Credit Where Credit is Due

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Walmart catches a lot of heat,  much of it probably justified, for its treatment of employees, low wages, sourcing practices, etc. but it rarely seems to get credit when it does something right. That's why I found this story from Louisiana so interesting.

Two Walmart stores in Louisiana will be stuck with most of the bill after food stamp recipients went on a huge shopping spree after a power outage temporarily lifted their spending limits, resulting in cleared store shelves and mass chaos…

According to a Louisiana Department of Children and Family Services’ spokesman, retailers who chose not to use the emergency procedures that limit sales up to $50 per cardholder during an emergency would be responsible for any additional amount spent during the power outage…

The shopping frenzy was triggered after the Electronics Benefits Transfer system went down because a back-up generator failed at 11 a.m. EST on Saturday…

Around 9 p.m. CT on Saturday, a Walmart employee made an announcement that the computer system had been restored and all card limits had returned. At that time, many customers left shopping carts full of food inside the store.

The focus of the story is on the food stamp recipients taking advantage of a computer glitch to go on a shopping spree, but what caught my attention was the fact that the Walmart stores continued to allow the customers to use their EBT cards even though they knew there was an issue. They could just as easily have said they wouldn't process the cards until the system came back online, but the store managers chose to continue processing. Maybe they thought they'd eventually get their money, or maybe they were compelled to by law – I have no idea – but the fact of the matter is they did a generous thing by not denying the EBT payments.

And those folks who took advantage of the situation? That's a perfect example of why the backlash against government aid programs is gaining traction.

C-SPAN Sports

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If you're into Robert's Rules of Order and all things parliamentary procedure-y you'll get a kick out of this. The Republican bloc in the House performed some parliamentary gymnastics to make sure they controlled how/if the Senate's continuing resolution made it to the floor and Maryland's Rep. Van Hollen (D) decided to call them on it. Confused? Welcome to the club, but it's crap like this that convinces the vast majority of Americans that Congress is totally screwed up.

The Red State ACA Donut Holes

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North Carolina, like many states controlled by Republicans, opted out of the Medicaid-expansion component of the Affordable Care Act. A New York Times article explores the practical effect it's having on those states' citizens:

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states…

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

We're going to be hearing a LOT about the ACA, aka Obamacare, rollout over the next few months. The program opened for enrollment on Tuesday (Oct 1) with a start date set for January and the traffic to the website was heavy enough that it slowed to a crawl.  Like any new program, especially one of this scale, there will be issues but it will be interesting to see if the overall benefits outweigh the problems enough that people will eventually say "Keep the government's hands off my ACA!"

If that does happen it will be with folks like the self-employed who couldn't get on a regular insurance plan that was anywhere near affordable, the employees working for small employers who stopped offering health insurance long ago because they couldn't afford to provide coverage and weren't legally required to, and the folks with preexisting conditions who couldn't get any coverage no matter how much they were willing to spend. Sadly it seems that a huge chunk of the working poor will fall in the "not poor enough" donut hole created by states' refusal to expand Medicaid and won't have access to a program that was most definitely intended for them.

As you can likely tell I'm one of those who is truly hoping that ACA is a step in the right direction for our country. I don't believe it's a silver bullet or that it truly fixes anything, but I'm hoping that it's a step in the direction of a comprehensive, effective reform of our health care system. It's still way too early to see what the end result of ACA is going to be, but quite frankly it would be hard to go backwards from where we've been in the recent past so I'm pretty confident it will be a net benefit for society. On the other hand I seriously doubt it's enough on its own and I hope we continue to look for ways to make sure the neediest have some form of health coverage without bankrupting the rest of us in the process.

Living in the Land of the Suicide Caucus

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The 80 Republican representatives who signed the letter sent to House Speaker John Boehner urging the course of action that has led to the government shutdown were dubbed The Suicide Caucus by none other than conservative columnist Charles Krauthammer. Who are they and where are they from? Let's see:

On August 21st, Congressman Mark Meadows sent a letter to John Boehner. Meadows is a former restaurant owner and Sunday-school Bible teacher from North Carolina…

Meadows was not pleased with how Boehner and his fellow Republican leaders in the House were approaching the September fight over spending. The annual appropriations to fund the government were scheduled to run out on October 1st, and much of it would stop operating unless Congress passed a new law. Meadows wanted Boehner to use the threat of a government shutdown to defund Obamacare, a course Boehner had publicly ruled out…

Before Meadows sent off his letter to Boehner, he circulated it among his colleagues, and with the help of the conservative group FreedomWorks, as well as some heavy campaigning by Senators Ted Cruz, Marco Rubio, and Mike Lee, seventy-nine like-minded House Republicans from districts very similar to Meadows’s added their signatures.

Here's a map showing the 80 districts. I live smack dab in the middle of the heaviest concentration:

SuicidePactDistricts

But are they really suicidal? Actually they're acting rationally if you look at where they're coming from:

In one sense, these eighty members are acting rationally. They seem to be pushing policies that are representative of what their constituents back home want. But even within the broader Republican Party, they represent a minority view, at least at the level of tactics (almost all Republicans want to defund Obamacare, even if they disagree about using the issue to threaten a government shutdown).

Most folks here in the land of the Suicide Caucus despise "libruls" and distrust the government intensely. What would be interesting to see is how they would react if their reps got their way and shrank government programs drastically. Most folks don't realize all the programs the government is behind – "Keep the government's hands off my Medicare! – so would they put two and two together and blame their representative for their lost money/service? Probably not. 

What’s In a Name

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This is easily the most unsurprising video you'll see today. Street interviews with people who are against Obamacare but for the Affordable Care Act. If you don't know why that's funny then you may now understand why we have a problem here.

Two big points to make here:

  • This highlights why the names assigned to bills/laws are so important. People like the Affordable Care Act not because they know what it is, but because it must be affordable because that's what they call it!
  • We can also see how effective the relentless hammering home of simple talking points like "Obamacare is Socialist" has been. There's a reason political hacks on both sides of the aisle come up with a couple of simple blurbs and repeat them relentlessly-in this day of 10-second sound bites it's a very effective way to frame an issue.

Enjoy:

Well Duh

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Sometimes you just have to be slapped upside the head to have some sense driven into you. I was catching up on some reading and came across this piece from Sasha Dichter and these words struck a chord with me:

In today’s world we all are continually experimenting with the lines between connection / productivity / responsiveness and distraction / rudeness.  Two colleagues of mine suggested the following four rules for managing incoming email and handheld devices, which I liked:

  1. Turn off desktop alerts of new emails coming in (the little box that pops up)  (in Outlook: File > Options > Mail > Message Arrival > Uncheck “Display a Desktop Alert”)
  2. No reading email before breakfast
  3. No reading email while in transit
  4. No phone or email in the bedroom

My own scorecard is as follows:

  1. I turned of desktop alerts for new emails about a month ago and I love it.
  2. I almost never read email before breakfast and when I do it’s a sign that I’m under a crazy deadline or stressed for some other reason.
  3. Hmmm.  I made a rule a couple of years ago not to look at my phone while in elevators, and I’ve stuck to that (it had become a reflex), but I spend enough time in transit that I don’t know that I can commit to this one.
  4. I do have my phone in the bedroom but I can honestly say it’s 95% as a time-piece and alarm

In reality these four rules are a really low bar.  Increasingly I think we will all be playing with the limits and rules that work for us, and everyone’s line will be different.  What makes me nervous is when I get reflexive about checking.  That sort of unconscious behavior feels unproductive. (Emphasis mine)

My wife has flat out told me it annoys her how much I check my phone. At the table, when we go to bed, etc. and today when I was checking out at a store I realized I was checking my phone even before the clerk was saying thank you. In other words I'm being exceptionally rude to the people around me, and what bothers me most is I'm certain I'm missing signifcant chunks of conversation with my family. My kids are only a few years from flying the coop permanently – two of them are already in college – so this is just crazy behavior. Do I seriously want to waste the limited days they're still under my roof with my nose stuck in my phone? Obviously not.

For some reason it took reading a stranger's blog to bring me to that "Well, duh" conclusion. I plan on using some of his rules augmented with some of my own to do better.

 

NC DHHS’ Software Armageddon

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North Carolina's Department of Health and Human Services (DHHS) is responsible for the launch of two new software systems this year that have experienced significant problems, and things likely will get worse before they get better.

The first problem you've probably heard about: DHHS' rollout of the NC FAST system to handle food benefits, aka food stamps, has been problematic around the state and has led to local agencies working with local food banks to make sure people have access to food until their benefit situation can be straightened out. The problem is that NC FAST is supposed to also handle Medicaid claims as of October 1 and it seems highly unlikely it will be able to do so particularly in light of DHHS' other, less well known software snafu.

Earlier this year DHHS rolled out NCTracks which is a new system to process professional Medicaid claims otherwise known as claims from doctors, medical groups, hospitals and other health care providers. That system is so screwed up that some independent practices have already gone out of business. From an article at charlotteobserver.com:

Karimi, 28, had worked for his parents for the past five years. Their company, Right at Home, had provided home health and personal care to the elderly and people with disabilities in Granite Falls. Karimi handled the billing.

But now Karimi is out of a job and his parents are out of business after a decade. The reason? They weren’t being paid for the Medicaid-reimbursed services they delivered in July and August after the state rolled out its new Medicaid payment system, known as NCTracks…

And it’s not just small providers who are having trouble.

In an interview last week, WakeMed CEO Bill Atkinson said his institution was down $1.5 million since July 1 because of NCTracks. He worried that his billers would have to re-submit all of those claims by hand.

It would be easy to blame the current administration for all this  but the reality is that these systems were contracted long before Gov. McCrory was elected and his folks now have the unenviable task of implementing very complex systems that affect a lot of people. If the response to client issues has been as slow or nonexistent as is being claimed by folks interviewed for these stories then the new administration, and by administration I mean Gov. McCrory's appointees at DHHS, needs to take responsibility and do whatever is necessary to get people the help they need. If they don't we'll be looking at a lot of lost jobs in the health care industry, and in particular we could see some small medical practices under severe stress or maybe even folding.
Glitches happen and anyone who's been through a systems upgrade knows they rarely if ever go as planned, but how an organization responds to those glitches is where the "men are separated from the boys" and right now the DHHS folks look like a bunch of little boys at recess the day after Halloween trying to burn off all the sugar they had the night before.