Sunday, February 19, 2017

Medicaid block grants: who to start calling, and points worth emphasizing // "Don't Let Me Down"

Kaiser Health News tells you "Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans" (h/t Audrey Provenzano).

Let's start thinking about how block grants can be defeated.

Republicans will try to pass block grants in the Senate, which is the most likely place for block grants to die, by introducing them as part of budget reconciliation, which would allow them to get it through on a 51 vote majority in the Senate. They will likely have the votes in the House... unless Republicans can be convinced by their states' governors that their constituents and states will a) get hurt by Medicaid cuts and b) will notice and c) will be mad about it.

Here's one strategy for citizen and clinician advocacy around this right now: specifically target legislators from states where federal contributions make up a significant portion of Medicaid spending. You can use this ranking (click the "federal" header to make the table sort by share of spending by federal government) to find where your state lands on this list.

This ranking is interesting as it highlights a potentially persuadable Senator, who wouldn't have come immediately to my mind: Dean Heller, in Nevada, who is up for re-election in a swing state in 2018 which also receives a large share of federal spending for Medicaid. Rob Portman, in Ohio, will also be up for re-election in a swing state in 2018, which also takes an above average federal share for Medicaid spending. Other targets for advocacy and persuasion might include Shelly Moore Capito, Republican of West Virginia, which had a significant Medicaid expansion in an impoverished state, and which ranks fifth in the nation in share of federal spending for Medicaid.

The limits of this ranking list in setting advocacy targets become clear, though, with the first state: Kentucky is a Medicaid expansion state, takes a bigger share of federal funds for Medicaid than any other state in the nation, and yet is represented by Mitch McConnell and Rand Paul, both of whom are likely to support block grants and worse. I mean, if you're from Kentucky, call their offices, but... they don't aim to represent Medicaid recipients.

Still, for the unpersuaded, the argument here is not that Medicaid block grants are bad because they hurt the healthcare of poor people. (After all, Republicans might reasonably ask, sotto voce, Isn't that what we were elected to do?)

The argument is more pragmatic: Medicaid block grants will hurt Nevada, or West Virginia, or Ohio, or Montana, or North Carolina (find your state on this list). And more to the point, they will hurt specific hospitals and community health centers. These are places that your Senator or Representative has been photographed with sick kids with cancer; cutting ribbons in front of the new women's health center; shaking hands with some urologist to "raise awareness" about prostate cancer; and, well, you know the drill. If you look on your rep's office website, odds are good that at some point in the last few months they were visiting somewhere that would get hit hard by cuts in Medicaid spending.

If you're a healthcare worker in Nevada, West Virginia, or Ohio, or any other state where Medicaid depends to a larger degree on federal contributions, not only should you consider contacting your Republican Senator about block grants--but also get your hospital or health center to start advocating as well. These are large employers--and block grants are likely to mean many of them will lose revenues and have to start laying people off. Sometimes it's jobs, rather than health or lives, that speak politically.

For calling your congressional representatives, here are some red state/swing state talking points:

"I am calling to ask Senator ____ to oppose Medicaid block grants. 

"Medicaid in [our state] depends on federal contributions--in fact, we have the ___nth biggest federal share of Medicaid spending of all states. 

"Medicaid can give latitude to [our state] to make our Medicaid program work best for our state--without cutting jobs and causing people to lose their health coverage. 

"Senator _____ should instead support Medicaid funding mechanisms that give flexibility to states without shutting off needed support."

And what's the blue-state phone script? Ironically, in part because states like Massachusetts are both wealthy (entitling us to a smaller federal contribution) and liberal (willing to kick in a fair amount of state revenue), we are quite low on this ranking list. And in that sense we will initially suffer somewhat less, proportionally, from block grants. But that's only because we are already spending a lot of state money--to the point where if federal money starts getting cut, we won't be able to make up the difference. Much of what makes our state Medicaid programs innovative and effective will be endangered. We still depend on getting a large share of our Medicaid funding from the federal government, and healthcare is a big part of our economy.

Here are some key points for a blue state congress call:

"I want Senator ______ to make saving Medicaid into a bigger priority of her office's work. I know I can count on Senator ____ to oppose Medicaid block grants--but I want her to make it a bigger priority to let people know how important this is not only to our states, but to all states. 

"Our state has done a lot of innovative things with Medicaid funding and I hope we can hold up that innovation as an example of the kind of flexibility for states that current funding allows. 

"I'm not hearing her talk enough about Medicaid block grants and how this will hurt people in [our state] and all over the country. Getting healthcare to people who otherwise couldn't afford it should be at the center of a progressive agenda. Can you let me know when she plans to make this a bigger part of her public agenda?

"I want to let Senator ____ know that I'm waiting for her to take a bigger leadership role on opposing Medicaid block grants and reaching out to her Republican colleagues who might be persuadable on this issue."

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Theme song: The Chainsmokers' megahit "Don't Let Me Down", of course:

here's a remix that I like, on Soundcloud, and since:
1. the original video is just, terrible;
2. the better part of the Chainsmokers' "performances" of this song amount to them basically standing behind a table dancing around to the already recorded and mixed track with fireworks going off around them; and most importantly,
3. their band name alone represents a threat to the public health; 
and therefore,
let it be resolved that if we need a video, we'll just watch a cover of the song by another artist, like, say... Usher? (Huh?)

I'm not 100% sure it's a good idea to get actual high quality musicians involved in trying to interpret a song like this one, where the backing track comes from some dude playing around on his MacBook while on a plane, "and I made that, and it was pretty vibe-y", and then the vocals come from a songwriter who is hired to come in and write "the top line" (you know, the lyrics and melody that old folks are used to thinking of as, the song). And where the heart-wrenching story of adversity related to the song is that the computer crashed and lost all the files and they had to remake all the tracks again.

But lots of truly great pop songs have been written in music factories, and Usher and his crew give it a valiant shot, and hey, well, maybe it's a little too jazz-festival-ish, but maybe that's a good thing:

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I don't know what to do with this. I feel like I have to keep you, dear reader, informed on any "Fast Car" versions of significance. So. Here is Justin Beiber singing "Fast Car." Don't get all nasty about it.