Mining the Mountaintops

One of the interesting questions that will fuel more than a single dissertation is the impact of  local political factors on PPACA acceptance and utilization.  The obvious answer is that states where there is uniform elite political support for PPACA will see higher public acceptance compared to states with uniform elite PPACA opposition.  We’re seeing this in the California versus Florida comparisons.  The more interesting question is in states where there is conflicted elite and popular support. is passing along some great news and a great research topic:

Excellent news out of West Virginia: Medicaid expansion has increased yet again, from 87,000 to 98,000 residents. This is particularly impressive considering that the total number of people in WV who are eligible for Medicaid post-expansion is about 143,000, according to the Kaiser Family Foundation.

Doris Selko, Southern Regional coordinator for the West Virginians for Affordable Health Care, said over 98,000 residents had enrolled in the Medicaid expansion by March 15 and an estimated 105,000 are expected to be enrolled by the end of the month.

Selko said three southern counties — Nicholas, Summers and Wyoming — have all enrolled over 100 percent of the anticipated enrollment numbers, and Raleigh County has enrolled 99 percent.

West Virginia and Kentucky are interesting case studies of states that don’t support Obama or Obamacare per se are doing aggressive implementation because the deal on the table is too damn good to pass up.  West Virginia is mining its mountaintops and hollows for Medicaid eligibilty and they are aggressively finding people who can benefit.  I am curious what the nationwide numbers would look like if every state was as aggressive as West Virginia in reaching out and more importantly signing up the people who are newly eligible for Medicaid.

25 replies
  1. 1
    srv says:

    So John must not be the only democrat in WV.

  2. 2
    Yatsuno says:

    @srv: Democrats did quite well in elections in West Virginia until some dark fellow won the White House. Should Hillary run odds are it will do so again. Caputo unfortunately is a lock due to her name and the ineptitude of the state party there.

  3. 3
    Roger Moore says:

    The other interesting thing about both Kentucky and West Virginia is that they’ve gone republican in presidential elections but have democratic governors. I think this is a great opportunity politically for democratic state governments to show the good stuff they can do.

  4. 4
    Fuzzy says:

    We all know that these disillusioned folks will vote GOP against their own best interests because if coal isn’t king they think starvation is the result.

  5. 5
    Anoniminous says:

    Booman has a post up about Opioid Addiction.

    Shorter: now that the special snowflakes in the suburbs are dropping dead something needs to be done.

  6. 6
    Roger Moore says:

    Religion Oxy contin is the opiate of the masses.

  7. 7
    Foxhunter says:

    Contrast those KY and WV stories with the dumassery here in Georgia.

    Lawmakers approved Tuesday night two anti-Obamacare bills that all but guarantee Georgia won’t expand its Medicaid program and that will prevent state agencies from helping consumers sign up for new insurance coverage offered under the Affordable Care Act.

  8. 8
    Yatsuno says:

    @Roger Moore: When they sell KyNect as the Kentucky health care reform, the approval is off the charts. As soon as it gets called Obamacare, it falls like a stone in water. Grimes is playing it smart by selling KyNect as Democratic idea without relying on the national name to sell it. I think she’ll pull it off if for no other reason than that.

  9. 9

    Confederate/Racist America is like a sick cat you don’t own; you try to give it medicine so it will get better, and the little fucker fights, bites and claws you every step of the way – and the whole time you’re thinking you wouldn’t be that sorry to see it die, but you’re compassionate and you don’t do that to sick cats.

    Being a Democrat means helping the people hellbent on your destruction. No wonder we have a motivation problem.

  10. 10
    Mnemosyne says:

    I’m trying to remember which state is was that got a waiver so that, instead of expanding their Medicaid program, they used the money to fill in the “donut hole” between Medicaid and subsidized insurance. Was it Alabama? That didn’t seem like a completely insane way to get to the same goal, especially if you had people whose incomes were variable enough that one year they would be at or below the poverty line and back above 125% of poverty the following year since it would mean they would not have to change insurers (and, presumably doctors) just because they made more or less year to year.

  11. 11

    Booman has a post up about Opioid Addiction.

    Shorter: now that the special snowflakes in the suburbs are dropping dead something needs to be done.

    @Anoniminous: Former friend of mine has that particular disease, from back before it was trendy. I’m pretty much all for letting them die. They kind of do anyway. The addiction is fundamentally not curable, and the person that comes out the other end bears no resemblance to the one that they were pre-addiction. Same physical shell, totally different brain, soul…gone.

  12. 12
    ulee says:

    Thanks NAFTA. The jobs have dried up, unless you want to work at Subway. I have seen several young people’s lives destroyed by oxycontin.

  13. 13
    Keith G says:

    ACA Enrollment Update from last night:

    (In Jan it looked like I would be offered a job in another state in Feb, so I held off doing the ACA thing. The offer did come last Friday with some changes in numbers leaving me to decline and stay put) So:

    Yesterday the application process went swimmingly until it was decided that my ID could not be verified by the online process.

    I was told to call a number to be verified by them, but the office was closed when I called . I called back this AM to the third party verifier. The process ended with them saying that I could not be verified by them and they told me to contact the Fed’s Market call center.

    Called the appropriate # and was on hold as I drove around town and prepping lunch at my hospice gig. (45 min terrible muzak).,Finally got a very nice human and through her efforts now have an application # and am free to complete the enrollment process (with one caveat mentioned below). I did not complete it then since I am already scheduled tomorrow to meet with a counselor/case manager from the wonderful folks who have been helping me with my AIDS related health care issues. With him, I will take one last look at the plans available and see which match up the best with my ongoing needs and medication. Then I pick a plan.

    Even though I will choose a plan tomorrow, the system is still not sure that I am who I say I am, and I need to send in copies of various document before June 1 – but as long as I complete the selection process tomorrow (or by 3/31) I will have met the basic requirements and am considered signed up (but on probation?)

    Nonetheless that database issue (as I was told) is aggravating and caused more than a bit of concern over the last 24 hrs. Hopefully there will be no more surprises.

  14. 14
    Anoniminous says:


    Sorry to hear about your former friend.

    Black tar heroin has been a plague in urban and rural America for 15 years, maybe more. Nobody cared … except for the family and friends of the people dying.

    There is a Finnish company, whose name I cannot remember, claiming a 70% success rate by having people take opioid blockers before shooting up. The blocker prevents the high which interrupts the Dopamine behavior reinforcement cycle. Thus taking the drug is pointless and by continuing to ingest the drug the physical side-effects are reduced or eliminated. So there is hope?

    Warning: all of the research data comes from the company selling the program AFAIK and so must be taken with salt. A slight counter is the person behind the science is a friend of a friend and my friend tells me his friend is a upright guy. I can’t say either way.

    One definite hopeful sign is a movement towards treating addiction as a physical disease not a moral, religious, talky-talk psychological, &/OR etc. problem.

  15. 15

    @Anoniminous: My point, and it was put poorly, is this. You might be able to figure out a way to cure the physical addiction. I have my doubts but OK, let’s say you can. It almost doesn’t matter. When people come out the other end of the opioid addiction process, they resemble a person who’s had a lobotomy. They’re not there anymore.

    I’ve know other people with other habits and my mother was an addiction counselor for many years. I’ve never seen any drug that does the profound mental/spiritual damage to the addict that opioids do.

  16. 16
    Commenting at Balloon Juice since 1937 says:

    hollows? I thought they were hollers.

  17. 17
    mdblanche says:

    @Fuzzy: Pretty much. Remember, the first Democrat not to carry West Virginia since forever wasn’t Barrack Obama, but Al Gore.

    @CONGRATULATIONS!: That reminds me of the time my kind-hearted but no longer as sharp as she used to be grandmother tried to rehabilitate a stray cat in her neighborhood. After literally biting the hand that fed it once too often, she eventually had no choice but to have it put down.

  18. 18
    Citizen_X says:


    One definite hopeful sign is a movement towards treating addiction as a physical disease not a moral, religious, talky-talk psychological, &/OR etc. problem.

    Maybe you didn’t mean it that way, but that’s dogmatic. What’s encouraging is that it is being seen more as a medical problem, meaning treatments are amenable to scientific evaluation. This guy (towards the end) describes one case he had where the patient definitely responded well to “talky-talk” therapy.

    The article is an excellent takedown of the AA/NA approach, and its lack of scientific basis. Maybe a whole range of therapies will be seen to work, depending on the individual. Maybe that will even include the semi-religious AA approach, since that does work for 5-10% of the population. But all approaches need to be open to evaluation.

  19. 19
    Anoniminous says:


    Yeah, that’s the sad truth.

  20. 20
    Anoniminous says:


    I originally wrote “medical” and then changed it for reasons that seemed good at the time.

    Point taken.

  21. 21
    Citizen_X says:

    @Anoniminous: I do recommend that article I linked to, though. It pretty much demolishes the reliance on the AA approach.

  22. 22
    tokyo expat says:

    @CONGRATULATIONS!: I know someone like this. He got into cocaine, I think. Whatever it was, it was bad. I remember him as a child, funny, smart, active. Now, he’s this forty year old who sits and stares into space, sometimes talking to himself, sometimes humming. It can be unnerving. He smokes, watches TV and his mother cares for him. He’s been like this for twenty years now.

    What’s really sad is his mother sent him and his two older brothers from Ethiopia to escape the war there. Her husband had been a pilot who’d been shot down. So off she ships them to America to save them and in the end, her youngest destroyed himself anyway.

  23. 23
    rikyrah says:

    Richard M:

    There was a poster who wanted to know about Michigan.

    1. Did they expand Medicaid?
    2. What about their state exchange.

    They put their Michigan question in one of the Sunday threads.

  24. 24
    rikyrah says:

    I am curious what the nationwide numbers would look like if every state was as aggressive as West Virginia in reaching out and more importantly signing up the people who are newly eligible for Medicaid.

    the numbers were FIVE MILLION MORE AMERICANS would gain access to healthcare of the GOP sociopath Governors didn’t refuse to expand Medicaid.

  25. 25
    Mnemosyne says:


    Interesting article that seems to illustrate one of the major problems we have with treating addiction: AA is a very helpful program for specific people with a specific mental illness that we currently call “alcoholism.” But it is not a cure-all for people who are not alcoholics and who are drinking or doing drugs for other reasons.

    I know several people who have been very successful in AA but all of them have very similar personality traits, including not seeming to have a natural “off” switch that helps them realize when they’ve taken a good thing too far (my most common example is the friend who, after getting sober, went from being a vegetarian to a vegan to an anorexic, because if not eating meat was healthy, then not eating at all must be even healthier).

    As I keep saying, we really, really need a more reliable screening test in this country so we can figure out which people have the specific mental illness that we currently call “alcoholism” who can be helped by AA (because for those specific people, it does work very well) and which people need a different treatment. Otherwise, it’s like we’re handing anti-depressants out to every mental patient and then being shocked and surprised that the bipolar and schizophrenic patients don’t get better, or even get worse.

Comments are closed.