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When ‘no’ isn’t good enough / February 05, 2014
A couple of weeks ago, your faithful columnist felt compelled to quote liberally from Senator Frank Ruff’s weekly constituent column to highlight just how gosh-awful his agenda is with the General Assembly currently in session.

Now it’s Tommy Wright’s turn.

Wright, of course, is Mecklenburg County's representative roaming the lower decks of the legislature, a.k.a. the Virginia House of Delegates, the oldest continuous legislative body in the New World. Say: you know what else is really old? As in “world’s oldest profession”? It’s almost like the two go hand-in-hand.

Del. Wright penned a column last week (er, submitted a piece that had all the earmarks of being ghostwritten) that faithfully summed up the position of Assembly Republicans on the biggest issue currently before the legislature: Medicaid expansion. Wright’s stance was nuanced, open to interpretation, and multilayered — in the same way that the word “no” can be rendered as “nyet,” “non,” “nein,” “nej” and “hell no.”

It wasn’t a very interesting column, except for what it said about the cynicism of the Republican position — and the party’s patently obvious strategy of distorting what Medicaid is and does in the hope that maybe, just maybe, the deluge of falsehoods will become impossible to dislodge in the public mind.

Just as an aside, I happen to personally like Tommy Wright — it’s hard not to, he’s a friendly guy — and I appreciate his efforts to help beat back uranium mining in Southside Virginia. The uranium battle marked one of those rare moments when people across the political spectrum could find common ground in working to protect the health, safety and well-being of the region. Alas, not all threats to Southside’s future lie buried in bedrock.

Part of the backdrop for the uranium debate was (and is) the abysmal health profile of Southside Virginia as a whole. With cancer such a clear and present danger within the community, it’s not difficult — nor is it unreasonable — to argue that the last thing the region needs is a potential catalyst for deadly disease.

Yet this essentially reactive stance is not enough. At some point, people need to think about positive ways to create a healthier society. There are few places where this responsibility weighs more heavily than in Southside Virginia. Exacerbating the problem is the fact that far, far too many poor people in our community go without regular, quality health care because it is financially out of reach.

That’s where the Medicaid expansion comes in. It’s a key part of the Affordable Care Act, née Obamacare: the law’s chief mechanism for extending health insurance coverage to adults struggling at or near the poverty line. Who are these people? They are Wal-Mart and McDonald’s workers; they are employees of small businesses, part-timers and full-timers alike. Their ranks include the people who clean your homes and serve your meals, who watch over the community’s elderly, who take care of our children. Many of them work, yet for all their efforts they have little fallback if something in life goes wrong, especially with their health.

Let’s jump this train back on the track and recall just what it is that Wright wrote (cough, cough) in his column last week:

"I believe it would be premature to expand Medicaid right now. Medicaid is a costly program that needs reform. It has grown by 1,600 percent over the last 30 years and now consumes 22 percent of the state budget. According to the Secretary for Health and Human Resources, 30 percent of all healthcare spending in Virginia is waste, fraud and abuse.

"It does not make sense to expand a poorly-run program. Instead, I would like to see the work of the Medicaid Innovation and Reform Commission continue. I believe we should reform Medicaid first, before we consider expansion."

Assembly Republicans are now demanding a two-year audit of Medicaid. This is only one of the requirements they say must be met before they will consider taking action — which, by the way, they’re not really agreeing to take at all. Still left in their arsenal is the everlasting whine that Virginia has no guarantee that the federal government will uphold its end of the bargain with the Medicaid expansion. I’m sure there are other objections they can muster in a pinch.

About that bargain: Medicaid is a shared federal-state program to insure the poor and disabled and to pay the long-term costs of caring for the elderly. (Most nursing home care in this area is financed by Medicaid.) For all the GOP’s caterwauling, the truth is that Virginia’s Medicaid program is pitifully stingy — for working-age adults who are not disabled and have no children, Medicaid is not available under any circumstances. (Even with children, working adults place out of the program once their annual income exceeds 30 percent of the federal poverty level, or $5,727 for a family of three.) To provide coverage for uninsured persons with incomes up to 133 percent of the poverty line (about $26,000 for a family of three), the federal government is financing 100 percent of the cost of expanding Medicaid for the first three years, and never less than 90 percent after that. The money has been budgeted by the feds, so it’s not like members of the General Assembly can win their constituents a federal tax refund by sticking their fingers in their ears and shouting “nyah nyah nan nyah nah” at the top of their lungs. Anything but.

Last week, legislators got the latest information on what it will cost Virginia to expand the program: Nothing. Nope, strike that — according to agency officials, Virginia actually will save $1 billion through 2022 by accepting the federal money, thus freeing up cash elsewhere in the budget. The response of the Republican leadership to this news was essentially to say no one should believe it, a curious complaint indeed in light of lawmakers’ own willingness to fudge numbers whenever it suits their purposes. On the Medicaid issue, Republican lawmakers are more vested in their own ideological biases than in the facts.

This becomes especially apparent once one begins to break down the rhetoric of opponents. Last week Wright wrote: “According to the Secretary for Health and Human Resources, 30 percent of all healthcare spending in Virginia is waste, fraud and abuse.” You have to parse that statement carefully to dig out the distortion that’s embedded within. In recent testimony before legislators, Virginia Secretary of Health and Human Resources Bill Hazel (a Bob McDonnell appointee who was reappointed by Gov. Terry McAuliffe) mused that 30 percent of health care dollars are wasted, although he attributed a relatively small share of that to fraud and abuse. But Hazel wasn’t talking about Medicaid in particular — he was talking about all health care spending. (A major culprit, by the way, is unnecessary medical procedures.) By twisting his words into an indictment of Medicaid alone, the Republican leadership “does fundamentally misrepresent what I presented” to lawmakers, Hazel told reporters last week.

What does it say for the GOP’s position that it would be called out as a lie by a Republican-appointed cabinet secretary? Contrary to the implication of Wright and others, Medicaid is actually more cost-effective than the private-pay insurance system, at least according to the New England Journal of Medicine, whose authority far exceeds anything you should expect from the Virginia General Assembly. (From the Journal, August 2, 2012: “With the per-enrollee spending growth in Medicare and Medicaid less than that in private insurance and close to the growth in GDP per capita, it’s hard to argue that spending on either program, on a per-enrollee basis, is ‘out of control.’”)

It’s ironic, in a way, that Assembly Republicans have built up Medicaid as some kind of lavish, wasteful program. Previously, the complaint was that Medicaid was too stingy — it doesn’t pay doctors and hospitals well enough for their services, the arguments went, therefore it dumps the burden of paying for health care onto other parts of the system. There are good reasons to question this line — Medicaid may be simply more effective at pushing down the charges of hospitals and other providers — but whatever the case, the Medicaid-is-out-of-control storyline is 180 degrees at odds with the prior notion that Medicaid punishes providers with its miserly reimbursement rates. It’s tough to spend like a drunken sailor and yet not spend nearly enough all at the same time.

The absurd arguments that Republicans are making on the Medicaid expansion have nothing, of course, to do with facts or merits. It’s all about the party’s decision to stake its political future on opposition to Obamacare. On the heels of Del. Wright’s contribution to the debate last week, the top two Republicans in the House of Delegates — Speaker William Howell and Majority Leader Kirk Cox — bylined a piece in the Richmond Times-Dispatch Sunday that offered a line of reasoning that was every bit as vacuous as that tendered by Wright. The Republican stance on Medicaid, stripped of pretense, has nothing to do with the best interests of the citizens of Virginia. It’s all about how the party thinks it can win the next election.

This is a shame in every sense of the word — a shameful approach to politics that threatens to cause needless suffering and hardship for the very people our elected officials are supposed to serve. The Commonwealth Institute, a left-leaning think tank whose findings are widely respected, recently went through U.S. census data to arrive at county-level estimates for the number of Virginians who would become eligible for Medicaid coverage with expansion. In Mecklenburg, it’s 2,081 persons. Tommy Wright, bless his heart, is not an especially endangered incumbent. Whichever way he votes, chances are he’ll be going back to Richmond to continue drawing his legislative salary and perks. At such a small personal political risk, Wright is in a position to provide tremendous help to 2,000 people hereabouts. Rather than a bunch of empty talking points, is it really so much to expect that Wright come up with a better idea for achieving an actual good?

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