This week, the New England Journal of Medicine published a major study of Medicaid in Oregon which has rapidly emerged of a Rorschach test of sorts. That is, partisans on either side of the political divide tend to see what they want to see in its results. While conservatives claim Medicaid expansion has been debunked by numbers showing little change in blood pressure, cholesterol, and diabetes over two years between those who did and did not gain access to Medicaid, liberals tout findings revealing "Medicaid improved rates of diagnosis of depression, increased the use of preventive services, and improved the financial outlook for enrollees."

Ultimately, as Ezra Klein, Kevin Drum, Aaron Carroll and Austin Frakt all conclude, the limited sample size, short-time frame and narrow measures of "health outcomes" make conclusions about the efficacy of Medicaid difficult to reach. But combined with other recent research, there is little question that Medicaid expansion will make the financial prospects and quality of life significantly better for the previously uninsured. As for the legion of Republican politicians instead insisting "no one goes without health care in America" because "you just go the emergency room," studies documenting the rapid disappearance of ER's and trauma centers show that GOP talking point is just a cruel joke.

Writing in the New York Times, Annie Lowrey provided a concise summary of what the NEJM paper says--and doesn't say--about the 10,000 out of 100,000 Oregonians who won the state's Medicaid lottery:

The Oregon Health Study released a new round of results on Wednesday, showing that Medicaid coverage does not seem to improve low-income adults' blood pressure, blood sugar or weight in a two-year time frame. It says nothing about the chance of diagnosis of, eventual health outcomes for or costs associated with any form of cancer, Alzheimer's, Parkinson's or dozens of other debilitating medical conditions. It also says nothing about health results outside of a two-year time frame...

Where it says something, it says a lot: it provides strong evidence that Medicaid recipients will spend more, use more tests, experience less depression, have fewer bills sent to collection agencies, and so on. It shows health insurance working just the way insurance is supposed to work: protecting the financial stability of the people purchasing it.

As it turns out, other recent analyses also had a lot to say about what happens when the uninsured gain coverage in ways similar to what will happen under the Affordable Care Act starting in 2014.

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Sooner or later, these right-wing corporations are going to learn the hard way. People do not like it when companies thumb their nose at the law and threaten to slash employees hours for the sole purpose of screwing them out of health care. After an Applebee's franchisee and Darden's restaurants felt the heat, you'd think they'd get a clue.

Alas, no. Regal Entertainment Group announced they were cutting employees' hours in order to deny them eligibility for health care under the Affordable Care Act. Fox News, of course, was quick to report this.

Regal Entertainment Group, which operates more than 500 theaters in 38 states, last month rolled back shifts for non-salaried workers to 30 hours per week, putting them under the threshold at which employers are required to provide health insurance. The Nashville-based company said in a letter to managers that the move was a direct result of ObamaCare.

“To comply with the Affordable Care Act, Regal had to increase our health care budget to cover those newly deemed eligible based on the law's definition of a full time employee.”

“In addition, some managers have requested guidance on what they should tell those employees negatively impacted and, at your discretion, we suggest the following,” read the memo obtained by FoxNews.com. “To comply with the Affordable Care Act, Regal had to increase our health care budget to cover those newly deemed eligible based on the law's definition of a full-time employee.”

“To manage this budget, all other employees will be scheduled in accord with business needs and in a manner that will not negatively impact our health care budget,” the message continues.

Fuck them and the horses they rode in on. Regal made billions last year, and they gave their CEO a hefty raise. I guess their health care budget allowed for a few extra million to fall into her pocket.

My reaction isn't unusual. Huffpost has an excellent sampling of Facebook posts from people letting Regal know their choice to screw employees forces a choice to stop spending money at their theaters.

I've grabbed a few more responses and posted them beneath the fold. In the meantime, pay their Facebook page a visit and let them know what you think of them. You'll feel better. I did.

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In just their latest failed effort to peel away supporters from one of the Democratic Party's most reliable constituencies, Republicans in 2012 still lost among Jewish voters by over a 2-1 margin. The reasons for the GOP's consistently dismal performance are no mystery. Survey data show that Jewish Americans overwhelmingly reject the Republicans' reactionary social policies and mockery of education and science. Worse still, many of the right's hardline supporters of Israel see God's chosen people as biblical cannon fodder needed to fulfill End Times prophecy. And then, as Rep. Virginia Foxx (R-NC) showed this week, Republicans routinely compare Democratic positions on guns, education, health, taxes, the debt--and almost everything else--to the Holocaust.

During a speech Tuesday to the National Association of Independent Colleges and Universities, the North Carolina Republican appropriated the famous Holocaust maxim to protest federal regulation of for-profit colleges. As Inside Higher Ed reported, Foxx complained that private institutions should have joined in their defense:

"'They came for the for-profits, and I didn't speak up'...Nobody really spoke up like they should have."

For her part, Foxx was only following in the footsteps of her GOP colleague, Rep. Roscoe Bartlett of Maryland (video above). Federal student loans, he cautioned last fall, weren't merely unconstitutional, but the first step to the gas chambers:

"If you can ignore the Constitution to do something good today, tomorrow you will be ignoring the Constitution to do something bad...The Holocaust that occurred in Germany -- how in the heck could that happen? And when you start down the wrong road, it can be a very slippery slope."

Virginia Foxx's previous claim to fame was her high-profile role in propagating the "death panels" slander of the Affordable Care Act that became Politifact's 2009 Lie of the Year. Democratic health care reform, she warned, will "put seniors in a position of being put to death by their government."

And that, some Republicans suggest, makes Obamacare little different from the Holocaust. State exchanges helping to enable 30 million people in the United States to obtain insurance, Idaho state senator Sheryl Nuxoll darkly warned last week, are the equivalent of a final solution for health care:

"The insurance companies are creating their own tombs. Much like the Jews boarding the trains to concentration camps, private insurers are used by the feds to put the system in place because the federal government has no way to set up the exchange."

As it turns out, she's far from alone in crying Holocaust over health care reform. In Maryland, the Republican Women of Anne Arundel County explained four years ago that "Obama and Hitler have a great deal in common." Last summer, Maine Republican Governor Paul LePage reacted to the Supreme Court's ruling upholding Obamacare:

"We the people have been told there is no choice. You must buy health insurance or pay the new Gestapo -- the IRS."

LePage was not the first Republican to compare the Internal Revenue Service to the Hitler's henchman. During the GOP's successful crusade to gut the agency in the late 1990's, Mississippi Senator Trent Lott decried the IRS' "Gestapo-like tactics" while Alaska's Frank Murkowski protested, "You don't need to send in armed personnel in flak jackets."

Michele Bachmann and Mike Huckabee couldn't agree more.

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Koch-kissing, ALEC-loving PA Gov.Tom Corbett had the advantage of a weak opponent and that "vote for me, I was a prosecutor who was tough on crime!" routine the first time he ran for governor. But he's pissed off just about everyone since then by following in the wing-nuttiest footsteps of Wisconsin's Gov. Scott Walker.

Just like Scott Walker, Gov. Corbett will be getting much closer scrutiny. The newly-elected Attorney General Kathleen Kane has appointed a special prosecutor to look into how Corbett handled (or mishandled) the investigation of Jerry Sandusky, and I suspect that will rough him up when he runs for reelection. We're going to have to work hard to defeat this jackass, who just turned down the Medicaid expansion offered by the Affordable Care Act.

In the meantime, if you're a PA resident, call the Governor's office at 800-515-8134. (or email him) and ask him what you're expected to do without affordable insurance. Call your state senator and state representative, too:

Pennsylvania Gov. Tom Corbett (R) announced Tuesday that his state will turn down the Medicaid expansion, becoming the first governor of a blue state to officially say no to the coverage provision of the Affordable Care Act that the Supreme Court made optional.

The decision will please conservative advocates who are urging leaders to stonewall Obamacare implementation. But it’s a blow to the many thousands of uninsured Pennsylvanians who would have received coverage through the program, which extends Medicaid eligibility to Americans up to 133 percent of the poverty line for participating states.

The Medicaid expansion is a financially enticing offer for states: the federal government would pay the full cost for the first few years and 90 percent after 2020. Conservative opponents fret that the federal government won’t come through with the funds. Top Democrats in Pennsylvania are already demanding that Corbett reverse course.

“Governor Corbett chose to pander to the far right and willfully inflict damage on Pennsylvania’s economy - he has undermined any promises he makes about jobs,” said State Rep. Dan Frankel, the chair of the Democratic Caucus. “The federally funded Medicaid expansion would be a win-win for Pennsylvania. … Governor Corbett should reverse his job-killing decision.”

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If you thought that the Obama administration's recent changes to the contraception mandate in the Affordable Care Act would quell the Fox News/right-wing fear mongering over religious liberty, think again. Fox & Friends Weekend this morning conducted an all-male discussion over the new guidelines in which their guest, Jim Towey, president of Ave Maria University, said that the contraception mandate is a “new federal entitlement, something like 'contraception stamps.'” It was very telling that he meant that as a slur, rather than a government safety net.

As Karoli described in an earlier post, the new rules allow religiously-affiliated organizations to avoid having to directly cover contraception yet still provide an opportunity for women employed by those organizations to get that coverage at no charge through a separate policy.

Think Progress has reported that a number of Catholic leaders have already come out in favor of the new regulations, including Bill Donahue of the Catholic League, normally a good pal of the Foxies. Think Progress also noted that “The U.S. Conference of Catholic Bishops has issued a statement to say they 'welcome' the new Obamacare regulations, and plan to comment further after a more thorough review of the rules.”

But the Friends held two discussions (this one and another with Father Jonathan Morris) about the new rules with two male, Catholic detractors without mentioning the support received elsewhere.

It wasn't clear to me whether Towey's Catholic university would qualify for the opt-out. Towey did, however, vow to continue fighting its lawsuit against the Obama administration, via the largesse of the Koch-supported Becket Fund.

But what host Mike Jerrick did make clear is what we should think about the new contraception compromise. Jerrick said, “They call it an accommodation. What do you call it?” But before Towey could answer, Jerrick added, “I mean other people say it's a gimmick.”

Speaking of gimmicks, Towey responded by characterizing the contraception mandate as some kind of welfare program. He called it “obviously” a “new federal entitlement, something like 'contraception stamps.' And so they've made this now available for free to all individuals, all women in the country and a lot of people are upset... If the federal government wants to do this kind of expansion, this kind of new entitlement, why involve religious organizations?”

It was also very telling that neither host objected to using food stamps to smear the mandate.

As Karoli emphasized in her earlier post, there's another question looming just behind all this self-righteous outrage: Why do the religious beliefs of employers who are out of step with mainstream American opinion, trump the beliefs of their employees? Especially when it's the employees who will or will not use the contraception coverage?

Yet this question was never asked, much less answered, in either of the segments.

In case you really, really missed the editorializing, Jerrick made it even more explicit as he wished Towey good luck with his lawsuit at the end of the discussion.

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Memo to Rick Scott: Of all the wingnut governors, you are the most evil, corrupt, and disgusting. Your latest nonsense proves it.

Via ThinkProgress:

Internal email messages uncovered by Health News Florida reveal that Gov. Rick Scott (R-FL) is knowingly citing inaccurate cost estimates to justify his refusal to expand Florida’s Medicaid program. Though the governor’s office is fully aware that the numbers are wrong, Scott continues to use them anyway, the documents show.

Yes, that shoots right up to the top of the wingnut hit parade list. At this point, Gollum ranks higher on my list than you do, Governor Scott. After robbing Medicare the way you did, you're the least credible when it comes to health care costs, but damn if you don't keep after it, anyway.

Here's how it works: Under the Affordable Care Act, Medicaid reimbursements go way up for the first few years, up to 90 percent of the total cost of new insureds covered under the Medicaid expansion. The only reason states wouldn't receive those funds would be because they decide they're not going to accept Medicaid funding under the ACA.

With that in mind, this could possibly be the lamest excuse I've ever heard for using numbers that are quite simply incorrect, because they assume that only 58 percent is reimbursed by the federal government:

But Michael Anway, Scott’s new coordinator for health policy and budget, sent an e-mail Friday to the others saying he will submit the original estimates as an “alternative forecast” when the revised AHCA report comes before the next budget estimating conference.

Anway said he doesn’t believe the federal funds will come through. “The federal government has a $16 trillion national debt, must borrow 46 cents of every dollar it spends, and in 2011 had its credit rating downgraded for the first time in history,” he wrote in explanation.

That's just right-wing crap. The real reason these contemptible trolls don't want to budget for the expansion is because they want to rebel against anything that might help poor and needy people. In fact, this is probably more likely to happen:

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We are hearing far too much of this from our elite news media:

And the fact is that the American people, who want all the benefits and want the free lunch, and don't want a single gray hair on the beautiful head of Social Security or Medicare touched, and basically don't want to pay for it, I mean, the old line is, we elect Republicans because we don't want to pay for it and we elect Democrats because we want everything that government is going to give us.

Instead, we should be hearing more of what Chris Hayes is saying. The Villagers are already playing into the right wing frame, that there is a crisis brewing, that the baby boomers are going to bankrupt the country, that health care costs will chew up our budget and our GDP over the next 20 years, and everybody batten down the hatches and hang on because, well...it's a crisis, stupid.

No, it's not a crisis, and thankfully there is one adult in the room who is asking why everyone is setting their hair on fire before the complete package of reforms built into the ACA come to pass. What he is saying is what we all need to keep hammering on. Here's the list:

1. Medicare is in about the same shape it has been in since its inception. It's solvent for 11 more years without touching anything. That's standard solvency now and yesterday for Medicare.
2. We spent an enormous amount of time and political energy on the Affordable Care Act, which is a 2,000 page bill, as the Tea Party and Republicans are fond of pointing out. The Affordable Care Act has consumer protections and Medicare reforms written into it. The consumer protection piece is about 60 pages. The other 1,940 pages are Medicare reforms intended to control the rising cost of health care.
3. We will not know whether those reforms are effective for three to four years. What we know today is that Medicare spending has decreased over the last three years, and that's before all of the ACA reforms take hold.

This is the conversation that isn't happening anywhere else. Note Megan McArdle's shocked reaction when Hayes actually dares to say that everyone is setting their hair on fire years early.

You know why it is that conservatives make such a big deal out of the Independent Payment Advisory Board (IPAB)? It has nothing to do with death panels and authoritarianism, despite what they whine about in public. It is because it will quite likely end the medical gravy train so many have been on for so long, without decreasing quality of care.

I repeat: Without decreasing quality of care. It will end practices like charging uninsured patients $3,000 for a colonoscopy that costs $300. It will begin to end unnecessary tests and procedures which are performed because fee-for-service medicine requires more and more services to maintain profitability. This is why conservatives hate it with an undying passion. It actually limits and controls costs.

These same Very Concerned Conservatives are so very concerned about Medicare costs that they are going to block the IPAB's fast-track funding required in the ACA. Via The Hill:

The House is set to vote Thursday afternoon on rules for the 113th Congress. The rules package says the House won't comply with fast-track procedures for the Independent Payment Advisory Board (IPAB) — a controversial cost-cutting board Republicans have long resisted.

The rules package signals that Republicans might not bring up Medicare cuts recommended by the IPAB — blocking part of a politically controversial law, and resisting Medicare spending cuts.

Let's review the bidding here. Republicans are making the rounds and gladhanding with the likes of Pete Peterson, rending their garments and claiming our children and grandchildren will be saddled with too much debt, too much debt because their parents and grandparents had the temerity to get sick and require Medicare coverage, while they are aggressively blocking the ONE SINGLE THING that will likely contain those costs.

Tell me more about how we must cut, cut, cut in order to avoid a terrible horrible future after they sit down and get out of the way. When the ACA reforms take hold (whether the House likes it or not), that cost curve will likely bend sharply downward.

Republicans are hoping they can distract us long enough with their incessant crying and stalling so they can gut it before the reforms happen.

Don't let them win.

No matter how many times Bible-thumpin' fetus worshippers insist contraceptives cause abortions, they just don't. But they do like to torture themselves (and everyone else) with their insistence that they do. When this case and the ones like it make their way to the Supreme Court, we will see the reality vs. non-reality split the court once again:

WASHINGTON -- The U.S. Supreme Court declined Wednesday to put a temporary hold on a controversial provision in the new health care law requiring employers to provide health insurance coverage for contraceptives.

Two businesses challenging the act -- the nationwide chain of 500 Hobby Lobby Stores and Mardel, a chain of Christian bookstores -- contended that the law violates their religious freedom. Their legal battle is continuing over the merits of their claim. In the meantime, they asked the US Supreme Court to put a temporary hold on the law, which takes effect January 1, 2013.

On Wednesday, Justice Sonia Sotomayor, who handles emergency appeals from the courts where the companies are based, declined to grant an injunction.

In a brief written opinion, she said the Supreme Court has never addressed similar freedom-of-religion claims brought by for-profit corporations objecting to mandatory provisions of employment benefit laws.

"Lower courts have diverged on whether to grant temporary injunctive relief to similarly situated plaintiffs," she said, "and no court has issued a final decision granting permanent relief with respect to such claims."

If the two companies ultimately lose in the lower courts, the justice said, they can still appeal to the Supreme Court.
Lawyers for members of the family that owns the two businesses, based in Oklahoma, told the court that the law will expose them to "draconian fines unless they abandon their religious convictions."

While they do not object to the provision of insurance coverage for all contraceptives, they do object to coverage for "certain drugs and devices that they believe can cause abortions," their lawyers said.

Once Obamacare kicks in and people learn that they get medical coverage at minimal cost, it will indeed begin to sink into the minds of the nation's poorest that the Republicans (and Fox News) have been lying to them. This is probably why John Boehner keeps insisting that the provisions of the Affordable Care Act be part of the deficit negotiations -- but Obama has apparently told them to kiss his behind. Via Booman Tribune:

Think about Boone County, West Virginia. It is 98.5% white and 22% of its residents are living in poverty. The median income for a household is $25,669. In 2012, the Federal Poverty Level (FPL) is set at $11,170 for a one-person household and rises by $3,960 for each additional family member. Thus, the FPL for a four-person family in 2012 is $23,050. I think we can surmise from these numbers that a very high percentage of the families in Boone County are going to be eligible for health care subsidies in the highest range.

People and families earning 133 percent of FPL, for example, will have to pay only 2 percent of their income toward the health insurance premium.

In Boone County, a family of four making the median income of $25,669 will only have to pay two percent of their income ($513/annually) toward a $10,000 health insurance plan. The government will also cover 94% of their out-of-pocket expenses. President Obama only received 32.9% of the vote in Boone County. I think candidate Biden or Cuomo or Clinton or Warner or whomever else will have a good shot at improving that number.

When Mitt Romney talked about the president winning the election by giving out gifts, he was wrong. Almost no one understood that they would be receiving gifts of this magnitude. If they had understood it, they would have told Romney to take his promise to repeal ObamaCare and shove it up his ass. I believe this is true in small, white, rural counties all over America.

I think John Boehner agrees with me, which is why he is still talking about destroying ObamaCare. When you take a poor, white family of four living in the Appalachian mountains of West Virginia and you give them $9,500 a year to make sure they all have health insurance and you cover 94% of their out of pocket health care expenses, you have effectively counter-programmed the crap they've been seeing on Fox News. You want a new New Deal coalition? Here it comes.

Brian Beutler at TPM explains why Romney is lying when he assures voters that he won't change Medicare at all for those 55 and up -- because raising the retirement age is a cut:

Mitt Romney and Paul Ryan want to neutralize Democratic attacks on their plan to turn Medicare into a voucher program for future seniors by replaying the GOP’s 2010 campaign against Democratic members of Congress: by attacking President Obama for Medicare cuts he signed into law.

As has been noted repeatedly, that strategy requires Romney and Ryan to disavow Medicare reforms the GOP recently endorsed overwhelmingly as a part of the party’s budget, which Ryan authored.

But the ticket also contends that a key difference between Obama and Romney is that Romney won’t change Medicare at all for existing beneficiaries — only future ones. Recent statements from his advisers and surrogates, suggest the claim is false.

As outlined in a memo the campaign released Saturday, Romney plans to repeal the Affordable Care Act in its entirety, and thus to spend over $700 billion more on the program in the coming decade than the government would spend if the health care law stands.

That commitment would leave Medicare poised for insolvency in 2016, years before he proposes to phase in the voucher system. Which means Romney would have two options: find new Medicare cuts or taxes to extend the life of the program, or preside over its demise.

On Fox News Sunday, Romney adviser Ed Gillespie tried to address the conundrum. “There are other reforms as well. As you know Governor Romney supports increasing over time bringing the Medicare eligibility age in line with the Social Security retirement age.”

But raising the Medicare eligibility age is a benefit cut, and implementing the increase before 2016 would violate Romney’s pledge to leave the program unchanged for people between ages 55 and 65.

Avik Roy, an outside health care adviser to the Romney campaign, admits that committing to billions of dollars in higher Medicare spending in the near-term will make it difficult for Romney to achieve its separate goal of reducing overall federal spending to modern lows. But he notes that Romney could make up the difference elsewhere in the budget or, by “mak[ing] other changes to the Medicare program, such as increased means-testing, that don’t alter the program’s basic structure.”