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Jeanie Forrester - Prudent to study Medicare Expansion issue carefully

Last year the Supreme Court ruled that the federal Affordable Care Act (ACA) could not mandate that states expand their Medicaid programs. Should New Hampshire expand its Medicaid program? The answer to this question will be a major policy decision for lawmakers.
To answer this question, lawmakers created the Medicaid Expansion Study Commission which will spend the next 3 1/2 months studying this issue. It is instructive to note that in at least three situations where Medicaid was expanded in New Hampshire in the past (1989, 1992, and 1994) in each case, there was a five-month deliberative process (SB-195, SB-319, SB-774 respectively). This commission will begin meeting in early July and make a report of findings and recommendations for proposed legislation on or before October 15, 2013.
So what is Medicaid and how does it work?
Medicaid (Title XIX of the Social Security Act) is a state and federal entitlement program that pays for medical assistance for certain individuals and families with low incomes. This program became law in 1965 as a cooperative venture jointly funded by federal and state governments to assist states in providing medical assistance to eligible needy persons. Medicaid is the largest source of funding for medical and health-related services for America's poorest people.
Medicaid is very comprehensive with little to no cost to the beneficiary for services.  Coverage is similar to private insurance with much less exposure to the beneficiary.  There are a number of providers who do not accept Medicaid so choices are more limited. According to staff at the N.H. Department of Health & Human Services (NHDHHS), a completed Medicaid application takes 30 days to be processed and individuals receive an ID card within 7-10 business days. The ID card can be used like an insurance card with very few limitations. There are no limits on primary care, hospitals, or the number of emergency room visits. Coverage is effective immediately and allows for a 90-day retroactive period where claimants can submit bills to be paid.
In New Hampshire, Medicaid is the state's largest and most expensive program, costing $1.4 billion a year and accounting for 27 percent of general fund spending. (According to the latest annual report —2008 — listed on the NHDHHS website, more than 147,000 citizens received Medicaid.) It is estimated that approximately 58,000 additional New Hampshire citizens will benefit if we accept the $2.5 billion in federal funds to expand Medicaid.
The bipartisan commission proposed by the Senate Finance Committee and signed into law by Governor Hassanwill have the time and resources necessary to study what expansion will mean for the state. Some issues to consider:
Over the next seven years, expanded Medicaid could have a net cost to N.H. taxpayers of up to $200 million. (Once the federal match drops to 90 percent after three years, state costs will be upwards of $50 million annually.) How will taxpayers fund this $50 million expenditure?
Using the federal funding estimates put forward by expansion proponents, it appears that federal and state government will be spending nearly $15,000 per new enrollee under expansion. At this cost, new enrollees would be on health insurance plans classified as "Cadillac" by the ACA — plans that are now subject to increased taxes. Will the new enrollees be able to pay the increased taxes or will someone else be responsible?
Given the state's already low Medicaid reimbursement rates, some providers have stopped accepting new Medicaid patients. Providers have been unable to guarantee they would have the ability to take on the thousands of new patients expected to seek care under the expanded program. Will there be enough providers to offer health care services with this new population?
According to the New Hampshire Center for Public Policy Studies, with the increase of Medicaid coverage up to 138 percent of poverty*, 34,000 people with existing private insurance will now become eligible for Medicaid. Will they drop their private insurance to go onto Medicaid?
A recent paper by the New Hampshire Center for Public Policy Studies proposes several expansion models to cover various segments of New Hampshire's uninsured population — each of which would have different costs and implications. To date, none of these additional options have been explored; despite the study showing that the one-size-fits-all proposal offered by the Governor is not the most cost effective for the state. Shouldn't these options be reviewed?
On issues of both cost and effectiveness, it is not clear that the one-size-fits-all Medicaid Expansion is the right path for New Hampshire taxpayers, patients or providers. It would seem only prudent that this commission hear from the experts, study this issue carefully, learn about the pros and cons of this entitlement, and assure that we have a plan that will be successful for our state.
As always, I want to hear from you. If you have a concern you'd like to share, an event you'd like me to attend, or a problem you think I might be able to help with — please call or email (271-2609 [o] or This email address is being protected from spambots. You need JavaScript enabled to view it. ). If you would like to subscribe to my e-newsletter, visit HYPERLINK "http://www.jeanieforrester.com"www.jeanieforrester.com and sign up.
(*2013 Poverty Guidelines: 100 percent poverty for a family of four is $23,550; 138 percent of poverty for a family of four is $32,499; Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Downloads/2013-Federal-Poverty-level-charts.pdf)
(Republican Jeanie Forrester of Meredith represents District 2 in the New Hampshire State Senate.)

Last Updated on Friday, 12 July 2013 07:49

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Michelle Malkin - Some women have fetish for sociopaths

I would like to declare a war on women — namely, all those cringe-inducing ninnies who lust after every celebrity criminal defendant with big muscles, tattoos, puppy-dog eyes or Hollywood hair.
You know who I'm talking about, right? America's Bad Boy groupies. They're on the courthouse steps with their "Free Jahar" signs, cooing over how "hot" and "cute" the bloodstained Boston Marathon bombing suspect is. He "can blow me up with babies," one moral reprobate quipped shortly after his capture. "I'm not gonna lie, the second bombing suspect, Dzhokhar Tsarnaev, is hot. #sorrynotsorry," another young girl boasted.
Among the callous accused killer's victims, in case you'd forgotten: 8-year-old boy Martin Richard, who had been cheering on his dad and other family friends at the race. But who cares about an innocent dead child blown to bits by pressure cooker bombs in the name of Allah?
Far from a minuscule fringe, the Ja-harem is a growing social media phenomenon. Its members mimic Justin Bieber's Beliebers, adopting the last name of their Tiger Beat terrorist and doodling hearts around his mug shot. In heat or in jest, these depraved females continue to spread viral photos, memes and hashtags of their Islamist Idol. One woman showed up at Tsarnaev's court appearance Wednesday donning a "Free the Lion" T-shirt. Another sported a "Dzhokhar Tsarnaev is innocent" tee, while her gal pal shouted, "Exonerate!"
For those ladies who prefer jocks to jihadis, there's accused murderer/NFL star Aaron Hernandez. He's "fine as wine," one woman lusted. He's "too damned sexy to go to prison," another lamented. "He can come to jail at my house," sighed yet another. In response to one of gangsta Hernandez's Glock-wielding Instagram pics, one sick chick slavered, "Soooo hot with the combination handgun-mirror selfie."
Fugitive cop-killer Christopher Dorner also had his own fan club. Parked in front of their TV sets, women cheered on the "kinda sexy" homicidal maniac as he terrorized Southern California before perishing in a cabin inferno. "I'd honestly hide Dorner in my house," one fan girl enthused. Tens of thousands "liked" Dorner's various support pages on Facebook.
Harmless Internet chitter-chatter? Don't kid yourselves. While some of the murderers' panting minions may be joking, it's irresponsible women like these who end up enabling, marrying and conspiring with public menaces.
They're your neighbors and relatives, suburban gals like Colleen "Jihad Jane" LaRose and Jamie "Jihad Jamie" Paulin-Ramirez of Colorado, who agreed to wed Muslim terrorists and conspired to kill Swedish cartoonist Lars Vilks. Paulin-Ramirez dragged her 6-year-old (whom she renamed "Walid") to Ireland to assist with the plot. Family members said she was "easily influenced" and that "any man that came along ... she kind of followed like a lost puppy."
It would be one thing if these morally stunted followers segregated themselves in enclaves outside the American mainstream. But some of these damaged goods end up on juries, entrusted to weigh evidence fairly, digest complex instructions, and render impartial verdicts in matters of life and death. Indeed, they are aggressively sought after by predatory defense lawyers. I'll never forget the female jurors of the first murder trial of confessed parent-killers Lyle and Erik Menendez. Star-struck by "glamorous" defense lawyer Jill Abramson, the women of the Menendez jury told Los Angeles reporters that "they admired her wardrobe and biting wit."
Their swooning for the hunky Menendez brothers, whom they praised as "bright" and "nice," was obscene. After a mistrial was declared, Abramson arranged for "her jurors" to meet the boys. Soon after, talk show queen Sally Jesse Raphael hosted a program on "women who would leave their husbands to marry a Menendez."
From Menendez mania to Free Jahar, the pathologies persist: Easily led. Emotion-driven. Desperate for male approbation. Prone to acting with their lady parts instead of their lady smarts. Heckuva job, feminism! All the equalization and parity in education and the workplace are for naught if women can't distinguish right from wrong and "hot" from evil.
Lesson learned: You can indoctrinate generations of American women in the ways of gender empowerment, but you can't make a goodly portion of them think straight. Hormones trump basic human decency and good judgment in the crowded coven of sociopaths.
(Syndicated columnist Michelle Malkin is the daughter of Filipino Immigrants. She was born in Philadelphia, raised in southern New Jersey and now lives with her husband and daughter in Colorado. Her weekly column is carried by more than 100 newspapers.)

Last Updated on Friday, 12 July 2013 07:44

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Jim Hightower - Mean Team piles on jobless Americans

"Come on, team, let's get mean!"
This is not the chant of rabid football fans, egging on their favorite team to crush the opponents. Rather, it's the raucous war cry of far-out right-wing ideologues all across the country who're pumping up Team GOP to pound the bejeezus out of America's millions of unemployed workers. Far from a game, this is real, and it's a moral abomination.
I've been unemployed before, and I can tell you it's a misery — all the more so today, when there are far more people out of work than there are job openings. This leaves millions of our fellow Americans mired in the debilitating misery of long-term unemployment.
But that's not miserable enough for a feral breed of Ayn Randian political zealots who are lobbying Republican governors, legislators and congress-critters to punish the jobless for ... well, for their joblessness. In this perverse universe, the conventional wisdom asserts that unemployment benefits and other poverty-prevention programs are sapping our nation's vitality by allowing "moochers" to live the Life of Reilly and avoid work.
The GOP's budget demigod in the U.S. House, Rep. Paul Ryan, expressed this dogma in a fanciful homily deriding America's safety net as "a hammock that lulls able-bodied people to lives of dependency and complacency." This from a guy whose family's wealth was gained from government contacts and who has spent practically all of his adult life in the sweet-swaying hammock of congressional privilege, presently drawing $174,000 a year from Old Uncle Sugar.
As ridiculous and just plain mean as this attitude is, it plays well in the insanity that now defines "the debate" in Republican primary elections. So, state-after-state (as well as Congress) are succumbing to this pound-the-poor, right-wing screed by frenetically slashing unemployment benefits.
Behind this faux-philosophical push are the smiling barons of corporate America. Without jobless payments, you see, desperate millions will be forced to whatever low-wage, no-benefit, dead-end jobs the barons design.
What's at work here is a profoundly awful ethical phenomenon that has seeped into the top strata of American society: Our nation's corporate and political elites have developed an immunity to shame. It has become morally acceptable in those lofty circles to enrich themselves while turning their backs on the rest of us. Even more damning, they feel free to slash America's already tattered safety net, leaving more holes than net for the workaday majority of Americans who've been knocked down by an ongoing economic disaster created by these very elites.
For a look at how shameful these privileged powers have become, turn to North Carolina. Until recently, this Southern state maintained a fairly moderate government with a populist streak, taking pride in its educational system and other public efforts to maintain a middle class. No more. A shame-resistant political leadership has recently taken hold, consisting of corporate-funded tea party extremists who loathe the very idea of a safety net.
The new bunch has been gutting everything from public schools to health care, and now they've turned on hard-hit citizens who're out of work. In a state with the fifth-highest jobless rate in the country, and with no recovery in sight, the right-wing governor and legislature recently whacked weekly unemployment benefits by a third, leaving struggling North Carolinians with a meager $350 a week to try to make ends meet, while simultaneously eliminating millions of consumer dollars that those families would otherwise be putting into the state's economy. Then, just to give the jobless another kick, the petty politicians cut the number of weeks people can receive unemployment aid.
This official minginess automatically disqualified the state from getting $700 million a year for long-term jobless payments from the federal government. Yet Gov. Pat McCrory issued a cockamamie, Kafkaesque claim that the gut-job ensures that "our citizens' unemployment safety net is secure," while providing "an economic climate that allows job creators to start hiring again."
Yeah, we'll all hold our breath until those "job creators" get going. Meanwhile, the GOP wrecking crew doled out a fat tax break for the corporate elites — for doing nothing. Take from the poor, give to the rich: backward Robin Hood. If ignorance is bliss, McCrory must be ecstatic.
Meanwhile, his shameless immorality has unleashed a growing storm of weekly demonstrations known as "Moral Mondays." For information about this remarkable citizens' uprising, link to the North Carolina Justice Center: www.ncjustice.org.
(Jim Hightower has been called American's most popular populist. The radio commentator and former Texas Commissioner of Agriculture is author of seven books, including "There's Nothing In the Middle of Road but Yellow Stripes and Dead Armadillos" and his new work, "Swim Against the Current: Even Dead Fish Can Go With The Flow".)

Last Updated on Wednesday, 31 December 1969 07:00

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Pat Buchanan - Vital interests vs. democratic ideals

Understandably, the Muslim Brotherhood is enraged. Having won the presidency of Egypt in free and fair elections after the overthrow of Hosni Mubarak, President Mohammed Morsi has been ousted in a military coup and placed under house arrest. Brotherhood leaders, convicted of no crimes, are being rounded up.
They played by America's rules. Now, with America's blessing, they are being locked up by America's friends in Egypt's armed forces.
Nor is this the first perceived betrayal. When Hamas won the free elections demanded by George W. Bush, America refused to recognize their legitimacy and plotted the violent overthrow of Hamas in Gaza.
When Islamists swept the first round of Algerian elections in 1991, the regime, with the blessing of Bush 1, canceled the second round, leading to a guerrilla war that cost 100,000 to 200,000 dead.
If Muslims have come to believe that Americans preaching democracy are charlatans and hypocrites, do they not have a point?
U.S. foreign policy once seemed to make sense. We put vital interests ahead of democratist ideology. We stood by those who stood by us. We did not spend time inspecting the moral credentials of those who took America's side. We played the cards we were dealt in this world.
Gen. Washington danced a jig when he heard Louis XVI, a descendant of the Sun King, would support America's cause against our mother country.
In 1917, Woodrow Wilson took us to war "to make the world safe for democracy" as an associate power of five empires — the British, French, Italian, Russian and Japanese. At war's end, Wilson signed treaties that plundered the lands and colonies of the three defeated empires, for the benefit of the victorious empires.
In the Good War from 1941 to 1945 against the Nazis, our greatest ally was the mass murderer of Christians and democrats Josef Stalin.
In the Cold War, Dwight Eisenhower sanctioned the overthrow of democratic governments in Guatemala and Iran and their replacement by autocrats who would take our side in the struggle for the world.
We welcomed the Shah, Saudi kings and Gulf emirs. JFK welcomed the "Butcher of the Balkans," Marshal Tito, to the White House. President Nixon sided with autocratic Pakistan over democratic India — for Pakistan had sided with us.
Nixon went to Beijing to toast Chairman Mao, a monster as great as Stalin. Liberals sickened by our alliance with the "corrupt and dictatorial regime" of President Ngo Dinh Diem in Saigon were ecstatic.
The Nixon White House celebrated the overthrow of elected president Salvador Allende of Chile by Gen. Augusto Pincohet.
Among other U.S. allies in the Cold War were Asian dictators and generals Chiang Kai-shek of China, Syngman Rhee and Park Chung-hee of South Korea, and Suharto of Indonesia.
Portugal's dictator Antonio Salazar and Spain's Gen. Francisco Franco were loyal allies against Bolshevism. Mobutu Sese Seko was for 32 years our man in the Congo, as Emperor Haile Selassie was in Ethiopia.
Anwar Sadat and Hosni Mubarak were American allies and dictators of Egypt from 1970 to 2011, until, in the name of our democratic ideals, we threw our flawed friend Mubarak to the wolves.
What is the cause of our present angst over what is happening in Cairo? Our democratist ideals appear to have been run over by U.S. armored personnel carriers driven by Egyptian soldiers trained by the U.S. Army. Whether or not our interests have been advanced, our ideals seem to have been wounded.
Behind our ambivalence and paralysis may be found several truths. First, the Cold War, the life-or-death civilizational struggle that defined our times, is over. No vital U.S. interest is at risk in Egypt to justify military intervention or the shedding of American blood.
This is thus their problem, not ours, most Americans believe, and our influence is receding there, even as that of the British, French and Russians did before us. Let them work it out.
Testifying to this truth is the tape of Secretary of State John Kerry inspecting his yacht off Nantucket as the Egyptian regime fell, and Obama, after a brief National Security Council conclave, heading off for the golf course on the July 4 weekend, then on to Camp David.
Today, from Egypt to Lebanon to Syria and Iraq, it is Islamist against secularist, Sunni vs. Shia, tribe against tribe, those in power against those who want power. The Arab Spring has ushered in the Arab war of all against all.
That year 1848, when all the thrones of Europe were shaken by revolution, was a similar time. And those wise old war hawks of 1812, Henry Clay and John Calhoun, found themselves again on the same side.
America, they said, should stay out.
"Masterly inactivity" is our role, said Calhoun. Added Clay, "Avoiding the distant wars of Europe, we should keep our lamp burning brightly on this Western shore as a light to all the nations than to hazard its utter extinction amid the ruins of fallen or falling republics."
(Syndicated columnist Pat Buchanan has been a senior advisor to three presidents, twice a candidate for the Republican presidential nomination and the presidential nominee of the Reform Party in 2000. He won the New Hampshire Republican Primary in 1996.)

Last Updated on Wednesday, 31 December 1969 07:00

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Froma Harrop - Good time for U.S. to lead from behind

"Leading from behind" would seem the right place for America to be in the complex crisis engulfing Egypt. But critics want President Obama up front, telling the Egyptians what's what.
Sen. John McCain complains on a Sunday talk show that Egypt's second coup in 2 1/2 years is "a strong indicator of the lack of American leadership, and influence, since we urged the military not to do that." The Arizona Republican goes on to insist that the leadership deficit is wrecking the whole Mideast. Citing the troubles in Syria, Lebanon, Iraq and Afghanistan, McCain says, "When American doesn't lead, bad things happen."
Now, can we seriously believe that a call from the president, even a stern call, would stop the whirlwind of conflict in Egypt? Sure we could threaten the $1.5 billion we give them in annual aid, but the new people in charge say they intend to reset the democracy and are friendlier to the United States. That's not going to happen.
In Egypt we saw a democratically elected president deposed for undemocratic behavior (and incompetent governing). A tough call for us, but must the United States publicly pick sides in a struggle that (a) we cannot control and (b) U.S. participation only complicates?
Naturally, both sides blame America, insisting that U.S. Ambassador Anne Patterson is plotting with their foes. The following quotes from The New York Times show our dilemma:
Mona Mohammed, a bank clerk supporting the overthrow of President Mohammed Morsi: "The ambassador is part of a conspiracy against Egypt and its people."
Mohammed Amr-All, a professor at a pro-Morsi demonstration: "The ambassador meets with the opposition and supports them."
Back in the United States, Patterson's to blame, as well. Conservative David Brooks writes: "She tried to build relationships with whoever is in power. This created the appearance that she is subservient to the Brotherhood. It alienated the Egyptian masses."
Of course, building relationships with whoever is in power is an ambassador's job, and Morsi was elected. And what about the pro-Muslim Brotherhood masses now protesting the Morsi ouster? Clearly, there are masses for every viewpoint.
Writing in The New Republic, Marc Tracy offers an "appropriate liberal response." That would be "making clear that we value democracy," while using the tools of diplomacy "to put ourselves and our allies in more certain positions when democracy, as it inevitably does, winds up giving us unwelcome surprises."
You wonder what "more certain positions" would be in the case of Egypt's unfolding chaos. Perhaps they don't exist — or put another way, the position we should have taken will be revealed by history, long after the dust settles on the tragic convulsions in Egypt.
The European Union is quietly talking to all sides, as is the Obama administration. But Obama's cautionary approach is not the American way, says a punditry frustrated that we aren't using our power to do whatever. Perhaps it should be in certain disordered situations, which describes almost every Mideast crisis. To do otherwise means choosing from equally unattractive options and taking the inevitable blowback from the side we don't seem to be supporting — which, as we see in Egypt, tends to be both sides.
More McCain: "Morsi was a terrible president. Their economy is in terrible shape thanks to their policies. But the fact is, the United States should not be supporting this coup."
The fact is, we are not supporting the coup. As Obama told a National Security Council meeting over the weekend, "The United States is not aligned with, and does not support, any particular Egyptian political party or group." Lack of leadership? No, the only sensible response at this time.
(A member of the Providence Journal editorial board, Froma Harrop writes a nationally syndicated column from that city. She has written for such diverse publications as The New York Times, Harper's Bazaar and Institutional Investor.)

Last Updated on Wednesday, 31 December 1969 07:00

Hits: 215

 
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