Red state Medicaid expansion momentum continues to grow

Protesters in Missouri (Photo by Tessa Weinberg/Missouri Independent).

The refusal of Republican legislators to expand Medicaid in North Carolina continues to render our state more and more of an outlier — even amongst states controlled by GOP legislatures.

In just the past week, two dark red states — Oklahoma and Missouri — received new attention for making expansion a reality.

This is from a report from the Center for Children and Families at the Georgetown University Health Policy Institute:

Oklahoma successfully implements Medicaid expasnion

Since Medicaid expansion became an option for states in 2012, most Oklahoma lawmakers have been reluctant to take advantage of this life-saving opportunity, despite its health, economic, and fiscal benefits. In response to legislative foot-dragging, advocates leveraged the initiative petition process to put the issue to a vote of the people. In June 2020, voters passed the measure, enshrining Medicaid expansion in the state Constitution. After nearly a decade of opportunity, expansion became reality in Oklahoma on July 1, 2021.

More than 135,000 Oklahomans have already been approved for expansion coverage, and some 70,000 more likely qualify. With thousands of newly eligible residents able to see their doctors without financial stress, Oklahomans will be healthier people, better workers, and more financially secure. Expansion also will bring financial benefits statewide, with an estimated 27,000 new jobs, $15.6 billion in economic activity, and nearly $500 million new tax revenue in the first five years.

Implementation of Oklahoma’s expansion has been successful, largely because of legislative commitment to funding the program, our Medicaid agency’s prioritization of enrollment, and a unified effort by a broad coalition of advocates and community members. While the state’s seen a few growing pains,  thousands of Oklahomans newly have access to health insurance, financial stability, and peace of mind. (Read more…)

Meanwhile, the Missouri Independent reports that GOP efforts to block the decision of voters to expand Medicaid in the “Show Me” state have also foundered:

Missouri Supreme Court rules voter-approved Medicaid expansion is constitutional

Missouri must expand Medicaid to 275,000 eligible people who were expecting coverage under a constitutional amendment that took effect July 1, the Missouri Supreme Court ruled Thursday.

In an unanimous opinion, the court overturned a trial court ruling that the amendment, passed in August 2020 was unconstitutional because it may increase the state’s cost for the Medicaid program. 

By funding the services required under federal law, the state must allow everyone eligible to access those services, the court wrote.

“With no ambiguity, the amounts appropriated and other extrinsic evidence cannot be used to alter the plain language of the purposes stated – to fund MO HealthNet without distinguishing between benefits provided to individuals who are eligible as part of the pre-expansion population and those eligible only under” the expansion amendment, the court wrote.

The ruling “is about as concise of a win as you could imagine for the people of the state of Missouri,” said Senate Minority Leader John Rizzo, D-Independence. (Read more…)

In short, as it has for years now, the national momentum to expand Medicaid continues to pick up steam and the stubborn obstructionism of Republican lawmakers in the shrinking minority of states that includes North Carolina is looking more and more like the obstruction that so many Southern states pursue in resisting civil rights legislation in the mid-20th Century: i.e. doomed to inevitable failure.

The best editorial of the weekend: General Assembly leaders need to end this deceptive practice

Senate leader Phil Berger has made “gut and replace” one of his favorite legislative tactics.

In case you missed it over the weekend, be sure to check out the fine Capitol Broadcasting Company editorial on WRAL.com entitled “‘Gut & Replace’ tactic hides legislators’ accountability to voters.”

At issue in the essay is the longstanding practice whereby state legislators evade their own rules (and public scrutiny) by bringing up and passing entirely new pieces of legislation out of nowhere late in a legislative session and well after the annual “crossover deadline” that’s designed to prevent such a possibility.

As the editorial explains, a bill is approved by one house and sent to the other to address a particular subject. Months later, the second house that received the bill, “guts” the measure and rewrites it to deal with an entirely different subject. Then the new bill is sent back to the house in which it started, where it can be approved in a single “concurrence” vote. Often the entirely new measure is not even reviewed by a committee when it returns to its original house, despite being in completely different form.

This is from the editorial:

“Gut & Replace.” It is a favorite strong-arm tactic of Senate Leader Phil Berger. There’s nothing new about this legislative version of “bait & switch.” It’s been used by Democrats as well as Republicans.

It is a troubling practice that destroys a basic pillar of representative government — the ability of voters to hold their elected representative accountable for their actions.

Berger has transformed “Gut & Replace” from a rarely used scheme into a routine way of doing the public’s business. The tactic takes a bill that has already been passed, deletes the content of that legislation and replaces it with whatever Berger wants. It transforms, not merely amends.

The editorial lists several recent bills in which this sketchy practice has been employed, including notably, a recent controversial bill to overhaul interscholastic athletics in the state that, as it was originally passed by the House unanimously, dealt with helping families dealing with autism.

As the editorial rightfully notes in conclusion:

This tactic makes things — the good or bad of the legislation; what needs it meets or misses; who it benefits or hurts – irrelevant. It renders critical votes moving it along in the legislative process meaningless.

“This is not a good way to do the peoples’ business,” said Rep. Pricey Harrison, a Guilford County Democrat who’s served in the House for nine terms. She knows from where she talks. In 2010, after the Deep Water Horizon oil spill disaster, she worked with others to take a Senate-passed environmental bill and transform it into the Oil Spill Liability, Response and Preparedness Act. “It was an emergency situation.”

There is no emergency concerning high school athletics, or the other issues now being rushed through via “Gut & Replace.”

Click here to read the entire editorial.

Billionaires slipped the surly bonds of Earth, but couldn’t escape its problems

Photo by Joe Raedle/Getty Images

If Bezos and co. wanted to “[touch] the face of God,” they could have kept themselves and their billions on solid ground, and devoted it to Her creation on Earth.

Billionaire space cowboys Jeff Bezos and Richard Branson have rightfully been taking some flack for sub-orbital jaunts earlier this month that garnered plenty of headlines but little in the way of actual scientific advancement, apart from trying to normalize the idea of routine spaceflight for other, exceptionally rich people.

With all the power of the rockets that propelled them and their titanic egos into the wild blue yonder, social media went incandescent with criticism, arguing persuasively that Bezos and Branson could have used their money to address a sprawling multitude of problems, from climate change to income inequality, back here on Earth.

“Jeff Bezos is going into space tomorrow. Yesterday, on earth, I saw a man search for food in a trash can,” the critic Charles Preston observed on Twitter.

Warren Gunnels, a top aide to U.S. Senate Budget Committee Chairman Bernie Sanders, I-Vt., piled on, tartly noting that “class warfare is Jeff Bezos, Elon Musk and Richard Branson becoming $250 billion richer during the pandemic, paying a lower tax rate than a nurse and racing to outer space while the planet burns and millions go without healthcare, housing and food.”

Others wryly noted that should Bezos, the former Amazon chief, need to relieve himself while rocketing through the skies, he could always use the same plastic bottles that his drivers have said they use as they try to meet punishing delivery schedules.

Bezos, at least, had the presence of mind to observe that his critics were onto something, conceding that they were “largely right,” CNBC and other outlets reported.

“We have to do both,” he said. “We have lots of problems here and now on Earth and we need to work on those and we also need to look to the future, we’ve always done that as a species and as a civilization. We have to do both.”

On one level, Bezos was right. There always has been a fundamental tension between humankind’s interstellar ambitions, which tend to be massively expensive, and the feeling that money could be better used to ameliorate more terrestrial concerns.

“I am not opposed to climbing mountains because they’re there, or pursuing knowledge for knowledge’s sake, but I would urge the Trump Administration to consider putting its scientific efforts into problems closer to home (climate change? Or, say, clean water in Flint?) before our plan to colonize the moon turns into a plan to escape to it.” Ana Marie Cox wrote in 2018 as the former president briefly floated the idea of lunar colonization before the Earth was plunged into the worst public health crisis in a century.

There is undoubtedly a case to be made for the utility of spaceflight of advancing the cause of human knowledge. The digital flight controls pioneered by the Apollo program is “now integral to airliners and is even found in most cars,” according to NASA, which, admittedly, has something to gain by touting the earthbound benefits of space flight.

Earthrise, the photo by NASA astronaut William Anders (Image via NASA).

Writing in Foreign Policy in 2019, Greg Autry reminded readers of the now legendary image of the Earth captured by Apollo 8 astronaut William Anders in 1968: A big, blue marble looking alone and so very vulnerable in the vast void of space.  That photo, dubbed “Earthrise,” has inspired ever since.

“Today conservationists and other critics are more likely to see space programs as militaristic splurges that squander billions of dollars better applied to solving problems on Earth,” Autry wrote. “These well-meaning complaints are misguided, however. Earth’s problems—most urgently, climate change—can be solved only from space. That’s where the tools and data already being used to tackle these issues were forged and where the solutions of the future will be too.”

Knowledge — and money — deployed in the service of the greater good is almost always welcome. And I remain as much an evangelist for the exploration of interstellar space as anyone else. I agree with the premise that there is a mandate to explore — while gleaning the knowledge that comes along with it.

But in the case of the billionaire space race, there was almost no sense that this was, to paraphrase Neil Armstrong, one giant step for humankind.

Rather, it was about puffing the egos of spectacularly wealthy men, who despite all the hoopla, never made it that far into space in any event, with negligible scientific benefit.

Bezos and Branson, slipped the surly bonds of earth, as the poet John Gillespie Magee once wrote. But they returned to a planet just as riven by inequality, war, a still raging pandemic, and the crisis of climate change.

I’d suggest that if they were looking, as Magee also wrote, to “[touch] the face of God,” they could have kept themselves  — and their billions — on solid ground, and devoted it to Her creation on Earth.

John Micek is the editor-in-chief of the Pennsylvania Capital-Star, which first published this essay.

Tentative opioid lawsuit settlement announced as deaths from drug overdose climb

Cities and county governments are in line to receive most of North Carolina’s share of the $26 billion opioid lawsuit settlement announced this week.

A bipartisan group of state attorneys general agreed to settle lawsuits with drug maker Johnson & Johnson and drug distributors AmerisourceBergen, Cardinal Health, and McKesson. The three distributors together will pay $21 billion over 18 years, and the Johnson & Johnson would pay $5 billion over nine years, with $3.7 billion paid in the first three years.

North Carolina Attorney General Josh Stein was one of the chief negotiators.

At least 44 states, 95% of cities and counties suing, and others suing the companies must sign on to the agreement to get part of the money, according to The Council of State Governments. States have a month to sign on, and cities and counties have 150 days.

North Carolina would be eligible for up to $750 million, with 80% going to all counties and 17 municipalities, 15% going to the state, which the legislature would use to address the opioid epidemic, and 5% going into an incentive fund to get local governments to sign on. The NC Association of County Commissioners is urging counties to sign.

Each local government would have to create a separate fund for the money and use it for opioid-related expenses.

The first payments are expected to arrive in April 2022, according to Stein’s office.

Lawsuits claimed that drug makers and distributors hold responsibility for helping fuel the opioid epidemic. The companies deny responsibility.

Even as this group of  lawsuits connected to opioid sales and distribution took a step toward conclusion, hospitalizations and deaths from drug overdose climbed.

Shortly before the tentative settlement was announced, the Centers for Disease Control and Prevention released data showing a sharp rise in overdose deaths last year. Drug overdose death in the US increased more than 29% in 2020. In North Carolina, the increase was nearly 35%, with more than 3,000 reported deaths from overdose.

The COVID-19 pandemic has overshadowed the opioid epidemic, but the NC Department of Health and Human Services continues to update the Opioid Action Plan it first released in 2017.

The May 2021 update says that 62% of overdose deaths in 2019 involved two or more substances. While overdoses from commonly prescribed opioids are declining, overdoses from heroin, fentanyl, and fentanyl-type drugs are spiking, according to the updated report.

In the first three months of 2021, emergency hospital visits for opioid overdoses in the state were 22% higher than the first three months of 2020, according to preliminary data.

The updated action plan widens the focus to include substances in addition to opioids, and looks to expand drug treatment, prevention, and harm reduction for historically marginalized communities.

Charlotte PD settles civil rights suit, promises to stop using tear gas on protesters

Law enforcement officers deployed pepper spray to block protesters off the Historic Alamance County Courthouse Square where a Confederate statue stands. Photo: Anthony Crider, licensed under Creative Commons

In a settlement with civil rights groups, the city of Charlotte and the Charlotte-Mecklenburg Police Department agreed to abide by directives geared toward a more peaceful response to protests, including a ban on the use of tear gas and the practice of corralling crowds, according to a press release distributed Friday by legal groups representing the plaintiffs.

The police department used chemical weapons, including tear gas on protesters around June 2, then trapped them by blocking their exits, the lawsuit filed in Mecklenburg County Superior Court alleged. The police conduct “violated the protesters’ rights to assemble, to freedom of speech and to due process under the North Carolina Constitution,” the lawsuit claimed.

The plaintiffs included the the NAACP, Charlotte Uprising, Team TruBlue, Southeast Asian Coalition Village (SEAC), the ACLU of North Carolina, and four Charlotte residents.

“We must not forget that people were protesting police violence and the police brutally proved the point of the protesters with their violent actions,” said Chantal Stevens, executive director of the ACLU of NC in a press release Friday. “We will continue to support protesters in their demands for justice and police accountability.”

The plaintiffs described the police response as “a premeditated and violent attack on peaceful demonstrators,” the press release stated.

The Charlotte-Mecklenburg Police Department said the lawful protests escalated into assaults on more than 50 police officers on June 2, 2020, WCNC reported. Officers from the department arrested 16, according to the report.

According to the settlement, the city and CMPD have added crowd control measures to policies and directives following the filing of the lawsuits — including banning the use of tear gas and from kettling, a military-style tactic of forming lines around protests to prevent them from leaving. The directives also require officers to give clear dispersal orders in both English and Spanish, with clear instructions on dispersal routes and time frame in their commands.

In addition, the city agreed to amend operating procedures to mandate pre-planning and pre-approval for the use of chemicals intended for riot control.

The settlement binds law enforcement officers to the newly developed rules and standards for four years.

ACLU of North Carolina, the Charlotte Chapter of the NAACP, the Lawyers’ Committee for Civil Rights Under Law, and several civil rights attorneys in Mecklenburg County represented the plaintiffs.