going to be handing out free brown bag lunches to poor children now! Say, that’s wonderful!

    Wait… you mean he’s not?

    And how exactly does he propose to address this problem? Get rid of the estate tax? Eliminate taxes from capital gains? Abolish social security? get rid f some environmental regulations? I can’t wait for his solution.

  15. 15
    mdblanche says:

    And Arkansas’ private option has been reauthorized.

  16. 16
    Chyron HR says:

    @Rob in CT:

    “Assassins, cons and rapists, might as well die.”

  17. 17
    Tommy says:

    @dedc79: Wow. Just wow. I mean what do you say to something like that?

  18. 18
    KS in MA says:

    @dedc79: As my dad used to say when something was really bad, That speech of Ryan’s doesn’t even stink.

  19. 19
    Mnemosyne says:


    “He wanted one, he said, because he knew a kid with a brown paper bag had someone who cared for him. This is what the left does not understand.”

    I see somebody still has abandonment issues from his father’s death.

    He should probably get some therapy and stop forcing the rest of us to deal with his problems.

  20. 20
    mdblanche says:


    He then told a story of a “young boy from a very poor family” who received free lunches at school “from a government program.”

    To be specific, that story’s called “An Invisible Thread.”

  21. 21
    🎂 Martin says:

    @dedc79: And the anecdote might be plagiarized. Well, and adapted because the original anecdote doesn’t prove his point at all.

  22. 22
    bemused says:


    I think Paul Ryan should take a vow of poverty, go sit on a top of a mountain and ponder the state of his own damn soul.

    The lunch bag boy story seems to have been altered to suit Ryan’s spin. What a surprise. Rightwingers’ anecdotes are always suspect. They never factcheck a story and repeat it over and over usually with embellishment or alteration. They or others makes up stories which they spread widely without conscience. They fall for onion type stories and never apologize when that is pointed out because it just might be true somewhere.

  23. 23
    AliceBlue says:

    @Rob in CT:
    He forgot the mother rapers and the father rapers.

    (h/t Alice’s Restaurant).

  24. 24
    Roger Moore says:

    @Rob in CT:

    We know, in the world that surrounds us, there are terrorists and there are home invaders, drug cartels, carjackers, knockout gamers and rapers, and haters and campus killers, and airport killers, shopping mall killers, and killers who scheme to destroy our country

    And the NRA wants to make sure that they have easy access to firearms.

  25. 25
    Roger Moore says:


    He should probably get some therapy and stop forcing the rest of us to deal with his problems

    Can we extend this prescription to the entire Republican party?

  26. 26
    Ash Can says:

    @Omnes Omnibus:

    TL:DR version: I am scared of everything. Pony up, you dumb rubes. Those guns aren’t going to buy themselves.

  27. 27
    Ernest Pikeman says:

    Richard, a tangential question. Where can I complain about atrocious information security and user-hostility with the health insurance companies in the exchanges?

    I’m on ACA in California and my plan is with Anthem. Their operation is a f*ing clown show. I’m trying to give them money, but they are not very interested. Meaning payment options are hard and ACTIVELY user-hostile. The phone payment says “put in your 9-digit member number, and if you have an A in it, input 2, and if you have an M, input 6”. Whut? OK, fine, but my ID# has 12 characters.

    Bailed out of that and tried to register for payment online. Their form doesn’t accept 12 characters either. Phone droid finally says breezily “oh of course you have to remove the 3-letter prefix from the number!”. It’s obvious, innit? And why can’t the validation code on the page do that?

    Finally, that done and I can register for Anthem to pull money from my checking account. YOU CAN ONLY USE A PASSWORD OF 5-8 CHARACTERS. Not longer than 8, nu-uh. So you want me to link my banking information and health information online, but forbid me to use a secure password? How is this even possible in 2014? Not. going. to. happen.

    I’m afraid there’s going to be a spectacular personal information leak with ACA at some point.

  28. 28
    Baud says:


    This is what the left does not understand.

    I’m confused. There are people out there who feed their children?

  29. 29
    Tommy says:

    I know I am preaching to the choir here, but when I read this I am at a loss for words:

    About 58,000 New Hampshirites are expected to gain coverage under the expansion.

    58,000 is a lot of people. You know humans. Our fellow citizens. I try to stay calm, but it is high times the folks we vote for get on TV and yell at the top of their lungs about how wrong this is. That millions could have care, but just because there is a black liberal in office, we can’t have “nice things.” Heck parts of the ACA was their darn ideas.

    I know yelling doesn’t often get you want you want, but my gosh I just wish somebody would yell a little. Show me they care. People are going to die because of this. They are going to go bankrupt and lost everything. I am sorry that is something to be mad about and yell a little.

  30. 30
    Belafon says:

    @bemused: Yes, as a kid who received free lunches, I just wanted to eat.

  31. 31
    Villago Delenda Est says:

    @Chyron HR:

    Sounds like the NRA board of directors, to me.

  32. 32
    🎂 Martin says:

    @Ernest Pikeman: Aren’t those all existing issues with Anthem? My CA insurer password is 20 characters.

  33. 33
    Villago Delenda Est says:

    @Roger Moore:

    And the NRA wants to make sure that they have easy access to firearms.

    Because the prime directive of the NRA is to move the product of our masters.

  34. 34
    dedc79 says:

    @Tommy: @Baud: I share your confusion/speechlessness

    @mdblanche: Was just about to link to the Wonkette story, but I see you beat me to it.

    @Gypsy Howell:
    Homeless person: I wish I didn’t have to depend on soup kitchens for my daily meals.
    Paul Ryan: See, the homeless don’t want to be fed so we should cut funding to soup kitchens. Problem solved. Souls saved.

  35. 35
    Tommy says:

    @Ernest Pikeman: I am very sorry to hear that and I hope somebody can help you.

    I just say this over and over again, cause I want folks to hear positive stories (not taking away from what sounds like a pain in the butt for you). It took me days to get onto my exchange, but alas I got a far better plan for almost $100 less per month.

    Once I could get registered and look at the plans, it was pretty much smooth sailing. My provider, which honestly I’d never heard of before, seemed to be organized and ready for new members.

    Again I don’t mean to belittle in the least the problems you are running into, I just want to stress that for many of us things are working. They in fact seem to be working well.

  36. 36
    GregB says:

    There must be a lot of people who care for poor folks in rough neighborhoods because I often see guys walking around with brown paper bags.

  37. 37
    🎂 Martin says:

    @Baud: I know, right? I mean, here I am trying to be a good parent, teaching my kids the value of hard work and independence, so I send them off to school with a good quality long-barrel rifle. They setup a little blind there by the monkey bars at recess and recruit a few other kids who are good runners to go flush out some wildlife – usually someone’s dog. Retrievers are easy – they’re friendly and eager to chase a ball out into the open. By 3rd grade they’re usually a steady enough shot to take it in one shot (ammo’s not cheap, boy! And remember you’re shooting into a residential neighborhood, so be courteous!) While they field dress some of the kids will start a fire in the sand under the swings. I always tell them to save some for the kindergardeners. While they need to try and get their own food, they’re going to miss a lot and you should show them the benefits of being persistent by sharing when they get really hungry.

    So why the fuck would I want to deny my child the satisfaction and pride of preparing his own lunch by just handing him one? What the fuck is he going to learn from a handout like that?

  38. 38
    Mnemosyne says:

    @Ernest Pikeman:

    I would complain to the California Department of Insurance. They’ve already fined Anthem Blue Cross multiple times over the years for shenanigans (they were one of the worst offenders in canceling people’s policies for trivial reasons), so they’ll be happy to hear from you about the new shenanigans.

  39. 39
    Ash Can says:

    @Tommy: psst — “alas” means “unfortunately” or “woe is me.”

    /grammar nazi

  40. 40
    bemused says:


    Yup and I doubt he thinks of this as he sends his well fed kids off to school. I read about his “quiet” outreach to the poor last year and snorted. I didn’t imagine for a second that he would actually learn anything but what he said at CPAC is appalling and self-serving. A cynic might think he only went on his outreach tour to gather some anecdotes to pad his rightwing resume.

  41. 41
    mdblanche says:

    @🎂 Martin:

    And the anecdote might be plagiarized. Well, and adapted

    “Only be sure always to call it please research.”

    I guess Putin isn’t the only Russian that Republicans admire.

  42. 42
    SiubhanDuinne says:


    “I am never forget the day….”

  43. 43
    MomSense says:

    I’m really happy for NH. It would be great if Maine could follow suit. I think last year the legislature in Maine failed to override our governor’s veto by just 2 votes. I also think I could insure my youngest on my insurance plan for less than cub care. Maybe not but I’m annoyed by them because I keep paying them even though they can’t send me an invoice and they don’t know how much I owe. Also too I got an infuriating letter from DHHS telling me that all the delays and inefficiencies are because of the affordable care act.

    Maine Community Health Partners is my insurer and they have been fantastic. They were slow in getting us cards but otherwise have been helpful and prompt. The workaround for the cards was to print our IDs off the website in the interim. I am a happy customer and we haven’t had any issues with keeping our providers.

    @Rob in CT:

    I would really like to call in a tactical meteor strike on Mr. LaPierre. Had the pleasure of picking up my 4th grader and his friend after school. Got to hear all about the school’s lockdown drill including how the teacher locks the door and sets her phone on silent so she can text all the parents. Got to hear about where they hide in the classroom and their thoughts on whether it is better to be gunned down while hiding or if they should try and fight the hypothetical gunman by grabbing his legs and biting him.

    I am pissed that this is the new fucking normal. There is nothing normal about this. It is an outrage. After 9-11 we instituted all sorts of changes like detailed security checks with shoe and belt removal and carrying sample size bottles, two wars, body scanning, and surveillance — all for the remote possibility that terrorists would strike. But we cannot have fucking background checks or any sort of limits on firearms???

    What messages are our children getting with these lockdown drills? I’m just so sick of this.

    Ok, rant over.

  44. 44
    Ash Can says:

    @MomSense: Guns, and gun ownership rights, are valued more highly than children in this nation. We can’t begin to address this problem unless and until everyone recognizes and admits this.

  45. 45
    Mike in NC says:

    Koch Industries must make lots of brown paper bags, so Ryan was just trying to steer a little more business to his paymasters.

  46. 46
    MomSense says:

    @Ash Can:

    The thing is I do believe that people, the majority of people, value children over guns in this country. We have this minority of people who are batshit insane gun fetishists who support an organization whose real interest is promoting gun sales and creating another market for modified military weapons and just enough congress critters on the take to fuck things up for the rest of us.

  47. 47
    Tommy says:

    @MomSense: Wow that is horrifying. Makes me think back to the day as a military brat, in the 70s, and we had drills to survive a nuclear war. I guess I am blessed cause it hasn’t gotten to that level by me. I don’t have any children, but a wonderful niece I spend a lot of time with. There are no metal detectors in schools. No guards. Things are kind of like when I was a kid. I’ve always felt schools should be a safe zone, and making me feel unsafe by having drills like this should be the last thing we ever do.

  48. 48
    MomSense says:


    It’s horrible but the schools are being responsible in holding these drills. Unfortunately they are reacting to the society we have created for our children.

  49. 49
    Roger Moore says:

    @Villago Delenda Est:

    Because the prime directive of the NRA is to move the product of our masters.

    And nothing moves it like the sure knowledge that criminals have no trouble getting guns. It’s a brilliant, if morally bankrupt, marketing strategy. Not only does it get sales from all the hardened criminals who want to be heavily armed, it encourages everyone else to buy too. The main people who win in an arms race are the arms dealers.

  50. 50
    Violet says:

    @MomSense: Our society is significantly less dangerous than it was fifty or a hundred years ago. Don’t let a few drills get you down.

  51. 51
    mclaren says:

    Time once again to strip away the lies from the posts of our resident $400,000 man, the one-percenter CEO of Mayhew Insurance.

    The superwealthy insurance company CEO Richard Mayhew tells us the flagrant lie that it’s “good news” that New Hampshire is “the latest state to get onboard with Medicaid expansion.”

    Like his fellow one-percenters Paul Ryan and New Gingrich and John Boehner, what our $400,000 man Richard Mayhew fails to tell us is that states are slashing Medicaid right and left because the ruinous medical costs are bankrupting them.

    Let’s take a detailed look superwealthy one-percenter Richard Mayhew’s lies:

    Federal authorities have dramatically lowered the amount that New York state can claim from the federal government for certain medical services, costing the state an estimated $1.2 billion.

    The Center for Medicaid Services (CMS), the federal agency that administers the nation’s medical insurance system for people on low incomes, cut the per-patient reimbursement rate for patients in developmental centers to $1,200 from $5,100 from April 1, according to CMS documents seen by Reuters.

    The move by CMS had been expected ever since a bipartisan congressional report said overbilling for the centers reached $15 billion over the last 20 years.

    Source: “Federal government slashes New York’s Medicaid payments,” Reuters News Service, 1 April 2013.

    The same pattern of slashed medicaid reimbursements repeats itself in California:

    When Ruth Haskins, a gynecologist in Folsom, California, does a pelvic exam and pap smear on a woman with insurance, she gets $95 to $200. If the patient is elderly, federal Medicare pays $36. For the low-income on Medicaid, the state gives $25, and it’s about to go down.

    The reduction comes as Medi-Cal, California’s Medicaid program for 8.5 million people too poor to afford health care, is on the verge of adding 1 million participants under President Barack Obama’s health-system overhaul, according to the state Health Care Services Department.

    Finding doctors willing to treat them may be harder. The biggest U.S. state by population is projecting its first budget surplus in almost a decade and spending $1.5 billion to expand Medi-Cal. Yet many physicians, as well as dentists and pharmacies, will see their fees cut 10 percent under a 2011 deal by Governor Jerry Brown to balance an $86 billion budget. (..)

    Just 57 percent of California physicians accepted new Medi-Cal patients in 2011, the second-lowest rate after New Jersey, the budget group said in an April report.

    Patient advocates say the flood of new Medi-Cal patients may be unable to find doctors, clinics and pharmacies willing to take them.

    “We can take only up to 20 pregnant patients per month,” said Haskins, who practices obstetrics and gynecology in Folsom. “As it approaches five Medi-Cal patients in a month, we have to say no, I’m sorry, I can’t take any new Medi-Cal patients.”

    “With the anticipated decrease in state reimbursements, that number will certainly go down.”

    Source: “California Cuts Medicaid Payments Amid Wave of New Users,” Bloomberg News, 4 October 2013.

    Wake up, Balloon Juicers! The superwealthy insurance company CEO Richard Mayhew is LYING TO YOU.

    Mayhew is telling you it’s “good news” that states are expanding medicaid — what the superwealthy top-one-percenter Richard Mayhew doesn’t tell you is that because of this massive expansion, states are going broke because underlying medical costs continue to skyrocket.

    So states and the federal government are cutting medicaid reimbursements across the board. This means that fewer doctors can provide basic medical services under medicaid.

    “Good news”?

    That doctors can see fewer patient under medicaid in most states?

    “Good news” that in most states, the poorest patients increasingly can’t find a primary care physician?

    That’s “good news”?

    Less medical care? Fewer doctors available? Poor people getting sick and dying and unable to find a doctor?

    This is “good news”?

    The $400,000 man Richard Mayhew is a typical superwealthy CEO — he lies and lies and lies about the effects of the policies which enrich him, while destroying the lives of the poorest Americans.

    Email John Cole.

    Ask him to remove the superwealthy top-one-percenter Richard Mayhew from the front page now. If Mayhew wants to tell his lies, let him peddle him scams and distortions at The Washington Times or The Daily Standard, not here.

    The basic problem of skyrocketing out-of-control underlying costs of medical care in America have not been solved by the ACA. In fact, the ACA legislation does not even address the problem of out-of-control skyrocketing costs of basic medical services in America.

    I’m far from the only person who has pointed this out. It’s been pointed out by many many other commenters — see, for example, Ezra’s Kleins article “21 graphs that show America’s health-care prices are ludicrous,” The Washington Post, 26 March 2013.

    Or see “Why an MRI costs $1,080 in America and $280 in France,” Ezra Klein, The Washington Post, 3 March 2012.

    Or see “One hospital charges $8,000 — another, $38,000,” Sarah Kliff and Dan Keating, The Washington Post, 8 May 2013.

    Or see “Bitter Pill: Why Medical Bills Are Killing Us,” Stephen Brill, The New York TImes Review Of Books,” 15 August 2013.

    Or see “Health Care Reform Does Not Mean Better Actual Health Care, Sorry,” Chris Bray, The Baffler, 27 February 2014.

    It would be hard to overstate how badly public policy has gone wrong in the arena of American health care, but here’s a remarkable personal experience to suggest the outlines of the problem. In November, too sick on a Saturday night to wait for Monday, I went to the dreadful emergency room in my own neighborhood. It was my first—and last—visit to the place, and almost nothing at all happened: a nurse practitioner asked some questions, ordered some tests that he told me, as he sent me home, he hadn’t gotten around to reviewing, and suggested that I try to see a doctor on Monday. No diagnosis, no treatment, no doctor.

    A month later came the punch line: an EOB to let me know how much of the emergency room physician’s $540 bill my insurance company had paid. The doctor on duty that night in the ER, having never seen me or spoken to me, billed me for her services.

    After a fruitless exchange of letters, I called the California Medical Board, traveled around the phone tree, and spoke to a regulator. She explained the rules for billing by a doctor for services provided by a nurse practitioner. The doctor sending a bill has to “supervise” the NP, but doesn’t have to be physically present to do it—not even in the same building—and only needs to review “some percentage” of the NP’s patient charts.

    This is a scam, “supervision” without supervision. To be sure, it does cut costs—it cuts the cost for the provider of medical treatment, but without cutting the costs insurers and patients pay for service. It’s a profit-enhancer, not a delivery system for cheaper medicine.

    Welcome to the Bizarro World of superwealthy one-percenter Richard Mayhew, the health insurance CEO who assures us of “good news” even as fewer Medicaid patients get access to primary care physicians while states slash their medicaid expenditures to stop the budget hemorrhage that’s bankrupting their budgets.

    Welcome to the Great Big World ‘O Scams in which patients and their insurance companies get billed for doctors’ services which doctors never provide — no diagnosis, no treatment, no doctor, but a fat whopping bill charged by the doctor and paid by the insurance company.

    Welcome to the Paul Ryan version of American medical “reform” — more profit for the greedy corrupt doctors and hospitals and superwealthy one-percenter insurance company CEOs like Richard Mayhew, while patients get fewer services and higher bills.

    And this is what superwealthy one-percenters like Richard Mayhew have the gall to describe as “good news!”

    Balloon Juice should be a place where evidence and facts get presented about public police…not a cesspool of lies and distortions spewed out by superwealthy spin doctors like our resident $400,000 man, health insurance company CEO Richard Mayhew.

  52. 52
    Studly Pantload, the emotionally unavailable unicorn says:

    @Chyron HR: Nice Dorothy Parker reference!

  53. 53
    El Caganer says:

    @dedc79: Why does Paul Ryan want to feed paper bags to poor kids?

  54. 54
    Rob in CT says:


    What the fuck is this?

  55. 55
    Persia says:

    @Tommy: The thing that really baffles me (not really) is that THESE ARE WORKING PEOPLE. That’s why they didn’t qualify for Regular Flavor Medicaid. But nope, comes from the govmit, can’t trust it, it’ll cost us money, fuck those poor people who don’t get better jobs.

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