Math has a well known liberal bias.


That is the Oklahoma House passing a Medicaid expansion bill.

The state is heavily dependent on cyclical resource extraction taxes (oil and gas) for a significant chunk of their state budget. The state is facing a a massive deficit and Expansion is a good way to solve a decent chunk of the problem while not destroying the public health system:

a huge $1.3 billion hole in the budget that threatens to do widespread damage to the state’s health care system.

So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from Obama’s new health care system.

What’s more, GOP leaders are considering a tax hike to cover the state’s share of the costs.

“We’re to the point where the provider rates are going to be cut so much that providers won’t be able to survive, particularly the nursing homes,” said Republican state Rep. Doug Cox, referring to possible cuts in state funds for indigent care that could cause some hospitals and nursing homes to close.

The law still needs to go through the Senate and get signed by the Republican governor. After that the state will need to negotiate with the Center for Medicare and Medicaid Services for a waiver as Oklahoma wants to adapt the Arkansas model. Arkansas buys private exchange plans and then tops up their cost sharing assistance for people to minimize the deductible.

From a cash flow perspective this is interesting. Private exchange plans tend to pay providers significantly higher rates than Medicaid. It allows Oklahoma to send their rural providers a decent income stream that should allow the state to hold steady or even decrease their Legacy Medicaid provider rates. That is one source of state cash savings. The other is it moves a lot of people from Legacy Medicaid with a high state share to Expansion Medicaid with a low state share of the costs.

Over the long run, state budget math has an expansionary bias. Expansion solves several big problems without allowing too many hard choices to be made (as well as make the residents of the state better off). It is a one way ratchet. This is why national Democrats have been proposing to give every state three years of 100% funding, and I wish that they would propose bumping up Legacy Medicaid federal shares by several points contingent on expansion being in place. Those policies are big bribes to get the hold-out states on board because sooner or later every state budget will need some relief. Federal Medicaid money is relief.
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Evil Infests Augusta

John Brunner said it exactly right in The Shockwave Rider:  “If there is such a phenomenon as absolute evil it consists in treating another human being as a thing.”

With that in mind, let me give you the latest from Maine’s governor, the utterly odious Paul LePage:

Gov. Paul LePage vetoed a bill Wednesday that would allow pharmacists to dispense an anti-overdose drug without a prescription, saying that allowing addicts to keep naloxone on hand “serves only to perpetuate the cycle of addiction.” [via Kerry Eleved at GOS]

That’s nonsense on its own terms, as the deeply valuable Maia Szalavitz — herself a former addict — has argued over and over again:

As with needle exchange, opposition to Naloxone distribution has mainly come from those who fear that reducing drug-related harm will lead to increased drug use.   Fortunately, also similarly to the data on needle exchange, the research doesn’t find this occurring.

But don’t let any actual experience bother you, LePage!

“Naloxone does not truly save lives; it merely extends them until the next overdose,” LePage wrote, repeating a contention that has caused controversy before. “Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”

It’s a strong word to use, I know.  But this is evil.


In LePage’s telling the addict isn’t a person.  He or she is rather just the worthless meat sack that locally reverses entropy between one overdose and the next.  He’s rather let those suffering an overdose die than live because, as he frames it here, the state of addiction robs the user of all other human attributes.

This is how a monster thinks.

I won’t say that this is the view that infects all of your modern Republican party, because on this issue it’s not. But it remains a perfectly mainstream one for the GOP — and this is a case of words (and inactions) that kill.

If you needed any more reason to go all yellow-dog Democrat on every line of your ballot, Governor (sic!) Paul LePage is exhibit (n)*

Last, to help wash the taste of tiny-minded misery out of your mouth, here’s Szalavitz again:

…one of the biggest misunderstandings we have about addiction is that tough love—is that being kind will fail and tough love will work. What really helps and why harm reduction, which is this idea that we will meet you where you’re at and we’ll help you whether you’re ready to stop or not—why that works is because when you have addiction, you tend to be very marginalized, self-hating. You might be homeless. You feel like a criminal. Nobody has any respect for you. And when somebody just hands you a clean needle or gives you access to naloxone and says, “I believe you deserve to live, regardless of whether you do what I want,” that’s a really powerful message of kindness.

And here a plug (full disclosure: she’s a friend) — here’s Maia’s new book on addiction.

*Where n is an arbitrary large number.

Image: Rembrandt van Rijn, Christ Preaching (The Hundred Guilder Print) c. 1649.

Saturday Morning Cartoon Open Thread: Potty Talk

toilet gender identity danziger

(Jeff Danziger’s website)

I’m so old, I can remember when No unisex toilets!!! was Phyllis Schlafly’s rallying cry against the Equal Rights Amendment, back in the early 1970s. Between NC Gov. McCrory and the news this week about Ted Cruz’s anti-dildo proclamation, it’s clear the Repubs — individually and as a party — have some strange ideas about other peoples’ swimsuit-covered bits…

Apart from stocking up on brain bleach, what’s on the agenda for the day?

toilet biz in nc toles

(Tom Toles via GoComics.com)

toilet for guv mccrory ohman

(Jack Ohman via GoComics.com)

toilets small gubmint sheneman

(Drew Sheneman via GoComics.com)

toilets men women other anderson

(Nick Anderson via GoComics.com)

Federalizing Medicaid funding

And another story from Oklahoma:

Facing a $1.3 billion budget hole, the Oklahoma House has passed legislation that would cut 111,000 Oklahomans from Medicaid.

House members on Wednesday passed the bill 65-34 mostly along partisan lines and sent it to the state Senate for action.

The measure would instruct the Oklahoma Health Care Authority to seek a federal waiver allowing the state to exclude from Medicaid all able-bodied adults under 65 with dependents.

That bill failed in the Oklahoma Senate.

Oklahoma is heavily dependent on oil revenue to make their budget work. Oil prices have cratered so state revenues have crashed. At the same time as oil prices have collapsed, economic activity in the state is decreasing which means more people don’t have jobs, more people don’t have employer sponsored insurance, and more people have become Medicaid eligible. The Medicaid eligible pool is counter-cyclical. As the economy does well, the eligible pool shrinks, and as the economy does poorly, the pool grows. So the number of people who are eligible for Legacy Medicaid grows just as the state revenue needed to pay for Medicaid services drops.  This is a problem.

Legacy Medicaid is financed by the state and the Feds splitting the bill.  Oklahoma pays 41% of the cost of the medical services component of the program.  The Feds pick up 59% of the medical side and a bit more on the administrative side.  Oklahoma has a balanced budget constraint.  the Federal government does not.  That means the Feds are willing and able to spend money to meet increased Legacy Medicaid demand in a downturn but the state can not.  Instead, the state needs to cut expenses to meet its balanced budget constraint and Medicaid is a very large line item in every state budget, so that means Medicaid is often one of the major areas of cut-backs in either eligibility, services allowed or provider payments.

So what is the solution?

The long term solution is that the Federal government should take on more and more of the cost of Legacy Medicaid.  The Feds can spend in a downturn when the states have to be 50 mini-Hoovers who have to cut during a recession.  This does three things.  The first it makes sure that people can get the medical care that they need and that the continuity of care is maintained.  Continuous care is usually better and cheaper  than people getting dropped and then added back to insurance months or years later.  Secondly, it transforms Medicaid financing from a pro-cyclical activity into a counter-cyclical macro-economic stability policy.  One of the major components of the stimulus in 2009 was a Federal Match rate bump.  This moved $87 billion in Medicaid expenses from the states’ books to the Federal books.

The Stimulus bump was a short term solution that required massive supermajorities from a party that believes that the federal government faces a different budget constraint than a typical household.  The long term solution is to have the Feds continually increase their share of the costs until Legacy Medicaid is funded on the same bases as Medicaid Expansion. The Feds pick up 90% of the tab and the states pay 10%.  This will still allow for state control  which allows Massachusetts to cover different services than Mississippi but it allows for a much stronger counter-cyclical automatic stabilizer to be in place.

The attraction this should have to a significant number of Republican state level elites is that by taking Medicaid off of their books, it frees up a lot of money for easy to justify tax cuts.


NC GOP “Bathroom Bill” Is A Steaming Load Of Crap

So North Carolina state Republican lawmakers called a special session of the General Assembly yesterday to stop Charlotte’s LGBTQ anti-discrimination law from going into effect on April 1, and it turns out it’s not just Charlotte’s ordinance they want to outlaw, but any real progressive change sought by cities and counties in the Tarheel State.

WBTV obtained a copy of the proposed bill, entitled “An Act to Provide for Single Sex Multiple Occupancy Bathroom and Changing Facilities in Schools and Public Agencies and to Create Statewide Consistency in Regulation of Employment and Public Accommodations,” Tuesday night.

The legislation requires that multi-occupancy bathrooms be limited to just one gender, using anatomy and birth certificates as a guide and applies to executive branch agencies controlled by the Governor as well as Council of State members and the UNC System.

A provision in the five-page bill allows school districts to use single occupancy bathrooms to make accommodations for students in special circumstances.

DOCUMENT: Click here to read the full bill

In addition to the provisions of the bill seeking to repeal the bathroom-related portions of Charlotte’s non discrimination ordinance, the bill also addresses several workplace issues.

The second part of the bill is referred to as the Wage and Hour Act. Under the act, local governments would be prohibited from setting their own local minimum wage.

The next section of the bill seeks to declare that the regulation of discriminatory practices in employment is an issue of statewide concern and, as such, must be left to the General Assembly.

Finally, the last section of the bill is referred to as the Equal Access to Public Accommodations Act, which places issues of public accommodation in the jurisdiction of the General Assembly.

So in addition to killing Charlotte’s anti-discrimination law, with this stupid bigoted bathroom bill, the NC GOP is looking to undo all local anti-discrimination, minimum wage, labor protection and equal physical access laws. because smaller, more responsive government, right?

Which just proves again that Republicans don’t care about government that works, they care about government that punishes those people whenever possible so that they become somebody else’s problem.  The best part?  It’s a combination of “bathroom bill”, home rule elimination, and “workplace protection” bill all rolled into one steaming pile of toxic GOP diarrhea.

By the way, the bill passed the NC General Assembly overwhelmingly, 83-24, the NC Senate 32-0 (as all NC Senate Democrats walked out) and GOP Gov. Pat McCrory signed this travesty into law last night.  Total time on this legislation from start to finish: about 10 hours.

They had this ready to go, in order to steamroll any opposition to it and to prevent the kind of boycott backlash from building that Georgia is facing now over similar legislation.  Blindside the opposition and dare them to react.

It’ll be up to the courts now to get the ball rolling on this.

One big hurdle, which reportedly killed South Dakota’s bathroom bill: Banning trans students from using the school bathroom that comports to their gender identity could violate federal law, particularly Title IX. The Justice Department and Department of Education interpret the law not just to ban sex discrimination in federally funded schools, but also ban anti-trans discrimination. So by passing an anti-trans bathroom law, North Carolina could risk big federal funds for public schools.

And my home state is well on its way to a complete disaster.

I Give You All I’ve Got to Give, Rings and Pearls and All

Here’s a depressing read about the absolute fucking disaster that is Louisiana:

Initially, Jindal had been able to cut taxes because Louisiana was buoyed by billions in federal money, an influx to help with the recovery from Hurricane Katrina, in 2005. But as that money ran dry, Jindal said he would veto any bills that would push taxes back up to where they had been. Instead, to plug budget gaps, Jindal relied not just on cuts, but also on controversial, one-off fundraising methods. The state sold off assets, including parking lots and farmland. It cleaned out money from hundreds of trust funds — among them, one intended to build reefs for marine wildlife. It pieced together money from legal settlements.


The math, now, is daunting: For the fiscal year ending June 30, Louisiana is facing a $940 million deficit, roughly one-eighth of what the state typically doles out from its general fund in a year. For 2016-17, which begins July 1, the gap is $2 billion.

“This was years of mismanagement by a governor who was more concerned about satisfying a national audience in a presidential race,” said Jay Dardenne (R), the lieutenant governor under Jindal who is now the state’s commissioner of administration. Dardenne said Jindal had helped the state put off its day of reckoning in a way that mirrored a “Ponzi scheme.”

Dardenne was elected separately from Jindal and said he wasn’t “part of his inner circle.”

Jindal suspended his presidential campaign in November, saying he couldn’t stand out in a “crazy, unpredictable election season.”

On Jindal’s watch, nearly every agency in Louisiana shed employees, and state lawmakers say some teetered because of the losses. The Department of Children & Family Services shrank to 3,400 employees, from 5,000 in 2008, and social workers began carrying caseloads above national standards. The state also cut funding for youth services and mental health treatment.

“When you cut those programs, it doesn’t change the need for people to get those services,” said Walt Leger (D), a state representative. “It just means you’re no longer providing them. Those folks end up in jail or wandering the street, not being treated for mental health issues, and all of those things have a huge societal cost.”

In recent days, lawmakers have zeroed in on a plan that would somewhat narrow the deficit for the rest of this fiscal year but barely make a dent in the $2 billion gap for next year. Lawmakers would raise sales and cigarette taxes while dipping further into a rainy day fund. They would also use settlement funds from BP, the company responsible for a 2010 oil spill in the Gulf of Mexico. Still, massive cuts would still be required for hospitals and universities.

The same thing, of course, has happened in the other state where the conservative ideal for fiscal governance has been implemented, and it’s a god damned train wreck, too:

Kansas Republican Gov. Sam Brownback’s aggressive tax cuts have come back to haunt him. In the latest move to make up for a massive state deficit caused by his economic policy, Brownback plans to cut nearly $45 million in funding for public schools and higher education in his state by March.

Brownback shared his plans for the current budget cycle on Thursday ahead of a Senate vote on a bill aimed at eradicating a $344 million deficit projected for the end of June. More than half of the money would be taken from funding for K-12 schools, and take place as soon as March 7, The Associated Press reported. The cut would also affect Kansas colleges and universities. Top Republicans said lawmakers need to agree on a solution to fix the budget by Feb. 13 to make sure the state pays its bills on time through the summer months.

Brownback spent his first term slashing taxes for the rich, promising it would lead to boom times for everyone else. Brownback’s “real live experiment” was supposed to lift Kansas out of the recession and into economic prosperity. The tax breaks instead led to debt downgrades, weak growth, and left the state finances in shambles. The Republican-led legislature in his state previously celebrated his massive tax cuts, but his action landed the state’s budget in shambles when it didn’t boost the economy like he’d hoped.

In his State of the State address last month to kick off his second term, Brownback announced that he would pursue tax increases, reversing his past policy. Republicans are also calling for higher taxes on cigarettes and liquor as part of the annual budget.

My own state has a budget hole that the legislature is going to blow open worse next year as they expand tax cuts for energy producers, and up north in Pennslyvania, Gov. Wolf is trying to clean up Corbett’s mess but Republicans are having a god damned siezure over raising the personal income tax from 3.07 percent to 3.4 percent. You read that right. from .0307 to .034. Meaning for every hundred dollars of taxable income, your income tax rises from $3.07 to $3.40. For the median income in PA, that is basically 150 bucks a year.

So while we are all freaking out about the Drumpf the Insult Comic Hairpiece talking about his dick- and don’t get me wrong, he’s a fucking head case and a fascist, it’s worth remembering that the sane Republicans are batshit fucking insane. The sane Republicans don’t even pass the Jon Rogers legendary 2004 “I miss Republicans” test.

How about someone in the media point that shit out? How many more times are we going to have to go test these failed policies that hurt people and the nation before we stop? As Charlie Pierce has quipped, “the thing about lab rats is that most of them die.”

Because Why Not On Such A Beautiful Saturday: Nevada Caucuses Thread

It’s freaking beautiful where I sit (Greater Boston — in the 50s, sunny, a delight).  I and the familial swarm will be heading out soon for a walk around a fair chunk of the Emerald Necklace. (We won’t be going to the Arnold Arboretum today, but it has a special place in my heart, as the site where my dad proposed to my mum).

All of that tedious personal detail is another way of saying that I’ll be doing my best to ignore the minute-by-minute breathlessness of the GOS types on the Nevada results. But that doesn’t mean the blog should!


The NYT’s results page is here.  Nothing yet, but early exits are apparently starting to come in.

Have at it, have fun, and be nice to each other. (Or at least nicer than SC Republicans — which, I admit, is a low bar.*)

*That should probably read “nicer than Ted Cruz” — which is a bar low enough I’m not sure an ant could limbo beneath it.

Image: William Hogarth, Humours of an Election: scene 3, The Polling, 1754-1755