In denying health care for the vulnerable, why are we smiling?

The chances are improving that today a group of well-off individuals — Congress — will cheer, shake hands, and slap each other on the back, celebrating their big win in the political arena.

They will have voted to take health care away from old people and the disabled.

Just one question: Why isn’t this a somber occasion?

To be sure, the health care debate is about the country’s dominant organized religion — politics. But surely even those faithful least likely to cut through the fog of politics must see the humanity that’s involved with the occasion. How can you not? It’s all around us.

Overnight, according to news reports, the House Freedom Caucus — the most conservative of the conservative Republican delegation — was willing to trade its vote for the removal of “essential health benefits” from the Republican replacement. That’s coverage for mental health services, for example.

The Republicans say the bill would reduce premiums and to an extent that’s true, unless you’re over 50, according to the Congressional Budget Office’s report, which says the premiums will skyrocket over the next few years for that age group. To the extent they drop for the younger people, it’s mostly because the insurance they buy won’t cover much.

The debate to now has mostly been partisan and academic, radio shows like Indivisible Radio, for example, that consider what is a “right” and what is a “responsibility” when it comes to health care for others. It’s an earnest discussion involving politicians and pointyheads who won’t have a health care problem regardless of what happens today.

It’s great talk show fare that gins up callers, but it does nothing to force us to look at the most vulnerable and to look at ourselves in the mirror or look at the pols on the House floor today and ask, “why are we smiling?”

“Our plan says in order to preserve Medicaid for the truly vulnerable — kids, [the] elderly, [the] disabled — we’ve got to reform this,” Minnesota GOP U.S. House Rep. Jason Lewis told constituents, according to a report Thursday by MPR News reporter Mark Zdechlik.

That’s an assertion contrary to the Star Tribune’s story today that shows exactly the opposite.

By 2025, the Star Tribune’s investigation found, half of the coverage losses in Minnesota will be disabled people.

“It is potentially going to have a devastating impact,” said Jeffrey Nachbar, a lobbyist with the Roseville-based Minnesota Brain Injury Alliance, tells the Strib. “The biggest impact is going to be on services that help keep people independent.”

Delores Flynn, 72, of Roseville said the legislation makes her fear for the future. For the past 16 years, Flynn has relied on Medical Assistance to fund home-care services for her 46-year-old son, Scott Semo, who suffered a severe brain hemorrhage.

The family relies on a network of personal care attendants to help Scott eat, bathe, and walk, and to perform a range of complicated tasks, such as suctioning his breathing tube five times a day. Were it not for this regular care, her son could die from an infection or choke on the mucus from his breathing tube, Flynn said.

“There is no humanity in this,” Flynn said. “My son has a right to live like everyone else.”

Currently, about 64,000 Minnesotans with disabilities and the elderly receive home and community-based services through Medical Assistance, with a median cost per recipient in 2015 of $22,000. The services include help with eating, dressing and transportation to and from jobs.

The cynical view is that the House will pass the legislation, and then send it to the Senate, hoping the adults there will bring a more sober focus on the task, allowing reps like Lewis to campaign on having fulfilled their promises.

Maybe cutting health care for the mentally ill, the elderly, and the disabled is simply the price of freedom, a price someone else will bear so that we may enjoy its benefits — collateral damage for the greater good.

If that’s who we are, then that’s who we are.

But can we please stop smiling?

  • MrE85
    • MikeB

      They know what is does. They just don’t care. They need to free up $ for tax cuts for the already wealthy

      • Rob

        Hands off my tax cuts!

      • Ben Chorn

        And to pay for Trump to keep golfing on the weekends.

  • wjc

    Thanks, Bob.

    The GOP said that they would repeal the ACA. So now they have to do it. The only thing that could possibly pass the House is the disaster that you are talking about. That mess seems to be DOA in the Senate. The whole process highlights the GOP dysfunction when it comes to health care.

    The impact on real people is quite irrelevant.

  • kevins

    And still no word from the 7th rep. Mr. Peterson. I have contacted him to encourage him to vote against, but I think his Iphone is broken because I have not heard back. Once again, Republicans have proposed legislation that will help the few at the expense of the many.

    • MrE85

      From the reports I’ve heard, not a single democrat in the House has indicated they would vote for the bill, including more conservative dems like Peterson. If you are wondering why the vote was scheduled for today, this is the 7th anniversary of the ACA being signed into law by President Obama.

  • Mike Worcester

    The terribly (and sadly) cynical side of me wants to say that they are smiling because no matter what the end result, they — meaning members of Congress — will still have the best possible health care of anyone in the country. They got theirs. Why care otherwise?

    I’m willing to hear alternative thoughts to this in the hopes they will damper that cynicism.

    • Rob

      Sorry. Cynicism is the order of the day here in the good ol’ USA.

    • Kassie

      They have to go through the health insurance exchanges to get their insurance, and it isn’t the best possible. My insurance is better than theirs, but I have a union who has fought hard over the years to make that be the case.

      • jon

        They buy it through the exchanges, and then their employer pays for most of it (something like 80%, not that different from most employer group plan coverage).
        Oh and their is only one plan on the exchange that they can get covered by the government…

  • Michael

    I have to wonder about our local Politicians as well. Don’t we have some that want to remove MNSure and move the whole thing back to the Federal Health Care exchange, just in time to have it potentially shutdown?

    I know MNSure didn’t start well and might not be working well even now, but it is getting better according to what I hear, so why are we talking about making it go away now, when some of the Republicans at the Federal level are trying to Block Grant Mediacare back to the states and get out of the Health Care business.

  • Anna

    There is nothing that compels the Republicans to repeal the ACA except their own greediness. They have to save face with their wealthy supporters and give them what they promised—tax cuts– to stay in power.

    It’s a crap shoot with the lives of helpless and vulnerable Americans on the line. There is absolutely nothing to be smiling about. We can only hope that the Republican members of Congress who have stood up for their constituents by refusing to vote for the repeal have a backbone and can’t be talked out of it.

    We are at a critical divide in this country. If Abraham Lincoln had not been fiercely intent on preserving the Union there would be no “United” States of America.

    This is where we come to the fork in the road much as the combatants just before the outbreak of the Civil War.

    This is a battle for the very soul of America.

    No parent would wish cerebral palsy on their child or Down’s syndrome, spina bifida or congenital heart defects for that matter. For whatever reason, Mother Nature plays a dirty trick.

    Car accidents happen no matter how vigilant the driver. Medical mistakes are made despite our efforts to eliminate them. The victims have to live with the physical outcomes, not the inattentive driver or the mentally ill physician or the wealthy hospital administrator.

    Congress’s view is these vulnerable people are dispensable. They don’t contribute anything and they are a drain on the system, so “let them die and reduce the surplus population.”

    And we were worried about “death panels.” This is a death panel of the worst possible kind.

    • jon

      Republicans drank their own kool-aid… obamacare is bad.
      Repeal it.

      It was a republican plan, Romney put it in place in MA…
      Democrats swung far to the right away from universal single payer coverage to get to obama care. They even dropped the public option…

      Republicans are walking away from their own health care plans as democrats moved over to meet them so quickly that they are left with “let’s just not bother with health care” as their only solution left… though “leave it up to the states!” is what they end up saying.

      Of course, if we really wanted to hand the responsibility for health care off to the states, we should hand the money over to them too…. not just as an annual distribution to the states for medicare, but let them collect the taxes, and run the programs, and STOP collecting the federal taxes for those programs, or use that money to reduce the deficit…

      But they don’t do that… so it’s not something they want to let the states handle… they want the federal government in control of it.

      But instead of reducing the deficit they are going to spend that money on the military… they’ve already given a budget that shows they have no intention of reducing the deficit…
      Fiscal conservative… keep spending money we don’t have!
      American first… Let’s create a bigger military that we don’t ever really use to the benefit of americans, as the cost of programs that benefit americans.

  • Rob

    Smiling? NOBODY with any sense of humanity or decency is smiling at the health care repeal clusterf&!k. It’s the starkest illustration that LIFE IS CHEAP in the U.S. and that American Exceptionalism is a myth/lie of staggeringly epic proportions. Gods help us.

  • Will

    Let me tell you a story about Medicaid, of those on Medicaid 1/3 of the people are able bodied adults. My good friend is making the choice to work only three and a half days a week so he and his family is eligible for Medicaid coverage, they make about $40k-45k a year and he owns his own business so he can choose to set his hours to be eligible for these types of government programs. He has told me that the ONLY cost he pays are the $3 co-pays when he visits the doctor. That’s it, no premiums, no deductibles…he only needs to keep his income below a certain level and everything is essentially free. He has a massive economic incentive to do so, for example I have $15,000/year in premium costs as well as $4,000 deductibles. That’s a ~$20,000/year incentive to keep your income below a certain level, he’s also trying to qualify for student loan forgiveness since he has $100,000+ in student debt and it continues to grow, yet another incentive to make sure he doesn’t make above a certain amount. He works in Faribault and he talks to a LOT of people on a daily basis in that area as part of his work, many people in that region are on government subsidized programs and are freely making the choice to cut back on hours and keep their income low to qualify for those programs. That’s what these types of Medicaid programs do, they incentivize people on that fringe to play the system, by replacing these free giveaways with tax credits it allows individuals to take into account costs of healthcare (like the rest of us must do) and they aren’t incentivized to work less or fewer hours to qualify. I’m just offering a reason WHY these changes are being offered by those in Congress by telling a personal story of an individual person in this state.

    • Angry Jonny

      How many people are in his family? How many people are in his taxable household? Does his wife have an offer of employer sponsored coverage? What is his annual Modified Adjusted Gross Income? There are mechanisms in place for reporting fraud.

      • Will

        They both work together in the business. They have 2 kids, I don’t have his tax forms just a general idea of what he and his wife make…which is just north of $40k/year as I put in my original comment.

        • chris

          Well we should totally cut medicaid for millions of people in order to cut taxes on the wealthy based on your anecdote.

          • Will

            Changing the rules slightly to remove the incentive to cut back in working hours is fine with me.

          • The incentive is they don’t have much money, probably won’t be able to send their kids to college, have little for their own retirement and have to live a frugal life.

            And of course, they’ll have to struggle to find providers that take Medicare and hospitals that won’t put them at the back of the line, Mayo Clinic, for example.

            Your friend, assuming you’re accurate in the numbers and he’s not BS’ing a little bit, is an idiot.

            Good luck to him when the next recession hits and the business goes belly up.

            let me guess: His wife is runnning a daycare business out of their home?

          • Will

            They have the earning potential for $60k/year if you simply extrapolate out working 5 days a week instead of 3.5 days a week. Are you okay subsidizing their lifestyle, that they use government programs when if they worked the same number of hours as most of us they wouldn’t qualify for those programs? I mean you probably are okay with it but we’re running a deficit so are you okay running the tab up on your kids and grandkids so some people can make the choice to work 30% less than the rest of us?

          • Laurie K.

            I think the point is, your friend is in the minority. Most people would not be exchange free healthcare for a lower standard of living.

          • Will

            My friend says he sees people making the same economic choices he is making on a daily basis.

          • I think you should factor into your view that your friend might be giving you a load.

            I know people with names and faces and stories to tell that are real and so the question becomes what is the logic to removing health care from those people to satisfy your belief in the story your friend is telling?

            Now maybe it would make sense to change the rules of eligibility, but that’s not what your representatives are doing .

          • Will

            There is a requirement to work clause for able-bodied adults in the AHCA bill.

          • Jerry

            Remember, if you can’t find work, you have no value and should probably just die.

          • Will

            Please don’t misrepresent other people’s views, it’s insulting and unproductive.

          • Jerry

            It is the core belief of conservative thinking. Poverty (in others) is always a choice.

          • Laurie K.

            Sorry, but I do not find third hand anecdotal evidence convincing.

          • Will

            Yep, not listening to stories from rural areas and ignoring those rural perspectives worked out really well for Democrats in Minnesota and nationwide in 2016, as a person who leans right I will suggest that you keep it up.

          • Laurie K.

            I am saying it will take more evidence than your stat claiming that one-third of all Medicaid recipients are able-bodied for which you provided no source and your story from a friend who heard from some acquaintances that there others just like him out there, to believe that there are thousands of Minnesotans right now “gaming the system” in order to get free healthcare.

          • Will

            Wow, so many are unable to do their own research on Medicaid numbers.

            Here are the numbers:


            24 million Non-Elderly Adults without SSI (which disabled people receive) covered by Medicaid while the total number of Medicaid coverage is about 70 million.

            Basic math will get you 24/70 = 34.29% which is above 33.333% which is 1/3rd.

            Btw, my original source was hearing Paul Ryan refer to the number on MPR but I doubt that is acceptable to many here.

          • Insulting the intelligence and integrity of people here in discussing an issue here isn’t an effective substitute for facts.

            One of the people you’re debating in this forum — I can tell you from a position of authority (and it’s not me) — is in the business of Medicaid and health insurance. So be careful in declaring that people aren’t doing their research on Medicaid numbers. Because you’re not. And they know more than you do on the subject.

            You can learn a lot from Google. But you’ll learn a lot more from them.

          • Will

            Everyone demanded numbers, I provided numbers so when you say go look it up it’s perfectly fine, when I say it’s amazing that people don’t look it up AND provide evidence it’s insulting, what was that about critical thinking again?

          • Carolie

            And here are the numbers of people with medicaid who are already working… Shaves a huge amount off of your 1/3 are able-bodied Will. Looks like most of them already have jobs. Not to mention the number of disabled who work to the maximum of their ability.,%22sort%22:%22asc%22%7D

          • Will

            Reread my statement, I simply said 1/3 of people on Medicaid were able-bodied adults, that was my only claim and it is backed up by the facts.

          • Carolie

            Great… and they are all working, so what is your point? They are not working enough? How many of them are like your friend and deliberately under-working?

          • Rob

            Paul Ryan is a bunko artist and unbending ideologue of the first order, whose ability to twist facts and distort reality has few equals. And anybody who says “I’ve been wanting to change Medicaid since I was drinking from kegs” has even less credibility. So yes, his claims are suspect as a matter of course.

          • Will

            Sure but I provided numbers and evidence outside of Ryan. Can you at least admit my statement was right?

          • These are the rhetorical gymnastics that insult the intelligence of the people here. A request for actual data over “I heard from someone who heard from someone” isn’t not listening. On the contrary, it IS listening. But it’s wanting actual data over heresay.

            But you’re right, that’s why Democrats lost. Because too many people were incapable or unwilling to question what they’re told and think critically and investigate for themselves.

          • Rob

            Also known, in my neck of the woods, as voting against your own interests.

          • Jerry

            What the does that have to do with this discussion besides being your traditional retort?

          • Angry Jonny

            How old are they?

          • Will


          • Well there’s a lot of stuff that’s going to bankrupt YOU, let alone your kids and grandkids. You’re still young but you’re not that far away from paying twice to four times as much for insurance.

            That’s the problem with the current debate with the swift rush through. Sure, poltiically,, it makes sense for the Republicans to deonize the REpublican-appointed head of the CBO and say hogwash. Sure, that might fool people into not bothering to look at the numbers.

            But, again, the attitude that something is being fixed here ignores reality and math.

            But it might get them through the next election, which the fools among us don’t understand is the point and the goal.

            BTW, before I’d base public policy on the story you’re telling, I want to the see numbers and the financial statements of your friend’s claim.

            I realize that ‘s so old school.

          • Angry Jonny

            If they earned $65k a year, their children would still remain MA eligible, and they would have upwards of a $600 per month advance premium tax credit. That would bring the premium for a silver plan down to about $470 to cover them both, with a $5200 deductible. That’s assuming that they are in their 40s.

            Medica Applause Silver Copay
            Medica – PPO – Silver Metal Level Silver
            Monthly Premium: $473.30 – after $600.00 subsidy
            Deductible: $5,200

          • Will

            Why do that? They get free insurance now!

          • Angry Jonny

            I guess it’s on their own conscious, then. And perhaps CMS.

          • Will

            What’s CMS?

          • Angry Jonny

            Center for Medicaid Services. It’s the fed agency that monitors medicaid fraud.

          • Will

            Ah, okay, yeah I doubt they are violating any rules… it’s the rules that need changing.

          • Will

            He already went bankrupt a few years ago, you’re right their kids may not go to college but college might be overrated…I might start a small post secondary account for the kids. Sure they aren’t saving now for retirement but if they ever make it, they can save $70k/year through the business, that’s the hope.

            Actually my friend is not BSing the numbers, he works strategically with his accountant to only accept a certain level of income to avoid taxes and qualify for government programs and the rest of the money goes into his equipment in his business.

            The best part is that his income is low because of those same government programs, he runs a small clinic and is a primary care physician/chiropractor and most of his patients are on Medicare and Medicaid which keep his payments low enough to keep him on those same government programs.

        • Laurie K.

          Keeping a family of four going on a combined hourly salary of about $20 per hour in order to get cheap health insurance would not be much of an incentive for most people. I do not know your friend’s circumstances, but apparently they are in need of cheap health insurance possibly due to health issues of one or more of the family members. Also, I agree with Mike W., I would like to know your source that 1/3 of the people on Medicaid are able-bodied?

        • Carolie

          The annual gross income limit for a family of 4 in MN to qualify for Medicaid is $32,398. So your friend is either committing fraud or lying to you about his coverage. Their children may have Medicaid, but they would need to at least be paying MNCare premiums for the adults.

          • Will

            Bob put out numbers that the limit is $44k/year for a family of 4.

          • That’s income AND ASSETS.

          • Will

            They don’t own anything, they made sure of that when they went through bankruptcy…Just loans on everything.

          • Angry Jonny

            The asset test was removed for most MA applicants who aren’t applying for residential/long term MA services, or are on disability.

            The state does place a lien on property at the end of life, once an estate goes into probate, to recoup the cost of care for long term recipients.

          • Laurie K.

            I thought the law change in 2016 barred DHS from placing estate liens for routine Medicaid expenses?

          • Angry Jonny

            Yes, for ROUTINE Medicaid expenses. Not long term. Plus, the MN legislature voted on that, but it has yet to be approved by CMS.

          • Laurie K.

            Oh gotcha, good to know!

          • Carolie

            I am a MNSure assister. I have the current income chart. Bob is incorrect

    • Mike Worcester

      // of those on Medicaid 1/3 of the people are able bodied adults.

      Do you have a source for that statistic?

      The National Health Interview Survey of 2015 found that:
      “Half (48 percent) of adults covered by the Medicaid expansion are
      permanently disabled, have serious physical or mental
      limitations—-caused by conditions like cancer, stroke, heart disease,
      cognitive or mental health disorders, arthritis, pregnancy, or
      diabetes—-or are in fair or poor health. Low-wage jobs are often
      physically demanding, precluding those with limitations from employment.
      Of the other half, who might be viewed as “able-bodied,” 62 percent are
      already working or in school and 12 percent are looking for work; only
      25 percent are not currently working or in school.”

    • Here’s the asset and income guidelines for qualifying for Medicaid in Minnesota.

      • Angry Jonny

        Here is the household composition and income grid for *most health insurance programs available through MNsure.

        This does not include certain MA eligible populations, such as the very low income disabled who may be on Medicare with MA as a secondary with a spenddown.

      • Will

        Correct, they have 2 kids and keep their income below $44k/year as your chart shows to qualify for Medicaid.

        • Kassie

          So they qualify. What’s your problem? Lots of people, especially those with high medical costs or complex medical issues, keep their incomes low in order to keep good insurance. The answer isn’t get rid of Medicaid. The answer is extend those health benefits to everyone so no one is kept back from achieving their potential in order to keep good insurance.

          • Will

            No but giving them credits would incentivize them to work more than 3.5 days a week.

          • Rob

            Where’s the data to back up that assertion?

          • Will

            Economics 101, supply and demand.

          • Rob


        • Carolie

          You need to read the numbers for family of 4 in the first column on the left for the adult coverage. Not sure where you are getting $44,00 but it looks like that is coverage for kids and/or pregnant woman?

    • BJ

      Sounds like your close friend has figured out that he is actually qualified for government assistance and is using it.

      I’m not sure I see what is wrong with that.

      Other than you thinking that living with a family of 4 and an income of $40,000 a year and ‘free’ health care is an easy thing to do, I’m not sure what the point was.

      • Kassie

        Exactly. And we have no problem when students do this with financial aid or when business do this with tax cuts or subsidies, but god forbid a private citizen do it for something we consider “welfare.”

    • Carolie

      And what percent of the able bodied people on medicaid are actually working low-paying jobs already? Many FT workers still qualify.. those in retail, maintenance and other service industries for example. Not the free-loaders you envision.

    • Rob

      Damn all those people who just want free stuff.

  • chris

    Perhaps the most cynical thing about the republicans health care bill is that the medicaid cuts are necessary to book a savings for the government that will very soon be spent on a tax cut for the rich. That’s why this bill has to go first before a tax bill. Trump voters have really been scammed.

  • Angry Jonny

    I work as a MNsure Navigator. I have worked first-hand with the people whom the GOP bill would eliminate care for. It’s a reprehensible and dispassionate attack (and I don’t invoke that word lightly) on the poor couched and disguised as fiscal responsibility, “free market self correction”, and cost containment. It becomes even more disgusting when considering that congresspeople still retain their gold-standard health insurance. We have not seen any bill introduced to strip, repeal, or scale back any of THOSE plans.

    Meanwhile, toads at the Minnesota Legislature (such as Matt Dean and Glenn Gruenhagen-whose answer to poverty was to have our agency “…set up a dating service to get all these single mothers married.” No joke.) are pushing a bill to eliminate MNsure and move out to the federal exchange. Not only is this giving up local control of a health care exchange, it is detrimental to citizens in so many ways. There is no mechanism on the federal exchange to indicate to applicants that they are eligible for the state basic health care plan (MinnesotaCare). They are told that they are either eligible for a Medicaid plan or a private plan with tax credits. It eliminates local control, it sacrifices local support, and it disenfranchises citizens and leaves them with little to no help and even fewer options.

    We are truly witnessing an out and out attack on the poor of our country. When did we become so callous?

  • Kassie

    I’ve personally cut people off of health care. I was the one who, after a law change, closed cases on the computer and then took the phone calls and walk ins from those people who suddenly did not have insurance anymore. It was horrible.

    I also worked on the policy side of things when another law went into effect cutting even sicker people off of Health Care. I heard the stories of people being kicked out of nursing homes and hospice to die on family members couches. It was also horrible.

    I worked on the IT side of things when another law went into effect which expanded Medical Assistance. It was hard work, but giving people health care by the thousands is much, much more rewarding than taking it away.

  • Al

    Abraham Lincoln said the following. It’s painted inside the Minnesota State Capitol, outside the Supreme Court (?):

    The best way to get a bad law repealed is to enforce it strictly.

    I can’t believe I’m going to say this, but: I think the only way Congress might pull back from the AHCA is to push it through and observe how heinous it truly is to Americans who need access to health care.

    That literally brings tears to my eyes.

  • Erick

    Thank you for this poignant column. We will be judged by how we treat the most vulnerable.

  • AmiSchwab

    and paul ryan has the biggest smile. the poor sacrifried for the very rich tax breaks.
    is this what we have become?

  • Rich in Duluth

    They are smiling because they are achieving their goals and furthering their own interests. None of these interests have anything to do with, making a “more perfect Union”, insuring “domestic Tranquility”, or promoting “the general Welfare”. Things that might be more achievable if all of us had access to healthcare.

    I have to throw in my expression of outrage at this legislation. I find it appalling that the House is voting to throw so many people off the healthcare rolls. But, when these Republican Representatives were running for office, they said they were going to do this. So, the entire responsibility for this travesty goes, fully, to those of us who voted these people into office. Frankly, I don’t understand how you can live with yourself, when you know you’ve voted to cause so much pain to so many people.

    And, I continue to be in favor of Medicare for All. A system where all workers pay in according to their income, and everyone gets healthcare.

  • LifebloodMN

    Saying that coverage of “essential health benefits” are no longer required under Medicaid, does not mean they won’t be an option. Or that they are taking things away! They just won’t be required under law. This will save money while shifting some costs to state medicaid. And states do cost sharing or pick up the tab(like they do today and did before ACA). But then again, Dayton is already using state money for something that is a federal program. We are already spending 100’s of millions of Minnesota’s tax payer money for individuals that are privately insured! How is that not wrong! How long do we continue to do this? We can make the law better and that’s what needs to be done. Help make the law better or get out of the way.