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In Republican Stronghold, Worries About End Of Obamacare

By Margaret Newkirk, Bloomberg News (TNS)

In Georgia’s Gwinnett County where Republicans rule, few really love Obamacare. Few want to lose it either.

In parts of the county, about 1 in 8 people get insurance from the federal health-care program, making Gwinnett, near Atlanta, one of the biggest per capita users of the Affordable Care Act. The coverage is advertised in road signs along busy Jimmy Carter Boulevard near Lilburn. It’s the reason enrollment has dropped at low-cost clinics in Snellville and Norcross. It’s seeped into the Asian, Latino and African immigrant communities, becoming a mainstay for retail workers, contractors and the downsized.

As the U.S. Supreme Court prepares to rule on a case that could make Obamacare’s private insurance unaffordable in Georgia and at least 33 other states, Gwinnett, where all five of the county commissioners belong to the Republican Party that has been leading the fight against the health care law, illustrates how for many the program has become a fact of life. Obamacare is both groused about and accepted, like taxes and the weather.

“I couldn’t buy insurance for myself after my husband retired, not until Obamacare,” said Ghada Nadhan, 63, an assistant manager of a food store who immigrated from Syria more than two decades ago. “Now I am afraid.”

Now before the Supreme Court, the King v. Burwell case threatens to make Obamacare unaffordable by ending federal subsidies that hold down premium costs based on income. A suit backed by conservative activists, citing a single phrase in the law, says those subsidies aren’t allowed in states that didn’t create their own health-care exchanges.

Led by the free-market Cato Institute in Washington, those opponents helped persuade Republican governors not to form state-run exchanges, as a tactic for undermining Obamacare.

More than 13 million Americans could lose tax credits that help pay for insurance coverage by next year, according to the Kaiser Family Foundation in Menlo Park, Calif. Florida, Texas, North Carolina and Georgia, the states with the most to lose, received a combined $19 billion, according to a December report by Democratic staff of the House Energy and Commerce Committee.

All four states declined to create exchanges and could have spiraling premium increases if the court nixes their subsidies. In Georgia, premiums would rise 381 percent without the credits, according to a June 3 analysis by Kaiser.

“It’s not something that should be done based on a twisted interpretation of four words in, as we were reminded repeatedly, a couple-thousand-page piece of legislation,” President Barack Obama said Monday at a news briefing in Germany. “Part of what’s bizarre about this whole thing is we haven’t had a lot of conversation about the horrors of Obamacare because none of them have come to pass.”

In Gwinnett, attitudes about Obamacare depend a lot on subsidies, said Luis De La Rosa, an insurance salesman who advertises in a Hispanic part of Lilburn. He says ending the federal help would be a disaster.

“The people who say it doesn’t work now are the people who aren’t getting the subsidies and facing fines if they don’t enroll,” he said.

They’re also people who aren’t sick, he said.

“That’s an advantage people forget. Before, you couldn’t get insurance if you were sick.”

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Gwinnett is a microcosm of a changing nation. Once overwhelmingly white, it’s now one of the most ethnically diverse counties in the U.S., largely because of its immigrant population. It had 73,839 people enrolled in Obamacare’s insurance exchange as of May, the most in the state. Two Gwinnett zip codes had 12 percent of residents enrolled in Obamacare, the most outside of Florida.

Obamacare has had the biggest impact on the area’s low-cost medical facilities. At Gwinnett Community Clinic in Snellville, staff began calling former patients this year after a 30 percent enrollment drop.

“The reason they were gone is that they now had insurance,” director Sheila Adcock said.

The same thing happened in Norcross, at a clinic run by Boat People SOS. Daily caseloads dropped to 10 from 20 after the organization helped enroll immigrants in Obamacare, said Han Nguyen, a health navigator.

Even enrollees with generous subsidies have complaints, said Adcock, who heard some during her phone outreach.

“If you are a person in poverty, you’re not used to the idea of co-pays and deductibles, and you’re wondering what you are paying for,” she said.

Charles Pierre, 58, a Haitian immigrant and substitute teacher, was among those signed up by Nguyen. He said his subsidized premium has already almost doubled, to $45 a month from $23, and that he also has a $35 co-pay to see a doctor.

Pierre said he likes the security the insurance brings but would have to drop it if the subsidy disappears and the price goes up again.

“It’s going to be a struggle for me to pay for it,” he said. “What I earn is not changed.”

Valerie Dalton, 64, got her Obamacare insurance in February, after her banking job was eliminated and she could no longer afford the $700 monthly price to stay on her former employer’s plan.

She said her Obamacare premiums are about $360 per month, a price she still thinks is high but that she won’t have to pay for long. Next month she’ll turn 65 and be eligible for Medicare.

“I’m not politically active at all, but I feel badly that they are threatening this,” she said. “I think it’s really sad.”

(c)2015 Bloomberg News. Distributed by Tribune Content Agency, LLC.

File photo: Protesters in Minnesota call for smaller government and the repeal of the health care law enacted in March, 2010. (Fibonacci Blue via Flickr)

Baton Rouge Emergency Room Closing Shows Cost Of Obamacare Fight

By Margaret Newkirk, Bloomberg News (TNS)

ATLANTA — A Baton Rouge, Louisiana, hospital is closing the only emergency room on the city’s impoverished north side, a real-world ripple effect of the ideological clash over President Barack Obama’s health care law.

The shutdown on April first serves as an early warning for hospitals in states like Louisiana, where Republican Governor Bobby Jindal turned down federal money to expand the Medicaid program for the poor. Charity hospitals will lose billions of federal aid beginning late next year, a cut that was supposed to be offset as more residents were covered by Medicaid.

The combination is a looming “double whammy,” said Shawn Gremminger, a lobbyist for America’s Essential Hospitals in Washington, which represents those that care for the poor.

“It’s not survivable,” he said. “Hospitals are going to close.”

In Louisiana, Baton Rouge General’s Mid City hospital was already caught in that vise. It was flooded with the uninsured after a nearby charity hospital was closed. Louisiana provided a one-time injection of funds last year from the federal aid program that’s about to be cut. With that money gone, the hospital is closing the emergency room.

“It was unsustainable,” said Mark Slyter, the hospital’s chief executive officer.

While Republican governors in states including Indiana, Ohio, and New Jersey have expanded their Medicaid programs under Obamacare, Jindal, a potential 2016 presidential candidate, has remained steadfast in his opposition.

A health-policy expert who began his political ascent as chief of Louisiana’s state hospital system in 1996, Jindal, 43, has said adding to the federal program would put nearly half of Louisiana on government assistance. Jindal instead decided to turn management of the state’s charity hospitals over to private operators to improve the efficiency of health care provided to the indigent.

In Baton Rouge, a city of 229,000, about one-fourth of whom live below the poverty line, the emergency room’s closing has been met with protests by residents and lawmakers who say Jindal’s policies are hurting the poor.

“The governor is putting ideology ahead of the welfare of the state,” said state Representative Alfred Williams, a Democrat from Baton Rouge. “He has an agenda and it’s to run for president of the United States. And if that causes the people of Louisiana to suffer, then I believe he’s OK with that.”

Alexis Nicaud, a spokeswoman for Jindal, referred questions to Kathy Kliebert, the secretary of Louisiana’s Department of Health and Hospitals.

Kliebert said Jindal’s decision to relinquish management of the state hospitals has helped the poor by giving them access to better-equipped facilities with shorter waits. She said Mid City was undermined by market forces as rival specialty hospitals lured away patients with insurance.

“Mid City has had financial problems for ten years,” she said.

Nationally, the Patient Protection and Affordable Care Act of 2010 has eased the strain of caring for the uninsured. The law allowed for making Medicaid available to those earning as much as 138 percent of the poverty level or about $16,200 for an individual. The expense is fully paid by the federal government through 2016 before being phased down to 90 percent.

After the U.S. Supreme Court in 2012 said it was up to states to decide whether to expand the program, the decisions initially broke down along party lines as Republicans questioned whether the federal government would keep its pledge to pay for it.

Ten of 28 states that have since decided to do so were led by Republicans. A new wave of the party’s governors in states including Tennessee, Wyoming, and Utah tried to follow this year though they have been stymied by lawmakers.

By January, 11.2 million more people were enrolled in Medicaid and its related program for children than during the three months that ended September 2013, before the provision took hold. In states that boosted the scope of Medicaid, uncompensated care costs dropped by $5 billion in 2014, twice as much as in those that didn’t, according to estimates released by the Obama administration.

In Louisiana, Obamacare would have added 242,000 people to the program, according to the Kaiser Family Foundation, a Menlo Park, California-based nonprofit that tracks health care policy.

Nationwide, charity hospitals are set to lose money from a Medicaid fund that partially offsets the cost of treating those who can’t pay.

Initially scheduled to kick in last year, Congress delayed the cuts until late 2016. The funding will decline by $35 billion during the following eight years, according to a 2014 analysis by researchers at Georgia State University in Atlanta and Tulane University in New Orleans.

Baton Rouge General’s Mid City hospital is a harbinger of the effect those reductions will have in states that didn’t expand Medicaid.

Mid City wasn’t the area’s safety-net hospital. It became one accidentally in 2013, when Jindal closed the nearby Earl K. Long Medical Center, which was part of a network of state teaching hospitals charged with caring for the poor.

When the Long hospital closed, Louisiana directed its patients and federal aid money to Our Lady of the Lake, a Catholic hospital in a wealthier, southern part of East Baton Rouge Parish.

Many of the poor showed up instead at the closer Mid City emergency room, which had to take them under federal law. Jerry Dean Johnson, 64, said Our Lady is at least 13 minutes farther from her home.

“It’s too far,” said Johnson, a Medicaid patient who has lung disease and has been rushed to Mid City twice in four months. “I think if I had to go way down there I would have died.”

Mid City’s uninsured patients rose by 400 a month, a 30 percent jump, said Slyter, its CEO. Psychiatric consultations rose almost 70 percent, also a spillover from the shuttered hospital, he said.

The state gave Mid City $23 million in one-time emergency funding in 2014 to keep the doors opened.

Expanded Medicaid would have relieved some of pressure on the emergency room, although it wouldn’t have saved an operation that was losing $2 million a month because of the uninsured, Slyter said.

“It would not have been a silver bullet,” he said. “But that’s one of several things that would have helped.”

Photo: Kevin O’Mara via Flickr

Deficits In U.S. States Have Alabama’s Governor Risking Career

By Margaret Newkirk, Bloomberg News (TNS)

MONTGOMERY, Ala. — Alabama Governor Robert Bentley is taking on fellow Republicans as he seeks to mend a $700 million hole in the state’s frayed $1.8 billion general fund with a tax increase.

The state party is urging lawmakers to defy him. Republicans distanced themselves in speeches and newspaper columns. One state senator who’s a former U.S. Marine paid for a billboard in Huntsville.

“Governor Bentley wants to raise your taxes,” it reads. “I will not let that happen. Semper Fi. Senator Bill Holtzclaw.”

Bentley, 72, joins at least eight Republican governors gambling their careers by bucking anti-tax orthodoxy as the party enjoys its greatest power over state capitals in almost a century. The blowback provides a lesson in the difficulty for Republican chief executives of running states when fiscal reality collides with decades of anti-tax rhetoric.

In Georgia, two-term Republican Nathan Deal is prodding lawmakers to raise funds for infrastructure. Louisiana’s Bobby Jindal, a potential 2016 Republican presidential contender, last week proposed rolling back more than $500 million of tax credits to avert steep cuts to universities and other programs.

“Some states are feeling they’re out of options,” said Norton Francis, who follows state issues at the Tax Policy Center in Washington. “The extent that they’re proposing these increases that they feel are necessary to protect the fiscal situation of the state is pretty remarkable, given the uphill battle they have.”

Aversion to taxes runs deep in Alabama, which enshrined a Tea Party-like distrust of government in its constitution more than a century ago. It ties the state’s hands on how much to tax, what to tax and how to spend the money taxes bring in.

Bentley is a reluctant agent of change.

“No one likes to pay taxes,” Bentley told reporters in Montgomery on Friday, when he released detailed plans for the first time. “No one wants to pay more tax. I don’t like it any more than you do, but we have failed to address the challenges that lie before us.”

A dermatologist, Sunday-school teacher and signer of activist Grover Norquist’s pledge to levy no new taxes, Bentley spent eight years in the Legislature before winning the governor’s office in 2010 with a longshot campaign.

He took office in 2011 as Republicans held majorities in the Senate and House of Representatives for the first time in 136 years. A Birmingham News columnist in February said Bentley’s first four years were “mostly irrelevant” as he was pushed aside by legislative leaders. Two months into his second term, that has begun to change.

Bentley proposed raising $541 million in additional revenue through taxes on cigarettes, car sales, and insurance premiums and utilities, among other steps. He also wants to use $187 million earmarked for other funds to close the deficit in the year beginning in July.

“There is nothing more conservative than getting our fiscal house in order,” Bentley said.

Alabama’s state and local government taxes per resident are the lowest in the U.S., according to the Public Affairs Research Council of Alabama. It also has the 12th-worst tax structure in terms of disproportionate impact on the poor, according to Meg Wiehe, state policy director for the Institute on Taxation and Economic Policy in Washington.

Alabama collects sales taxes on food. In 2010, its property levies were the nation’s lowest, according to the Tax Foundation. And it’s one of only three states that allow citizens to deduct all of their federal income tax, no matter how much they earn.

The system has roots in the Reconstruction era after the Civil War. Concerned that newly empowered blacks would foist higher taxes on richer whites, Alabama’s leaders wrote rate caps and spending rules into the constitution.

Changes to income-tax rates have to be approved by a vote of the people. All but 9 percent of the revenue Alabama collects is earmarked for specific purposes, Bentley said. While income taxes dedicated to education have surged since the end of the recession, the hodgepodge of more than 40 levies that feed the general fund hasn’t kept up.

“During the past several fiscal years, the general fund has relied on significant support from non-recurring revenues, including drawing down reserves,” according to a Standard & Poor’s report in July.

The fund pays for most services outside education. That includes the prison system, which has half the guards and almost twice the inmates it’s built to hold. Parole officers supervise 195 ex-convicts each. Judges have been sending people to prison because they know the probation system can’t handle them, said Eddie Cook, the assistant director of the Alabama Board of Pardons and Paroles.

The Highway Patrol has less than half the troopers it should, according to a University of Alabama study. Wait times at the motor-vehicles department are infamous.

“Just try to renew your license in Birmingham,” said Carol Gundlach, policy analyst with Arise Citizens Policy Project, a Montgomery-based nonprofit that advocates for the poor. “You need to bring a sack lunch.”

The last governor to try to change the system was Bob Riley, a Republican former congressman. He led a campaign to overhaul it 12 years ago, putting a constitutional amendment on the ballot that raised money and moved toward equalizing the impacts on rich and poor.

Every major interest group in the state supported him, except the powerful Alabama Farmers Federation and the Christian Coalition. His radio ads featured beloved football coaches. Voters rejected the amendment by 68 percent.

Senate President Del Marsh said Bentley’s record as a budget-cutter may help him sell the plan. Bentley said his administration has saved $1.2 billion a year.

“We have a case to make that Riley didn’t,” said Marsh, who has said he will at least look at Bentley’s plan. “Maybe we can lay it all out there and ask them, ‘Do you want to fix this once and for all?'”

Some Republicans aren’t persuaded. Alabama state House Speaker Mike Hubbard said there’s more room to cut.

“We will avoid any solutions that might slow Alabama’s ongoing economic growth,” Hubbard said.

Holtzclaw, who put up the protest billboard, may be the first to see the impact of a cash-starved state. The transportation department halted road projects in his district after the sign went up.

Bentley was unapologetic. He told reporters Friday it was “irresponsible” to criticize a plan that hadn’t been announced. He said the projects will eventually be restarted.

When, he wouldn’t say.
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With assistance from Mark Niquette in Columbus, Ohio.

Governor Robert Bentley, AEMA Director Art Faulkner and FCO Mike Byrne discuss tornado recovery (Alabama EMA via Flickr)