Late Night Open Thread: Another Act in the Shutdown Shitshow Begins

Of course Trump doesn’t mind being in the spotlight, even a negative spotlight. But Mitch McConnell is every bit as selfish as Donny Dollhands, and a lot smarter about how he’s perceived by normal people his voters. He doesn’t mind being the anonymous Little Man Behind the Curtain, destroying other peoples’ lives for his own benefit — but how much appetite does he have for getting yelled at in public?

From the Washington Post, “House Democrats vote to reopen government and deny Trump wall money, defying veto threat”:

The newly Democratic-controlled House passed a package of bills late Thursday that would reopen the federal government without paying for President Trump’s border wall, drawing a swift veto threat from the White House and leaving the partial shutdown no closer to getting resolved.

But two Senate Republicans who are up for reelection in 2020 broke with Trump and party leaders on their shutdown strategy, saying it was time to end the impasse even if Democrats won’t give Trump the more than $5 billion in border funding he is demanding.

The comments from Sens. Cory Gardner (Colo.) and Susan Collins (Maine) — the only Senate Republicans running for reelection in states Trump lost — pointed to cracks within the GOP that could grow as the shutdown nears the two-week mark. Senate Majority Leader Mitch McConnell (R-Ky.) reiterated Thursday that the Senate will only take up government spending legislation that Trump supports…

The six-bill package passed the House 241-190 Thursday night, and the short-term Homeland Security spending bill passed 239-192. A handful of Republicans broke ranks on each measure to vote “yes” with the Democrats.

The House strategy could allow Senate Republicans to pass legislation that would reopen most of the government while setting aside the debate over the border wall. But thus far, because of Trump’s opposition, party leaders have refused…

“What we’re asking the Republicans in the Senate to do is to take ‘yes’ for an answer. We are sending them back exactly, word for word, what they have passed,” Pelosi said. “Why would they not do that? Is it because the president won’t sign it? Did they not hear about the coequal branch of government, and that we the Congress send the president legislation and he can choose to sign or not?”…


Read more



Criminal Abuse Open Thread: Ready Player Individual-1

Balloon Juice commentor Waldo:

What prosecutors say: The president was in on it.
What Trump hears: The president was innocent.



Medicaid expansion will be on the ballot again

Bruce Japsen at Forbes makes a very good point. 

Medicaid expansion will be on the ballot again as the referendums to pass Expansion succeeded in three very red states this year: Utah, Idaho and Nebraska.

The Fairness project says at least six states could become targets for Medicaid expansion ballot initiatives in 2020 thought the group says it’s not ready to announce any campaigns.

“Right now we think those states include Florida, Missouri, Oklahoma, South Dakota, Mississippi, and Wyoming,” the group said.

The big Expansion hold-outs are Texas, Florida, Georgia and North Carolina.  An initiative process to get Medicaid Expansion passed in Florida would be a big deal.  If you are looking for something political to do and want to avoid the pie fighting of primary season, helping out with signature collection and organizing for Expansion may be the thing for you.

 

 



Schrodinger’s Coverage

Here is a koan for Balloon Juice:

If you do not know you are insured, are you insured?

Maine is in the process of expanding Medicaid.  The new Governor-Elect, Janet Mills (D), has promised to expand Medicaid on her first day in office.  She wants to make the coverage retroactive to July 2, 2018.

A Maine judge has ordered the current Maine governor to expand Medicaid with claims payment retroactive to July 2, 2018.

In most states, Medicaid has an individualized retroactive eligibility processes.  Someone who is uninsured will interact with the medical system.  The medical service provider will ask several standardized questions to determine if the uninsured patient is highly likely to be eligible for Medicaid.  If they determine that the patient is likely to be eligible, they can file a claim and an eligibility determination.  If the beneficiary is deemed eligible, some state Medicaid programs will pay both the index claim that initiated the eligibility determination process and claims in the three previous months if the benefeciary would have been eligible for Medicaid if they had applied.

The trigger event is a claim which means the trigger is an encounter with the healthcare system.  Most people who are eligible for Medicaid but not enrolled don’t interact with the healthcare system in any given month because most people don’t interact with the healthcare system in any given month.

Retrospective eligibility is a safety net for both the patient who will not be faced with crippling medical bills and healthcare providers who will get reasonably timely payment that is most likely more than the net present value of the minimal cash stream that uninsured and Medicaid eligible patients can and will pay.

Retrospective eligibility is highly likely to occur for either pregnancy or major medical events that require hospitalization.  More common and lower cost events like a primary care physician visit are less likely to generate a claim and retrospective eligibility determination because that appointment will either not be made by the beneficiary or the appointment will be denied by the provider once they are sure that they won’t get paid.

Maine is going to be doing something very different.  It will be declaring that all claims on or after July 2 will be eligible for retroactive payments if the beneficiary would have been Medicaid eligible (either for legacy or expansion).

Now this is where I have a question.

Will we see changes in provider and beneficiary behavior in anticipation of a Medicaid Expansion?  Did they increase the number of determination assessments that they submitted that would fail for legacy Medicaid but pass for Medicaid Expansion in July, August and September?  Are providers pre-emptively opening up appointment blocks for people who are uninsured but Medicaid Expansion eligible?  Are people who are Medicaid Expansion eligible making appointments in anticipation of retroactive eligibility?

How do people behave when they are covered if they are not sure that they are covered?

 

I don’t know but I think that this is one hell of a question.

 

 



Saturday Morning Open Thread — Pelosi: Watch and Learn, Younglings!


 
… And by gosh, the kids *are* learning…

She keeps taking notes like this, and she’ll do just fine, that Ocasio-Cortez person.



Monday Morning Open Thread: Off to A Good Start



Friday Morning Open Thread: This Much We Know…

(Tom Toles via GoComics.com)
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It absolutely, positively, was a Blue Wave!