Author: TheFatLadySings

While most of us are focused on universal care, the Bush Administration has been incrementally shredding our existing public health safety net in ways that have yet to become apparent.  The most recent assault on our public health care infrastructure is escaping the notice of mainstream media and citizen journalists alike, probably because it is not easily explained. I am referring to a proposed set of arcane regulation changes by the Center for Medicaid and Medicare Services (CMS) which, if enacted, will result in $15 billion dollars in cuts over five years to service providers.

The damage that Bush has not been able to inflict through legislation is now being secretly implemented through an administrative back door. Even if Congress rejects the cuts Bush proposed to public health in his most recent budget, changes in regulations will insure that funding is not available for specific programs and activities.
The proposed CMS regulations will drastically reduce resources for programs as diverse as  graduate medical education (FR72:28930-28936), hospital and ER care (FR72:29748-29836), outpatient hospital and clinic services (FR72-55158-55166), school based health programs including enrollment efforts (FR73635-73651), services to individuals with disabilities (FR72:45201),  and case management services (FR72:68077-68093).  Moreover, the rules changes severely restrict   (FR72-73708-73720)or eliminate avenues for appeal of future CMS decisions.

The most dramatic of the proposed changes will enforce draconian cuts to public and teaching hospitals, and eliminate public subsidies for training the next generation of physicians.  If enacted, these rules could leave low income and rural communities completely without trauma coverage, and some states with no way to train new doctors. The rules changes will impede homeland security efforts to prepare communities for pandemics, terrorist attacks or other disasters.

In a letter to Henry Waxman dated February 14, 2008, Dr. Bruce A. Chernoff, the Director and Chief Medical Officer of Los Angeles County Health Services wrote, “Within the last five years, ten hospitals in the [LA] county have either shut down their ER or completely closed the hospital.  If a series of Medicaid regulations currently awaiting implementation by the US Department of Health and Human Services (HHS) are allowed to go into effect, ER care in the county will be devastated.”

Arnold Schwartzenegger, the Republican Governor of California agrees, along with his colleagues on both sides of the aisle. The New York Times reported strong support from Republican and Democratic governors alike for a moratorium on the proposed rules.  A group of 17 states called the rules “simply awful policy” according to the NYT.

While heavily populated states such as New York and California may lose greater amounts of funding, rural states such as New Mexico will also be heavily impacted.  “In New Mexico, sometimes there is only one hospital for a multi-county region larger than an eastern state.  If you lose that hospital, then there is no trauma care,” said Lorenzo Valdez, county manager of Rio Arriba County which is approximately the size of Massachusetts.

In addition to these rules changes, the administration has announced its intent to publish changes to three more mystery rules.  As these changes have not yet been published, it is impossible to predict their future impact.

Most of the $15 billion dollars of cost for indigent care will be shifted onto state and local government at a time of economic slowdown.  States and counties will be hard pressed to raise revenues to offset federal losses. Moreover, states and counties that are economically disadvantaged will experience greater impact from these cuts for two reasons: they have poorer populations which are unable to bear the disproportionate levels of taxation necessary to preserve their healthcare infrastructure; and, because the poor are the first to lose insurance, need in these communities will increase at a faster rate.  Finally, economically disadvantaged local governments are already forced to devote high percentages of their budgets to unfunded federal mandates such as the jail expenditures caused by mandatory minimum sentencing, and hence, will have less budget available to offset health care losses.

The proposed Medicaid Rules Changes will exacerbate the growing disparity between those who can access health care in America and those that cannot.

Last year, at the request of the nation’s governors, Congress repeatedly acted on a bi-partisan basis to delay the implementation of new rules through a series of moratoria.  This year, 139 organizations have signed a letter to Congressional leaders requesting a blanket moratorium on changes to all Medicaid rules for a one year period.

In addition, there is a bipartisan effort in both houses to introduce a moratorium on two of the most devastating rules changes.  Senators Jeff Bingaman (D-NM), Elizabeth Dole (R-NC) and 22 co-sponsors have introduced S 2460 extending a one year moratorium on rules changes targeting subsidies to public and teaching hospitals.  Representatives Eliot Engel (D-NY) and Sue Myrick (R-NC) along with 208 co-sponsors have introduced HR 3533, the “Save Our Public and Teaching Hospitals Act.”

“New Mexico depends on Medicaid funding to ensure the state’s most vulnerable citizens have access to health care.  The proposed rules would severely restrict the state’s ability to provide medical services to uninsured patients,” Bingaman said for this article.  “This is an issue that will impact states nation wide and I strongly urge my colleagues to support this bill.”

While Senator Hillary Clinton has signed on as a co-sponsor of S 2460, Senators Barak Obama and John McCain have not.

Actions You Can Take

You can contact Senator Charles Grassley (R-IA), the ranking Republican on the Senate Finance Committee at (202) 224-3744 and politely let him know you would appreciate his help passing S 2460 as well as a one year moratorium on all CMS rules changes. Remember, this is a bi-partisan issue and we need Republican support.

You can contact Senator Harry Reid (D-NV) at (202) 224-3542 and tell him to help pass S 2460 along with a one year moratorium on all CMS rules changes.

You can contact House Speaker Nancy Pelosi (D-CA) at 202) 225-0100 and ask her to support HR 3533 as well as a one year moratorium on all CMS rules changes.

You can contact your own senators and representative and ask them to support these bills along with a one year moratorium on all CMS rules changes.

You can contact Senator Hillary Rodham Clinton (D-NY) at (202) 224-4451 and thank her for her support for S 2460. Ask her to support a one year moratorium on all CMS rules changes and to make stoppage of CMS rules changes a platform in her campaign.

You can contact Senator Barak Obama (D-IL) at (202) 224-2854 and ask him to please support S 2460 as well as a one year moratorium on all CMS rules changes.  Ask him to make the moratorium a talking point in his campaign.

You can contact Senator John McCain (R-AZ) at (202) 224-2235 and ask him to please support S 2460 as well as a one year moratorium on all CMS rules changes.  Ask him to make the moratorium a talking point in his campaign.

Thank you for your support on this very important issue!

(Also available in purple.)

Voter disenfranchisement is a fact in New Mexico.

Although the Gubenatorial Mansion and both houses of the state legislature are comfortably controlled by Democrats, the systematic disenfranchisement that tossed New Mexico to Bush in 2004 threatens to throw the 2008 presidential election results to the Republicans as well.

Systematic voter disenfranchisement in 2004 occured in two stages. First, Governor Bill Richardson ushered a bill through the legislature establishing a February presidential “caucus” in advance of the traditional late primary. The “caucus” was actually a limited primary run by the Democratic Party rather than the state.

Richardson probably favored the “caucus” as a means of improving his own chances at the presidency by pushing New Mexico to the front of the voting pack.

While the February date insured New Mexicans a greater stake in the selection of the Democratic presidential candidate, it also subjected rugged rural mountainous counties to the risk of blizzards and impassible roads. This was probably not bemoaned by the Richardson campaign since he had lukewarm support among rural subsistance ranchers in the north where the blizzards fester.

The state Democratic Party countered the possibility that poor weather might depress voter turn-out by limiting voting hours to 12-7, and cutting back the number of polling places in each county to five or six sites.  Many counties in New Mexico are larger than Connecticut.  The new rules insured that rural New Mexicans would have to request time off from work to drive several hours in the snow through mountain passes to their polling place.  Once there, they were forced to wait in line because of the consolidated voting venues for hours.

The voters who were excluded from the selection process for the Democratic presidential candidate were primarily low income, rural Native American and Hispanic voters. Many were angered by the deliberate effort to depress the vote and did not show up at the polls in November to support  Kerry.

Even so, were it not for a second disenfranchisement in November of 2004, Kerry would probably have won New Mexico.  In November of 2004, the Democratic Secretary of State (Rebecca Vigil Giron) and the Democratic Governor (Bill Richardson) employed voting machines made by Sequoia, Danaher and ES&S. Oddly, the machines systematically undercounted the votes of rural Native Americans and Hispanics at two to three times the rate that Anglo votes were undercounted.
In some Native American precincts, over 99% of the people who drove through a snowstorm to wait in line in the blowing wind at the polls, did not (according to the machines) care to cast a vote for president.

New Mexicans rebelled and brought a lawsuit against the state. Richardson withdrew the machines and was hailed nationally as a voting reform pioneer.

But the disenfranchisement has not ended.  On Super Tuesday of this year, somehow, despite the fiascos caused by overcrowding and long lines at consolidated polling stations, the Democratic Party of New Mexico (which had now switched to paper ballots) again did not anticipate high turn out.  Predictably, the rural north was socked by a ferocious blizzard on “caucus” day.  People braved the storm to wait in line for two or three hours only to learn that the polling stations had run out of ballots.  

The incompetence of the party apparatchik was again compounded by the shenanigans of the new Secretary of State, Mary Herrera, who had retained ES&S, the same company whose machines previously undercounted Hispanic and Native American votes, and allowed them to “clean up” New Mexico’s voting lists just prior to the caucus. As a result of purged lists, over 16,000 “provisional ballots” were cast. In New Mexico, it is normal for 50% or more of all provisional ballots to be discarded. A discarded provisional ballot is a lost vote. Moreover, oversight of the primary by the Democratic Party rather than the county clerks, along with the return of old fashioned paper ballots, meant that ballot boxes in some counties notorious in previous years for vote tampering, were taken home by party officials for sleepovers before being counted.

I called the Office of the Secretary of State to ask their spokesperson, James Flores, whether they plan to fix the voter rolls prior to the November election.  According to Mr. Flores, the Secretary of State does not need to examine voter rolls if the public complains.  “The Democrat Party has not contacted us,” he said, adding that the voters who were purged were probably members of the Green Party who would not have been allowed to vote anyway.  “The Democrat Party ran the election,” stated Flores. “If they call us and say there were problems, then we need to work on it.”

Flores complained that he was fielding the same questions from reporters repeatedly. When informed that reporters were asking due to public interest, and that the Secretary of State is a public employee and must presumbably respond to the public, he repeated, “When the Democrat Party calls us and tells us there was something wrong with the list, we will investigate.”  

He also stated that the current Secretary of State was not responsible for the contract with ES&S, as it had been signed under the administration of the previous Secretary, Rebecca Vigil Giron and that he had not heard any complaints from the county clerks about the caucus. However, since the caucus was run by the Democratic Party, the clerks were not involved and would have no reason to complain.

It is relatively insignificant whether the purged voter lists and subsequent failure to validate all provisional ballots threw the election to Clinton. One extra delegate at the Democratic convention is probably not an election-breaker.

The scary fact is that Secretary of State Mary Herrera’s ES&S voting lists are scheduled for deployment in the November presidential election.  The rural Hispanics and Native Americans who have been systematically undercounted and purged, vote overwhelmingly Democratic.  There is a strong possibility that disenfranchisement caused by faulty lists will once again throw the presidential election in New Mexico…this time to McCain.

Bill Richardson chastised the party for its incompetence after Super Tuesday.  We need to pressure him into more than lip service.  The voter lists must be restored.

New Mexico is not the only state relying on private companies to run its elections. Now is the time for vigilance.  How well does the voting apparatus serve democracy in your state?

In early December, I diaried a proposed Medicaid Rules change, which, if it goes into effect in May as scheduled, will result in draconian cuts to public and teaching hospitals.  This is a non-partisan issue: the US v. the Bush Administration.  Representatives Eliot Engel (D-NY) and Sue Myrick (R-NC)  have introduced HR 3533, the Preserve Our Public and Teaching Hospitals Act into the house to block the odious rules change.  Senators Jeff Bingaman (D-NM) and Elizabeth Dole (R-NC)have attemtped to introduce a moratorium on the rule in the senate.

Unfortunately, the good guys have not been able to muster the votes to extend an existing moratorium on the rules change, which would spare our frayed public health care infrastructure a possibly mortal blow for at least another year.

Find out what you can do about it after the jump.
There can be no doubt that Bushco is using post Katrina New Orleans as a model for healthcare in America.  If you recall, one of the first initiatives of reconstruction was the elimination of Charity Hospital, the primary refuge of New Orleans’ poor.  I live in a very large rural state.  There are only three urban areas in our entire state.  If Bush’s proposal passes we could be eventually  left with only three to six hospitals in the state, leaving many residents without hospitals for hundreds of miles. What kind of sense does this make given that our “terrorist threat alert” never drops below orange ?

There is no chance this moratorium will succeed without public awareness.  I have been calling and emailing reporters in my state and Washington for six weeks without success. So far, the only press I have noticed is my own diary.  I have spoken several times with a reporter from McClatchy who says he will cover the topic once it becomes a crisis.  The others have not even been willing to return my calls.

I have decided to take matters into my own hands as a citizen journalist.  In early March, I am flying to DC where I will visit Time and WaPo, camcorder in tow, to ask why they are not covering this story.  A number of health officials from communities across the US will be in town pondering the impacts of the rules change at that time.  I will try to enlist a few to join me.  I will post diaries and videos informing you of my findings.