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The Cornered Canine

Shutting Down Government Just as the new Health-Care Exchanges Open for Enrollment


Thursday, October 3, 2013
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GREEN EGGS AND HAM: Without Dr. Seuss, there would be ​— ​could be ​— ​no Bob Dylan. Likewise, hip-hop would not ​— ​could not ​— ​ever exist. For my money, Dr. Seuss ​— ​a k a Theodor Geisel ​— ​belongs on the same jammed pedestal of American letters as Mark Twain and Bill Watterson of Calvin and Hobbes fame. For generations, the good doctor ​— ​not really an MD ​— ​provided the subliminal psychic metronome by which so many of us explored the exhilaration of our own twisted syncopations. So when I saw Senator Ted Cruz, the one-man Texas Tea Party, pimping out the Dr. Seuss masterpiece Green Eggs and Ham as part of his faux filibuster against Obamacare last week, I was inclined to grind my teeth a few miles past the gum line. Certainly the ironies overflowed up like a backed-up toilet. In real life, Dr. Seuss was as progressive as they came and would have no doubt winced at the reactionary hysterics of Cruz and his coconspirators. At its core, Green Eggs was a cautionary tale against digging in one’s heels and just saying, “No.” With Cruz and other Congressional Republicans having now voted to repeal the Affordable Care Act no less than 42 times ​— ​each time with no hope of success ​— ​clearly they have not taken that message to heart. In fact, it’s impossible to imagine that the self-proclaimed Texas Tornado ever cracked the book’s spine, let alone ever read it to his kids. Given that the Tea Party members and Republicans in Congress saw fit to shut down the federal government over Obamacare ​— ​on the very first day the health-care exchanges created by the Affordable Care Act were open for customers ​— ​these insults have become mere incidental details to the more profound injury inflicted by the sublime dysfunction of Congress. Little wonder the popularity of that legislative body ​— ​now at 10 percent approval ​— ​has plunged lower than that of a colonoscopy.

Angry Poodle

For something supposedly so heinous, there was a striking abundance of interest among Californians about signing up for the new insurance exchanges on day one (but the new law doesn’t go into effect until Jan. 1). Most news outlets report there were 2.8 million e-mail hits, causing the system created by Covered California to crash or freeze multiple times. Like many of my knee-jerk ilk, I regard the passage of the Affordable Care Act as a genuinely historic and imperfectly positive achievement. That’s not to say it won’t be a huge mess. It absolutely will be. At least for a while.

Along the Central Coast, an estimated 58,000 people will benefit by vastly improved health care access because of the Affordable Care Act. About 30,000 will now find themselves eligible for Medi-Cal coverage for the first time. That’s because the eligibility rules were expanded to include people who make 138 percent the federal poverty level. Given that the cutoff had previously been no more than 100 percent of poverty ​— ​defined by the feds as $11,000 for a single individual ​— ​we’re talking seriously poor. The other major good news is that 28,000 locals now without insurance will be eligible to sign up for one of the two insurance exchanges set up in Santa Barbara. Yes, insurance will be mandatory. But so is car insurance, and I don’t see the Tea Party going to the barricades because city cops issue approximately 1,029 citations a year to motorists for driving without proof of insurance. Yes, it will cost, but even families earning up to $95,000 a year can get subsidies.

The whole plan hinges on the availability of primary care physicians of which we have a national and local shortage. It came as a huge shock to me to find out that Sansum Clinic ​— ​by far the biggest outpatient care provider in the county ​— ​is not part of this new exchange system. Sansum CEO Kurt Ransohoff told me that he’d always assumed Sansum would be involved, but that as recently as a few weeks ago, Sansum was never approached by either of the two exchange providers, Anthem Blue Cross or Blue Shield. At that time, he said Sansum approached the providers, only to be informed that Sansum was excluded. Sansum, it was explained, had failed to respond in a timely manner to an inquiry the providers had sent out. Ransohoff said Sansum has no records of any such inquiries having been made. Since then, he said Sansum and the exchanges have been talking multiple times a week. But the problem, it turns out, goes well beyond the my-dog-ate-my-homework variety. Ransohoff said the reimbursement rate the exchanges were offering to pay Sansum for treatment provided fell well below the line of economic sustainability. He said Sansum was willing to eat some form of discount but said what the exchanges were demanding was beyond huge. There are many primary care docs outside the Sansum orbit, but many are already booked solid and are likewise leery about the low rate of return offered by the exchanges. Cottage Health System, it should be noted, has signed a contract with the Blue Cross and Blue Shield exchanges, but hospitals are not in the business of outpatient care, despite the intense use of emergency rooms by those without insurance. It’s assumed by many medical professionals that the Santa Barbara Neighborhood Clinics will provide primary care for many of these new patients, and maybe that’s the case. But it’s worth remembering that the Neighborhood Clinics have been bleeding hundred-dollar bills and are currently undergoing emergency intervention. Despite all the optimism expressed over the changes being made, it remains to be seen the extent to which they can shoulder the load. Like I say, there are a lot of bugs still to be worked out. How that happens I don’t pretend to know. I am certain, however, you can’t get from here by shutting down the federal government and voting ​— ​42 times ​— ​to repeal Obamacare. As a start, I’d suggest Senator Cruz and his cohorts reread Green Eggs and Ham. Better yet, read it for the first time.

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Gee, Nick, if Obama was elected by 53% of the people and proclaimed it a mandate, then why aren't the 53% of people polled who are AGAINST Obamacare given the same courtesy.

And BTW, it is Obama and Reid, not the Republicans, who are the roadblocks here. Refusing to even discuss? Now THAT's democratic! Actually, Democratic.

JohnLocke (anonymous profile)
October 3, 2013 at 9:59 a.m. (Suggest removal)

@JohnLocke: "And BTW, it is Obama and Reid, not the Republicans, who are the roadblocks here. Refusing to even discuss?"

So what's the list of laws for which it is perfectly fine for a minority wing of the Republican party to hijack the entire federal government? Should we be thankful that desegregation isn't up for discussion? Hell, even Grover Norquist thinks Ted Cruz is a nut.

You want to appeal the ACA? GREAT! Get the votes!

But that's Tea Party "logic" for you. Republicans set the house on fire, Obama isn't putting it out fast enough, so the Tea Party is going to blow it up. 'Mazing...

EatTheRich (anonymous profile)
October 3, 2013 at 10:59 a.m. (Suggest removal)

Trapped again by useless government officials telling us it makes sense if we don't think about....
I need affordable health care. I just don't have the time to analyze, then re-analyze loads of paperwork (and the drawn out phone calls) before medical staff can diagnose something I'm sure to seek a second opinion on anyway (due my distrust of government efficiency over many numerous experiences in the past.)
I can go on all day...

touristunfriendly (anonymous profile)
October 3, 2013 at 11:23 a.m. (Suggest removal)

Of course the ACA is popular in CA. We have 1/8 of the nation's population but 1/3 of the nation's welfare recipients. As long as we keep that ratio and keep people dependent of government for their support, The Democratic supermajorities will continue unabated.

Botany (anonymous profile)
October 3, 2013 at 11:35 a.m. (Suggest removal)

@JohnLocke

"...why aren't the 53% of people polled who are AGAINST Obamacare given the same courtesy."

1) It's unclear to what "courtesy" you are referring. (Possibly, the proclaiming of a "mandate", from the previous half of the sentence?)

2) I think that is a false equivalency--saying that 53% of the voting populace = 53% of "people polled". Also, do you have a source for these numbers?

@touristunfriendly

"...before medical staff can diagnose something I'm sure to seek a second opinion on anyway (due my distrust of government efficiency over many numerous experiences in the past.)"

How does a medical diagnosis depend on the efficiency of the government, and not the capability of the doctor--and/or the trust/faith in that doctor?

equus_posteriori (anonymous profile)
October 3, 2013 at 12:01 p.m. (Suggest removal)

Thanks, Nick, for the heads-up on the Sansum Clinic mess. Hope there's more coverage in the Indy about this.

Moonrunner (anonymous profile)
October 3, 2013 at 12:31 p.m. (Suggest removal)

Mr. Locke maybe you should also read green eggs and ham...or maybe just eat some green eggs and save us all the headache of listening to your tea party psyco-babble.

This law was passed, upheld by the supreme court, and is now the law of the land. That's how things are done in this country. What is there for the Democrats to negotiate?

Ted Cruz and his tea party wacko's are masters at framing the debate to suit their purpose. Luckily most people are aware of their tactics and don't buy the BS. It's ok though, the longer this craziness goes on the more people realize just how out of touch these guys are. Good luck with re-election tea party, you guys are digging your own graves.

billd (anonymous profile)
October 3, 2013 at 2:27 p.m. (Suggest removal)

Sansum and Cottage are also dropping UCSB...

http://gauchocast.ucsb.edu/Panopto/Pa...

snugspout (anonymous profile)
October 3, 2013 at 9:22 p.m. (Suggest removal)

It's off the main point, but props for the relative probity and rectitude of colonoscopies.

Adonis_Tate (anonymous profile)
October 4, 2013 at 1:07 a.m. (Suggest removal)

agree blld, and don't waste time on JL's "tea party psyco-babble", s/he never listens, except when s/he pretends to be "center-left" (ha!). Best not to feed the trolls.
BTW for several months the Demos wanted to conference with the Repubs and they refused: NOW they suddenly wanted to conference on ACA at one second to midnight: this is called face-saving BS and Obama/Reid were too intelligent to fall for it. Hold the line: they will crumble.

DrDan (anonymous profile)
October 4, 2013 at 6:10 a.m. (Suggest removal)

snugspout, it is absolutely NOT true that "Sansum and Cottage are dropping UCSB". They both accept HealthNet, which is one of the HMO insurance options available to UCSB employees.

Nockamixon (anonymous profile)
October 4, 2013 at 8:43 a.m. (Suggest removal)

Sorry, Nockamixon, several hundred UCSB employees attended a town hall meeting yesterday at UCSB (the audio is linked) to learn from UC system administrators who came down from Oakland about the details of Cottage & Sansum's dropping of UCSB.

snugspout (anonymous profile)
October 4, 2013 at 9:23 a.m. (Suggest removal)

Sorry, snugspout, but if you were at the townhall forum, then you would know that there is a NEW, 3-tiered insurance option being offered to UC employees. ONE of these tiers (Tier 1) will not offer Sansum-Cottage as a preferred provider. The other two tiers allow access to Sansum-Cottage. And of course, HealthNet HMO will continue to offer access to Sansum-Cottage. I challenge the accuracy of your statement that "Sansum and Cottage are dropping UCSB".

Nockamixon (anonymous profile)
October 4, 2013 at 10:22 a.m. (Suggest removal)

QED. Sansum and Cottage are dropping UCSB from the preferred plan. My statement is entirely accurate.

If you are a UCSB employee and show up at Sansum or Cottage and offer to pay cash upon admission, or pay a similar amount (after the very complex rate calculations... don't pretend those are comprehensible) through a second or third rate plan, Sansum & Cottage will take you.

snugspout (anonymous profile)
October 4, 2013 at 11:31 a.m. (Suggest removal)

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