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24 February 2014


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nick b

nick b

The House of Delegates would oppose any expansion of Medicaid (I would not). Nevertheless the joy available in kneecapping this Yankee machine politician is palpable. pl

nick b

"Nevertheless the joy available in kneecapping this Yankee machine politician is palpable."

Well, I guess that is an added bonus. McAuliffe will probably get his expansion eventually, but I see no real harm in making him suffer for it. It builds character.


One of the little known aspects of the Medicaid expansion is that if an individual earns less than 138% of the poverty level, that person will automatically enrolled in Medicaid, while a person who earns one dollar more than that will be enrolled in a subsidized insurance program.

Ok so far, but a provision of Medicaid calls for clawback of all costs incurred on behalf of the insured if that person is over the age of 55. And yes, most people are aware that nursing home care is subject to the estate recovery system, but again, over 55, and it also includes the costs paid for physicians, hospitalization, etc.

There are even provisions for going after burial trusts if the costs of a funeral exceed a certain amount.

And if a state has privatized Medicaid--essentially paying a premium to a private insurer for the individual's coverage--the state is authorized to recover 100% of all premiums paid, regardless if any claim has been paid or ever made by the insured.

Keep in mind, if this individual earned 1 dollar more, he/she would be entitled to heavily subsidized private insurance, and the government would not be entitled to any estate recovery for the amount of that subsidy.

Under the ACA, the Medicaid asset test has been dropped, so many working poor will die with perhaps small savings and a modest house, all of which can be seized.

Also, remember, the person is automatically thrown into medicaid without choice, but with a mandate that he be insured.



Nick b, "as long as it is federally funded". How long is that? More citizens"dependant on government programs" Mr. Marshall just pointed out the problem with liberals - they destroy the capabilities of free citizens to provide for their own families. Why would any Virginia leader support that?


If liberal Virginia wishes to share the fate of California they can vote themselves all the gimmedats they want.

The question remains, as it always has: who pays for it? Too many often the answer is me and mine.


"They prefer instead to reimburse hospitals for money that is removed in former Gov. Bob McDonnell’s introduced budget and to increase funding of free clinics and community health centers."

Are they willing to replace all the federal dollars to the hospitals and also provide equal funding to the free clinics and community health centers to anywhere near the level that Medicaid expansion would given them?

I cannot imagine that they would.

I am not trying to make anybody love McAulife.

But the sums involved in healthcare are so vast. The states have taken a hit since the recession, and are continuing to be faced with paying for much of the expenses incurred due to mass migration, both legal and illegal.

I do not believe any of our American states can hold out for long over the Obamacare. The amounts are too big, the number of uninsured and underinsured who will not be getting employer-paid healthcare anytime soon are too many.

The Twisted Genius

nick b,

Bob Marshall's HB39 sounds interesting as summarized in his email alert.

"HB 39 will not cost a dime of tax money and will avoid Medicaid fraud because Medicaid is not used. My measure would simply empower the Attorney General’s office to defend doctors who live in Virginia in any malpractice claims in their private practice as well as their charity care as long as they donate four hours a week of free primary care to Medicaid-eligible residents through a non-profit."

I think something like this could be a more dramatic shift towards a single payer system than Obamacare. Does this mean that Virginia is willing to become the provider of malpractice insurance to all Virginia physicians? Saying that will not cost a dime of tax money is a bigger lie than saying you can keep your plan if you like it. Don't get me wrong. I think this plan has merit. Would the federal government provide medicaid equivalent funding for what would essentially be a fairly robust network of state government health care facilities? Would a sufficient number of Virginia physicians go for this? Is this what Bob Marshall wants instead of Obamacare? If both sides would seriously discuss this rather than concentrate on trying to screw each other, it would be refreshing.



One of my childhood friends is a delegate. He shared this just last week.

"Del. Riley E. Ingram, R-Hopewell, was called to a brief meeting at the governor’s office this morning, during which McAuliffe made the pitch for Ingram’s support for one of the governor’s key goals – expanding the Medicaid rolls.

Ingram, who opposes Medicaid expansion “for now,” said he left the governor’s office with the impression that biofuel grants in the Senate budget that are important to Hopewell could be in jeopardy.

“The governor told me that if I did not go with it that the Senate was going to kill the bill,” he said." - Richmond Times Dispatch

Threats may work in Washington, here they're a matter of honor. There's no surer way to stiffen the opposition.

- Eliot

Alba Etie

Col Lang
Its why we need public financing of campaigns to keep such machine politicians as McAuliffe & Gillispie farther removed from our Comity .



"a matter of honor" A concept incomprehensible in many quarters. pl

nick b

As I understand the new law, the federal government will fund this @ 100% for the first three years, then @ 90% thereafter. I think Mr. Marshall's statement is based more in politics than reality. It's a conservative boilerplate argument.
Don't forget the new ACA taxes are already in place on Virginia business. They're already paying for it, they might as well access the money, no?

nick b


I think the House of Delegates will eventually read the writing on the wall and acquiesce to Medicaid expansion. Leaving money on the table is never a good strategy, and the drum beat in the media of hysterical pronouncements like 'failing to expand Medicaid kills 3 Virginians each day!' or 'this is costing Virginia 30,000 jobs!', absent any other narrative, will take its toll.

There have been some interesting ideas coming from some of the states in terms of how Medicaid expansion could be done differently. Unfortunately, none has passed muster at the federal level. The federal govt, for the moment, seems to be taking an 'our way or the highway' approach. So, even though some ideas have merit, they seems to be squashed at the next level.

I wholly agree, that it would be much better if everyone were to discuss this in a way that was less political, but who am I kidding? The Republican opposition to Medicaid expansion might be better served to make their case, hold their noses and approve it, especially if they can extract concessions in another area that is of importance to their constituency. Give and take, as it were.

Just musing on the idea of the state providing malpractice coverage, or defending Drs in malpractice law suits, suppose an AG declined to defend a Dr. because they didn't believe in the type of medicine practiced? What a mess that would be for the medical community. Actually, let me rephrase that: what a bigger mess that would be for the medical community.


nick b

As I recall you live on the west coast? I don't think you understand Virginia. pl

Dr. K


I thought your were from Maine?

nick b


No Sir, the great state of Pennsylvania. And I agree, as you describe it, I do not understand the state of Virginia. But it's interesting and I'm trying.


Dr. K

You are not paying attention. My mother was from Maine and I lived there 4 years when I was in high school. I never thought of myself as a Down Easter. Stonewall Jackson wrote in his plebe journal at West Point that "You may be whatever you resolve to be." At VMI I resolved to be a Virginian. pl


Nick b,

After three years 90% funding, as determined by the federal government, as long as some politicians from the other 49 states who are in congress don't cut said funding.

As to boiler plate, sure. Glad to know that the millennial generation is doing well in the current economy. Why the press can't tout those facts in light of all the boiler plate is just astounding. Maybe I should just stick to reading the NYT and Huffington. Except they aren't doing so well, are they?


nick b


It's just my opinion. FWIW, I only read the NYT selectively and avoid Huffpo like the plague.

As for funding, I agree it could change and probably will. But it the meantime, if businesses in the state are already paying in to fund it, why not access the funds available? Otherwise the taxpayers of Virginia are paying for something and getting nothing for it in return. That doesn't sound right to me.

William R. Cumming

ALL! A basic campaign reform at the STATE and Local Level would be a statutory prohibition on out of state donations. This would not make such contributions a crime but instead a civil forfeiture of the amount of the donation to a fund supporting enforcement of the law and a civil fine in the amount of the contribution to the same fund.

It is my belief that even at State and Local levels contributions by foreign governments may well be occurring just as it is in federal campaigns that as all know are largely policed and designed by STATE law not federal law.

nick b


Why stop there? Full public funding of all campaigns would eliminate a host of evils. Yes, it would carry a cost, but it seems not doing so carries a worse one.

nick b


I ran across this today, and thought it might be of use to you.

"How much they err,
that think every one which has been at Virginia
Understands or knows what Virginia is."
-- Captain John Smith


Nick b, they don't opt in because they can't opt out when the funds get cut. Who willingly binds themselves economicly to somdthing they don't agree with?


nick b

I don't know how many Virginians now reflect their normal values. My alma mater has abandoned its values. pl

nick b


I'm not sure I follow. I thought the quote reflected what you have told me many times, and I found it interesting that this is sentiment that has been held since before the founding of the Commonwealth. I thought it placed you in excellent company, and that you would enjoy it.

Your alma mater may have abandoned its values, but clearly you have not. Therefore, they live on.

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