Another 5-4 Supreme Court Ruling Hammers Medicaid For 68 Million Americans

Elizabeth G. Taylor and Jane Perkins of the National Health Law Program (NHeLP) (see also Taylor's blog), writing at TPM:

When it comes to health care at the Supreme Court this year, all eyes are focused on the Obamacare tax credits case, King v. Burwell. But a case decided this week, Armstrong v. Exceptional Child Center, Inc., has raised significant concerns for the availability of quality health care for those who need it most.

In a 5-4 ruling, the Supreme Court turned against decades of legal precedent and ruled that Medicaid providers cannot use the Supremacy Clause of the U.S. Constitution to stop state provider payment policies that are inconsistent with the federal Medicaid Act’s requirement for adequate reimbursement rates. That may sound like a bunch of legalese, but the outcome has a real impact on the 68 million-plus people relying on Medicaid. If a state’s Medicaid payment rates are too low (and many providers complain these rates are below their cost of providing services), then provider participation in Medicaid—and the ability of enrollees to obtain care—is at risk.

...

[/face-palm] Yes, that's our Supreme Court, all right.

Dr. GOPer 'fixes' Medicaid

And unfortunately, that's our Medicaid system. Taylor and Perkins note that "Congress established Medicaid in 1965 as a cooperative program between states and the federal government"; the operative word there is "cooperative" ... in states run mostly by Republicans, the state implementation of Medicaid is as obstructionist as the state's governor and legislature can make it. I know: my late mother finally qualified for Medicaid to help with my late father's payments for her otherwise uninsured institutionalization for Alzheimer's disease... the week my mother died in 1990. Dad ended up nearly broke from paying for her treatment. Texas GOPers can be very proud [/irony] of what they accomplished in that case, goddamn them.

If there is one good reason above all others to hold your nose and vote for a Democratic president in 2016, it is to make sure the effing bastards of the Greedy Oppressive Party lack the power to appoint another Supreme Court Justice for at least another four years. A Democratic president will not assure an optimal replacement for a Justice who retires or dies... the GOPers can continue playing their obstructionist politics as surely as they obstruct Mr. Obama... but if the GOP has the presidency and both houses of Congress, it will be an utter disaster for healthcare in America. Don't let that happen!

The Community Cold

Stella has had one version of it for over a week; she got it from literally half her coworkers and brought it home to me. I've had it for 3-4 days, the version that is mostly a head cold and a sore throat... yucky and unpleasant, but not life-threatening.

At night, I have adequate concentration to read novels, news and blogs, but not to follow anything complex or to write anything of much substance; don't expect any intellectual tours de force from me this week. I've successfully read a not unduly challenging private eye novel and had rather less success facing some of Noam Chomsky's oeuvre for the first time... and I do want to give Chomsky his due; IMHO he deserves my close attention.

Beyond that, my intake has been confined mostly to PBS Kids, probably entertaining because I don't have kids, PBS or otherwise.

I'll check in occasionally, but don't expect any great works from me until I stop drowning in my own fluids and rasping every word I speak.

NC Senator Would Not Wash His Hands Of The Matter

When Senator Thom Tillis (R-NC) offered his opinion that food workers at public accommodations like restaurants should be allowed to opt out of the legal requirement that they must wash their hands, I thought he was joking, perhaps satirizing the anti-vaxxers. I should have known better.

As Jen Hayden at Kos points out, quoting the CDC:

The spread of germs from the hands of food workers to food is an important cause of foodborne illness outbreaks in restaurants. It accounts for 89% of outbreaks in which food was contaminated by food workers. Proper handwashing can reduce germs on workers’ hands and the spread of germs from hands to food and from food to other people. [Bolds mine. - SB]

In other words, a food worker's handwashing is all that stands between you and food poisoning.

But in these days of utter Republican insanity, the whole GOP seems as dependent on magic as the wizards at Unseen University, with results no better than many of those wizards achieve. Basic precautions known to health workers for at least two or three centuries are both necessary and sufficient to prevent devastating outbreaks of some kinds of disease. People who believe they have some sort of personal individual right to ignore the laws establishing those precautions in public accommodations like restaurants are themselves a danger to society. People who are both stupid and hostile make me sick: their liberties must end with their endangerment of the community's health.

Not Yet Back To Good Health

I don't know what it will take to shake this cold, not to mention some aspects of my usual medical problems which are demanding attention. At a minimum, I need another few days of rest. A trip to the doc is probably also in order.

And I need this !@#$%^&* band-in-a-brain (see previous post) to STFU, no matter what its source.

AFTERTHOUGHT: It occurs to me that many people may not recognize "band-in-a-brain" as a sideways ref to Band‑in‑a‑Box™ accompaniment s/w by PG Music. Recommended... BiaB is about as much fun as you can have playing with yourself.

Yuck

Last week was Stella's turn at the community cold/cough. This week it's my turn. If Stella's experience is typical, it lasts about two weeks. I'm not absolutely dead, but I doubt I'll be blogging very much. Thanks for your patience.

A Regular Vegetarian Option In A Public School Cafeteria? What A Concept!

Well, OK; it's in New York, specifically, in Queens. But apparently it's more popular than anyone ever expected, let alone predicted. I wonder how long it will be before the same cattle ranchers' association that tried to shut down Oprah Winfrey when she commented on mad cow disease gets cranked up about this...

Are 'Good Male Contraceptives' Possible, Or Is It 'Pick Two Of The Three Attributes'?

Birth control: old standards

Valerie Tarico of RH Reality Check discusses eight new possibilities for male contraceptives (some completely new to me) in various stages of testing, and of course necessarily examines women's and men's attitudes, old and new, American and international, toward men's taking responsibility for pregnancy prevention... not all that common through history. Here's an excerpt that gets to the point:

...

On the surface, it may seem that scientific challenges are the primary barrier to excellent male birth control. A woman produces an egg only once each month, while men produce millions of sperm daily. Female fertility can be detected and timed. It starts later and ends sooner than male fertility. But those in the know say biology isn’t the problem. The question is one of politics and priorities. The National Institutes of Health summed up the problem [.pdf] in direct (if wonky) terms over a decade ago:

The lack of progress in developing affordable, safe, effective, and reversible male contraceptives is due not to the biological complexity involved in suppressing spermatogenesis [the production of sperm], but rather to social and economic/commercial constraints.

Today, research on male contraception is 50 years behind research on female contraception. The difference is as much as anything an artifact of history and tradition, which ripple into the present. ...

...

Well, yes. Perhaps some progress on that 50-year gap will be made in the more progressive nations of Western Europe, and possibly against all odds in parts of Asia, where the incentives for limiting family size are often matters of both health and law. But I doubt seriously the advances will be made in America or by Americans. If gender relationship stereotypes in America weren't already beginning to harden in highly asymmetric ways, there is always religion to obstruct real progress... and religion's new best friend, national politics. I am not hopeful.

---

(On a not completely unrelated matter, a federal judge has declared the part of Texas's new abortion law (the one State Sen. Wendy Davis filibustered unsuccessfully) requiring clinics to have admitting privileges at a nearby hospital to be unconstitutional, ruling that the provision “lacks a rational basis and places an undue burden on a woman seeking an abortion.” Note two things: 1) Judge Lee Yeakel did not declare the entire law unconstitutional, only the one provision; and 2) the six Catholics of the US Supreme Court have yet to get their soiled mitts on the law. Don't expect this ruling to be sustained.)

One-A-Day

No, not multiple vitamins... appointments this week. Yesterday was physical therapy. Today I have a doctor's appointment. Thursday I see my prosthetist for some adjustments requested by my physical therapist. Friday I have PT again. Every day, Stella has health-related issues for which she needs my genuine support.

If I'm scarce here this week, you'll know why. Thanks for your patience.

The Prosthesis Arrived Today!

My prosthetist turned it over to me at today's appointment. He had completed the socket, and with a suitable liner and other miscellany, it was ready to go. Not me; I'm exhausted (don't ask). And I have an appointment with the hospital case manager tomorrow, so I can't stay up tweaking the "new" computer as I would prefer, so I'll have to write more later. Thanks as always to friend and neighbor George, who prevented this day from ending before it began because of transportation obstacles.

"Tomorrow, tomorrow [evening], there's always... tomorrow..."

Higgledy Piggledy, Physical Therapy...

It's a promising beginning for a double dactyl, but it will have to wait, because I have too much, um, physical therapy on my plate at the moment.

I haven't forgotten the blogosphere or this blog, but when even the simplest household acts require twice the time and four times the energy, it's a bit overwhelming. E.g., imagine going to the bathroom, on a walker, on only one leg.

Or changing clothes. Or rinsing a dish in the kitchen sink while sitting in a wheelchair. AND having assignments of exercises, some supervised by your P.T., some using fancy equipment but many just as difficult using cut-out sections of colorful balloons, either gripped in your hands or tied in knots around your leg(s) and the chair you're sitting in. Or lifting weights that seem tiny when you read the numbers on them, but not so small on the 10^th, 15^th, 20^th... repetition of some simple exercise.

Or learning to climb the shallowest step from a brick patio to a wooden deck using a walker... when you lack one foot or one leg.

Or walking around a typical American 3-2-2 house on a walker for every. damned. thing. you. need. to. do in the course of a day.

I'm sure jams knows exactly what I mean; he's been through it. I don't doubt others of you have some first-hand experience as well.

Twice this week I've slept 12 hours in a night. The greatest injustice is that Stella can't do the same herself, and goodness knows most of the housework falls on her, including the chores that once were mine. With luck, they will be mine again at the conclusion of this process. But that's weeks or even months away.

---

Still, none of us has any real complaint, compared to the many children with disabilities (and their caregivers) who face all these things and more. And my disability, though permanent, can often be remedied to a point of resuming a more-or-less normal life. How many people, including children, have no such prospect? I have no basis for bellyaching.

For an amputee, balance is the key

I suppose the WSJ sees these kids as "lucky duckies" because they receive government benefits including some tax breaks. There's about as much basic human compassion in these members of the 1% as in Republican candidates in the last election. And they wonder why they did so poorly in that election. And I wonder why Democrats cut GOPers any slack at all. I mean, it's not as if the 1% never ends up physically disabled...

If this post has a point, it is that the political IS personal, the more personal for those with greater disabilities, and more personal in the other direction for people with greater advantages.

---

I know none of the people in these pictures personally. But I share a bond with all of them. We face a challenge which does not confront people who have no major disability. Every day we face such a challenge... sometimes with good grace, sometimes with unrestrained frustration, but it is always there in front of us. Steering a wheelchair through narrow hallways or balancing on a walker as one transitions from a chair or bed or wheelchair to our primary means of mobility... at least for now... or making it up a single stair (even 2" or 3", even just one), we grin and grit teeth and go for it. It is a game we win every time we arrive on our feet (or foot) without crashing, or return to the table with a dish not shattered on the floor, or just plain make it to the bathroom with no accidents. The victories in this life are small but savored unreservedly by every one of us you see in those pics.

Join us in our fortune, good and ill... it's like nothing the WSJ's self-satisfied "lucky duckies" are likely to experience in their lives. We are alive, when we might so easily not have been... and damn, we know it every single moment. Join us!

Rachel Maddow Discovers: Myth Rmoney Is Absolutely, Totally, Completely LYING About His Position On Contraception, With The Help Of (Among Others) Sitting Republican Senators

I missed this segment five days ago when it broke. I was foolish to put it aside, briefly so I thought, when it happened. Rachel Maddow was appropriately diligent about the matter, and found the truth: Rmoney is lying about his position on the Blunt Amendment, and hence about women's access to contraception through their employer-provided health insurance. Despite repeated disclaimers by Rmoney and other Rmoney surrogates (including, e.g., Senator Kay Bailey Hutchison (R-TX)), Rmoney would, in fact, allow employers to prevent women from obtaining contraception through their employer-provided health insurance. Contrary to what he and his surrogates have said, he believes it is, indeed, the business of employers... religious institutions or otherwise... to make that decision for a woman.

Please view Ms. Maddow's segment. And, as GeeDubya Bush once said, you "won't get fooled again." I know many women for whom this is a go/no-go issue, so it is very important to know that Myth is LYING about it. Please watch Maddow's segment, and be enlightened if you aren't already.

Lying, motherfucking bastard. Scheming, selfish, deceiving bastard! Lying-straight-in-your-face BASTARD!

I Am One Of The 89 Million

There was considerable argument last night over Rmoney's unsupported statement that his proposed replacement for Obamacare assured coverage for individuals with preexisting conditions.

Well, apparently, he held that position for the duration of the debate and a few hours on either side of it. Via Paul Krugman, we have Sarah Kliff on Ezra Klein's Wonkblog:

...

Pants on Fire!

It started with the Republican presidential candidate saying during an appearance on “Meet the Press” that he liked the Affordable Care Act’s provision that requires insurers to cover preexisting conditions, and would support something similar. Hours later, his campaign clarified he did not, however, support a federal ban against denying coverage for preexisting conditions. Around 10 p.m., the Romney camp had circled back to the same position it held back in March: that the governor supports coverage for preexisting conditions for people who have had continuous coverage.

...

Please read both Krugman's and Kliff's posts; both are informative... and eyebrow-raising. In short, Rmoney lied about favoring coverage of preexisting conditions. How many Americans would fall through the cracks if continuous coverage were required to obtain coverage of preexisting conditions?

About eighty-nine million... 89,000,000.

I am among the 89 million. Many of my friends are among the 89 million. How many of those people watched the debate, but did not stay tuned for long enough to hear Rmoney's staff issue the correction? In essence, Rmoney used the way the debate is framed to swindle the American people out of preexisting condition coverage... while telling them the exact opposite.

Older Republicans and Republicans with chronic illnesses must be desperate to capture the presidency if they can vote for this chronic liar.

AFTERTHOUGHT: this phenomenon may explain in part why Rmoney effectively won the debate. Obama saw it as his duty to explain how things are and how they can be repaired. Rmoney, not the first politician to do so, feels free to promise anything... anything, true or false... if it gains him votes. Republicans promise pie-in-the-sky; what they deliver is all too often pie-in-the-face. But some Americans inevitably believe them. Suckers!

CPPP: If Rick Perry Accepted Texas Participation In ACA, Texas Uninsured Count Would Be Cut In Half

According to a new report, Choices and Challenges, issued by the Center for Public Policy Priorities (press release [.pdf], full report [.pdf]), thanks to "Gov. Goodhair" Perry's rejection back in July, along with other Republican governors, of his state's full participation in all parts of the Affordable Care Act, we are losing an opportunity to cut Texas's uninsured rate in half.

In other words, half of the people in Texas who have no medical insurance now would be able to obtain insurance, if Gov. Perry would relent on his heartless commitment to... well, to whom, exactly? His refusal is even bad for the state's health care industry! ThinkProgress put it this way back in July:

...

Perry’s announcement is an especially harmful move because Texas will benefit more from the Affordable Care Act than any other state. Texas was recently ranked worst in the country for health care delivery by the federal Agency for Health Care Research and Quality, scoring “weak” or “very weak” in nine of 12 categories. Perry’s office discounted the study as overly broad, and has argued that Texans’ real problem is personal health choices, not lack of health insurance.

More than 25 percent of Texans – 6,234,900 people – are uninsured, the highest rate in the nation. ...

...

Between Perry's dismissal of people's need for medical insurance (reminiscent of the CEO of Whole Paycheck a few years ago) and Mitt Rmoney's remarks about the 47% who are dependent on the government, this seems to be "National Republican Blame‑the‑Victim Week." They really are proper bastards, aren't they?

So WTF are Perry and three other Republican governors thinking? Matthew DeLuca at The Daily Beast attempts to answer that question:

...

Perry may not like the idea of expanding Medicaid,  ... Some studies show that without the Affordable Care Act, the number of uninsured Texans could climb all the way to one third of the population.

Health care is one of the state’s biggest industries, and hospitals in Texas are likely to push hard in the coming months to get the Lone Star State to take Obamacare into its warm embrace. ...

...

Let me insert a note: a quick glance does not show any change in Perry's position since July (ThinkProgress Aug. 27, Dallas Morning News Sep. 17). Resuming DeLuca:

...

The Affordable Care Act is supposed to go into full effect in 2014, but Perry says he will not implement the expansion of Medicaid or creation of a state health-care exchange prescribed by the law. ...

“To expand this program is like adding a thousand people to the Titanic,” Perry said Monday on Fox News. “You don’t expand a program that is not working already.”

...

Could we please arrange for a deck chair for Gov. Perry? His disinclination to implement federal law (even if he is legally entitled... can I say "entitled" about a Republican?) reminds me of the Tea Party, or worse. Say, could we arrange for the TP to make up the rest of the "thousand people"?

Rmoney On Pre-Existing Conditions

I tell you, that man really knows how to charm a voter. Here's Sahil Kapur of TPM:

...

“I’m not getting rid of all of health care reform. Of course there are a number of things that I like in health care reform that I’m going to put in place,” the Republican nominee said on NBC’s “Meet The Press.” “One is to make sure that those with preexisting conditions can get coverage.”

His campaign later told TPM he wasn’t signaling a shift in policy and was instead referring to his existing stance in favor of protections on preexisting conditions only for those with continuous insurance coverage — not for first-time or returning buyers.

...

Such a deal! Sing it, Billie; it's the Republican anthem, only they sing it without irony...

Them that's got shall get
Them that's not shall lose
So the Bible said and it still is news
Mama may have, Papa may have
But God bless the child that's got his own
That's got his own

Oh No, Not Popcorn, Please!

Via AMERICAblog's Aravosis, we learn from (forgive me) NY Daily News: Popcorn's butter flavoring may trigger Alzheimer's disease:

Diacetyl, already linked to lung damage in people who work in microwave popcorn factories, is also used to produce the distinctive buttery flavor and aroma of margarines, snack foods, candy, baked goods, pet foods, and even some chardonnays.

...

University of Minnesota drug-design expert Robert Vince, PhD, and colleagues found that diacetyl causes brain proteins to misfold into the Alzheimer's-linked form called beta amyloid. Vince's team also found that diacetyl has an architecture similar to a substance that makes beta-amyloid proteins clump together in the brain -- clumping being a hallmark of Alzheimer's disease.

...

I can live without chardonnay. Candy I can cut back on, if necessary. But I do like my popcorn; I probably eat it once a week. Left to my own devices, I'd use real butter and take my chances, but with microwave popcorn, it's not easy to avoid the artificial buttery flavors. Damn... another of life's pleasures revealed to be bad for you. That really sucks!

ObamaCare: A 'Death Panel' For Private Insurance?

Rick Ungar of Forbes explains why he thinks the answer is "yes":

...

That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.

...

That clause, says Ungar, ultimately makes offering private insurance unprofitable. Given how the biggest thieves in the modern business world operate, I have my doubts. But the article is worth reading.

(H/T ellroon.)

CNN: SCOTUS Strikes Down Individual MandateSustains All Parts Of Health Care Law

No details yet. I'll post them here when I have them.

CORRECTION: CNN is now saying "Correction: The Supreme Court backs all parts of President Obama’s signature health care law." Now how the fuck could an org like CNN make a mistake like that? Somebody's ass should be fired...

UPDATE about 9:30am CT: fuck CNN; here's a tiny bit more from TPM Editor's Blog, David Kurtz:

Because of the archaic way the Supreme Court releases its decisions, there was lots of initial confusion about what the holding in the case was. We’re still awaiting the actual opinion, but the upshot is that the individual mandate survived under the taxing power of Congress, not under the Commerce Clause.  ...

Brian Beutler of TPM has details.

Scott Lemieux of Lawyers, Guns and Money has a tidy list of important facts.

ADDED: The estimable Laurence Tribe at SCOTUSblog explains, in "Chief Justice Roberts comes into his own and saves the Court while preventing a constitutional debacle," how this decision makes constitutional sense even as it disagrees with the opinions of the other conservative Justices.

AFTERTHOUGHT:  of course I have some thoughts of my own on the Affordable Care Act. It is far from the legislation I would have preferred, which for brevity I will call "Medicare for all" or "single payer." But the most disgusting thing is that when Obama, as he so often does, adopted a Republican position almost intact, the GOP, as a purely political act, with no redeeming motivations of aiding America's ill and infirm, turned 180 degrees and did everything they could to kill it... despite having effectively authored it themselves. They even turned loose their nakedly partisan Supreme Court on it, but one of their regulars (Roberts) betrayed them. The degree of acid-tossing raw enmity almost all Republicans exhibit toward Obama, who aside from being Black is almost one of their own, is... well, actually, no, it is no surprise. The GOP has sunk to the bottom, and is feeding on the toxic waste down there. Couldn't they at least, you know, like... pretend to advocate the good of the nation and its society? But noooo...

Republican evil knows no bounds.

GMO Grass Near Elgin, TX Apparently Kills Cattle

ellroon has the basics, and a link to an article with details. The GM grass, Tifton 85, is a "scientifically modified" (?!) hybrid of a hybrid, in use since 1992, but suddenly, on a number of farms in central Texas, it apparently started generating cyanide. Cyanide, f'chrissake! Sixteen of eighteen cattle on one ranch died; other farms showed traces of cyanide but no deaths.

I've driven through the countryside surrounding Elgin, TX. There is nothing even remotely strange about the farmland there; it looks like any other central Texas farmland, and I've never seen it glow in the dark. But... Jeebus on a crutch... cyanide?

If you've been thinking of writing your member of Congress about labeling foods that contain GMOs, or labeling meat or milk from animals have been fed on plants with genetic modifications, now might be a good time.

Catholic Hospitals In America: 'We Reserve The Right To Refuse Service To Anyone'

Americans of a certain minimum age will remember the signs on the doors of dining establishments back in the 1950s, mostly but not exclusively in the Deep South: "We Reserve the Right to Refuse Service to Anyone". What they meant, of course, was "We Reserve the Right to Refuse Service to People of Color". Lunch counter occupations were among the early protest events of the Civil Rights movement.

Via Adgita Diaries, from AMERICAblog's John Aravosis, we learn that

...

The Catholic church is now making rumblings about turning away non-Catholics from the emergency rooms of Catholic hospitals. I shudder to make a Nazi analogy, so I won't. But what other analogy is there for a hospital to even dare start talking about picking and choosing who lives and who dies based on their religion?

...

From Maureen Dowd, writing about the latest Catholic scare tactic, distributed in tax-exempt churches, to oppose President Obama's new contraceptive policy that Mitt Romney previously endorsed as well.

The Archdiocese of Washington put an equally alarmist message in the church bulletins at Sunday’s Masses, warning of apocalyptic risk:

“1. Our more than 600 hospitals nationwide, which will need to stop non-Catholics at the emergency room door and say, ‘We are only allowed by the government to heal Catholics.’

Aravosis goes on to note the cognitive dissonance experienced by many non-Catholic Americans over the difference between the surveyed beliefs of Catholic Americans regarding contraception, abortion, premarital sex, etc. on the one hand, and on the other hand the fist-of-iron approach of the newly mean-spirited Catholic hierarchy in America. And he's right; it bugs the Hell out of me.

But hospitals are institutions that are necessarily ultimately under secular law, laws not about the practice of faith but the practice of medicine. Any hospital that decides to threaten to deny emergency care to any human being for reasons not related to the current best practices of medicine should have its doors shut and padlocked until it recants the threat. Every institution that calls itself "hospital" should without hesitation render emergency medical aid to any person... no exemptions, no qualifications... who needs it. Enough is enough.

Sliiiiime In The Supermarket Sushi!

Houston's ABC-13 was home of the late great Marvin Zindler, a reporter and executive who was famous (infamous?) for many things. For example, Marvin was the character depicted in The Best Little Whorehouse In Texas, the newsman whose dogged determination brought an end to the Chicken Ranch. But that's not what brought Marvin to mind today.

Marvin used to read the local health inspector's restaurant journal on the air once a week. He called it the "restaurant rat and roach report," and the classic phrase with which he ended every segment (because in a big city there is never a shortage of violators) was

"SLIIIIIME IN THE ICE MACHINE!"

Well, it's not in the ice machine, but Lindsay Beyerstein of duly Noted has found red sliiiiime, um, I mean, red slime, this time in supermarket sushi. And it is at least as disgusting as the "pink slime" about which so much has been said on evening news segments lately.

I doubt that veggie sushi is affected by this revelation; I presume no one uses tuna skeleton scrapings to supplement the avocado sushi at Whole Paycheck. But the carnivores among you may want to take notice.