Medicaid Expansion: Missouri Style

I had to laugh when a reporter asked me, this morning, what you would say in response to a “what’s the problem?” question on Missouri’s Medicaid expansion.

What’s the problem, you say?

First, Medicaid expansion by referendum is the difficult path because no coalition of legislators has formed to shepherd the expansion from theory to activation. Yes, I know, legislative compromise did not work here (nor in Oklahoma) but it is, nevertheless, the more difficult path.

Second, why would the Governor seek waiver and all the accommodation necessary to expand Medicaid consistent with the summer of 2020 referendum by reaching out to HHS in February of 2021 only to retract his request — after huge sums of money, time, and effort had been invested for a July 2021 referendum-mandated roll out– in May, 2021 in the name of fiscal responsibility?

Third, after all, if everyone can have their own guestimate on what Medicaid expansion would cost Missouri in the short term or the long term, shouldn’t respectably-sourced data indicating that the federal government cost share of 90%, sweetened even more recently by COVID-19 relief legislation would render Medicaid expansion a budget neutral act, count for something? Or, maybe not.

Maybe, as I have written elsewhere, this is all about the transformation inherent in expansion of of Medicaid under the ACA from a program for the worthy poor to a program that casts no judgment on the relative worthiness of the recipient. And that’s what it is all about.

Count Me Relieved: No Missouri “Vaccine Passports” Allowed

After all, no governmental entity has, as far as I know, required a “vaccine passport” in Missouri, but it is always smart to play to the gallery. And, it is smart to talk about Missouri HB 271 as targeting vaccine passports when the bill’s much more potent attack is on local public health authority, limiting local government control over emergency health orders.

Courtney Love Speaks Truth to the Sacklers

The night before (September 2019, New York Fashion Weeks LBV show), Courtney Love, responding to a reported offer of over $100,000 from Sackler’s camp to attend the show, had told Page Six, “I am one of the most famous reformed junkies on the planet—my husband died on heroin. What is it about me that says to Joss Sackler, ‘I will sell out to you?’” (A spokesperson for LBV and Sackler told the tabloid at the time that Love’s account was “not accurate.” Sackler told WWD in 2020 that LBV never made Love a formal offer.)

Thinking Hard About Nursing Homes

This is a good article but, no, I don’t think we need to “rethink” nursing homes.

Rather, we need to think hard about nursing homes, possibly for the first time. Hardly anybody, now, gets the time and luxury of thinking before they put a family member in a nursing home. It is done in panic mode and, often enough, as part of the reign of terror known as “hospital discharge.”

Some Serious Thinking About Indoor Air Ventilation and COVID-19

Bottom line: buildings lacking air control systems designed for infection control are problematic if both individual and collective efforts to limit transmission are not considered.