health care

John Kasich's Misguided Moralism for Medicaid Expansion

Ohio could freeze expansion enrollments next year, ignoring the governor's pleas.

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Jose More / VWPics/Newscom

When Gov. John Kasich expanded Medicaid eligibility in Ohio, he disregarded the state legislature's opinion. Lawmakers had voted to block the Medicaid expansion portion of the federal Affordable Care Act, but Kasich, a Republican, moved unilaterally in February 2013 to accept federal dollars tied to expansion.

Nine months later, he convinced the legislature to go along with the decision, in part by linking the growth of a joint federal-state entitlement program to questions of faith and morality.

"When you die and get to the meeting with St. Peter, he's probably not going to ask you much about what you did about keeping government small," Kasich told the Columbus Dispatch in June 2013, "but he is going to ask you what you did for the poor."

Four years later, Kasich is still evangelizing, even as many of his fellow Republicans try to cap Medicaid expansion spending or freeze enrollments made possible by the Affordable Care Act. Kasich was one of six Republican governors to sign a letter urging Congress to keep Medicaid expansion as part of the American Health Care Act, which calls for freezing Medicaid expansion enrollment in 2020. Just last week, he vetoed a bill passed by the Republican-controlled state legislature that would have frozen Medicaid expansion enrollment in 2018 (anyone who would have been eligible for Medicaid before the Obamacare expansion will still be able to enroll) in Ohio.

Freezing the expanded enrollment in Medicaid would be "to the detriment of the state's economy in general and needy Ohioans in particular," Kasich wrote in his veto message.

This week, state lawmakers might turn the tables and ignore him. A veto override vote is expected to take place, perhaps as soon as Thursday, though the outcome is uncertain.

Ohio's political and budgetary fight over Medicaid expansion is reflective of the intraparty schism that has hindered Republican efforts to repeal and replace Obamacare in Congress.

Kasich, a 2016 presidential candidate who is term-limited and cannot seek re-election as governor in 2018, has emerged as one of the most outspoken Republican advocates for Medicaid expansion, drawing ire from conservatives, libertarians, and anyone worried about entitlement spending and the national debt.

Kasich's advocacy for expansion has relied on mental gymnastics, with the governor using his "ol' shucks" rhetorical style to turn the debate over a massively expensive entitlement program into an exercise in moralizing to the masses. Those who oppose expanding Medicaid—or those in the state legislature who now want to freeze enrollments—are just mean, he says.

"When people say in my state we should drop 700,000 people, a third of whom are mentally ill or drug-addicted or—and a quarter of whom are chronically ill, and we should turn our back on them, that's not America. That's not a country that loves all of its citizens," Kasich said during an interview with CNN's Dana Bash in March. "That is really extreme. Frankly, it borders on mean."

On top of the creepy paternalism, Kasich's argument for Medicaid expansion relies on misleading messaging about who is eligible for the joint state-and-federal program, and who ultimately pays for it.

Pre-expansion, Ohio's Medicaid program was open only to low-income people, children, pregnant women, the elderly, and individuals with disabilities, though the criteria varied in other states. Under the Affordable Care Act, the income threshold was raised so anyone making less than 138 percent of the federal poverty line ($16,642 for an individual or $33,948 for a family of four) would be eligible, even if they were able-bodied, childless and of working age.

Opponents of Medicaid expansion say the program has actually hurt the truly needy by forcing them to compete with a larger share of the population for limited doctors' appointments (since many medical providers don't accept Medicaid) and has strained the budgets of state programs meant to help those who really need it. Among new Medicaid enrollees, 82 percent have no kids and 45 percent do not work, according to an analysis from the Foundation for Government Accountability, a Florida-based think tank focused on reforming entitlements.

That crowding-out effect is part of the reason why Ohio has 60,000 people who qualify for traditional Medicaid on a waiting list to receive services. "These are children and adults with developmental disabilities who need anything from specialized medical equipment to assist them with their daily lives to therapeutic intervention, to at-home medical services," says state Rep. Wes Goodman (87th District), who supports the freeze on Medicaid expansion enrollments.

What about the claim that cutting off funding for Medicaid expansion would leave drug addicts, the mentally ill, and the working poor without health coverage? That is also misleading. Kasich's claim doesn't jibe with the realities of the Medicaid expansion population, in Ohio or anywhere else, and the state budget bill that Kasich vetoed last week included funding for new opioid addiction treatment programs, even after the freeze on the Medicaid enrollment for those above the federal poverty line.

"Freezing Obamacare expansion enrollment is a proactive way for the General Assembly to help Ohio recover from Kasich's mistakes," says Jason Hart, an Ohio-based web developer and freelance columnist who has spent several years researching and debunking the Kasich administration's Medicaid expansion claims, across a variety of platforms. "Freezing Obamacare expansion enrollment would not kick anyone off the program, and the General Assembly wants to let Ohioans being treated for mental illness or drug addiction re-enroll in Medicaid even if they leave the program after the freeze takes effect."

Ohio's experience with Medicaid expansion is a useful microcosm of how that element of Obamacare has ramped-up federal spending on an entitlement program that was already on an unsustainable path.

Before Kasich signed the bill to expand Medicaid eligibility in Ohio, there were about 2.2 million residents of the state on Medicaid and Ohio's Medicaid population cost state and federal taxpayers about $17.7 billion.

By the end of 2016, though, Medicaid rolls in Ohio had swelled to more than 3 million, and costs increased to $25.5 billion.

Again, Ohio's experience mirrors what's happened across the rest of the nation.

In 2013, the Kaiser Family Foundation estimated that 40 percent of the 25 million people who could gain insurance under Obamacare by 2016 would do so through Medicaid expansion. In reality, almost three quarters of those who gained coverage under Obamacare did so because of Medicaid expansion. In Ohio, the Kasich administration in 2013 projected there would be 447,000 Medicaid expansion sign-ups by 2020, but the number of new enrollees topped 500,000 by the end of 2014 and exceeded 700,000 by the end of last year, according to the state Department of Health.

Most of the costs created by the new enrollees have been paid for by the federal government, since the Affordable Care Act promised to pick up 100 percent of the initial cost for newly eligible Medicaid enrollees through 2016 (and 90 percent afterwards, a much larger share of the 63 percent rate the federal government pays for traditional Medicaid enrollees in Ohio). Kasich repeatedly has said that expanding Medicaid makes good fiscal sense, since it allows the state to tap into federal dollars that would be collected from Ohioans and given to other states if Ohio didn't opt into the expansion.

Kasich's argument ignores the federal fiscal situation. Medicaid is a $550 billion program that is one of the chief drivers of the nation's long-term debt. In making what sounds like a fiscally conservative argument for bringing federal dollars back to Ohio, Kasich is actually doing the exact opposite. He's arguing for the federal government to continue runaway spending on an unsustainable entitlement program.

Critics of Medicaid expansion look at the long-term trajectory of the program and conclude that there's little chance the federal government will be able to keep its promise to pay 90 percent of the cost for the expansion population in perpetuity. (The Senate health care bill would phase out the expanded payments starting in 2021.) Whether it happens as part of a Republican overhaul of Obamacare or as part of some fiscal reckoning at a later date, states will ultimately be stuck with paying for a larger share of that population, as Michael Cannon, director of health policy for the libertarian Cato Institute, has been warning for years.

"Regardless of whether Congress ever repeals Obamacare, it's only a matter of time before the federal funding for the law's Medicaid expansion is cut," says Hart. "The Ohio House and Ohio Senate should override the governor's veto of their Medicaid expansion freeze, and hold Kasich accountable for working with the federal government to put it in effect."

Kasich has spent four years championing Medicaid expansion by claiming that St. Peter likes it, by arguing that government should "love" its citizens, and by mischaracterizing who benefits from expansion and how it is paid for. There may be a good argument for why the Ohio General Assembly should not override Kasich's veto of the enrollment freeze, but we've yet to hear the governor make it.

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  1. “When you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small,” Kasich told the Columbus Dispatch in June 2013, “but he is going to ask you what you did for the poor.”

    Santa Claus and the Tooth Fairy are also very disappointed in your fiscal austerity.

    1. Yup. Skip right past all those old, dead-guy commandments about stealing, coveting other peoples’ stuff, and bearing false witness. Straight to the unwritten and vaguely interpreted 11th commandment.

      1. “Thou shalt do kind-hearted stuff for the Poors?”

        1. Thou shalt pander to voters.

          1. I’m making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.

            This is what I do… http://www.onlinecareer10.com

          2. I’m making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.

            This is what I do… http://www.onlinecareer10.com

    2. Man, that line made me grind my fucking teeth.

      1. You have fucking teeth? I generally use my regular teeth when fucking…

    3. How about looking St. Peter square in the eye and answering, “I kept government small, that’s what I did for the poor. I kept taxes and regulation to a minimum so as to allow poor people the maximum freedom to earn money and to keep what they earned. What did you do, Peter? Oh, you prayed for them? Yeah, see I didn’t ask Jesus to take care of them, I pitched in and did the work myself.”

      1. Kasich is an idiot. What the poor need is a job to go to every day. The way to have that is to have small government and to allow the wealthy to invest in jobs and factories and new productivity enhancing technologies. Guys like Kasich are usually call “democrats.”

    4. “How I helped the poor? Why, I kept government small, which allowed decent people to voluntarily, directly support hospitals and other charities of their choice, rather than at the point of a gun.”

      1. I agree, absolutely.

    5. “but he is going to ask you what you did for the poor.”

      Responding to St. Peter that you assigned that problem to the government is only going to get you a raised eyebrow.

      1. And to be as blunt as possible. If, when you face that question of what you did, all you can say is “paid my taxes,” then according to mainstream Christian doctrines that will be recorded as a big fat zero.

        Kasich knows this, which makes him doubly execrable.

      2. You increased government? Go directly to the 5th circle of hell. Do not pass go, do not collect $200.

      3. Kasich: “How did I help the poor? I robbed a bunch of little children at gunpoint and gave their money to drug addicts.”

        St. Peter: “Welcome to Gehenna!”

    6. I’m betting “I gave them insurance doctors won’t take anyway but managed to fuck over my state budget royally” won’t go over too well with St. Peter, either.

    7. Last time I looked, Jesus didn’t advocate taking stuff from other people so that he would look good giving to the poor. He preached personal responsibility for charity as well as life conduct. Mr. Kasich needs to reread some of those passages written in red. BTW, Jesus didn’t have a real high opinion of lawyers, either.

    8. St. Peter will ask Kasich why he thought it was OK to use government force against others to take their money for people he decided deserved it more rather than allowing God to decide. Kasich harmed a lot of people with his decision.

      It’s never a moral endeavor to use force to take money from some, for the benefit of others. The reason we have government is to put people in jail so they don’t do that.

  2. When you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small, but he is going to ask you what you did for the poor.

    Fucking maroon, that doesn’t mean you’re supposed to make more people poor, or make more poor people.

    Christ, what an asshole.

    1. You don’t remember the part of the Sermon on the Mount about “Blessed are the thieves who give away what they’ve stolen, some of it from poor themselves?”

    2. We are talking about Kasich here.

      St Peter’s not even gonna let him stand in line. They got an express elevator for his kind.

      1. “elevator” implies that the device ever carries passengers upwards.

  3. “Blessed are the poor, for they shall receive free substandard medical care in perpetuity.”

    1. …. or until the feds turn off the spigot.

      1. Or we all run out of money.

  4. Would all the liberals who went “If only Republicans had nominated someone sane like Kasich” still supported this guy? He’s trying to justify a program they like with reasoning they hate. My vote is no.

    1. Give how many Bern Victims were throwing around the whole “Jesus was a Jewish socialist, too!” thing late in 2015, i don’t think that’s a given.

      1. It’s true, Socialism as a philosophy is nothing more than “Be nice to other people and share.” So this cleanly fits with Jesus.

        1. It seems to me that Jesus wasn’t terribly interested in government one way or another. Based on what Jesus actually said, Christians should probably stay away from the whole government mess altogether and focus on spiritual matters and direct acts of charity.

          1. I always took “Render unto Caesar what is Caesar’s” as an early call for the separation of church and state.

              1. It would make more sense if i’d used the full quote: “Render unto Caesar the things which are Caesar’s, and unto God the things that are God’s.” Strongly implied here is that Caesar and God have separate things, which do not overlap.

                1. Nah, I’m being obtuse on purpose for this bit.

                2. The ‘render unto Caesar’ also came in response to him first asking what image was on the coinage.

            1. That’s a common interpretation, but I wonder if that makes sense in the original context before Christianity had any real influence in the realm of government. It’s interesting to look at how the religion changed as it became the religion of the powerful.

              1. IMHO, you have to look at it in the context of the revolutionary movements to expel the Romans from Israel. One of the biggest personal questions of the time was whether you accepted Roman rule, whether you were against it, and if you were against it how far you would be willing to go.

                So I personally read the immediate context as anti-revolutionary, with the subtext of “God doesn’t care about Rome/earthly government one way or the other; but if you’re participating in the social system that requires you to pay taxes (the direct subject of the “render unto Caesar” line), then not paying your taxes in the name of ‘God doesn’t care about government’ is wrong.”

                I think you can extrapolate separation of church and state from this, but I think you’re right that it’s not really foregrounded in the original context.

                1. It wasn’t secular revolutionary, because his focus was expressly not on the Earthly realm. But when you contrast his accession to lawful authority vs. how he responded to the Temple money changers I do think the church/state dichotomy becomes stronger.

                  But I’ve always considered Jesus to be something of the inevitable outcome when Greek thought encountered Eastern religion.

            2. Personally I think that story and the earlier conflict with the moneychangers were distorted/misinterpreted at some time between when they were an oral tradition (while the temple was still standing) and when they were written down (after the jewish revolt and the temple destruction)

              His conflict with the moneychangers was directed against the Sadducees (the priest class who owned the non-circulating Tyrian shekel – the temple tax coin) – not the moneychangers (those who exchanged circulating coinange for the shekel) directly. Debasement of circulating coins (like denarius) made the shekel more expensive over time. Which meant that the privileged Sadducees were screwing the working poor via both their monopoly control of the temple tax coin and their creation of ‘fake competition’ among the moneychangers.

              After Jesus’ rage, the coin that is ACTUALLY shown to him is the Tyrian shekel (which had an image of Baal on it). Render unto Baal what is Baal’s and unto God what is God’s is a overt damnation of the Sadducees and a direct economic threat. That’s why he is killed.

              1. Also – Judas’ payment of 20 pieces of silver is also payment of Tyrian shekel – not denarius or circulating silver. IOW – his temple tax obligations are being paid for the rest of his life. THAT is his betrayal. He decides to side with the Sadducees – thinking that that is what buys Gods favor when the Jesus-message is that that mere ritualistic stuff is not what God favors.

        2. Exactly. I’ve studied religion and history, and that kind of shallow, ignorant take on both is really infuriating.

          1. What double-plus annoys me about it is the sleight-of-hand by which they try to piggy back on religious authoritarianism while simultaneously denying it.

            It’s even more logically bankrupt than Kasich’s notion that you’re going to have some sort of post-death sit-down with St. Peter in one of the heavenly conference rooms to go over the Power Point presentation of your life and make your case for admittance to the Eternal Tea Garden.

            It’s like none of these people actually read the books they try to club people with.

            1. I think it’s a powerful healing force for people’s guilt. They can vote for to have the government give money to someone else, and think they have done an act of charity. Thus, they get to heal their fears that they’re not living well, and they get to do it without actually doing any real act of charity.

              Because voting for the government to do something and actually giving of your own freewill are not in any way the same.

              1. They can vote for to have the government give money to someone else, and think they have done an act of charity.

                I think this is true of both what Kasich is doing and what the “Jesus was a Jewish Socialist” crowd is prone to doing.

                “If Government can take care of my healthcare, my retirement, and my general safety and welfare, why not my almsgiving, too? Hell, I pay them enough!”

                1. With the added bonus that they get to feel good about themselves – nay, morally superior – merely for voting and posting shit on Facebook.

        3. Its seems more a ‘fuck each other over and share – or else’ type of philosophy.

    2. They wouldn’t support him if he justified something they liked with reasoning they liked. They’d claim he was insane, and then wax nostalgic about when Republicans were reasonable.

      1. ^ This.

        He’s fine as long as he’s far from the White House and advocating Team Blue policies.

        Had he been nominated, he’d be worse than Hitler. But that only takes a few years to get over if you don’t run again – just look at McCain!

        1. Yeah, the American Constitution Center in Phila. just announced today that McCain will be the receipient of this year’s Freedom Medal. Biden will be presenting it; Hillary was a past receipient.

          1. Like Nobel prize, I will be writing off any announcement that the American Constitution Center’s awards are something to be admired.

          2. Is it me or all these awards and medals and trophies all past their ‘best by’ date?

            Lord me, same deal with the Order of Canada. Some of those recipients are just head scratchers.

            1. Eh, the actual Nobel Prizes tend to be pretty reasonable, who knows what the peace prize is about though. Fields Medal as well.

      2. “Yeah remember Bush? Those were the days when Republicans were reasonable. Sure, they started wars that killed lots of Muslims, but at least they didn’t say mean things about Islam while doing it”

        1. It happens ever time. It allows them to claim that they are open for bipartisanship, the only problem is that the other side is just TOO EXTREME now.

    3. There are plenty of liberal/socialist Christians out there (just look at the goddamn pope). I don’t know why people seem to think there aren’t.

      1. Because politically here in America, religion seems to have been conflated with conservatism. This really doesn’t seem to be true in my experience, at the very least not fiscally conservative.

        1. The hard core religious tend to be more conservative for the most part. But many of the old mainline protestant denominations, Episcopalians and a lot of Catholics have gone pretty left (with some more social conservatism for the Catholics).

          1. Not to mention all the AME-type evangelicals.

      2. *Technically* it’s Pope. But since he’s a commie, we can let ‘pope’ slide.

    4. No, supporting things they like with reasoning they hate is how they define a “serious” opposition politician. Supporting things they don’t like, gets you defined as a crazy fringe racist, regardless of the reasoning.

    5. No. See Romney, Mitt. He fucking signed proto-Obamacare into law and all we heard about was binders full of women.

      1. And don’t forget how unforgivably evil an individual insurance mandate was when it was a Heritage Foundation idea being pushed by heartless Governor Romney.

        1. The individual mandate is evil and Romney is a RINO. Romney lost because he was too lefty.

    6. Of course that won’t make a difference. The beginning and ending of progressivism is free shit. Kasich is for free shit. Therefore, progs will always see him in a positive light.

  5. few things worse than a religious tyrant.

    1. The anti religious tyrants have been worse

      1. true. i left wiggle room.

  6. Ohio’s political and budgetary fight over Medicaid expansion is reflective of the intraparty schism that has hindered Republican efforts to repeal and replace Obamacare in Congress.

    It’s much more existential than just Obamacare, the TEA Party libertarianish wing of the GOP and the RINO Establishment Rockefeller Republican wing of the GOP are in two different parties. Look at Kasich and Cruz, the last two contestants against Trump when Trump was winning the nomination with a mere plurality of the votes. You might think since the majority of Republican voters were not voting for Trump that Cruz and Kasich might unite their support and keep Trump out, but there’s no uniting those two groups. Kasich supporters were more likely to have Hillary as their second choice than to have Cruz as their back-up plan. I think Kasich was operating under the assumption that the reason McCain and Romney lost was because they weren’t moderate enough, Cruz under the assumption that they weren’t conservative enough.

    1. Hell, many of the Hillary voters i know had Kasich as their second choice.

    2. RINO Establishment Rockefeller Republican wing of the GOP

      I find it really funny that people (or is it all you?) keep calling mainstream Republicans RINOs. Isn’t the mainstream/establishment of the party by definition the real Republicans?

      1. I think the notion is that they have an R by their name, but they have abandoned the allegedly Team Red principles of limited government for Team DC Establishment principles.

        1. Team Red is the limited government party the way Team Blue is the anti-war party.

          IOW, just as HRC could literally campaign on escalating the war in Syria against Trump’s skepticism of ME interventions and not even dent the tribal perception that Team Red is the warmonger party, Team Red hasn’t ever but paid lip service to limited government, and that pretty much only by Reagan, but nothing seems to shake people’s faith that limited government is a Team Red fundamental.

          1. Dang, I ripped off your point a little below here. I’m a fucking con-man.

      2. I don’t know. There still seems to be a public perception of Republicans as the fiscal conservatives and all that. And they certainly don’t live up to that perception.

        Maybe it’s just cognitive dissonance, but still language is based in how it is used.

        1. There still seems to be a public perception of Republicans as the fiscal conservatives

          Not since Coolidge has that been true.

          1. Yes, that what was I meant. This seems to be the perception, but it does not line up with reality.

          2. And other than maybe Carter, there hasn’t been an anti-war Democrat in, well, ever.

          3. It’s been true, but only in a relative sense. The zeitgeist has gone so big-gov’t that those who don’t want to increase gov’t much are by default ltd.-gov’t types.

        2. I’m saying that I don’t think that’s how RINO has been used, though. My understanding is that RINOs are the ones like Lincoln Chafee or something who might as well be Democrats based on their voting habits, not the party leadership. Republicans are a group of people, not a set ideology. And those people have been growing government while paying lip service to some idea of fiscal conservatism for a long time now.

          1. Republicans are a group of people, not a set ideology.

            ^ This.

            There’s precious little consistency in either party if you trace them back to their origins. Other than opposition to each other, of course.

          2. I agree, but there does appear to be broad perceptions in the culture with what each party stands for. And so when people say a RINO they mean it against some broadly perceived ideal of what Republicans are.

            Like the other day, I was talking with someone about how Hillary was extremely war-mongering during the election but she still managed to be perceived as more peaceful than Trump. Because democrats are considered to be anti-war, even if that doesn’t particularly match up with reality.

      3. It’s definitely not me, I’ve said the same thing myself many times – people like Cruz and Rand and Massey are the real RINO’s. The GOP stands for nothing but mouthing platitudes about all the things they stand for and when somebody gets in there and starts acting like they’re serious about all that stuff they get slapped down real quick.

      4. The documented party platform is supposed to define the “real” Republicans. The platform is moving left, but not as fast as the GOP leadership. Therefore, the GOP leadership is, by definition, not the real Republicans.

        1. ‘Party platform’ only has one purpose – to market the party to the 25% or so of the electorate that is, psychographically/behaviorally, motivated or partially motivated by ‘ideas’. Those are irrelevant to the rest of the electorate which is motivated purely by ‘achievement’/’success’/’belonging’/’emulating’ or by ‘experience’/’sensation’/’feelz’ or who are so poor that they are solely motivated by physical survival/safety.

  7. “When you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small,”

    I’d expect him to say something more like “what the fuck are you doing here?”

  8. Another fucking retard who apparently thinks that Jesus used his divine superpowers to steal other people’s money.

    1. Yeah, all you GOPers know that Jesus was really about stopping abortion and gay marriage.

      1. I don’t really know that, but I do know the world would be a much better place if you would tie a millstone around your neck and drown yourself in the Potomac.

        1. When is your next WAR BETWEEN THE STATES reenactment, Mikey?

          1. Go ahead and give in to those suicidal urges, you “sad clown”.

          2. Yes PB, listen to DD and just let go. I’ll bet there’s a bottle of yummy drain cleaner under the sink calling your name.

      2. I am registered GOP and I don’t give a flying FUCK what Jesus had to say about anything.

        Now, do you have a few minutes to talk about the Allfather?

        1. I know lots of Republican Odinists.

          1. I think Loki is a better monarch of Asgard. He has a better thought out trade policy.

        2. Allfather apparently was for saving money on infrastructure repair, and wound up getting an 8-legged horse in the bargain…eventually…with some detours & byplay along the way. Of course that could be giving support to Trump because it was about building a wall around his country. But he did get someone else to pay for it, sort of.

  9. Ohio increased participation by 36%, and since we’re making up the savings by volume, the cost only grew by 44%!
    Kasich also needs reminding of the Establishment clause of A-1, and told to stuff his religion up his ass.

    1. You know he’s a governor, and not a member of Congress, right? The first amendment to the U.S. Constitution has nothing to do with what a state does. The doctrine of incorporation is a legal scam.

      1. “The first amendment to the U.S. Constitution has nothing to do with what a state does.”

        Why does this bit of horseshit keep getting repeated?

        “Preemption
        A doctrine based on the Supremacy Clause of the U.S. Constitution that holds that certain matters are of such a national, as opposed to local, character that federal laws preempt or take precedence over state laws. As such, a state may not pass a law inconsistent with the federal law….”
        http://legal-dictionary.thefre…..Local+Laws

        Please STFU.

  10. The instant you start pounding the Bible, I tune you out.

    1. I’d probably pay a couple bucks to see someone fuck a bible. Always good to expand one’s horizon.

      1. Vulgate of St. Jerome!

    2. What if I pound the Elder Edda?

      1. I already listen to Black Metal.

        1. Dude, “Black Metal” is not the preferred nomenclature. “African-American Metal,” please.

    3. Too busy pounding my dick.

  11. “but he is going to ask you what you did for the poor.”

    Well, John, from my understanding Christ elevated poverty over wealth, was famously unconcerned about spending money on personal luxuries instead of on the poor, and had a big thing (along with, you know, *God*) about STEALING.

    IIRC, there’s this big list of do’s and don’ts for Christianity and the poor are not mentioned but not stealing has a fairly prominent place in the top 10.

  12. By the end of 2016, though, Medicaid rolls in Ohio had swelled to more than 3 million, and costs increased to $25.5 billion.

    So more than 25% of Ohio is on Medicaid. Probably another 25% on Medicare. And 10% are on opiates.

    What a fucking shit-hole.

    HEY< BUT TRUMP WILL SAVE US ALL AND COAL JERBS TOO!fucking moron state.

    1. Tell us how you really feel about Ohio, Blue Mikey!

      1. Its like West Virginia + Cleveland and Lake Erie, John.

        1. Yet another thing you’re wrong about. Oh well.

        2. Goddamnit, PB was bound to be right about something some day.

          Ohio is the shittiest state in America. By miles and miles and miles.

          If you disagree, you either a.) haven’t traveled this country much, or b.) you’re a piece of shit from that piece of shit state.

          1. Worse than Maryland? Really?

    2. Half the kids in “We’re so lefty we have a fucking Lenin statue on display” Washington are also on Medicaid.

      Is that a progtopia a shit hole too?

    3. Democrats are sure to win Ohio with comments like that.

    4. IOW they’re most of the way to socialized medicine; and yet somehow bridging the remainder of the way is wjats going to bring on the utopia?

    5. So more than 25% of Ohio is on Medicaid. Probably another 25% on Medicare. And 10% are on opiates.

      What a fucking shit-hole.

      HEY< BUT TRUMP WILL SAVE US ALL AND COAL JERBS TOO!

      fucking moron state.

      Remember when the Chocolate Messiah somewhat literally bought Ohio with the auto-industry bailout? If not, It’s worth going back and taking a look; if only to contrast the rhetoric about why America doesn’t like Hillary to the rhetoric about how Romney kicked his own ass.

  13. Wow, that St. Peter comment really missed the mark, at least with the commentariat.

  14. Kasich is a RINO and good thing he didn’t win 2016 Presidential nomination.

    Lefties were for him, so that told me all I needed to know about him.

    1. Yeah, asshole Weigel up there was his biggest cheerleader around here.

      It hardly needs to be said that didn’t work out any better for him than all the other bad bets he has lost over the years.

  15. “The state budget bill that Kasich vetoed last week included funding for new opioid addiction treatment programs, even after the freeze on the Medicaid enrollment for those above the federal poverty line.”

    In regards to opioid addiction, which has become a real sticking point in killing the ACA Medicaid expansion, people keep equating cutting off treatment for addiction with cutting off Medicaid–but ignoring the other side of the equation.

    I can dig up the stats if someone want to see them, but they pan out something like this:

    People who make less than $20,000 a year are about 3.5 times as likely as the rest of us to become addicted to opiods.

    The overwhelming majority of the opiod addicts out there either get their drugs from a doctor or from a friend for free–who has a prescription from a doctor.

    People on Medicaid, disproportionately, make less than $20,000 a year.

    Add this all up together, and it’s easy to see that expanding Medicaid must have added substantially to the opiod epidemic.

    In addiction treatment parlance, Medicaid is both an enabler of addiction and a facilitator of addiction–it’s moral hazard at work.

    Point being, treating the addicted is only half of the equation–what about cutting down on the number of new addicts? Killing the Medicaid expansion, given those stats above, will almost certainly mean fewer opioid addicts in the future.

    1. Just make that shit legal.

      Problem solves itself.

      1. Yep. I was recently hospitalized for a relatively serious medical condition. I was in constant pain for weeks leading up to it, just horrible. Then they gave me narcotics. It all went away and I could actually sleep.

        I can completely sympathize with someone who has a significant pain disorder who choose to help themselves with narcotics. If you can live 30 years in agony, or 25 years medicated with Vicodin, then I don’t particularly blame someone for making that choice.

        1. I don’t think there’s enough political support for legalizing heroin or letting people get opiods without a prescription right now.

          Killing the ACA Medicaid expansion has already passed the House, and we’re just a few votes short of passing it in the Senate.

          And the president has promised to sign it if the Senate passes it.

          We’re not talking pie in the sky, wouldn’t it be nice, stuff here.

          1. No, I don’t either. Narcotics, particularly Heroin, are probably viewed as the scariest drug. Either it or Meth/Crack seems to be in most people’s minds, the final step to a complete life of drug-addiction and debauchery.

            It will be one of the last legalized, damn all the evidence that it’s not that bad.

            1. It will be one of the last legalized, damn all the evidence that it’s not that bad.

              ^ This.

              There’s actually almost no chemical in widespread use that is as destructive and life-destroying as alcohol.

              People think there’s some exotic narcotic scourge on our society, when your average homeless whacko is just a drunk, plain and simple.

        2. Sorry, you only get to make a choice about your body if you are a woman. And then, only about reproduction issues.

        3. THIS. Vicodin used to be Schedule 3 (unlike Oxy or Fentanyl). Docs could phone it in. Then about 3 years ago, it was bumped up to Schedule 2, which is fucking ridiculous.

          And besides, like you said, if someone is in pain, let them take what they need to feel better.

          1. I mean, of course I’m ultimately for “if you feel like it, then do whatever.” but I figure making it more accessible to people in horrible agony is probably an easier intermediate step then full legalization.

            1. Absolutely.

              1. Trouble is, everyone favoring a crackdown says they’re for giving narcotics to those truly in pain.

      2. PB, you and I actually agree on something for once.

    2. We could start with denying Medicaid eligibility for longer than 6 months if you are an able bodied male.

      1. I’m not sure the government discriminating again people on the basis of gender is the solution. Why let the courts weight in?

        Let’s just start with getting rid of the ACA Medicaid expansion. The CBO estimated that would kick 11 million people off the Medicaid rolls and save us $880 billion over four years.

        The House has already passed it, and all we need is the support of a couple more Senators for it to become law.

        The president has already promised to sign it.

        Do that, and then we can work on getting rid of the rest of it. Moving everyone from Medicaid to private insurance is the ultimate solution–just like moving kids from public schools to private schools with vouchers is the ultimate solution to those problems.

        1. “The CBO estimated that would kick 11 million people off the Medicaid rolls and save us $880 billion over four [ten] years.”

          Fixed!

        2. So replacing Medicare with more Obamacare is your solution?

          1. Does Tony not know the difference between Medicaid and Medicare?

            Moving people from Medicaid to private insurance with subsidies is exactly like moving people from public schools to private schools with vouchers.

            That’s what the AHCA does with people on Medicaid because of the ObamaCare Medicaid expansion, and once we’ve gotten rid of the Medicaid expansion and moved those people to private insurance, we can get to work with doing that for the rest of them, too.

            Medicare is a separate issue, and if you don’t know the difference between Medicaid and Medicare, then there’s no point in discussing this with you. That’d be like discussing differential equations with someone who can’t count to ten.

            1. I meant Medicaid.

              Your solution is moving people from Medicaid to the non-Medicaid part of Obamacare. Or are you advocating the Paul Ryan approach: “People are free to be too poor to afford private insurance if they want to”?

              1. “Moving people from Medicaid to private insurance with subsidies is exactly like moving people from public schools to private schools with vouchers.”

                Why is this hard to understand?

                The AHCA moves people from the Medicaid expansion into private insurance with what amounts to vouchers. The Medicaid eligibility expansion goes away, these people are given subsidies to buy private insurance based on income.

                Do you know nothing about what the AHCA does expect for what you read at Salon? Does the fact that Paul Ryan supported something mean you’re against it–without even understanding what it is?

                Get a dictionary if you need to. It’s not hard to understand.

              2. People would be better off paying cash for minor medical stuff and have catastrophic health insurance for major medical stuff.

                Just like before 1965.

                1. “People would be better off paying cash for minor medical stuff and have catastrophic health insurance for major medical stuff.”

                  Perhaps, but, again, if there isn’t enough political will right now to just kill the ACA Medicaid expansion, why would there be enough to go back to before 1965?

                  Killing the ACA Medicaid expansion is on the agenda right now. Two, three votes short–max. And the President has promised to sign it. That’s why we’re talking about this.

                  It might be better if we got rid of social security and replaced it with a private system like Chile, too–but no one has proposed that, that hasn’t cleared the House, the Senate isn’t only a few votes short of passing it, and the president hasn’t promised to sign it.

                  So why bother talking about that or going back before 1965 on Medicaid?

            2. I presume it goes without saying that your primary goal here is not increasing access to healthcare but validating your silly antigovernment philosophy by getting people off Medicaid before they realize it’s better than the private market.

              1. “I presume it goes without saying that your primary goal here is not increasing access to healthcare

                Moving people from Medicaid to private insurance doesn’t decrease access to healthcare.

                If you think giving things away for free make them accessible over the long run, then you should go grocery shopping in Venezuela sometime.

                1. It’s not free, it’s just cheaper. It’s not advocates of government healthcare who insist that ten dollars out of your pocket for private healthcare is somehow more freedom than five dollars out of your pocket for taxes to pay for public healthcare.

                  1. It’s not advocates of government healthcare who insist that ten dollars out of your pocket for private healthcare is somehow more freedom than five dollars out of your pocket for taxes to pay for public healthcare.

                    I don’t think anyone actually does insist that, but “advocates of government healthcare” do insist, contra all of the evidence that the course of human history affords, that five dollars spent on taxes to provide a service will get you the same level of service that ten dollars would without the government siphoning off a portion of it in between you and the service provider.

                    1. will get you the same level of service that ten dollars would without the government siphoning off a portion of it in between you and the service provider

                      THERMODYNAMICS BE DAMMNED, THIS TIME THE PERPETUAL MOTION MACHINE WILL WORK!!!1111ONEONEONEONE

                  2. Tony|7.6.17 @ 1:40PM|#
                    “It’s not free, it’s just cheaper.”

                    This ignorant piece of shit thinks it’s OK if you’re a little bit pregnant

                    1. It’s like explaining things to a retard who has a slightly better vocabulary.

    3. If government wants to help drug addiction problems but will not make drugs legal, shift ~50% of jail and prison populations to cheaper drug centers and put them on probation.

      Drug rehab is cheaper than jail and prison costs and might solve some of the drug addictions.

      1. Like I said, the question isn’t just about what to do with the addicts we already have. That’s only half of the equation.

        The other half is the demand side. The government is making opiods available for free to the people who are most likely to use it recreationally.

        Most people who use opiods recreationally are a) getting them from a doctor (either directly or for free through a friend) and b) are making less than $20,000 a year and are, hence, disproportionately on Medicaid.

        If we want fewer addicts to treat in the future, we cut Medicaid, which is the machine that’s making new recreational drug addicts.

        1. I have yet to hear Republicans really push home that ObamaCare made opiates more available to fuel this “crisis” that states like Ohio are having.

          1. I’m the one making that argument.

            Sometimes people in power want to do the right thing for the wrong reasons.

            There are lots of good reasons to cut Medicaid. One of the reasons the moderate Republicans in the Senate say they don’t want to cut it is because of the opiod epidemic. They’re afraid it’s going to hurt treatment for addicts.

            I’m the one pointing out that expanding Medicaid exacerbated the opiod crisis, and I’m the one pointing out that keeping Medicaid eligibility expanded will lead to more opiod addicts in the future than there would be otherwise.

            This is a direct response to moderate Republicans who don’t want to cut Medicaid because of the opiod epidemic–and Kasich is hardly the only Republican making that case.

            1. I wish conservatives would add easy availability to opiates to that to the long list of ObamaCare problems and repeal that horrible law.

              1. I wish we would say ‘fuck it’ and let people buy opiates if they want them.

                1. Lack of access to opiates has only lead addicts to far less safe narcotic alternatives. Oxycodone is a far better option than heroin, methadone, or this fentanyl stuff. And then responsible users of opiates like me can have what we need when shit gets bad. Nothing like negotiating with an indifferent physician to get (at best) marginally inadequate pain meds.

  16. When you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small, but he is going to ask you what you did for the poor.

    So, John, why don’t you pull out your tax return and show us how much you personally gave to the poor. Maybe we were reading different bibles, but the one I read said it was a personal responsibility to care for the disadvantaged. I don’t remember Jesus telling his followers that they were supposed to grab swords and make everyone else provide for them. I don’t recall Jesus starting any petitions to demand Caesar squeeze the public a little more to up the size of the grain dole. So, since you’re going to cite what St. Peter is going to ask of you, I’m sure you can give me a good account.

    1. Oh, wait, I think we have an answer on that one:

      However, his tax returns show that his reported charitable contributions totaled $27,326, less than 2 percent of his total income that year, and far less than the 10 percent tithe that is generally expected of believers.

      Kasich’s contributions were also well below the average amount given by his millionaire peers. According to data from the Internal Revenue Service’s statistics of income data set, tax filers who earned between $1 million and $1.5 million in 2008 contributed an average of just over $32,500, or 2.5 percent of overall income, to charitable causes that year.

      http://thefederalist.com/2015/…..-preaches/

      Didn’t Jesus call people like that Pharisees?

      1. That reminds me of Rand Paul just savaging Bernie for saying Americans aren’t charitable when I think we voluntarily give more than any other country

  17. “He is going to ask you what you did for the poor”

    “I made more of them by taxing everyone under the guise of helping them”

    1. “I also locked them in cages for smoking plants”

  18. I remember when Kasich wasn’t such a moralizing buffoon.

    What a useless dipshit he is now.

    The costs for your pet project have, as usual, exploded. Your estimates on enrollees were comically low. Why trust your judgment NOW?

    1. Kasich has been a moralizing buffoon since at least the ’90s.

    2. His hayseed Lil’ Abner act was one of the more grating features of the Republican primary last year.

      “Golly gee willikers, can you believe I’m here with all of you today?”

      “Good gosh, I’m just so happy the New York Times endorsed me!”

  19. “When you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small,” Kasich told the Columbus Dispatch in June 2013, “but he is going to ask you what you did for the poor.”

    Interesting take, because in the Bible I’ve read, it’s by faith and not by your works that you’re judged. Now, your faith should theoretically lead you to practice charity in this life for those less fortunate, but this idea that Christ gave a damn about the survival of earthly institutions like governments or a single-payer healthcare plan isn’t really borne out by any scripture in the Bible. He made it pretty clear that the earth and human-run institutions were inherently corrupt and their ultimate demise in the last days was something to be welcomed, not lamented.

  20. I’m sure it’s been pointed out, but this is a seriously flawed reading of Christianity:


    “When you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small,” Kasich told the Columbus Dispatch in June 2013, “but he is going to ask you what you did for the poor.”

    Assuming for the sake of argument that St. Peter is guarding some pearly gates, I doubt he will ask about what your taxes did for the poor. He’d probably be more interested in what you personally did for the poor.

    I guess in the particular case of Mr. Kasich, he could say ‘I stole money from millions of people to ostensibly help the poor, but I didn’t do anything in particular myself.’

    1. If Gov. Kasich wants to help the poor, then he can go down to the soup kitchen and pick up a fucking ladle.

  21. We should, as libertarians, be ridiculing Kasich not for the fact that he wants to help humanity (the poor, or whomever) but for the fact that he mistakenly thinks that government handouts are actually a method to help the poor. The data, and common economic sense, suggest otherwise. The best way to help the poor is to let markets flourish. Need proof? Compare the “poor” in the US with Venezuela or Cuba.

    Kasich should lose all credibility for his ridiculous St. Peter statement, because it’s clear that he doesn’t have any principles, except apparently, that there’s a guy that is literally going to interview him to get to go to fairy land when he dies.

  22. Kasich has been consorting with the devil ever since he ran for office. St. Peter wouldn’t have to ask him anything, he’d send him straight to the hell he so richly deserves.

    1. Your moniker says it all… the progressives inside the GOP are tag teaming the citizen hand in glove with democrats, and damaging our great nation.

  23. When you die and get to the meeting with St. Peter…
    You’re not my supervisor!

  24. This article is about as insightful as Trump’s twitter feed. The author says Medicaid sucks because it doesn’t pay doctor’s enough. The solution? To somehow magically provide poor people with private insurance capable of taking care of their every need.

    How do we pay for it? Somehow magically states can do things to 1/10th of what it cost the federal government. Source: Delusion.

    1. Watch that doctors video again: the idea that doctors doing a minimum charity care getting their malpractice insurance paid for by the state is not perfect, but very good in comparison to our current situation. Medicaid is being heavily stressed on account of the ACA, and is a problem in and of its own right: the bulk of dollars are not going to care, but into the ether when we examine doctors reimbursements from taxpayer to the sick. It follows that since doctors are getting paid less than plumbers, the bureaucrats are soaking it up – office upon office, layer by layer of pinheads and booger eating morons hired to rubber stamp the vote for expanding government. It would indeed be cheaper to underwrite their malpractice, as in most states that is a doctors highest expense.
      The bigger answer to the current problem is to restore charity medicine – it was working reasonably well until Ted Kennedy came along in the 60’s and sold the nation down the river by laying the foundations for single payer/government medicine. Will life on earth ever be perfect? No, but we should never be fooled into thinking centralized power fixes all – there are too many voices to listen to and respond to needs in such a structure. That… is the lesson of the implosion of the Soviet Union politburo: it became too big to succeed, and philosophy of governance didn’t even matter past the point of critical mass.

  25. One problem not mentioned in this column: the people who are on Medicaid but don’t want to be.

    It used to be that you only got on Medicaid if you applied for it. Yes, the requirements were stringent(*), but you only got on the program if you needed it — as defined by _both_ the government and _you_. After the ACA expanded Medicaid, some people who tried to get insurance through the ACA “exchanges” were instead put on Medicaid because their income was below 138% of the poverty line. This meant that they could no longer use the network of their old insurance program. They could no longer see their old doctor, because that doctor would not take Medicaid’s ridiculously low level of payments.

    (*) My wife was helping one acquaintance apply for Medi-Cal, the California version of Medicaid. He apparently didn’t qualify (at least according to the people in the Medi-Cal office), even though he’d had a stroke and was paralyzed on one side, and even though his income and total disposable assets were well under the limits set for Medicaid. Hemiplegia is a lot more crippling than paraplegia — loss of use of your legs. Try doing something without using either your right leg _or_ your right hand & arm! He finally qualified when he reached 65; apparently going from Medicare to Medi-Cal is a lot easier.

  26. I should also note that Medicaid is (or was, before the ACA) a trap. Whatever Medicaid paid for your care was effectively an interest-free loan. If you should happen to acquire any income above the $35/month then allowed, or if your liquid assets rose above the limit of $2,000 (at that time), it had to be used to compensate Medicaid for the money it had spent.

    This means that even if you should manage to find a way to earn money, there is no point to it: it will all go to Medicaid. If you’ve been on Medicaid for a few years and piled up some significant medical bills — or worse yet, in a nursing home — there is no way you will _ever_ pull yourself out of poverty.

    Again, I know this because of the acquaintance I mentioned in the footnote above: he is able to edit books on his computer and has some sales. But whatever he receives in the way of advances and royalties goes to Medi-Cal, except for that $35/month that he can use for his personal needs — clothes, toiletries, etc.

    Medicaid is the pits, and only people who really need it should be on it.

  27. this is all a fiscal policy / smoke & mirrors game Kasich is playing with FEDERAL reimbursement dollars. Current (repeal/replace) Obamacare negotiations include cutting back on Medicaid (Expansion) reimbursements from 100% to the 50%-80% range. Kasich is crying foul behind closed doors – calling Congressmen he knows well – to convince them to leave the reimbursements in place. Any reduction will totally jack up the Ohio budget forecast, thus ruining his legacy… and that’s the piece of the puzzle (his ego) that Kasich really cares about.

    If he is (was) so concerned about the poor, why when he made $1,200,000 (2011??) from book deals, politics, FoxNews, investment banking – why did he only give less than 2% to ANY charities?

    this isn’t about he and St. Peter… this is a pure and simple political maneuver

  28. Sanctimonious fool thy name is Kasichs.

  29. The only way we will bring costs into line with our European friends and others is to radically restructure how, and how much we pay for healthcare. Right now, US physicians, particularly specialists, make three times what specialists are paid in most European countries. Americans pay at least double for the exact same prescription drugs and medical devices. The US spends the lion share of healthcare dollars treating the elderly in the last year or two of life. Until these problems and others are dealt with, we will not reduce our healthcare expenditures regardless of how we pay for it.

    1. The only way we will bring costs into line with our European friends and others is to radically restructure how, and how much we pay for healthcare.

      The first step towards that would be to recognize that we have to bring our costs under control.

      Notice how, so far, the entire discussion among both Republicans and Democrats centers around how to “pay for” health care? How even Republicans consider “not keeping up with inflation” to be the same as “cutting”?

    2. What about frivolous litigation? We definitely need a ‘loser pays’ system here to discourage phony lawsuits and shakedowns of hospitals by weasel attorneys.

  30. “When you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small,” Kasich told the Columbus Dispatch in June 2013, “but he is going to ask you what you did for the poor.

    And, Gov. Kasich, you can tell St. Peter that you royally screwed the poor in order in exchange for political power and social signaling. Hopefully he’ll then cast you into the pit of hell.

  31. So now Reason is into denying folks health coverage? Because they are ABLE- BODIED?

  32. Can somebody provide a reference for the 1960s charity hospital system that worked so much better than Medicaid and Medicare? I can’t find data supporting this. I did see these articles:

    https://tinyurl.com/7jdx4mj
    https://tinyurl.com/ycu6l7ro

    To really help people the first second and third order is to cut healthcare costs, cut costs and cut costs. What worked, albeit poorly it seems, in the 1960s won’t work now due to the enormous costs increases, for both care and medication, compared to inflation. Insurance companies in areas with little competition (like many rural areas) increase costs, as do monopolistic hospital groups and drug companies with “forever and ever” patent protection. Not sure how to increase competition. Letting people buy across state lines won’t fix everything because it just doesn’t pay for insurance companies to set up in new markets where they won’t make a lot of money. They need to find whole networks of doctors and hospitals in the new states and sign them up and work out all the mechanics. That’s a lot of investment.

    I’m all for letting people buy their medications from Canada and Mexico. Why should the U.S. subsidize most of the profits of the pharma companies? Make them flatten the curve if they need to maintain profits.

  33. Ohio can constitutionally fund any charitable cause it wishes with the permission of it’s citizens to any amount those citizens wish to fund it. Kasich doesn’t need the federal government to do that, his problem is that the federal government is sucking billions of dollars out of the state of Ohio and using it to commit extortion. It can do that because, as SCOTUS ruled, the tax code is a gigantic loophole in the constitution which allows the federal government to commit actions which would otherwise clearly be unconstitutional.

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