Tag Archives: Medicaid Expansion

Fake Medicaid or No Medicaid? Don’t Buy It


Governor Bentley has persisted in failing to offer hope for the uninsured poor in Alabama, through a Medicaid Expansion or otherwise. Behind the scenes, various insiders are passing rumors not to worry—he really will do it… after the primary. Or after the general election. If the rumors are true, the plan is to apply for a “private option” style Medicaid waiver similar to programs in Arkansas and a handful of other states, and he is making people wait for his personal political interests, without regard to their present needs. If the rumors are not true, one can imagine he might benefit from public perception that he is simultaneously accepting and declining the Expansion.

One of the candidates in the Democratic Primary, Parker Griffith, got supporters by promising to expand Medicaid. Now he has revealed his grand idea: private option Medicaid, the same type of program Governor Bentley is/is not planning.

Except it isn’t such a grand idea.

Private option Medicaid is Fake Medicaid. One writer called it “Conservatives’ Awful New Medicaid Ploy”—and it isn’t even conservative. It is just a way to siphon off federal and eventually state money into private pockets, away from providing needed healthcare. Instead of simply directly adding people to the existing state Medicaid program, to be funded mostly by federal money and with generally about 3% overhead, it uses those funds to purchase private insurance at significantly higher overhead and for profit. It’s a skillful bit of flim-flammery to convince conservatives that this is anything but a scam and liberals that it is the only choice—fake Medicaid or none.

These “new” – what scam is ever really new?—programs don’t just eat up healthcare funds.  They have to limit health services to turn a profit. How?

By charging people with no money premiums and/or co-pays, so they will be discouraged from applying at all or seeking care if they do. You may think $35 a month for a household premium isn’t much—if you do, you aren’t likely poor enough to qualify for Medicaid. Even $3 can mean the difference between filling a prescription and skipping it.

By adding “wellness programs” of no proven cost-savings, an additional time charge for workers without sick leave. See page xix of a large analysis on workplace wellness programs by Rand: “[w]e estimate the average annual difference to be $157, but the change is not statistically significant.” This doesn’t mean $157 isn’t significant—it means the $157 “difference” is most likely due to chance instead of a difference and could just as easily be a $157 loss.

By charging a fine for coming to the ER for a non-emergency, instead of making sure all patients have 24-7 access to primary care and developing better ways to triage and redirect patients to appropriate settings. By charging $50 for the crime of being sick enough to be admitted to the hospital.

Already, just a few months in, Arkansas is finding out how much this fake Medicaid is going to cost them.  Are we really looking to follow their footsteps? If you haven’t read Confessions of an Economic Hitman, I highly recommend it. I suspect we are currently the target of the same strategy used to bring developing countries into debt, except this time it is on our own soil.

Both Bentley and Griffith were practicing doctors. I find it hard to believe they are completely unaware of the harm a private option Medicaid could do to patients and our state’s economy. Even so, it may be worth your time to tell them.

For those who have decided the fake option is better than nothing, it might not be so. Once people get their Medicaid cards, they will no longer be able to visit free clinics, get charity care, or apply for patient assistance programs for medicines. I am not sure how to predict whether on balance more people will be better off. I can say with a fair amount of certainty that a good many people will be actively harmed. Sometimes a false front for a good thing is actually far worse than nothing.

Fortunately, there is no reason to believe the choice is between fake Medicaid and nothing. We have more options. We can support candidates who are supporting the real Medicaid Expansion. Democrats could consider taking a look at Kevin Bass in the primary. Those who are determined to support Griffith could put pressure on him to drop the fake Medicaid idea. Republicans could put Bentley on the spot, and decide not to support someone who is/is not doing—hasn’t done— anything specific to address un-insurance and its economic damage to hospitals around the state. You can speak up against wasting funds in a fake program.

In that same vein, there’s no real reason we need to keep putting ourselves in the position of choosing between only two parties, between private insurance and nothing, or between all manner of pretend reforms and nothing. Some of you reading this are donating substantial sums or time to a lose-lose game. Are you getting what you’ve paid for?

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Filed under Alabama Politics, Bad solutions for the uninsured, Medicaid

Going Home Another Way– Why We Need to Thank Jan Brewer


Surprise announcement on the healthcare reform front this week—Governor Brewer of Arizona has announced she wants her state to participate in the Medicaid Expansion.  I’m posting a link to the Huffpo article, even though I realize it is not the most unbiased source, because of the comment section.  Scan through it if you have a few minutes because of late work openings from icy roads today! (Hey, give us a break, Yankees—we want to sleep in now and then, and if we have to declare black ice that is almost as imaginary as a Te’o girlfriend, cut us some slack).

 

Notice a common theme?  Apparently she is doing the “right thing for the wrong reasons.”

 

I understand what they are saying.  They think she should have a change of heart and do it because she cares about the uninsured poor, not because she wants Arizona’s cut of the money.  But that kind of thinking isn’t helpful.  We have to stop insisting everyone gives us good reasons for actions, as long as there ARE actually good reasons and evidence.  Let her use whatever reasons she needs to use, as long as she does the right thing.

 

I’m not a believer in using any means to a good end—the path to a goal needs to be as ethical as the goal itself, or something screwy will happen.  The end result will be tainted by what it took to get there.  I’ve seen it happen in person too many times to believe otherwise.  But reasons are not the same as means, even if they make us roll our eyes.

 

Neurology research points more and more to reason being evolved as an overlay—something may we generate AFTER we decide what we are really going to do.  We crave reasons and can’t avoid making them, but we have to take them with a grain of salt, because we don’t always know where they really came from.  As Pascal said, “the heart has its reasons of which reason knows nothing.”  It might have been a word we didn’t even know we noticed.  We use reasons to persuade each other, so being a skillful reason maker does matter.  What we DO with our reasons matters more.

 

Why do we need to be more generous in our tolerance for reasons?  Because that’s how we are going to get the good things we need.  People who oppose a good plan and change their minds need to save face—they need to be able to get there another way.  If we have single payer healthcare one day, it will not likely be because all the Tea Party people suddenly become tree huggers—it will be because they have another reason that makes sense to them.  Let it go!  Even better, thank them.  Maybe they’ll return the favor, when our reasons sound flat-out looney to them.

 

I’m very interested if Governor Bentley will be able to catch this wave.  Our Alabama Medicaid Advisory Committee just announced they are recommending we restructure Medicaid by using Community Care Networks instead of the third party vultures.  I’m not entirely pleased with parts of the plan, but I suspect almost anything would be better than having 15% of our Medicaid budget eaten up by the bad guys.  Although Bentley said he planned to turn down the Expansion, he left himself an out—he said he wouldn’t expand Medicaid in its current form.  Very important words!

 

Here’s your chance, Governor.  Medicaid will not be in its current form.  Jan Brewer has provided a Red State argument for doing the Expansion.  We could copy them on something good for once!  And fellow Progressives, let’s just clap our hands and get busy with nonpartisan rationales for single payer.  Everybody in, Nobody out—a winner for all reasons.

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Filed under Medicaid, Politics

Alabama NAACP gets the ball rolling: Speak up for Healthcare Reform next Saturday!


It’s been a busy winter already—flu season is in full force, and that means I have a little less time to get to blogging.  I do want you to know about an important upcoming event.

Our state NAACP chapter is having a rally next week, Saturday January 12, from 12 to 2 pm on the steps of our Capitol building in Montgomery, to support healthcare reform.  I understand there are plans for an ongoing effort to move our state forward, especially around the Medicaid Expansion—let’s ALL show up next Saturday.  The bigger the crowd, the more press and legislative impact we can make!  I’m supposed to be in a marathon all-day board meeting in Prattville, but I’m going to slip out for a bit to participate as one of the speakers.  Maybe someone will write me a doctor’s excuse?

I’ve written previously about the Expansion—in a nutshell, it would extend Medicaid benefits to adults below 133% of the federal poverty level.  There is nothing in the ACA to help them otherwise—over 100% of poverty, they are eligible for subsidies on the Exchange, but they may not be able to afford the premiums and cost-sharing required.  I tried looking up the exact amounts on the Kaiser calculator but it automatically puts anyone under 133% of poverty on Medicaid.  I guess the people at Kaiser are so reasonable that they couldn’t imagine a state refusing the funds.  When I enter a 27 year old single person making 16K pre-tax a year, 139% of poverty, it tells me he would pay $537 over a year for premiums—not too bad.  But cost-sharing (co-pays and deductibles) is capped at $2083, in addition to the premiums.   I doubt that 27 year old has 2K in a savings account.  He might have an insurance card he can’t afford to use.

If you are at 100% of poverty or below, you will have NO access to subsidies on the Exchange.  So it is the Medicaid Expansion or nothing.  Let’s say you are a 27 year old single mother of 3.  Or, for those who will get caught up worrying about whether a 27 year old single woman with low income “should” have 3 children, let’s make it easier and say you are a 27 year old widowed mother of 3.  You could work more than 60 hrs a week at minimum wage and still be below the 100% poverty level!  You could get Medicaid for your children, but for you—nothing.  I see this in my office every day.  Hardworking parents or even grandparents raising children, who can’t get health insurance.  Many of them know they have untreated high blood pressure, untreated asthma, untreated diabetes—all their resources go into doing everything they can for the children.  Wouldn’t you do the same? Sadly, many will die early from the long-term effects of these illnesses.

Governor Bentley says we can’t afford to do right by them, but he is wrong.  Ask him why we can afford to hand out subsidy after subsidy to big businesses as “incentives” to employ people at wages or hours too low to get insurance.  They are increasing our healthcare costs, but somehow we can still afford to give them welfare.

By now, he must have read UAB’s research showing how the Medicaid Expansion would boost our whole state economy.  I haven’t heard him comment on it yet.

Medicaid should not be the end of our work—we need badly to proceed with efforts to get Medicare for All.  But it’s the least we can do for people who are currently without any other option.  There is no deadline on accepting the Expansion.  The earliest we can start is January 2014, only a year from now.  If we wait, we can still do it but would miss some of the 3 year period of 100% federal funding.  Why should our fellow Alabamians have to wait a single day longer than needed to get healthcare?  Why should Alabama miss out on any of that money?  I’ve heard through the grapevine our Governor is worried about doing the Expansion before the 2014 primaries—let’s show him that if he doesn’t do it on time, he shouldn’t even bother entering the primaries at all.  If we can’t convince him not to put his political ambitions ahead of human life, maybe we can at least make our lives fit his ambitions.

I asked Benard Simelton, President of Alabama’s NAACP, to give me a few words.  He said, “When it comes to affordable healthcare, we must do all that we can to provide health care to everyone.  It should not be just for those who have a certain income but for every human being regardless of circumstances… You would think that the Governor, being a physician himself, would appeal to the Hippocratic Oath he took when he became a doctor. There is a passage in the modern version of the oath that states ‘I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.’  Where is the warmth and sympathy and understanding in the Governor’s refusal to provide health care for people in Alabama, especially since the Federal Government will pay for the vast majority of it? There is another passage that states, ‘I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.’  Governor Bentley, show that special obligation to all your fellow human beings so that those who are infirm because either they can’t afford or don’t have a job can have access to affordable health care…live up to your oath.”

I agree.  Please let’s show folks in Montgomery we stand up for each other.  Get your carpools together—I hope to see you there!

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Filed under Healthcare reform, Medicaid

Exchanges, Expansions, and Secessions: Follow the Money


Ever sing the song “one of these things is not like the other” when you were a kid?  Let’s try it with three things Governor Bentley said this week.  First up:  Alabama won’t set up our own health insurance Exchange—we will let the feds handle it.  Second: Alabama won’t participate in the Medicaid Expansion intended to start in 2014—we won’t let the feds help us insure Alabama citizens below the poverty line because after 3 years we would start having to pitch in.  Third: the petition asking permission to peacefully secede from the United States (started by a colorful-sounding dude who got ticked off when his topless carwash got shut down) is, according to our Governor, “silly.”

At first, I thought the third pronouncement didn’t belong with the other two.  By foot-dragging every step of the way, we are engaging in continuous passive-aggressive secession already.  Kind of reminded me of a favorite parents’ book “Get out of my life, but first could you drive me and Cheryl to the mall?” But I think I was wrong.  All of these decisions are about money, and all of them result in the steady upward transfer of funds to those who already have plenty.  Even much of the federal money we receive eventually finds its way to the deepest pockets.

I’m not surprised by us bowing out of the Exchange.  The Exchange, for those of you who don’t know, is supposed to be a central marketplace for health insurance products up and running by 2014.  It will be a tremendous windfall for insurers who get a spot—free advertising, mandatory customers, and big federal subsidy bucks for premiums and out of pocket costs.  Since we are great lovers of both corporate incentives and federal handouts in Alabama, why on earth would Bentley bow out?  Part of it is simple grandstanding and playing to the secessionist base.  Bowing out doesn’t remove the incentives— it just gives Bentley a chance to make his symbolic stand, knowing they’ll get their money anyway. It may pay off for him in 2014.

He also won’t catch his share of the blame when the corporations do what corporations always do—maximize their profit at our expense.

Does it matter?  Alabama Arise thinks we need to talk him out of it.  If you agree, you have time to speak up, because HHS extended the deadline.  They have an easy way for you to get your message to our Governor here.  I’m not sure it will make much difference who runs our Exchange.  Insurers will have the bulk of influence on how things are set up, either way.  At state level, it might be more likely that our currently predominant insurer would continue to have the advantage.  At federal level, all the multi-state players would probably have more traction.  I doubt if the outcome will be much different for people who get stuck with one of these products.

The one qualm I have is the outcome of challenges to federally run exchanges.  Apparently the law was slightly misworded so that subsidies technically can’t be given unless an Exchange is run by the state.  The administration says everybody knows what it was supposed to mean, but some folks are counting on a challenge to be successful.  I haven’t found an article that directly quotes the miswritten section, but I think maybe it is Section 1311 d (1), which says “An Exchange shall be a governmental agency or nonprofit entity that is established by a State.”  Further on in Section 1321, there is a provision that if a state doesn’t do what it is supposed to, the Secretary of HHS will operate the Exchange.  If you know of a different glitch in the wording, let me know.

What about the Expansion?  That surprised me.  When SCOTUS first made their call this past summer, I was horrified at the meanness of finding a way to kick people who are already down.  Then I got reassured by friends who convinced me we would be forced, economically, to take the big federal money that accompanies the Expansion.  I also heard the hospitals were in favor of it.  Right now, hospitals get extra money to help compensate for the expense of caring for patients who can’t pay, but that is being drastically reduced over the next several years to account for the expected decrease in uninsured patients.  So I had expected the hospital lobby to be a strong factor in us getting the Expansion.

Apparently, they have figured out they don’t need this money, if this quote (see third page) from a hospital association representative accurately reflects the hospital lobby’s opinion. They “understand”—no objection in particular.  I would guess this may be the major reason Bentley went ahead with his announcement, along with the chance to look heroic to his topless carwash loving fans.  The formulas are complicated.  I have seen some discussion that no one was completely sure what the effects of not taking the Expansion would be, and that depending on what other states did, hospitals here might get MORE for maintaining a higher level of uncompensated care.  Which would also be in keeping with our tradition of whining about big government while raking in more than our share of federal subsidies.

The stated reasons (rarely the full story) are that he doesn’t agree with Medicaid in general, that we can’t afford it when we have to start putting in our share after three years of a free ride, and that we don’t have enough providers.  I don’t agree with Medicaid in general either and would of course rather see Medicare for All, but it is better than being left in the ditch.  I agree we probably wouldn’t be able to come up with our share in three years, given our history of poor-mouthing to the poor and sweet (incentive)-talking to the rich.

As far as insufficient providers go, we have some alternatives—we could allow independent practice of allied health professionals (I’ll have more about that later).  We could use the federal Expansion money to boost the healthcare economy and increase provider supply.  But there’s a nasty part of this provider shortage that didn’t make it into Bentley’s announcement.  It’s not just that this is like saying we don’t have enough food to feed all the bodies here, so we’ll let some die rather than accept truckloads of money to help grow crops.

It’s that even with the providers we have, too few accept Medicaid, about 68.5% in Alabama according to this study.  That study included specialists.  I would guess the percentage of primary care doctors accepting Medicaid in Alabama is lower, based on what I see locally.  Look here on the Madison County Medical Society page—pull up the number of pediatrician members who are taking new Medicaid patients (15) and then total pediatrician members (23).  Then pull up family medicine doctors taking new Medicaid (8) and total family medicine members (70).  Then internists taking new Medicaid (1) and total internists (30).  That’s only 19% of our primary care doctors here who belong to the county medical society and who are taking new Medicaid patients!  For doctors who see adults, only 16%.  We might not have enough doctors accepting Medicaid to meet the minimal federal standards for provision of care to adults who qualify.

What would fix this?  The even nastier possibility is that money alone might not do it.  In 2013 and 2014, primary care doctors will get paid by Medicaid at rates equal to Medicare rates (a big raise for us), because of the ACA.  I think that might pull more docs into the system, but unless I’m wrong, there will be holdouts.  All the docs who refuse Medicaid participation now could manage at least a small percentage of their practice already, if they really cared about the patients.  It would not kill them or bankrupt them to accept, say, 10 or 20% Medicaid.  When I talk to those doctors, they won’t say outright that they are uncomfortable with poor people.  They say the patients don’t come to appointments or don’t follow instructions, the same as they told this researcher.  They say there is too much paperwork.  But their faces say “I don’t know if I want them in my waiting room.”

We have some wonderful, heroic physicians in Alabama, including our Surgeon General.  But we also have too many who don’t take the Hippocratic Oath seriously. Some just try not to think about it and rationalize their choices.  Others go “concierge” and limit their practices to a small percentage of well-off patients, while they work as hard as they can to prevent other providers like nurse practitioners from filling in the gaps.

Should we push for the Medicaid Expansion?  I have heard Bentley might not be firmly decided.  It is probably worth trying to persuade him.  If the hospital lobby doesn’t find it compelling, I doubt we’ll get it.  Medicaid is better than being uninsured.  Doing the Expansion, while not a cure for health disparity, would give some partial relief to widespread misery.  But people with low incomes will never have real access to quality care unless their insurance cards look the same as those with private insurance.

Medicare for All would go a long way towards decreasing health disparity.  Will failure of the Medicaid Expansion be enough to create pressure for single payer?  Probably not.  The pain of poverty is already great and remains invisible.  Invisible enough so that many liberals celebrated the SCOTUS decision without taking time to mourn over the impact of gutting the Expansion.  Invisible enough so that some were willing to play chicken with Alabama’s Medicaid money for 2013 to make political points.  We will get real healthcare reform only when the middle class finally feels enough personal underinsurance pain to get fed up with being abused.

Is there an option in the meantime?  Maybe.  Is it possible we could persuade the President and Congress to subsidize private insurance coverage on the Exchanges for those who would have qualified for Medicaid, with zero co-pays and deductibles?  Not out of sympathy, but because the insurers would be thrilled to get that extra money and we rarely pass up a chance to support our corporate persons.  Remember that the mandate was dreamed up by the Heritage Foundation—they could come up with a way to make private insurance subsidies sound good, with enough insurer support.  Just call it a voucher—certain groups love that word—but make sure it is enough to cover the product.  It would be more expensive, probably at least 12% more, and that’s probably enough to make this idea a no-go. , and that’s probably enough to make this idea a no-go.  On the Exchange, individual and small group insurers are capped at 20% (edited) overhead and profit, compared to our state Medicaid at 3% overhead. But plans with large risk pools generally can get within 15%, and perhaps we could add regulation requiring 100% subsidized plans to stay within a 15% range.   That would be in line with the roughly 11% higher payouts to privately run Medicare Advantage plans compared to traditional Medicare.

I hate like the dickens to hand over more of our tax money to these corporations.  But I hate even more to see the people who struggle every day to keep their heads above water, the people who deliver our pizza and ring up our purchases and care for our children, be so utterly abandoned. They should at the least be able to access the same inferior products the rest of us can.   If we will not expand Medicaid, and if our doctors will not accept the responsibility to provide care without regard to social status and insurance type, subsidized private insurance is the only moral option until we have achieved real healthcare reform:  Everybody in, Nobody out.

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Filed under Healthcare reform, Medicaid

The ACA stands: Poor People Left in the Dust


 I’ve written most of this in advance of the expected Supreme Court ruling on the Affordable Care Act (ACA).  Instead of going into great detail about what the ACA will do (been there, done that), here’s my synopsis:  the ACA, after being riddled in the womb with bullet holes by Republicans and Corporate Interests, had its best part amputated shortly after birth by the Court. 

The Justices said they didn’t read the whole thing, but they must know the law has a deadly infection—private for-profit health insurance.  No matter what else is in it, we can’t save healthcare reform until that infection is cured.  So they found a way to let it live, including all the elements that profit the insurers, but they cut out the only part that would have helped poor adults get desperately needed care—the Medicaid Expansion. 

That was the only version of the ruling I hadn’t prepared for, ironically.  I should have known.  States can still participate and get the federal money, but they won’t be required to do so.  This is especially bad news for Alabama, with our long-standing habit of leaving federal Medicaid dollars on the table so we can give tax breaks to the rich corporations.  Will we take it during the initial period, when it is fully federally funded?  I have my doubts but hope I’m wrong.

 President Obama once wanted something better.    I believe in my heart our President still dreams of a day when we will have real healthcare reform—quality, affordable medical care for every one of us.

We can’t afford to take much time for regrets.  We need to push, harder and more effectively, for Expanded, Improved Medicare for All.   How can we learn from this experience, quickly, to do better next time?  I have a few lessons to suggest.

Votes Count.  Even though we didn’t get to directly vote for constitutionality or for the Justices, we did elect the Presidents who appointed them and the Legislators who confirmed them.  We had a part to play in letting the ACA stand and in this blow to the poor.  The Republicans have a number of ways to continue finishing off the rest, and you can be sure they’ll do their darndest.  We are only going to get as good as we vote for.  For Court appointees, our votes can affect what happens to our country for decades to come.  There is no excuse for taking your right to vote lightly.  Contrary to the Randian/ Libertarian fear about being made to support the public good at the “point of a gun” and despite serious corporate influence on policy-making, we the voters still have a say.  Use it.

Emergency relief measures are not a substitute for real reform, but they matter.  It may still take us awhile to get the national health insurance program we need.  In the meantime, it is the right and decent thing to enact some stop-gap help for those in the worst straits.  The ACA has a few of those left, mainly coverage of young adults and prescription coverage for Medicare.  But to cut out mandatory coverage for the poorest poor adults is a travesty.  If the Court could finagle around to change the “penalty” for the individual mandate to say it really meant a “tax”, they could have found a way to save this part.  We didn’t have to wait for a more comprehensive solution to do this basic act of humanity.  We wouldn’t wait to give pain medicine until after a broken leg is fixed.  At the same time, we should not get confused and think pain medicine will repair the problem.

Unless we get conservative buy-in, we will fail.  We aren’t likely to have a Democrat controlled Congress in the near future, even if we re-elect Obama as I hope.  If we did, and we rammed a single payer bill down the opposition’s throat, they might not notice their lot had improved in time to prevent sabotage of a new system.  We need to spend more time studying how to enlist the good parts of conservativism – decisiveness and unyielding dedication to a cause, for instance (thank you, Chris Mooney), and communicate with our brethren in their own language.  We can help bring out their better natures, and they have some skills we need.

Quit Compromising.  Surprised, after what I just said?  We have made a huge error in confusing persuasion with negotiation. We need bipartisan buy-in at the grassroots level, not a bipartisan solution in Congress.  Unless we become fiercely devoted to the goal of real healthcare reform, to the point we will absolutely not compromise our principles, we are always going to wind up being the patsy.  My husband loves the Bible quote “because you are lukewarm, and neither hot nor cold, I will spit you out of my mouth”. Come on, people!  Get some fire.  We can do this.

Remember why it matters.  I haven’t got much choice here—I see the consequences of our current healthcare system right in my office, every day, in ways that range from frustrating to tragic.  The father who quit bringing his children for checkups because he knew he had a deductible  in his grandfathered policy and was too embarrassed to say he couldn’t pay. The child who suffered terrible itching for weeks from eczema, waiting for insurance to authorize his prescriptions, because they insisted he try the things that had already failed before he could get what had already worked before. The working and uninsured mom who chose to spend her limited funds on her family’s food and shelter, who would have qualified for the Medicaid expansion.  Who, when  I asked “are you ok?” broke down sobbing because she was so tired of pain, for months, but it couldn’t be cured in a trip to the ER and the free clinic here didn’t have a specialist to help her. 

All the numbers you hear about have faces.  Remember that.  We cannot forget why, whether we are tired of working on this or whether we really have time to do it, we have to keep going.  Until we fix the problem.

 It will be tempting to get caught in a sort of righteous jubilation  here—it looks like we won something big.  I would have had more sympathy for that if the poor hadn’t been shamefully hung out to dry.  Let’s don’t go there!  We have work to do.  Medicare for All or bust!

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Filed under citizen responsibility, Healthcare reform, SCOTUS Ruling on ACA