May 062018

The Star Tribune reports on young people with disabilities who are forced to live in nursing homes because of a dire shortage of home care workers across the state. Medical Assistance (the Medicaid program that funds most long-term care for Minnesotans with disabilities) pays only $12-$13 per hour for personal care assistants, which is simply not enough to attract people to a demanding profession with variable hours. The most obvious solution would be to increase the pay of these workers and disability advocates are working hard to convince the Legislature to do just that. The legislative session ends in a couple weeks, so if you’re in Minnesota, please consider calling your state legislators to ask them to support a pay increase for PCAs so that people with disabilities aren’t forced into lives of isolation.

Plenty of people with disabilities (including me) live with the nagging fear that we could end up in an institution because of a lack of adequate staffing. I’m fortunate to have a devoted team of nurses caring for me, but it would only take the sudden loss of a couple nurses for me to face the imminent possibility of life in a facility. Articles like this remind me both of how lucky I am to live at home and that my independence hangs by a tenuous thread. I’m also regretting that I read some of the nasty, dismissive comments that accompanied the article–Ayn Rand has no shortage of acolytes around here. I remain hopeful that lawmakers will recognize that they must act to preserve Minnesota’s position as a leader in supporting people with disabilities, but we need to make some noise to ensure this happens.

Mar 162015

Sarah Kliff of Vox offers an excellent explanation of Republican plans to transform Medicaid into a block grant. Instead of guaranteeing to cover a fixed percentage of all enrollees’ medical expenses, the federal government would give each state a specific amount of money to spend on Medicaid coverage. Republicans claim that this would give states more flexibility to tailor coverage to meet the needs of their residents. But by placing a specific dollar limit on Medicaid spending, millions of people would likely lose coverage. In other words, “block grant” is a euphemism for deep cuts.

Republicans are deeply hostile to any Medicaid spending that benefits low-income adults because they see it as a disincentive to work. These are the people who are most likely to suffer under Medicaid block grants. And many of them work low-paying jobs that don’t provide affordable health insurance. It would remove an already frayed safety net from those who dwell on the economic margins of society. The elderly and people with disabilities are also likely to see substantial cuts in services, so everyone will feel some pain if block grants are implemented.

Republicans will do their best to disguise the true human cost of their policy proposals, which is why explanatory posts like Kliff’s are so important. We can’t allow conservatives to put innocuous labels on their terrible ideas.

Feb 042015

FCC Chairman Tom Wheeler formally announced strong net neutrality regulations that would allow the FCC to regulate broadband providers as a public utilities. This move was widely expected, but it still reflects a major shift in the politics of net neutrality. A year ago, it was almost inconceivable that the FCC chairman, a former telecom lobbyist, would propose such a sweeping reclassification of broadband services. Net neutrality advocates did a masterful job of mobilizing public opinion to such an extent that the FCC had no other viable course of action.

The new rules don’t go as far as some would like. Broadband providers will not be required to lease their infrastructure to other companies interested in providing broadband service, which would do a great deal to increase competition and lower prices. However, the rules will require providers to treat all Internet traffic equally. I’ve noticed recently that Comcast has been throttling certain sites that I visit (such as digital comics seller Comixology), so these rules are certainly needed. The Internet has become too vital to daily life to allow telecom companies to continue operating in a completely unregulated environment.

Jan 272015

Over at Vox, Sarah Kliff looks at the growing number of Republican governors who are expanding Medicaid under the Affordable Care Act—with conditions attached. GOP governors are negotiating with the Obama administration for waivers that allow them to give  their state Medicaid programs a more conservative bent. For example, some states use Medicaid dollars to purchase private insurance for low-income individuals. Other states require enrollees to pay an increased amount of cost sharing or they restrict access to certain benefits that aren’t deemed essential.

These waivers are expanding Medicaid to millions of individuals, which is better than not expanding coverage. Some of these conservative policies, like charging premiums to individuals with extremely limited means, seem to have less to do with promoting personal responsibility than with winning the favor of far-right state legislators who possess an almost pathological animosity towards the poor. But thanks to the Supreme Court, states are not obligated to expand Medicaid and they are in a much stronger position to seek concessions from the feds.

Aug 072014

Governor Dayton is pushing state agencies to hire more people with disabilities through a recently signed executive order. It establishes a goal of having people with disabilities represent 7% of the state workforce by 2018 (up from the current figure of 3.2%). The Strib article notes that Minnesota has fallen behind neighboring states and the federal government in the hiring of people with disabilities.

This executive order signals good intentions from the Dayton administration, although I’m hesitant to predict what its real impact will be. People with disabilities continue to face myriad obstacles to employment including difficulties accessing transportation, job training, and health care. Any initiative to increase employment of people with disabilities must at least recognize these challenges and offer strategies for shaping appropriate accommodations.

The state has been a good employer to me. It has provided me the flexibility I need while giving me the opportunity to have a career and enjoy financial independence. I’m hopeful that this executive order will give other people with disabilities similar opportunities to realize their potential.

May 022014

I’m late linking to this, but Harold Pollack has a great post in Wonkblog about how Medicaid forces poverty on people with disabilities. This is common knowledge in disability policy circles, but most people don’t grasp how difficult it can be to maintain Medicaid eligibility and have any semblance of financial independence. It’s common for people with disabilities to hide assets with a family member or keep income off the books to ensure that they don’t lose access to vital services. Those of us who buy into Medicaid are allowed a bit more leeway with our finances, but we still must be careful.

Congress really should revisit the strict Medicaid income and asset limits for people with disabilities. But as long as Medicaid is regarded as a program for only the poor, policymakers won’t be eager to change the status quo.

Jan 292014

Republicans finally got around to releasing a concrete alternative to Obamacare and it’s kind of awful. It reduces eligibility for subsidies to purchase insurance and does away with most of the Medicaid expansion. Even better, it eliminates the requirement that insurance companies cover individuals with pre-existing conditions. Finally, it pays for the whole thing by making employer health plans taxable, an idea that has already proven wildly unpopular.

None of this has a chance of becoming law anytime soon. But as Sarah Kliff notes, the most interesting thing about this plan is what it doesn’t do. It doesn’t completely scrap Obamacare. It doesn’t envision a pure free-market solution and it doesn’t take away coverage from everyone who currently has coverage under Obamacare. To a degree, this plan accepts the status quo and recognizes that we can’t return to the health insurance regime of 2009. As more people gain coverage under Obamacare, it will probably become even more difficult to propose more limited alternatives. The plan put forth by the GOP presidential nominee will likely be even more moderate. And that’s a good thing.

Jan 212014

Frequent readers know that I’m a fan of Ezra Klein and his Wonkblog at the Washington Post. It offers thoughtful and well-written  analysis on complicated policy issues like health care, economics, and the environment and it has become a formidable driver of traffic to the Post‘s website. But it seems that Klein may have become a bit too high-profile for the paper’s liking. At least, that’s one way to interpret the news that Klein and some of his Wonkblog colleagues are leaving the Post to start their own wonky news venture.

Klein is just the latest high-profile New Media personality to depart a traditional news outlet in favor of opportunities that offer more creative control and, possibly, richer rewards. Political blogger Nate Silver will soon be re-launching his 538 site as part of the ESPN empire. Blogger Andrew Sullivan just took his website independent, supported only by reader subscriptions. These moves are a loss for the news conglomerates that fostered their talent, but these new efforts by Klein and Silver will be a boon to us policy and stats nerds who can’t start our days without reading two thousand words on the latest federal budget compromise. I’m excited to follow Klein’s new venture and I’ll continue to visit Wonkblog for Sarah Kliff’s invaluable health policy reporting.

Jan 022014

A new study in Science finds that expanding Medicaid increases emergency room visits, undercutting previous claims from lawmakers and policy wonks that expanding Medicaid would decrease ER use. these findings shouldn’t be a complete surprise to those who are familiar with the program and the people it serves. Many of those who are newly eligible for Medicaid likely have medical conditions that have gone unadressed for long periods of time. They also didn’t have an existing relationship with a physician, which probably explains why they turn to the ER as soon as they have coverage.

These findings shouldn’t be interpreted as a reason to not expand Medicaid. Access to Medicaid results in better mental health and increased financial stability, which are no small things. But as health economist Jonathan Gruber notes, making people healthy shouldn’t be framed as a cost-saver. States should expand Medicaid because it’s the right thing to do. And perhaps state Medicaid programs can do a better job of connecting new enrollees with primary care physicians.

Dec 102013

Iowa may be the latest Republican controlled state to expand its Medicaid program. The federal government is poised to approve a waiver that will allow Iowa to use federal funds to purchase private insurance for individuals eligible for the expansion while charging some a premium for their coverage. I’m not thrilled with the idea of requiring people who live near the poverty line to pay a premium for Medicaid. But if this is the kind shell game conservatives need to play to convince themselves that they’re remaining true to their skewed free-market principles, then fine. It’s a better option than completely denying health coverage to people for no other reason than geography. And perhaps the feds’ flexibility on the mechanics of the expansion will encourage other red states to follow suit and do the right thing for their citizens.