Kentucky released their revised Medicaid waiver application earlier this week. We had looked at their draft application a few months ago. The base story in their draft application was that people on Legacy Medicaid would barely be touched by the institution of road blocks, bureaucratic barriers, confusion and add-on requirements. The Medicaid expansion population that is currently being served by a straight Expansion would be hit by the creation of Health Savings Accounts, lock-outs, job training requirements and half a dozen other systems of friction to get people to not sign up.
I am a firm believing that budgets are profoundly moral documents and the draft document’s solution to customizing Medicaid was to make it more confusing while serving fewer people at higher trend rates.
The final version was released and there is minimal change in the budgetary outcomes.
Again the plan is the same. Magic pixie dust will be sprinkled on the kids in Medicaid to bring down their trend cost rate but most of the enrollment side barriers won’t touch the kids. Adult Legacy Medicaid which in Southern states means the completely disabled, poor pregnant women and extraordinarily poor working parents will see an annual 2.2% decline in enrollment instead of half a percent increase. Roughly one in eight member months that Kentucky anticipated covering with no change will now not be covered. The cost trend rate will be roughly the same. That implies the people who are not being covered are costing roughly the same as the people who still have coverage so it is not a matter of kicking out the healthy people and only covering the sick as that would have had at least a one time bump in per member per month (PMPM) cost trends.
Medicaid Expansion adult is where things are still very screwy. The enrollment gains will be reversed at a higher rate than the Adult Legacy population. At the end of 5 years, 13% fewer member months will be covered. This time, the cost trends hint that the actuaries project that healthy/low utilizing people will be the ones driven from the program as we see a noticable bump in trend PMPM rates.
Medicaid 1115 waivers are supposed to cost the Feds no more money. This proposal meets that criteria. They are also supposed to be at least coverage neutral. This proposal fails miserably on this aspect. The next best alternative to approving this waiver is the continuation of the status quo and a forty seven page technical response document by CMS staff. The threat by Governor Bevin to pull out of Medicaid entirely is a non-credible threat as that destroys Kentucky’s medical system.
HinTN
Gov Bevin sticks fingers in ears, “la la la I can’t hear you.”
These are sick people and I’m with Villago, they need tumbrels.
Iowa Old Lady
Iowa has a waiver privatizing Medicaid. The one person on it who I know is much worse off now. She a former professional dancer and now an aerobics teacher with a lot of joint damage. The private company (I want to say AmeriGroup, but that sounds like insurance) has to pre-approve nearly every treatment she needs and takes literally months to do it. It’s a shame.
But frankly, I don’t see how you can expect a for-profit company to provide the same coverage plus turn a profit for less money than the government. This always seems like pixie dust to me.
rikyrah
This is who they are.
This is not a shock Mayhew.
This SOB told them what he was going to do.
Lowdown, rotten muthaphucka ????
Baud
I’ll give Bevin this. He didn’t lie.
p.a.
Privatize the TVA*. I don’t have subsidized energy supplies, why should the goobers. They want to fuck their own people, Feds can help ’em out. Maybe an implied ‘tit-for-tat’ might penetrate the skulls of southern voters. Nothing else has.
*exec order? don’t know how it could be done.
NorthLeft12
I guess I will never understand how many people can be so mean, ignorant, and careless of their fellow human beings. These are peoples’ health, and ultimately their lives at stake here.
Any Kentucky Bevin voter who says “I did not vote for this.” is either an idiot or liar or both.
amk
If you vote for a loser, you are the loser.
p.a.
@efgoldman: who came up with the box/curtain rod/roasted sparrow meme? It was genius, and still the best explanation for this. (Game theory: player 1 has $100 to distribute between p1 & p2, player 2 has absolute right to deny both players any money. Even though p2 benefits no matter how little p1 shares with him, in the lab p2 will usually beggar himself and p1 if p1 shares less than ~$30)
Baud
@p.a.: That’s not hard to understand. The amounts at issue are small, and p2 has a nonmonetary interest in not feeling like the goat in the negotiation.
I'mNotSureWhoIWantToBeYet
@p.a.: It was Davis X. Machina. From the Lexicon (in the entry for 27 percent:
HTH.
Cheers,
Scott.
OzarkHillbilly
@NorthLeft12: It’s really not that hard to understand, you just need to be an American to get it. Fortunately for you, you are spared that ignominy.
I'mNotSureWhoIWantToBeYet
So, should we expect a year or two of back-and-forth between Bevin and CMS over this waiver, with the plan ultimately being rejected? What happens in the meantime? Does Kynect continue as it was before the election, or what?
Could Bevin be working this from a political angle without actually trying to gut Kynect (since doing so would cost the state money)? “I ran on gutting Obamacare, and I’m trying to do so, but those evil Bureaucrats in Washington won’t let me. Send me more money so I can fight
ObamaHillary!1Thanks.
Cheers,
Scott.
O. Felix Culpa
This. And budget proposals reveal the morality and ethics of the proposers, e.g. the aptly-named ZEGS.* Really, it’s all about punishing the poor, especially THOSE people.
*h/t Charlie Pierce
Paul in KY
That’s my gov!!! Great fellow he. I’m thinking more & more Kentuckians are having buyers remorse over this & his whacky/costly legal problems with abuse of power issues.
Am back on the grid. Have a new Mac & am at present time retired. Going to go for a nice walk in woods. Hope all is well with you fine Juicers!
NorthLeft12
@OzarkHillbilly: Trust me, we have them in Canada too, just a lot less of them thank Dog.
Honestly, IMO it goes back to the basic mistrust of the government. I was in Mobile Alabama about twenty years ago on a business trip and having dinner with a co-worker and about eight American customers. They were poking us about our high tax rate, which they thought was obscene. I pushed back [gently, as they are our customers] and told them that most Canadians feel like we get good value for our taxes; ie. a good health care system, good schools, and decent social services. The customers were horrified that I would send my kids to a public school. “Only people who have no choice [read poor] send their kids to public school. All our kids go to private school.” They also sneered about social services as they felt that they would never use them.
I’m guessing that it is more important to save on taxes and end up paying more in the end in the US because ….FREEDOM!
the Conster, la Citoyenne
I recall an interview on NPR before the election with a woman who was on KYNECT, who was going to vote for Bevin. She was asked if she knew he was going to take her insurance away and she said yes, she wasn’t happy about needing it, but believed it bred dependency and that there were jobs that people should be doing instead. I heard “those” in front of “people” although it wasn’t said. O_0
So yes, she knew she was giving up her sparrow in the hope that those people’s curtain rods would be taken away. These are the statistically dying-before-their-time white people we’re now hearing about, and it’s really hard to care.
Matt
@the Conster, la Citoyenne:
Never mind “care”, it’s hard not to CHEER. Choke on that “freedom”, wingnuts.
Chris
@NorthLeft12:
I understand it just fine on an intellectual plane, with words like “racism” and “classism” and “ideological blindness” providing ample explanation. On an emotional plane, though, there’ll always be a big part of me that simply can’t grok how you could ever get that fucked up.
Golda Meir’s quote, “when they love their children more than they hate us, we will have peace” may or may not have been accurate in her own context, but it’s a pretty damn good summarization of U.S. politics today.
the Conster, la Citoyenne
@Matt:
Exactly. Anyone incapable of rationally connecting obvious dots to come up with a simple cause and effect scenario is too stupid to live.
Roger Moore
@p.a.:
The situation you’re describing makes sense if people are used to thinking about the long term. Yes, you hurt yourself in the short term by denying the other guy anything when you think he isn’t being generous enough, but in the long term you’re teaching him a lesson about not being a skinflint. If you know you’ll have to deal with him repeatedly, the cost of teaching that lesson is worth it.
Chris
@NorthLeft12:
I think there’s a modern American creed of Inherent Government Inefficiency that comes into play here: a staggering number of Americans have simply unquestioningly absorbed the notion that Government Can’t Do Anything Right, so it doesn’t even occur to them to try to modernize or upgrade or improve it. On those occasions when people do try to improve it, the goals often fall short of an ideal solution (partly because the anti-government types have so much influence over the government in the first place) – witness the ACA whose best feature, the Medicaid expansion, wasn’t able to be implemented in half the county on account of the Nine. So people just shrug, point at the effort and go “see? I told you government doesn’t work!”
You end up with a giant self-fulfilling prophecy.
Mike in NC
Kentucky voters deserve what they voted for, good and hard.
Chris
@the Conster, la Citoyenne:
Yeah, it really, really is.
The fact that she and those like her are doing it specifically to ensure that the other person doesn’t have a sparrow is what makes it that way the most for me. I can forgive stupidity to an extent, but I can’t forgive malice. It’d be one thing if this lady were just trying to shoot herself in the foot, but the reason she’s doing it is that she thinks the bullet will go through and hit other people – people like you and me. I really can’t sympathize with this kind of mentality, for obvious reasons.
Frankensteinbeck
@Chris:
I understand it just fine, but I grew up surrounded by these people. The joys of patting yourself on the back for righteousness and freely venting your anger whenever you feel like it often, even usually outweigh mere greed.
@Chris:
The source of, and one of the major ongoing foundations of, that ‘the government is useless’ meme is that the government stops them from abusing whoever they like – especially blacks. It was the federal government that ended segregation, and yes, they remember and resent.
piratedan
@Mike in NC: I understand that, yet I have a great deal of despair for the folks that didn’t vote for Bevin and will still be served this shit sandwich at the expense of their idiotic racist neighbors
NorthLeft12
@Chris:
I am right there with you on this. A lot of stupidity I can ascribe to ignorance through poor education and lack of alternate experiences and influences, but if you do something out of hate, its all on you.
Frankensteinbeck
On the OP, aren’t the poor shaming elements automatic disqualifiers? Unless Trump pulls out a victory, Bevin is never going to get his Medicaid waver. He has to either cut it entirely or keep it as is. Not that he’s likely aware of that. Most conservatives cannot grasp that dogmatically correct actions might have anything but the desired, perfect effect.
Roger Moore
@Chris:
It’s no coincidence that the creed of inherent government incompetence cropped up at the same time people were trying to dismantle government programs for other reasons. It’s a rationalization for destroying programs to keep them out of the hands of Those People, and one that is not-so-incidentally beneficial to the business owners who want to avoid government regulation and/or step in to replace stuff the government is now judged too incompetent to do.
Frankensteinbeck
@Roger Moore:
It was Reagan’s genius to realize that polite racists and the asshole upper class want the same things. Now that’s breaking down because the racists are tired of being polite.
Seanly
Off topic, but this is burning my chap. NPR gives so much cover to racist f*cksticks. David Greene was talking to some presidential historian who wrote a book about alt right IIRC. Said something about “but people say they like telling non-PC jokes in their backyard and they say that doesn’t make them racist”. I tweeted that if one tells racist jokes, one is a racist. NPR does this all the f*cking time. GRRRRRR
the Conster, la Citoyenne
@Seanly:
The entire media full of mediocre white men is caping for white supremacy now. If you think about it, it makes sense – where would extremely mediocre people like Chuck Todd, Chris Matthews, Matt Lauer, Charlie Rose, David Greene, Wolf Blitzer, etc. etc. be without white supremacy?
MomSense
The problem is that very vulnerable communities of people will suffer because of this. I’m thinking about children, elderly, and people living with disabilities and mental illnesses.
I cannot tell you how terrible it is to deal with ever shrinking and disappearing sources of funding that keep vulnerable populations safe, fed, housed.
Greed, hatred, racism, fear, and anger are the core Republican values. It’s disgusting.
Frankensteinbeck
@Seanly:
The great majority of whites, and it’s strong even here on BJ, want to give every possible benefit of the doubt before admitting a person is racist. It became an iron-clad law in the 80s, and has only really started to relax since Obama’s presidency slapped so many of us so hard with racism’s reality.
amk
@the Conster, la Citoyenne:
Yup. As journalistic talents and ethics go, they collectively ran the entire gamut from A to B.
WereBear
True, and at least in some cases, it might be that it is so inhumane, so senseless, and so freakishly stupid it is difficult to believe of someone.
HinTN
@Mike in NC: Have you liked at what your neighbors to the west are doing? Having legislated the sanctity of guns in bars, our solons are contemplating the arming of STUDENTS in college. This idiocy of the majority will play out badly for some who didn’t vote for these fools, just as those who didn’t support Bevin will suffer. It’s really hard to cheer this mess.
NCSteve
@Paul in KY: Having been born and raised there, studied poli sci there, and with my immediate family and 90% of my extended family out to the second degree of consanguinity still there, I believe I have some small familiarity of the state where the “politics are the damnedest.”
And you can model state elections pretty simply. The majority of Kentuckians who don’t live in Jefferson or Fayette County can go no more than seven years before they are overwhelmed by an uncontrollable urge to punch themselves in the face. They then continue blacking their own eyes, breaking their own noses for up to three years, all the while professing to love it, until the pain exceeds the pleasure they derived from watching the people on disability dodge the splashing blood and flying teeth. At which point they can settle down and endure four to seven years of relatively sane government, all the while complaining bitterly about the governor’s failure to completely repair the accumulated damage they did to themselves during past face-punching fits.
sherparick
@NCSteve: Really is amazing that so many Kentucky voters (I suppose White Kentucky voters) have voted and continue to vote for the Neo-Confederate Party (whether under the D-label before 1948 or the R-label since 1964). Its like punching the poor and black (even if so many are poor and white and end up getting punched themselves) is the most important thing in the world. Bevin joins the class of so absolutely horrible Republican Governors that even “Conservative” intellectuals have stopped “celebrating” their “achievements.” (LePage, Jindal, Brownback, Scott Walker, Snyder, and Pence come to mind.)
Juju
@sherparick: Mccrory, Scott, Christie, also come to mind.
NCSteve
@Juju:
Used to be that the worst thing about moving from Kentucky to North Carolina was having to draw the shades when the ‘Cats played the ‘Heels.
@sherparick:
Kentuckians were doing the politics of anger and white grievance before it was cool. Though honestly, resentment of white people who managed to get on disability was alway at least as potent as racism.
Prescott Cactus
@Matt: Bevin won with just over 52%. So we have 48% sane people voting against him and some of them have /or will lose their coverage.
We can’t paint with a broad brush stroke all of KY and wish them this result. Lots of innocent collateral damage has been done to many folks.
Paul in KY
@NCSteve: By God, Steve, you do know KY!!!