With all the noise, hot air and nonsense over the last year, it is no surprise that folks might now know what the recently passed healthcare legislation actually includes. A couple of resources that might help: this one summarizes key points of the bill, and this one shows a timeline to implementation.
To give you a sense of what to expect in the next 6 months:
--Access to insurance for uninsured patients with pre-existing conditions.
--Small business tax credits.
--$250 rebates for seniors in the Medicare Part D donut hole (no drug coverage).
--Eliminating pre-existing condition restrictions for children.
--Prohibiting recissions (when insurance companies take back a policy you bought).
--Eliminating lifetime limits.
--Regulating use of annual limits on insurance.
Honestly, not a bad 6-9 months' work.
Friday, March 26, 2010
It Is Accomplished...
Last night, the House passed the reconciliation bill after the Senate's modifications. With this action, the legislative process for healthcare reform is complete. This bill will be forwarded to the President's desk for signature, and means that healthcare is now law. The House's fixes to the Senate bill include improving the affordability provisions for lower income families, and repealing some of the more egregious special deals put into the bill during Senate negotiations.
Prohibitions against health insurance companies denying care for children due to pre-existing conditions go into effect immediately. Health insurance reforms start to take meaningful effect in 6 months with increasing protections over the next 4 years.
This bill is far from what I might have hoped for. It essentially props up the private insurance market, although it does make the market less predatory towards individuals and more accountable for their actions. This law extends healthcare insurance to 32 million uninsured people once it takes full effect.
Most importantly, this bill addresses the issue of whether healthcare is a right or a privilege. As a nation, we have now moved forward and determined that it is a reasonable and appropriate goal for healthcare to be available for all. This law is an imperfect vehicle for bringing this to pass, but it has been accomplished just the same.
So--after more than a year of effort and a century of hope, the country to move forward.
Now, our work is to help make this bill life up to its intent and anticipated benefit.
Prohibitions against health insurance companies denying care for children due to pre-existing conditions go into effect immediately. Health insurance reforms start to take meaningful effect in 6 months with increasing protections over the next 4 years.
This bill is far from what I might have hoped for. It essentially props up the private insurance market, although it does make the market less predatory towards individuals and more accountable for their actions. This law extends healthcare insurance to 32 million uninsured people once it takes full effect.
Most importantly, this bill addresses the issue of whether healthcare is a right or a privilege. As a nation, we have now moved forward and determined that it is a reasonable and appropriate goal for healthcare to be available for all. This law is an imperfect vehicle for bringing this to pass, but it has been accomplished just the same.
So--after more than a year of effort and a century of hope, the country to move forward.
Now, our work is to help make this bill life up to its intent and anticipated benefit.
Thursday, March 25, 2010
And From The Senate Back To the House
Now that the healthcare reform bill has been passed by the House, the remaining issue is to address the reconciliation package. This package passed the Senate today and has to return to the House for the final vote because of some procedural changes brought about in the Senate. This is apparently expected tonight and, if passed, will bring to a close the legislative process regarding healthcare reform.
Sunday, March 21, 2010
Healthcare Reform Passes The House
Tonight, the House passed the Senate's healthcare reform bill, and then passed the budget reconciliation bill. The Senate's bill, now having been passed by both chambers of Congress, moves to the President for signature into law while the reconciliation package moves back to the Senate for passage.
This is a big day--the first time in over 60 years that presidential and national efforts to expand healthcare coverage has passed out of the Congress. I truly and deeply believe that this legislation will make a substantial difference in peoples' lives. The expanded access to care and the reforms on insurance companies are critical steps.
Did I want more? Yes. Am I happy with the bill? Happy enough.
Every journey of 1,000 miles begins with a single step. This is the first significant milestone on that journey.
This is a big day--the first time in over 60 years that presidential and national efforts to expand healthcare coverage has passed out of the Congress. I truly and deeply believe that this legislation will make a substantial difference in peoples' lives. The expanded access to care and the reforms on insurance companies are critical steps.
Did I want more? Yes. Am I happy with the bill? Happy enough.
Every journey of 1,000 miles begins with a single step. This is the first significant milestone on that journey.
The Beginning Of The End
Debate on passage of healthcare reform has just begun in the House of Representative. Those in favor of the bill have successfully hurdled each of the preceding test votes on this bill, so hopefully the bill will be successfully passed.
It's been a long days, with the same lies and half-truths put forward by the opponents. This should not surprise us, as this has been the Republican's plan since the beginning.
The bill being discussed will expand coverage to over 30 million currently uninsured individuals and will bring meaningful reform to the out-of-control for-profit health insurance companies.
This is a day that matters, and hopefully a day we can celebrate later.
It's been a long days, with the same lies and half-truths put forward by the opponents. This should not surprise us, as this has been the Republican's plan since the beginning.
The bill being discussed will expand coverage to over 30 million currently uninsured individuals and will bring meaningful reform to the out-of-control for-profit health insurance companies.
This is a day that matters, and hopefully a day we can celebrate later.
Sunday, March 14, 2010
Una Vida Sana!
Somewhat off the subject, but I wanted to mention that work is moving forward on the Una Vida Sana project. This program is intended to provide health screening services focused on the uninsured, Spanish-speaking community in Richmond. These are individuals that will not be helped by healthcare reform, whatever the final product looks like.
The short description of the project is: "A service learning program to provide cardio-metabolic disease screening and health outreach services to the Spanish-speaking community in Richmond while also providing clinical learning opportunities for medical, pharmacy and nursing students; clinical experience for Spanish-speaking medical interpreters; and health education experiences for lay health promoters."
The group has held 2 events thus far (last September and November) with another event coming up on March 20--next Saturday.
As this project grows and moves forward I plan to blog about it in greater detail.
The short description of the project is: "A service learning program to provide cardio-metabolic disease screening and health outreach services to the Spanish-speaking community in Richmond while also providing clinical learning opportunities for medical, pharmacy and nursing students; clinical experience for Spanish-speaking medical interpreters; and health education experiences for lay health promoters."
The group has held 2 events thus far (last September and November) with another event coming up on March 20--next Saturday.
As this project grows and moves forward I plan to blog about it in greater detail.
The Current Health Care Reform Proposal
I tried to place this info in the preceding post, but for some reason when I did so it threw the rest of the post off-balance. I thought it was worth laying out some details of the current proposal:
--Affordability: Makes it easier for low-income families and middle-class families to purchase insurance; if a family's income is <$55,000, that family would have between 73%-94% costs covered.
--Fine for not purchasing insurance: $2,850 or 2.5% family income.
--Employer responsibility: Senate bill lacked employer mandate; President endorses the Senate approach but increased the fees on employers if ANY employee purchases insurance on the exchange. Employers with fewer than 50 employees are exempt; there is no employer mandate, but there are provisions to make providing insurance more attractive.
--Medicaid/CHIP: coverage extends to 133% federal poverty level (for a family of 3 this would be less than $24,000); there would be a 100% match 2014-2017, 95% 2018-2019, 90% 2020 and beyond for all states. President’s plan removes the “Cornhusker Kickback" that would have provided disproportionate benefits for Nebraska.
--Health insurance exchange in both plans; national in House, state in Senate. The President endorsed state-based exchange for individuals & small businesses must be administered by govt agency or non-profit.
--President proposed a plan without a public option, but develops Health Insurance Rate Authority to provide Federal assistance and oversight to States regarding unreasonable rate increases and other unfair practices. There must be at least two multi-state “qualified” plans in each exchange, at least one non-profit and one w/o abortion coverage.
--President’s plan probably leaves 20 or 21 million uninsured; of those about 7 million would be illegal immigrants (who were not covered in either congressional proposal, either).
--Neither bill includes coverage assistance for undocumented immigrants and (in Senate) cannot buy policies from exchanges.
--Abortion coverage: President’s language would permit a state to prohibit any plan from providing coverage (so it is possible that NO plan on an exchange would provide coverage); plans that offer coverage must create allocation accounts to ensure that no federal $ goes to abortion coverage and plans are not allowed to discriminate against providers who do not provide coverage.
--Phase out Medicare D prescription coverage donut hole. --Both bills provide significant support for increased primary care workforce and President’s bill provides $11 billion for community health centers.
--Physician payment system would move away from the “fee for service” model, move towards accountable care organizations or other models.
--4 Republican ideas are included in compromise legislation: $50 million to reduce state demonstration projects for malpractice reform, improve Medicaid reimbursement to physicians, include health savings accounts in the exchange, and begin random undercover investigations to reduce fraud.
--Affordability: Makes it easier for low-income families and middle-class families to purchase insurance; if a family's income is <$55,000, that family would have between 73%-94% costs covered.
--Fine for not purchasing insurance: $2,850 or 2.5% family income.
--Employer responsibility: Senate bill lacked employer mandate; President endorses the Senate approach but increased the fees on employers if ANY employee purchases insurance on the exchange. Employers with fewer than 50 employees are exempt; there is no employer mandate, but there are provisions to make providing insurance more attractive.
--Medicaid/CHIP: coverage extends to 133% federal poverty level (for a family of 3 this would be less than $24,000); there would be a 100% match 2014-2017, 95% 2018-2019, 90% 2020 and beyond for all states. President’s plan removes the “Cornhusker Kickback" that would have provided disproportionate benefits for Nebraska.
--Health insurance exchange in both plans; national in House, state in Senate. The President endorsed state-based exchange for individuals & small businesses must be administered by govt agency or non-profit.
--President proposed a plan without a public option, but develops Health Insurance Rate Authority to provide Federal assistance and oversight to States regarding unreasonable rate increases and other unfair practices. There must be at least two multi-state “qualified” plans in each exchange, at least one non-profit and one w/o abortion coverage.
--President’s plan probably leaves 20 or 21 million uninsured; of those about 7 million would be illegal immigrants (who were not covered in either congressional proposal, either).
--Neither bill includes coverage assistance for undocumented immigrants and (in Senate) cannot buy policies from exchanges.
--Abortion coverage: President’s language would permit a state to prohibit any plan from providing coverage (so it is possible that NO plan on an exchange would provide coverage); plans that offer coverage must create allocation accounts to ensure that no federal $ goes to abortion coverage and plans are not allowed to discriminate against providers who do not provide coverage.
--Phase out Medicare D prescription coverage donut hole. --Both bills provide significant support for increased primary care workforce and President’s bill provides $11 billion for community health centers.
--Physician payment system would move away from the “fee for service” model, move towards accountable care organizations or other models.
--4 Republican ideas are included in compromise legislation: $50 million to reduce state demonstration projects for malpractice reform, improve Medicaid reimbursement to physicians, include health savings accounts in the exchange, and begin random undercover investigations to reduce fraud.
Push For Healthcare Reform
It appears that we are approaching the defining votes on healthcare reform. From what I understand, the House of Representatives will pass the bill the Senate passed, while the reconciliation process will be used to change some of the Senate's language to be more aligned with what the house passed.
Conservatives need not fear. The public option is, unfortunately, not on the table. It's a shame, because I still feel that a public plan would be a necessary counterbalance to private insurance companies.
There are severe costs to doing nothing. There is evidence indicating that, had health care reform been implemented in the past, US health care spending would be much less than it currently is and would be more in-line with spending in other developed countries. The average family premium was $12,300 in 2008 and is expected to increase to $23,842 in 2020. This sort of cost escalation is unsustainable, either if the family purchases insurance privately or if it is employer purchased. Add this to private company denials of coverage, rescissions, and the like and it is clear that the already horrifying condition of health coverage will only get worse.
The House and Senate bills have a number of areas of agreement already:
--Individual mandate to purchase insurance
--Greatly increased regulation of private insurance companies
--Eliminates preexisting conditions
--Eliminates rescission (companies cannot drop people who are ill)
--Eliminate annual & lifetime caps
--Medical loss ratio of 80-85% (how much of every insurance $ is spent on care)
--Eliminate anti-trust exemption
--Expands coverage for preventive care
--Increased emphasis on primary care
--Increased support for public health
--Incentives for small businesses to provide insurance
--Creation of a health insurance purchasing exchange
--Support for health information technology
--Support for comparative effectiveness research
The President's proposal looks more like the Senate bill, but does have some proposals that reflect the House (and Republican) preferences.
Polling suggests that the country is divided about 50/50 regarding the legislation. Interestingly, if you discuss the policies and changes that are actually included in the legislation, support increases. People are distrustful of the process used to reach the current proposal and are skeptical that it will benefit them. However, if you discuss the specifics of the legislation, people increasingly support the proposals.
The general public is more likely to support legislation that includes the following pieces:
--Stop insurance covers from denying coverage.
--Require insurance companies to spend $ on care, not on insurance company profit.
--Helping small businesses to afford health insurance.
--Fix Medicare drug benefit.
--Help control costs and make good insurance available for all.
The current legislation provides for all the above. Opponents of reform have worked hard and, unfortunately, fairly successfully to criticize the proposal by being less than honest with what is actually contained in the legislation (death panels, anyone?).
This legislation cannot wait, and must be passed ASAP. Too many people die yearly, too many people defer care, and too many people are left behind for us to delay.
(By the way, don't fall for Republican claims that budget reconciliation is an underhanded, devious technique. Worked fine for them in the past on bills that dramatically increased budget deficits. It's just another attempt to pull attention away from what matters.)
If you read this, call your legislators and ask them to vote for health care reform. Now is the time, and this is the opportunity.
Conservatives need not fear. The public option is, unfortunately, not on the table. It's a shame, because I still feel that a public plan would be a necessary counterbalance to private insurance companies.
There are severe costs to doing nothing. There is evidence indicating that, had health care reform been implemented in the past, US health care spending would be much less than it currently is and would be more in-line with spending in other developed countries. The average family premium was $12,300 in 2008 and is expected to increase to $23,842 in 2020. This sort of cost escalation is unsustainable, either if the family purchases insurance privately or if it is employer purchased. Add this to private company denials of coverage, rescissions, and the like and it is clear that the already horrifying condition of health coverage will only get worse.
The House and Senate bills have a number of areas of agreement already:
--Individual mandate to purchase insurance
--Greatly increased regulation of private insurance companies
--Eliminates preexisting conditions
--Eliminates rescission (companies cannot drop people who are ill)
--Eliminate annual & lifetime caps
--Medical loss ratio of 80-85% (how much of every insurance $ is spent on care)
--Eliminate anti-trust exemption
--Expands coverage for preventive care
--Increased emphasis on primary care
--Increased support for public health
--Incentives for small businesses to provide insurance
--Creation of a health insurance purchasing exchange
--Support for health information technology
--Support for comparative effectiveness research
The President's proposal looks more like the Senate bill, but does have some proposals that reflect the House (and Republican) preferences.
Polling suggests that the country is divided about 50/50 regarding the legislation. Interestingly, if you discuss the policies and changes that are actually included in the legislation, support increases. People are distrustful of the process used to reach the current proposal and are skeptical that it will benefit them. However, if you discuss the specifics of the legislation, people increasingly support the proposals.
The general public is more likely to support legislation that includes the following pieces:
--Stop insurance covers from denying coverage.
--Require insurance companies to spend $ on care, not on insurance company profit.
--Helping small businesses to afford health insurance.
--Fix Medicare drug benefit.
--Help control costs and make good insurance available for all.
The current legislation provides for all the above. Opponents of reform have worked hard and, unfortunately, fairly successfully to criticize the proposal by being less than honest with what is actually contained in the legislation (death panels, anyone?).
This legislation cannot wait, and must be passed ASAP. Too many people die yearly, too many people defer care, and too many people are left behind for us to delay.
(By the way, don't fall for Republican claims that budget reconciliation is an underhanded, devious technique. Worked fine for them in the past on bills that dramatically increased budget deficits. It's just another attempt to pull attention away from what matters.)
If you read this, call your legislators and ask them to vote for health care reform. Now is the time, and this is the opportunity.
A Conservative Failure
I admit, I look at the world from a certain perspective. As I've mentioned elsewhere (and earlier) in this blog, I approach medicine as a service career. I trust that I could make more money in other careers or, even if I stay in medicine, could make more money working elsewhere. But I don't feel that is my calling. I feel a need to work with patients who need care and who would have trouble accessing care elsewhere.
As a result of this, I look at marginalized and impoverished individuals as being worthy of our help and our care. I feel it is society's responsibility to help those who need help and, because I see the need as being so great, I believe that government and society has a critical role to help. These individuals usually come from communities and families that have become entrenched in poverty. I acknowledge that some people make poor decisions--but so do well-off people. The well-off just have more wiggle room if they make a mistake, and live in a society where tax policies, investment plans, etc are weighted to their benefit. (If you disagree, let me ask you whether mortgage interest deductions or deductible IRA contributions are more likely to benefit the wealthy or the poor)?
The counterpoint claimed by conservatives is that the public sphere, and public money, should not be used to help the poor and underprivileged. They claim that private citizens, churches and charities can provide the necessary help. In their vision, marginalized people are helped by kindhearted individuals and organizations with a mission to do just that.
So how do they explain Glenn Beck's recent nonsense? (It's an MSNBC link, b/c I can't bear to find the original clips on Fox.) Here is an individual beloved by many conservatives and who acts as a mouthpiece of the conservative movement calling on his fans and listeners to abandon and run away from any church that supports social justice and economic justice.
So, apparently there is a part of the conservative movement that believes not only that public money should not assist the poor, but faith communities shouldn't either. So where does that leave the poor? Apparently up the proverbial creek without a paddle. Couple this with the fact that the charitable organizations that do so much to help the less fortunate are badly hurt by the economy at the same time that their services are needed (link here) and you have to ask yourself: exactly what to conservatives want the poor do to?
Last time I checked, Jesus preached social and economic justice and called on followers to care for (and about) the poor. It takes precious little bible study to see this--the Beatitudes in the Sermon on the Mount make an easy starting point.
So, Beck is wrong in calling on people to abandon churches that promote social and economic justice. And he shows a critical flaw in conservative thought (if you can call him a conservative thinker--I think his current comments show that the jury is still out on that). If the poor are supposed to rely on churches and charities when those churches and charities are already strapped, and if "leaders" of the movement are calling on parishioners to leave their churches, then again: what are the poor supposed to do?
I readily acknowledge that there are may Christians who will disavow Beck's comments, and that many churches and secular charities will continue to do strong work to benefit the underprivileged. That doesn't change the basic fact that conservatives' answers to these questions are woefully inadequate.
And this is why we need to sustain a viable and meaningful public safety net.
As a result of this, I look at marginalized and impoverished individuals as being worthy of our help and our care. I feel it is society's responsibility to help those who need help and, because I see the need as being so great, I believe that government and society has a critical role to help. These individuals usually come from communities and families that have become entrenched in poverty. I acknowledge that some people make poor decisions--but so do well-off people. The well-off just have more wiggle room if they make a mistake, and live in a society where tax policies, investment plans, etc are weighted to their benefit. (If you disagree, let me ask you whether mortgage interest deductions or deductible IRA contributions are more likely to benefit the wealthy or the poor)?
The counterpoint claimed by conservatives is that the public sphere, and public money, should not be used to help the poor and underprivileged. They claim that private citizens, churches and charities can provide the necessary help. In their vision, marginalized people are helped by kindhearted individuals and organizations with a mission to do just that.
So how do they explain Glenn Beck's recent nonsense? (It's an MSNBC link, b/c I can't bear to find the original clips on Fox.) Here is an individual beloved by many conservatives and who acts as a mouthpiece of the conservative movement calling on his fans and listeners to abandon and run away from any church that supports social justice and economic justice.
So, apparently there is a part of the conservative movement that believes not only that public money should not assist the poor, but faith communities shouldn't either. So where does that leave the poor? Apparently up the proverbial creek without a paddle. Couple this with the fact that the charitable organizations that do so much to help the less fortunate are badly hurt by the economy at the same time that their services are needed (link here) and you have to ask yourself: exactly what to conservatives want the poor do to?
Last time I checked, Jesus preached social and economic justice and called on followers to care for (and about) the poor. It takes precious little bible study to see this--the Beatitudes in the Sermon on the Mount make an easy starting point.
So, Beck is wrong in calling on people to abandon churches that promote social and economic justice. And he shows a critical flaw in conservative thought (if you can call him a conservative thinker--I think his current comments show that the jury is still out on that). If the poor are supposed to rely on churches and charities when those churches and charities are already strapped, and if "leaders" of the movement are calling on parishioners to leave their churches, then again: what are the poor supposed to do?
I readily acknowledge that there are may Christians who will disavow Beck's comments, and that many churches and secular charities will continue to do strong work to benefit the underprivileged. That doesn't change the basic fact that conservatives' answers to these questions are woefully inadequate.
And this is why we need to sustain a viable and meaningful public safety net.
Saturday, March 6, 2010
Some Thoughts On Working In Southside
I work at an outpatient practice in Southside Richmond. My pediatric patients are essentially 100% Medicaid/FAMIS (Virginia's state children's health insurance program --SCHIP) and nearly 90-95% Spanish-speaking. On the adult side, probably 70% of my patients are uninsured and receive assistance from our health system's patient assistance program; another 15% or so have Medicare coverage, and the other 15% are mostly Medicaid. I've been working here for over 2 1/2 years, and have developed some thoughts about working in this setting:
--Medicaid is very poorly responsive to its patients' needs: many children are covered for 1 year after they are born, but have to reapply for coverage. Many of the letters that are sent out are in English (to Spanish-speaking families), or are hard to understand. There is no evidence of any proactive approach to avoid this, so we get a number of kids that fall through the cracks at their first birthday. Similarly, many patients are unaware that their insurance coverage includes transportation to and from doctors' visits. Our Spanish-speaking patients do not receive full value from their insurance coverage.
--It is nearly impossible to get Medicaid as an adult in Virginia. You could be destitute, living in a box near a highway, and have no employment but you still do not qualify for Medicaid assistance.
--Even $4 prescriptions are expensive. Patients receiving our health system's assistance can get prescriptions for $4 for 30 days. I have been asked more often than I imagined to identify which of the prescriptions is the most important one because they cannot afford all $4.
--Our health system provides a full scope of referrals, but doesn't really accommodate the need very well. Already I have some appointments scheduled for patients in February 2011. I am glad to have the referrals (on paper) but I wonder if we couldn't find a way to make them more meaningfully useful.
--If you are approved for Disability income, don't expect much. Disability pays most of our patients who qualify somewhere around $700-900 a month. This really isn't enough to do much of anything. People who accuse the poor of spending all their money on big-screen TVs and fancy stereos can probably find a few people who validate their claims, but for the most part these people have no idea what they are talking about.
--There are levels of poverty in our very city that would not be out of place when I work in international settings. As a nation, state and city we should be embarrassed and appalled by this.
--It is much less expensive and resource-intensive to fix problems before they develop than to play catch-up later. Many of the adult patients I care for present with multiple uncontrolled medical problems and it takes a great deal of time, effort and resources to get things under control. It would be much more efficient if these problems could have been detected, controlled or prevented long before. That, of course, would require having meaningful access to health care even if one was unable to purchase private health insurance. This is why healthcare reform is so critical--it would open access to health care for everyone.
--Medicaid is very poorly responsive to its patients' needs: many children are covered for 1 year after they are born, but have to reapply for coverage. Many of the letters that are sent out are in English (to Spanish-speaking families), or are hard to understand. There is no evidence of any proactive approach to avoid this, so we get a number of kids that fall through the cracks at their first birthday. Similarly, many patients are unaware that their insurance coverage includes transportation to and from doctors' visits. Our Spanish-speaking patients do not receive full value from their insurance coverage.
--It is nearly impossible to get Medicaid as an adult in Virginia. You could be destitute, living in a box near a highway, and have no employment but you still do not qualify for Medicaid assistance.
--Even $4 prescriptions are expensive. Patients receiving our health system's assistance can get prescriptions for $4 for 30 days. I have been asked more often than I imagined to identify which of the prescriptions is the most important one because they cannot afford all $4.
--Our health system provides a full scope of referrals, but doesn't really accommodate the need very well. Already I have some appointments scheduled for patients in February 2011. I am glad to have the referrals (on paper) but I wonder if we couldn't find a way to make them more meaningfully useful.
--If you are approved for Disability income, don't expect much. Disability pays most of our patients who qualify somewhere around $700-900 a month. This really isn't enough to do much of anything. People who accuse the poor of spending all their money on big-screen TVs and fancy stereos can probably find a few people who validate their claims, but for the most part these people have no idea what they are talking about.
--There are levels of poverty in our very city that would not be out of place when I work in international settings. As a nation, state and city we should be embarrassed and appalled by this.
--It is much less expensive and resource-intensive to fix problems before they develop than to play catch-up later. Many of the adult patients I care for present with multiple uncontrolled medical problems and it takes a great deal of time, effort and resources to get things under control. It would be much more efficient if these problems could have been detected, controlled or prevented long before. That, of course, would require having meaningful access to health care even if one was unable to purchase private health insurance. This is why healthcare reform is so critical--it would open access to health care for everyone.
Oh, Virginia...
Virginia's General Assembly session is drawing to a close, and the state's budget woes are currently the focus of legislators and advocacy groups. There are many arguments and discussions about how best to address the state's budget shortfall.
At this point, budget proposals include cutting K-12 education, cutting Medicaid reimbursement, cutting public health departments, and cutting programs promoting child health and wellness.
I cannot understand this plan, and I cannot see any value in it. How is cutting childhood education and health services and cutting public health departments actually supposed to help anything? If there ever was a "penny wise, pound foolish" plan, this is it. I cannot understand how sick, undereducated children are supposed to be in anyone's best interest.
It gets even more frustrating when you consider the current budget environment. The cuts to Medicaid and K-12 education total approximately $1 billion. Virginia spends $950 million every year paying for car tax relief, thanks to this guy's foolish campaign pledge. My opinion: we have a certain amount of choice in the kind of car we buy, and so we can control to a great extend the amount of personal property tax we pay. If the car tax "relief" was repealed, this would free up approximately $950 million dollars.
So: if people who buy more expensive cars are held responsible for doing so and are expected/required to pay the full amount of the personal property tax on those more-expensive vehicles, we could pretty much balance out the cuts to education and Medicaid. This would not address the issues of funding the local departments of public health and would not address CHIP funding, but it would at least be a start.
The local newspaper's web site has a widget allowing you to adjust income and spending to see how you could balance the budget. If you use this tool, increasing the personal income tax by 1% and raising the cigarette tax by $0.30, you end up with a $300 million surplus. This seems to be a reasonable proposal, but our current governor has absolutely ruled out any tax increases--a position supported by the Republican-controlled House of Delegates.
When did we decide as a society that it would be just to balance the budget on the backs of Virginia's poor and marginalized? This might be a rhetorical question, except that this seems to be the arc of American history.
Just to add insult to injury, Virginia's new Governor removed protections that would prevent state government from discriminating in employment on the basis of sexual orientation. Now, our Republican Attorney General is calling for all public colleges and universities to repeal their policies protecting individuals against discrimination on the basis of sexual orientation.
The Republican party in Virginia: carrying the Commonwealth backwards on the backs of the poor. Not the most attractive slogan, but it certainly reflects the way I feel right now.
At this point, budget proposals include cutting K-12 education, cutting Medicaid reimbursement, cutting public health departments, and cutting programs promoting child health and wellness.
I cannot understand this plan, and I cannot see any value in it. How is cutting childhood education and health services and cutting public health departments actually supposed to help anything? If there ever was a "penny wise, pound foolish" plan, this is it. I cannot understand how sick, undereducated children are supposed to be in anyone's best interest.
It gets even more frustrating when you consider the current budget environment. The cuts to Medicaid and K-12 education total approximately $1 billion. Virginia spends $950 million every year paying for car tax relief, thanks to this guy's foolish campaign pledge. My opinion: we have a certain amount of choice in the kind of car we buy, and so we can control to a great extend the amount of personal property tax we pay. If the car tax "relief" was repealed, this would free up approximately $950 million dollars.
So: if people who buy more expensive cars are held responsible for doing so and are expected/required to pay the full amount of the personal property tax on those more-expensive vehicles, we could pretty much balance out the cuts to education and Medicaid. This would not address the issues of funding the local departments of public health and would not address CHIP funding, but it would at least be a start.
The local newspaper's web site has a widget allowing you to adjust income and spending to see how you could balance the budget. If you use this tool, increasing the personal income tax by 1% and raising the cigarette tax by $0.30, you end up with a $300 million surplus. This seems to be a reasonable proposal, but our current governor has absolutely ruled out any tax increases--a position supported by the Republican-controlled House of Delegates.
When did we decide as a society that it would be just to balance the budget on the backs of Virginia's poor and marginalized? This might be a rhetorical question, except that this seems to be the arc of American history.
Just to add insult to injury, Virginia's new Governor removed protections that would prevent state government from discriminating in employment on the basis of sexual orientation. Now, our Republican Attorney General is calling for all public colleges and universities to repeal their policies protecting individuals against discrimination on the basis of sexual orientation.
The Republican party in Virginia: carrying the Commonwealth backwards on the backs of the poor. Not the most attractive slogan, but it certainly reflects the way I feel right now.
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