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Gail Kerr is Wrong on Medicaid Expansion for Tennessee

12/23/2013

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Gail Kerr, a columnist for The Tennessean, wrote an article in the December 22nd edition of the paper expressing support for the state expanding Medicaid (or as it's called in Tennessee, TennCare).

No facts, logic or reason is used in her support for such an expansion. She uses emotional arguments and arguments tinged with the "Republicans don't care about poor people" line that has become so prevalent in the discourse of the intellectually dishonest Left.

Kerr mainly directs her attacks at Governor Bill Haslam who is up for re-election in 2014. She correctly points out that, "
He has no known opponent to stop him from easily being re-elected. The possible negatives he may face during a campaign are long shots. He’s Teflon right now." However, I see this issue being used more against Republicans running for the Tennessee General Assembly than against Governor Haslam. That is why I decided to address this issue one claim at a time in an attempt to head this off at the pass.

Claim:
He [Gov. Haslam] has not been swayed by arguments that other states will get our federal tax dollars.
What she is saying here, is that if Tennessee does not expand Medicaid, then the money that Tennessee would have gotten if the program would have been expanded would go to other states instead of Tennessee. This is false. Nina Owcharenko explains: "The federal share of Medicaid is based on a formula calculation and actual expenditures. Rejected funds do not go into a general fund for redistribution to other states."

I also find it puzzling that in her previous paragraph, Kerr says that "Instead, the governor is trying to persuade the federal government to allow Tennessee to use federal dollars to pay private insurers to take on those people." Wouldn't this qualify as Tennessee getting "our" federal tax dollars?

Claim:
He has not been convinced that Tennessee would get this money with no strings attached.
Really? No strings attached? How many federal dollars come into states with absolutely no strings attached? (Also notice that no source was given to substantiate this claim by Kerr.)

How's this for a string
:
"Expanded Medicaid’s fine print holds surprise: ‘payback’ from estate after death." Or how about the fact that the states will eventually have to pay 10% of the total cost of expansion? (Medicaid is one of the biggest expenses state governments face. It makes no difference the percentage that the federal government pays if states can't pay their piece.)

The biggest "string" attached to the Medicaid expansion is that Medicaid is not really that effective of a program if you consider that:
  • One third of physicians will not accept new Medicaid patients (what good is putting more people on Medicaid if they can't see a doctor?)
  • Patients with Medicaid (and uninsured patients) are both 50% more likely to die from head and neck cancer
  • Patients with Medicaid are 13 % more likely to die from surgery than people without insurance
  • Lung transplant recipients on Medicaid are 8.1% less likely to survive after 10 years than uninsured and privately insured recipients
  • An Oregon study found Medicaid had no significant effect on health outcomes vs being uninsured
These all seem like pretty big "strings" to me.

Claim:
In three years, the state would be required to pick up part of the tab, but the state can withdraw from the program at any time.
Can you imagine the disaster this would be? What exactly would happen if a state was to withdraw? Would that mean that the state would then be responsible for all the added costs of Medicaid expansion? What would be more likely to happen would be all the new enrollees would be kicked off Medicaid. This is too much of a risk to make this an argument for expanding Medicaid.

Claim: He’s not convinced, even though 26 other states have opted into this program with great success
Again, no source was given to show the "success" of other states. We can look to two states who have expanded Medicaid, Arizona and Maine, and see what experiences they have had. They don't look like successes to me:
  • Medicaid expansion had little impact on the rate of uninsured. Arizona’s uninsured rate actually increased in the five years after expansion, while Maine’s
    did not change
  • Enrollment among the expansion populations was much higher and faster than the slow and gradual enrollment that was projected
  • Per-person costs for the new expansion populations were much higher than projected—particularly for the childless adult populations

Claim:
Logic has not convinced the governor that it makes more sense to insure people than to require you and me to pay for them with higher health care costs stemming from their frequent emergency room visits. With no insurance, the uninsured wait until small problems become big ones and then seek help in the ER. They also go to the emergency room with nonemergencies, because it’s the only way they can receive a doctor’s care. That expensive price tag is passed to paying patients.

Here's the biggie. This is the most common argument used to support expanding Medicaid. It might seem logical on the surface, but if you dig a little deeper it becomes obvious it is not. Kerr makes a lot of assumptions here that are flawed. Let's dive in.

First, Kerr claims that
"it makes more sense to insure people than to require you and me to pay for them with higher health care costs stemming from their frequent emergency room visits."

This is a silly claim to make. Why? Because when Kerr says it makes more sense to "insure" people she means to insure them with Medicaid. Well, who pays for Medicaid? You and me! The same people are paying for it. They are just doing it through a different financial apparatus. The "insuring" of the uninsured through Medicaid doesn't magically absolve taxpayers from paying for it. We are still going to pay for it.

This statement also makes one big assumption: that the amount paid for uncompensated care for the uninsured will be reduced  if more people are insured with Medicaid. This is not true.
Let's look at Maine and Massachusetts for an example.

Maine expanded their Medicaid program in 2002. This state's Department of Health and Human Services Commissioner said in 2013 that uncompensated care more than doubled
to $194 million from $94 million dollars and also that this expansion has been a "calamitous failure". So, Maine's uncompensated care went up even after Medicaid was expanded. Why? Because the number of uninsured people was not significantly reduced.

Massachusetts's program was expanded in 2006. Their share of uncompensated care didn't decrease either. Hospitals have still successfully lobbied for continued funding of over $200 million a year to cover uncompensated care.


The second claim made by Kerr is this:
"With no insurance, the uninsured wait until small problems become big ones and then seek help in the ER. They also go to the emergency room with nonemergencies, because it’s the only way they can receive a doctor’s care."

To make this argument another way, you could say because people are uninsured, they use the ER more. If they were insured they would use the ER less because they wouldn't go for "nonemergencies". This is the implication given with Kerr's statement. However, the evidence shows that the opposite is true.

The Journal of the American Medical Association conducted a study centered around
Emergency Department visits from 1997 to 2007. They found that, "Adults with Medicaid accounted for most of the increase in ED visits....These findings indicate that ED visit rates have increased from 1997 to 2007 and that EDs are increasingly serving as the safety net for medically underserved patients, particularly adults with Medicaid."

If giving people Medicaid would prevent Emergency Room visits then why did ERs see the biggest increase of visits by Medicaid recipients? If Kerr was correct, the biggest increase would be among the uninsured, but it wasn't.

The New York Times
reports that people on Medicaid use Emergency Rooms more than uninsured people, "Among the uninsured, 7.4 percent made two or more visits to an E.R., but so did 5.1 percent of people with private insurance. Medicaid recipients were the heaviest users of E.R.’s, with 15.3 percent of them making two or more visits during the year." So, if we want to reduce the amount of ER visits, expanding Medicaid is not the answer.

Another study, The Oregon study mentioned above that looked at Oregon's Medicaid expansion, found "
we did not find significant changes in visits to the emergency department or hospital admissions."

The Boston Globe reported that, "
The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use."

All of this is all well and good, but this has been the experience of other states. What about in Tennessee?

The
University of Memphis Methodist LeBonheur Center for Healthcare Economics released a study showing similar results. Here is the main highlight:

"TennCare patients made up 35.0% of all ED visits, and 59.3% of these were non-urgent. Uninsured patients, in contrast, made up 17.5% of all ED visits, and 52.0% of these were non-urgent"

This study strikes a death blow to Kerr's claims that expanding Medicaid will reduce ER visits and would reduce the ER being used for "nonemergencies." As we can see, visits to Emergency Rooms by TennCare enrollees were double that of the uninsured. Not only that, but TennCare enrollees use ERs for non-urgent visits
more so than uninsured patients.

Emotional rhetoric never stands up to facts.



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Fun with a Lamar Mailer

7/9/2013

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I received a letter in the mail today from Lamar Alexander's campaign asking for a donation. Yeah, right.

I put a little comment in here and sent it back:
Picture
If you can't read it, it says: "Senator Alexander's vote for the Immigration bill did it! I hope Freedomworks, The Madison Project, and the Beat Lamar campaign is successful in finding a true conservative to represent Tennessee in the Senate. Tennessee needs a Ted Cruz, not a John McCain Republican like Lamar."

Short and sweet. If you get one of these, come up with something pithy and send it back to him. You know they will read it because they think it's money. Pretty sneaky, huh?
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Senator Corker Defends Immigration Bill

6/28/2013

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The absolute arrogance of this man.

He attacks opponents of the bill as "demagogues" and labels the Heritage Foundation as a "politcal" group and not a think tank.
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Sen. Alexander Responds: "Have You Read the Immigration Bill"

6/26/2013

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It was a simple question, really. I asked Senator Lamar Alexander's office via email if he has read the Corker/Hoeven Amendment.

This is his "response."

Thanks for getting in touch with me and letting me know what’s on your mind regarding immigration.  

The federal government clearly has not done enough to enforce our immigration laws, and Americans have lost faith that this mess can be fixed.  The problems with both our legal immigration process and illegal entry into the United States can only be corrected by the president and congress, and I am happy to see some of my colleagues in the Senate step up to discuss ways we can get this under control.  Conservatives should lead the charge to create a legal system of immigration for our country. You cannot become French or Japanese, but to become a citizen of our country you must become an American, and it’s Congress’ job to set the rules for that.

I will carefully review any legislation to ensure that it is an appropriate solution to our problem.  In 2006 and 2007, I voted against the Senate immigration bills because they didn’t do enough to secure the border.  My priorities for immigration reform include securing the border, allowing the best and the brightest who can create jobs for Americans to legally come to the United States, and helping legal immigrants learn English and what it means to be an American.  I have also cosponsored legislation to declare English to be our national language, and I led the fight to protect employers from being sued for requiring their workers to speak English on the job.  There is no single solution to the range of immigration and illegal entry problems we must deal with but there is no doubt that we have to secure our borders, create a legal entry system that works, and enforce the laws we create.  

I appreciate you taking the time to write me and let me know where you stand on this important issue.  I’ll be sure to keep your comments in mind as immigration is discussed and debated in Washington and in Tennessee. 


Platitude after platitude after platitude. I did get a kick out of some statements. To me, they illustrate the point that Senator Alexander's office thinks we are just a bunch of rubes.

The federal government clearly has not done enough to enforce our immigration laws, and Americans have lost faith that this mess can be fixed. The problems with both our legal immigration process and illegal entry into the United States can only be corrected by the president and congress....


First, he says that the federal government hasn't done enough to enforce our immigration laws, then he says that our immigration problems can only be fixed by the federal government. So the very people who "aren't doing enough" are now going to "correct" it. Call me a cynic, but I call bullcrap.

Conservatives should lead the charge to create a legal system of immigration for our country.


Um. Don't we already have a legal system of immigration, Senator? Of course we do. It just is not being followed or enforced.  But don't worry, 1200 pages of new legislation will fix everything.

I really do hope there is  strong primary challenger for Lamar Alexander.



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Alexander and Corker Sellout- Part II

6/24/2013

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Alexander and Corker both gave the go-ahead to proceed with the amnesty bill.

They support amnesty first, border security never.
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Discussing TN State Rep. Joe Carr's Anti-Gun Control BillĀ 

1/19/2013

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Joe Carr has introduced HB0042 in the Tennessee General Assembly. This bill would make it a Class A Misdemeanor for any federal agent to enforce any new regulation, executive order, etc. that seeks to:

(1) Ban or restrict ownership of a semi automatic firearm, firearm accessory, or ammunition; or
(2) Require any firearm, firearm accessory, or ammunition to be registered in any manner.

It also requires the Attorney General to represent any Tennessean who is prosecuted by the federal government for violating 1 or 2.

Naturally, Tennessee Democrats (who support the President's gun plans) were apoplectic. The party's chairman, Dip Forrester, called Carr an "extreme politician" and said it was "disgraceful."

I for one, would love to see this bill become law in Tennessee not only for the individual liberty it would protect but as an added bonus, we would get to see Dip Forrester's bow tie pop off in a fit of rage.....

Anyway......if it did pass, it would no doubt face a court challenge. The challengers would no doubt base their arguments on the Supremacy Clause of the Constitution (Article VI, Section 2) which states:

This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding.

Maybe I'm a purist, but the first sentence of this is the most important; This Constitution, and the Laws of the United States which shall be made in pursuance thereof.

So, the Supremacy Clause only applies if the law itself is constitutional. If it isn't then the Supremacy Clause does not apply. I'm not the only one who has this interpretation. Alexander Hamilton, writing in Federalist 33, has this to say:

"But it is said that the laws of the Union are to be the supreme law of the land. But what inference can be drawn from this, or what would they amount to, if they were not to be supreme? It is evident they would amount to nothing........... But it will not follow from this doctrine that acts of the large society which are not pursuant to its constitutional powers, but which are invasions of the residuary authorities of the smaller societies, will become the supreme law of the land. These will be merely acts of usurpation, and will deserve to be treated as such......... It will not, I presume, have escaped observation, that it expressly confines this supremacy to laws made pursuant to the Constitution"

How then, does this apply to Joe Carr's legislation and the Supremacy Clause argument against it if it is taken to court?

First, the easy one. If Carr's legislation is applied to protecting Tennesseans from an Executive Order, then there is no way the Supremacy Clause can be used as a shield. The reason is that the Supremacy Clause only applies to laws. Does the President have lawmaking authority? Obama might think he does, but he does not.

Second, what about new laws passed by Congress? This will be a little trickier and I'm not really sure how it would play out. Would the new law have to be declared constitutional before Carr's legislation would be declared unconstitutional? What if the new law never made it up to the Supreme Court? What would happen in the meantime? Could Carr's legislation be declared unconstitutional even if there are no new federal laws?

It will be an interesting fight and it's one that I think will be a good one to have.






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Herman Cain Meet and Greet 10/14/11

10/16/2011

 
Herman Cain made an appearance in Waverly, Tennessee at the Humphreys County Tea Party meeting. Below are some photos of the event and some videos. (I took the videos  with my cell phone so the quality isn't that great.)
Herman talks about his and the other GOP candidates' recent fundraising numbers.
Cain describes the choice the American people will have in the upcoming election.
This is a long video. If you are short on time fast forward to 33:20.
Herman Cain does something no one expected.
On his way to the bus, Herman Cain met some of the people.

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