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The Caste System

To understand the GOP mindset about the Poor (and frankly much of the Democratic one as well) is that poor people are lazy and when they are "given" anything it only further contributes to their laziness and unwillingness to get off their asses and get a job. The old adage, give a man a fish eat he will eat for a day, teach a man to fish he will eat for a life is part of it. But in Trevor Noah's book, Born a Crime, he makes the most salient point and missing element - what about a rod and hook is that part of the deal.

That is the point, we have with regards to "entitlements" which were set up by FDR during the Depression to assist the populace that were in need and in turn via Social Security nudge or urge those with jobs to feel free to retire and in turn open up the job for others. Many of these programs remained and many did not despite the fact that some of them were actually pretty darn good.

And because in partisan politics anything one party does the other party can do better, you are seeing that right now with the ACA to the ACHA or Obamacare vs Trumpcare. Whatever acronym they apply the idea is that we should have just taken a hint from FDR and gone Medicare for all and stopped all of this decades ago.

But one thing the Republicans do better is to vilify recipients of any government program, be it food stamps, pell grants, HUD loans and of course Medicaid. This is where the poor and race suddenly collide. I see it here in Nashville daily. The idea that many if not most people of color and largely that refers to the color black as there is some inherent belief that Mexicans are hard workers who though take white men's jobs and actually they mean manual labor jobs that blacks could do and that Asians are super intellectual and community oriented making those International Districts self sufficient. I lived in between those three colors of the Neopolitian manwhich and I can assure you my food bank had way more Asian residents and most of them Seniors than any other group. Myth busted. I am not even going to get into American Pacific Islander or Native American as they are utterly ignored as no one seems to acknowledge their existent other than colonized ones. Hey Puerto Rico that means you too!

When you establish a poverty level that in some cities is easy to reach when one earns double the federal poverty guidelines there is one problem the other is the presumption that we are just not working hard enough and if we were we would immediately be given executive level jobs and the appropriate salary.

I moved from Seattle to Tennessee to ostensibly a lateral move career wise. I am not making 1/3 of what I made in Seattle. I have the same costs of living, literally the same from rent to utilities and here they tax food. Explain to me what I need to do more of?

So when I read the below from the new Medicaid czar/chief/whatever I can assure you we are heading into dark times, dark times. And this is what it is really about the color of skin and not money. And when Trump rails against Immigrants I do find it ironic as they are the most conservative of the lot and truly believe that poor people are poor as they refuse to do anything, and the irony is that the caste system from which our class system is based had no mobility nor concept of meritocracy it was a position one is born into. That has become the truth of our America and those that come here come to escape that same system and yet instill and believe in in wholeheartedly.



On first day in office, new Medicaid chief urges states to charge premiums, prod recipients to get jobs



By Amy Goldstein
The Washington Post
March 15 at 10:07 AM 

Hours after she was sworn in, the Trump administration’s top official for Medicaid and her boss dispatched a letter to the nation’s governors, urging states to alter the insurance program for poor and disabled people by charging them insurance premiums, requiring them to pay part of emergency room bills and prodding them to get jobs.

The letter, sent Tuesday night by Seema Verma, the new administrator of the Centers for Medicare and Medicaid Services (CMS), and Health and Human Services Secretary Tom Price, also derides the Medicaid expansion that 31 states and the District of Columbia adopted under the Affordable Care Act (ACA).

The expansion, which has extended Medicaid to 11 million people with incomes of up to about $16,000 for a single person or nearly $34,000 for a family of four, “was a clear departure from the core, historical mission of the program,” the letter says.

By giving states greater help with these new beneficiaries, it contends the ACA has “provided states with an incentive to deprioritize the most vulnerable populations.” The three-page letter does not mention that, for the first three years, the federal government paid the entire cost of covering the expansion group and still pays nearly all of that.

The message from Verma and Price signals an initial step toward redesigning the program along lines that conservatives have long favored and that the new Medicaid administrator brought to Indiana as a consultant and the chief architect of broad changes that state first adopted nearly a decade ago. Overall, their letter encourages states to innovate and attain more freedom from federal standards by seeking “waivers” from government rules on the program, which covers 68 million low-income people, including children, pregnant women, and those who are elderly or disabled, as well as adults who merely are poor.


Both officials have in the past railed against a system that requires states to get federal permission to “modernize” their Medicaid programs, but the letter makes no mention of eliminating that requirement.

This impetus for states to rethink their approach to insuring their poor and vulnerable residents comes as House Republicans are debating plans that would rewrite the program in fundamental ways, ending the federal government’s open-ended responsibility in paying for beneficiaries’ costs while abolishing the ACA’s expansion over the next several years.

What "patient-first" care really looks like

Empathy is the guiding principle behind the entire patient experience at Cleveland Clinic's new Cancer Center. Take a tour.

A particular concern among critics of such conservative directions is the possibility that Medicaid might require people to be employed or training for jobs to qualify for benefits — as the nation’s main welfare program has done for the past two decades. In approving a variety of Medicaid experiments under the ACA, the Obama administration consistently rejected requests from any state that wanted to compel its Medicaid beneficiaries to hold a job.

Andy Slavitt, who had been serving as CMS acting administrator until January, said that inviting states to adjust their programs through federal waivers, as the letter encourages, gives them useful flexibility: “It’s a better path than using one-size-fits-all legislation to cap the program.”

The letter stops short of urging an outright work requirement, saying that CMS will “review and approve meritorious innovations that build on the human dignity that comes with training, employment and independence.”

Asked late Tuesday whether the Trump administration would allow states to impose work requirements within Medicaid, an HHS spokesman replied, “We can’t speculate.”

Verma was sworn in on Tuesday, a day after the Senate confirmed her nomination by a vote of 55 to 43 along party lines. The vote reflected the deep divisions on Capitol Hill over the Trump administration’s plans for the nation’s health-care system. At her confirmation hearing earlier this month, Verma sidestepped the question of whether she would favor a nationwide extension of the unusual Medicaid provisions she helped Indiana’s program secure.

Indiana requires everyone who receives benefits to pay monthly premiums, and their contributions are invested in health savings accounts. Very poor people who do not make the payments are bumped down to a lower tier of coverage, while people with slightly more income are removed from the program.

CMS is a powerhouse within the Department of Health and Human Services, overseeing about $1 trillion in spending on the two vast entitlement programs. For the past seven years, the agency also has carried out most of the implementation of the ACA, which Trump and others in the GOP are working to demolish and replace with more conservative health policies.



This post first appeared on Green Goddess VV, please read the originial post: here

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The Caste System

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