medicaid

Chasing millions in Medicaid dollars, hospitals buy up nursing homes

The nursing home can afford these multimillion-dollar improvements partly because it has, for the past five years, been collecting significantly higher reimbursement rates from Medicaid, the state-
federal health insurance program for the poor.

.. A wrinkle in Medicaid’s complex funding formula gives Indiana nursing homes owned or leased by city or county governments a funding boost of 30 percent per Medicaid resident. The money is sent to the hospitals, which negotiate with the nursing homes over how to divvy it up.

.. Nearly 90 percent of Indiana’s 554 nursing homes have been leased or sold to county hospitals in the past 14 years

.. Today, more than two-thirds of Indiana’s Medicaid long-term care dollars go to nursing homes. The U.S. average is 47 percent.

.. they say, it has provided incentives to steer patients to nursing homes rather than lower-cost options, such as home health care or community-based day-care centers.

.. a bad deal for the poor because it takes a large portion of Medicaid dollars targeted for services for low-
income nursing home residents and sends it instead to hospitals to use as they please.

.. States pay no more than half the costs, although the federal match varies based on a state’s wealth.

.. All the Medicaid funding for nursing homes should be going to those homes to care for the poor, not shared with hospitals to use as they choose, he said.

Are We Down to President Pence?

Lately, Trump’s stupendous instability has actually been looking like a plus. There he was, telling Democrats that he didn’t want to cut taxes on the rich. Trying to find a way to save the Dreamers

.. Better insane than sorry.

.. Then came the U.N. speech, and the reminder that the one big plus on Pence’s scorecard is that he seems less likely to get the planet blown up.

.. Nikki Haley, our U.N. ambassador, argued that the president’s speech was a diplomatic win because “every other international community” has now started calling Kim “Rocket Man,” too.

.. Does this sound like a triumph to you, people? It’s perfectly possible Kim takes it for a compliment since he does like rockets. And I’ll bet he likes Elton John songs, too.

.. But about the “totally destroy North Korea” part: I believe I am not alone in feeling that the best plan for dealing with a deranged dictator holding nuclear weapons is not threatening to blow him up.

.. We tell ourselves that the president is surrounded by men who are too stable to let him plunge us into a war that will annihilate the planet. But Trump’s U.N. speech was a read-from-the-teleprompter performance, not a case of his just blurting out something awful. People in the White House read it and talked about it in advance.

.. The president also kept saying he was always going to “put America first,” which is of course true. But at a U.N. venue, it was a little like going to the first meeting of the PTA and repeatedly pointing out that you only care about your own kid.

.. He tried to be super-nice at a luncheon with African leaders, assuring them, “I have so many friends going to your countries trying to get rich.”

.. The big takeaway, however, was that the president of the United States had threatened to destroy a country with 25 million people.

Comments:

We can survive an ultra conservative president who is not totally insane and who listens to advisors…at least until 2020. It’s not at all clear that we or the rest of the world can survive the insanity of the Child in Chief now in the Oval Office.

.. There’s little doubt that Democrats stand to gain politically from the train-wreck presidency of impulsive and short-sighted Trump. But the Democrats must choose country before party. A sane, hard-line conservative like Pence is better for the nation than an irrational narcissist who could plunge the entire world into war.

.. A president Pence would give the right just what they wanted a twitterless occupant of the Oval Office. If anyone would like to know how a Pence would run the 50 states just look at how he ran the state he was governor of.

.. Trump, while not exactly the devil I know, is at least fairly predictable in that his main concerns are self preservation and self enrichment.

.. It is time for this fantasy of impeachment to stop. An election is not “fraudulent” because a foreign power releases information that persuades Americans to vote one way or another. Absent evidence that Russia actually hacked the voting machines and changed votes, or that Trump personally colluded with Russia to influence the elections, there is no shot at impeachment, and such evidence seems unlikely to emerge. Russia should pay a price for its actions, and the Democrats – and I am one- should forget about Hillary, stop the apocalyptic rhetoric, stop fantasizing and demonstrating, and concentrate on winning state, local, and. Congressional elections in the short term, and the next presidential election after that.

.. Threats like these only ADD to Kim’s determination to escape the fate of Iraq and Libya. The US has a “big stick.” It should “speak softly.”

.. 70 percent of the voters in Pennsylvania were Democrats and yet Pennsylvania is represented by a majority of Republicans.

.. That’s called gerrymandering.

.. In Pence’s favor he does not have a legion of “supporters” who back him no matter what he does or says. Pence doesn’t seem to have won allies either as a governor or a representative from Indiana. Trump supporters seem to tolerate him, but reserve their adoration for Trump himself.

.. there will be no easy end to the Trump/Pence administration. Their crimes against the people of the US will linger for generations. They will not go quietly by vote or impeachment.

.. As awful as he is, I’ll still take Trump over Pence. Trump is so ignorant and unhinged that he’s not helping the Republicans destroy our own country with their selfish, hate-the-people agenda. Pence would be the driving force that would allow the destruction to move ahead unchecked. We’d lose Social Security, Medicare, Medicaid, women’s reproductive rights, and religious freedom. (The Republicans and their extreme-right-wing Christian supporters believe in religious freedom only for themselves and want their beliefs turned into law.)

Donald Trump’s Identity Politics

Millions of white voters began to see themselves more openly not as white supremacists but as white identified.

It is no secret that the president has capitalized on the increasing salience of race and ethnicity in recent years. The furious reaction to many different historical and cultural developments — mass immigration; the success of the civil rights and women’s rights movements; the election and re-election of a black president; and the approaching end of white majority status in the United States — has created a political environment ripe for the growth of white identity politics.

The vast majority of white Americans who feel threatened by the country’s growing racial and ethnic diversity are not members of the KKK or neo-Nazis. They are much greater in number, and far more mainstream, than the white supremacists who protested in Virginia over the weekend.

.. total of 36 percent of whites described their racial identity as either “very important” (16 percent) or “extremely important” (20 percent), according to an American National Election Studies survey in January 2016. Another 25 percent said it was “moderately important.”

.. The survey, they write,

asked four questions that captured dimensions of white identity: the importance of white identity, how much whites are being discriminated against, the likelihood that whites are losing jobs to nonwhites, and the importance of whites working together to change laws unfair to whites. We combined those questions into a scale capturing the strength of white identity and found that it was strongly related to Republicans’ support for Donald Trump.

.. In a separate essay on the Post’s Monkey Cage site in March 2016, Tesler and Sides explained that

Both white racial identity and beliefs that whites are treated unfairly are powerful predictors of support for Donald Trump in the Republican primaries.

.. What are the views of “white identifiers”?

According to Jardina, these voters

are more likely to think that the growth of racial or ethnic groups in the United States that are not white is having a negative effect on American culture.

And they are

much more likely to rank illegal immigration the most important issue facing the U.S. today, relative to the budget deficit, health care, the economy, unemployment, outsourcing of jobs to other countries, abortion, same-sex marriage, education, gun control, the environment or terrorism.

.. Perhaps most important, Jardina found that white identifiers are

an aggrieved group. They are more likely to agree that American society owes white people a better chance in life than they currently have. And white identifiers would like many of the same benefits of identity politics that they believe other groups enjoy.

In other words, most — though by no means all — white identifiers appear to be driven as much by anger at their sense of lost status as by their animosity toward other groups, although these two feelings are clearly linked.

Tesler argued last November, after the election, that the

Trump effect combined with eight years of racialized politics under President Obama, means that racial attitudes are now more closely aligned with white Americans’ partisan preferences than they have been at any time in the history of polling.

.. Podhoretz recognizes Trump’s adamant refusal to alienate his most dogged backers:

If there’s one thing politicians can feel in their marrow, even a non-pol pol like Trump, it’s who is in their base and what it is that binds the base to them

.. He did so, Podhoretz argues, by capitalizing on media and organizational tools disdained by the establishment: Alex Jones’s Infowars; the American Media supermarket tabloids, including The National Enquirer, Star and the Globe; the WWE professional wrestling network where “Trump intermittently served as a kind of Special Guest Villain.”

.. 43 percent of Republicans said there is a lot of discrimination against whites, compared to 27 percent of Republicans who said that there is a lot of discrimination against blacks.

.. Direct and indirect references to threats to white identity continue to shape Trump’s rhetoric. In his ongoing drive to demonize the media, Trump declared during his rally in Phoenix on Tuesday that “they are trying to take away our history and our heritage.”

his supporters think that whites and Christians are the most oppressed groups of people in the country.

.. No one doubts that it has been unsettling for many Americans to adapt to an increasingly interconnected world. Still, history has not been kind to those who have unequivocally yielded to racial grievance — to our local agitators, the David Dukes and the Father Coughlins, as well as to the even more poisonous propagators of racial hatred overseas. As Trump abandons his campaign promises

to end endless war,

to provide “beautiful” health care,

to protect Medicaid,

to restore American industry, jobs and mines,

to make Mexico pay for a border wall,

he has kept his partially veiled promise to focus on white racial essentialism, to make race divisive again. He has gone where other politicians dared not venture and he has taken the Republican Party with him.