State-level Republicans just can’t help themselves when it comes to Paul Ryan’s Medicare bill – you know, the one the conservative Wall Street Journal said “would essentially end Medicare” – and Virginia’s Ben Loyola is the latest GOP candidate to pledge his support for the idea.

But Loyola, running in the competitive 6th state Senate district, went even further than most Tea Party candidates. Not only is there “a lot to like about the Ryan plan,” according to Loyola, but the only problem he saw was that ending Medicare as we know it “didn’t go far enough:”

Ryan, R-Wisconsin, became the House GOP's point person on the budget after Republicans retook control of the chanber following the Nov. 2010 elections. He offered a budget plan that included austere cuts to the federal budget and a plan to revamp Medicare which would essentially end the program.

In a web chaton dailypress.com Tuesday, Loyola was asked by a reader if he supported Ryan's budget plan.

“Actually, there was a lot to like about the Ryan plan, although with the problems we face in Washington, DC, some say it didn't go far enough. I'm sympathetic to that point of view," Loyola responded.

Virginia Democrats quickly put Loyola’s comments in their proper context. Job creation is clearly the top issue in this November’s elections, but Virginia’s struggling middle class will not be helped by a plan that could throw tens of millions of seniors into crushing poverty:

“It’s bad enough that Ben Loyola embraces Paul Ryan’s Tea Party plan to end Medicare as we know it, but saying it doesn't go far enough is outrageous,” said DPVA Executive Director David Mills. “What other cuts on the backs of working families would Ben Loyola require before the Ryan plan goes far enough for him?

Ultimately, though, Loyola’s comments are just a symptom of a larger problem vexing Virginia Republicans: a slate of Tea Party state Senate candidates who are extreme and out of touch, pretty much across the board.

Earlier this week, the Iowa state Senate took some time out of its busy schedule to vote on a resolution (a message to Iowa’s congressional delegation, really) expressing its disapproval of Congressional Republicans’ bill to essentially end Medicare.

Every Iowa Senate Democrat voted for the resolution condemning the GOP plan, because no Iowa Senate Democrat wants to dismantle Medicare.

Every Iowa Senate Republican present voted against the resolution, presumably because they favor the GOP plan to dismantle Medicare. We say “presumably” because Senators all had the opportunity to speak and explain their votes, but only one Republican did. And his statement didn’t exactly inspire confidence among those who value seniors’ health care:

Senator Brad Zaun of Polk County was the only Republican to speak on the resolution, calling it a “stupid little resolution” that should not have been brought to the floor.

Zaun also said the issue did not affect Iowans. The cuts to Medicare and Medicaid are part of the so-called “Paul Ryan plan” to replace traditional Medicare with a plan under which individuals would buy their own private insurance with the help of government subsidies.

Medicare somehow doesn’t affect Iowans? That’s probably news to the half a million Iowans currently over 65 years old, as well as the 800,000+ who will be eligible for Medicare in the next 20 years.

As for the value of non-binding resolutions like these, well, that’s a matter of debate. All we know for sure is that the overall message – that Iowans do not want the GOP plan to dismantle Medicare – isn’t being heard by the state’s GOP members of Congress, who clearly need as many “stupid little” reminders (as Sen. Zaun put it) as they can get.

Evan McMorris-Santoro | June 9, 2011, 5:23PM

State legislators aren't able to vote either way on the Medicare-ending House Republican budget authored by Rep. Paul Ryan (R-WI). Nevertheless, Democrats, labor leaders and progressives trying to recall GOP state Senators in Wisconsin are eager to tie them to Ryan's budget which, in one prominent case at least, has proven to be political kryptonite for supposedly safe Republicans.

In the case of state Sen. Alberta Darling (R), Democrats may have just found the connection they needed.

TPM has learned that Ryan will be attending a fundraiser for Darling tomorrow in Milwaukee. The coordinator for the event told TPM she invited Ryan as a "courtesy," but the Darling campaign told TPM they expect Ryan to attend.

...

"Working families and the middle class clearly come last to all Wisconsin Republicans, regardless of the office they hold," said Carolyn Fiddler, spokesperson for the DLCC. "The kind of extreme right-wing agenda items supported by both Rep. Ryan and Sen. Darling sparked the recalls in the first place, and Rep. Ryan's support of the subject of one of those recalls is a fitting reminder of that fact." 

Read the full article here. 

In a state whose GOP leaders are still fighting to criminalize homosexuality and flirting with abolishing Medicaid, a leader with a great deal of skill, commitment, and persistence is often the only hope for even remotely progressive legislation.

Texas has such a leader in Democratic state Rep. Garnet Coleman, a DLCC Board of Directors member, who capped off a multi-year fight with two critically important legislative victories this session: a new suicide-prevention law and a law to dramatically increase access to health care in rural areas.

SB 984, the rural health care bill, solves a problem that has been vexing hospitals in rural communities for decades: how to ensure there are enough doctors. Enrique Rangel of the Lubbock Avalanche-Journal explains the solution:

Coleman, who is considered one of the leading health care experts in the Legislature, said the legislation he and Duncan worked on is a milestone.

“This is a major shift in state policy,” Coleman said. “Doctors will have the choice between hanging up their own shingle, or, working directly for a hospital.”

Jeff Barnhart, CEO of Ochiltree General Hospital in Perryton, said he is just as happy that after years in the works, Duncan and Coleman finally succeeded.

“In the future, when we need a doctor, this will make it easier for us to recruit and hire the doctor or doctors we need,” Barnhart said.

Dr. Bruce Malone of Austin, who today becomes president of TMA — which in previous sessions opposed similar proposals Duncan and Coleman filed — said the 45,000-member organization supported the bill this year because it recognizes that rural hospitals “have special needs.”

Under current law, doctors shoulder the financial risk themselves if they choose to practice in under-served areas. For younger doctors carrying potentially hundreds of thousands in medical school debt, that risk is often simply too heavy.

Another Coleman victory this session was the passage of Asher’s Law (HB 1386), which will provide new guidance and resources for Texas schools to help prevent suicide among students. This law, and a new anti-bullying law which was passed the same day, will ensure that more Texas youths have someplace (and someone) to turn to when it matters most:

Tonight, the Senate voted 28-3 to pass a suicide prevention bill by Rep. Garnet Coleman, D-Houston. This is the bill that was originally called Asher’s Law in honor of Asher Brown, the 13-year gay youth from the Houston area who took his own life last year in response to bullying at school.

Neither bill in its final form contains specific references or protections for LGBT youth. But the fact is that if they did, they wouldn’t have had any chance of passing the Republican-dominated Legislature.

Daniel Williams at Legislative Queery reports on Coleman’s bill:

HB 1386, the teen suicide prevention bill by Garnet Coleman (D-Houston) has passed the Texas Senate on a 28 to 3 vote. The bill instructs the Texas Department of State Health Services to develop resources designed to prevent teen suicide, including mental health counseling, crisis prevention tools and suicide prevention eduction. Schools would then have the option of implementing those programs, but would not be required to do so.

Congratulations to Rep. Coleman on these legislative victories, both of which were years in the making – Rep. Coleman is proving once again that he is a friend to the people of Texas.

Arizona Republicans have finally admitted that their unconscionable and deadly decision to rescind payment for organ transplants to patients who’d already been approved for them was a mistake. (They’ll never say it out loud, but Governor Brewer’s weekend proposal to reinstate transplants says everything Republicans won’t.)

But the Republican “solution” isn't just illegal; it would also kick an estimated 140,000 poor and working Arizonans off of Medicaid.

How bad is the GOP proposal? Arizona business advocacy groups are practically jumping up and down screaming “Tax me, tax me!” as an alternative:

Brewer’s move comes despite a proposal by the Arizona Hospital and Healthcare Association to tax its members to raise enough money to much more sharply limit the number of people who would need to be cut from the program to balance the budget. The hospitals say that, aside from increasing the number of uninsured in Arizona, Brewer’s plan would force layoffs at hospitals.

It also is going to trigger a lawsuit if and when Sebelius approves the change.

That is because Brewer hopes to phase in her plan by immediately refusing to enroll any childless adults and some parents with children. But attorney Tim Hogan of the Center for Law in the Public Interest said these people remain eligible for AHCCCS coverage under a 2000 ballot initiative that requires the state to provide care for anyone below the federal poverty level, about $18,310 a year for a family of three. And a state constitutional provision generally bars lawmakers from altering or repealing voter-approved measures.

The hospitals’ stance appears counter-intuitive at first, but it makes perfect sense once you delve into the numbers. As a joint federal-state program, 76.1% of Arizona’s Medicaid expenses are paid for by the Federal Government in 2011. Therefore, for every dollar Arizona hospitals are taxed (at their own request) to pay the state’s share of the program this year, the health care industry can expect up to four dollars in revenue from Medicaid services. In addition, when some of the 140,000 kicked off the program need emergency care and are unable to pay for it, heath care providers would absorb much of the cost themselves.

But for ordinary Arizonans, of course, the calculation is much simpler: Should the State of Arizona save more lives, with someone else offering to relieve taxpayers of the costs? Or should Arizona toe the national Republican Party line?

Because right now they can’t do both.

All across New Hampshire this holiday season, residents found their stockings stuffed with crazy, courtesy of the new GOP majorities in that state’s legislature.

The writers at the indispensable Blue Hampshire have published a series exploring incoming GOP legislators “Legislative Service Requests” (LSRs). These contain basically a bill number and a brief description of a law the legislator intends to propose, and they provided the first real glimpse of the priorities of the new GOP majority.

By Blue Hampshire’s count, LSRs so far include:

• Four bills seeking to abolish marriage equality;

• Three bills withdrawing from the wildly successful Regional Greenhouse Gas Initiative, and another challenging federal climate action;
• Eight bills challenging the federal health insurance reform law;
• One bill abolishing the Federal Reserve and switching New Hampshire to a system of gold and silver currency; and
• One bill “ordering” Senators Shaheen and Ayotte to vote against the UN Convention on the Law of the Sea.

There are a lot of head-scratchers in that list, but none more so than the LSR filed by Rep. Daniel Itse opposing the Law of the Sea Convention.

For one thing, state legislatures do not and have never had the authority to “order” their U.S. Senators to vote a certain way. Not even in the years before the 17th Amendment. Rep. Itse clearly needs to re-read our constitution (or perhaps the Cliffs Notes version) before voting on any legislation.

As for the Convention itself, it’s an extremely important body of international law. But the section gaining the most attention lately is arguably Articles 100-107, which define and establish every nation’s “Duty to cooperate in the repression of piracy.”

You read that right – piracy.

So, to recap, New Hampshire Republicans apparently think climate change, health care costs, and piracy are all imaginary. And the “threats” they take seriously? Gays and paper currency. Ridiculous.

New Hampshire, welcome to the Republic of Tea.

Too often, talk of health care policy focuses on the numbers and statistics. But from Arizona, we now have the disturbing story of how budget cuts imposed by GOP ideologues in the legislature have broken the state’s promise to save 98 individuals’ lives:

You can hear the weakness in his voice, even though doctors implanted a pacemaker in 2008. They've told [Randy] Shepherd that he needs a heart transplant to survive.

AHCCCS (pronounced like "access") was the only health insurance Shepherd could get because he had a pre-existing condition and, since he was forced to stop working in his plumbing business, little money. The agency authorized his transplant more than a year ago.

"The nurse who's the transplant coordinator did tell me about two months ago that I'm the next one of my body size and blood type, so the next [heart] that's available is mine," Shepherd says. (…)

But as of Oct. 1, AHCCCS said it is unable to pay for Shepherd's transplant. In fact, facing a $1.5 billion budget deficit, Arizona has cut out all state-funded lung transplants, some bone-marrow transplants and some heart transplants — including transplants for the condition Shepherd has.

Unlike typical budget cuts that might end state health coverage for a certain number of citizens – itself a difficult decision to make – Arizona Republicans decided to cancel coverage for procedures that had already been approved for individual patients.

Those individuals then spent months, even years, believing their procedures would be covered when a donor match was found. And that deception, according to University of Pennsylvania bioethicist Arthur Caplan, makes the GOP's decision doubly cruel:

"They then stop trying to raise money, stop trying to see what Uncle Fred might be willing to give them," Caplan says. "They don't have the bake sale. They don't make the appeal in church."

But rather than accept responsibility for their cruelty, Arizona Republicans attempted to deflect blame to Washington, DC – an outright lie that legislative Democrats quickly condemned:

Brewer’s office lied by blaming federal law on Tuesday for their own state cuts to transplants after a man was turned away from a liver transplant. In fact, Brewer and the Republican majority attempted to cut transplants in 2009, then successfully cut transplants in 2010 before the federal health care law passed.

“This was no one else’s choice but that of the Republican majority and Gov. Brewer, and it was theirs only,” said Assistant House Democratic Leader Kyrsten Sinema. “Every other state in the entire country pays for these transplants, every single one. The federal law has nothing to do with this.”

In 2009, the transplant program was saved thanks to a Sinema amendment.

HB 2010, the legislation that explicitly ended converge for most transplants, was opposed by every Democrat in the state legislature and supported by every Republican except one. Unless GOP leaders call a special session to reverse their catastrophically cruel action, January is the earliest that this issue can be addressed.

Meanwhile, those 98 individuals will be forced to suffer through the holiday season unsure of their very survival.

Maine’s new Republican-controlled legislature hasn’t even been sworn in yet, but GOP leaders are already crowing about their plans to abolish a public health insurance plan that was once considered a potential model for a national public option:

Before there was a federal health care overhaul, and before there was a Massachusetts law to use as a model for the national plan, there was Dirigo. That’s what Maine called its first-in-the-nation attempt at achieving universal health coverage when Democrats approved the plan back in 2003. (…)

[Incoming GOP Governor Paul] LePage, a Tea Party favorite, has called Dirigo “a costly failure.” He claims taxpayers have spent more than $160 million to cover just 3,400 uninsured Mainers under the program. Baldacci’s administration disagrees with that portrayal, arguing that since it began, Dirigo has covered more than 32,000 people without using any general fund dollars to pay for it.

Under a complicated funding arrangement, Dirigo is funded 50 percent by the “savings offset payment” from private insurance companies. That’s the amount the state figures insurers are saving because the uninsured aren’t seeking emergency care they can’t pay for. The rest of the funding comes from premiums, the federal government and tobacco settlement dollars.

But the scope and efficiency of Dirigo Health aren’t the only areas where Maine Republicans are relying on distortions and outright falsehoods. They’re also lying about why they want to ax the program in the first place.

The GOP will likely claim it as a budget-cutting move. But in fact, abolishing Dirigo Health will actually worsen the state’s budget situation:

With Maine facing a nearly $1 billion budget deficit for next year, Michael Franz, a Bowdoin College political scientist, predicts Dirigo will be repealed “in the name of budget cuts.” But he questions the long-term consequences. “If health care services for the poor are scaled back for short-term budget balancing, this will shift more care into the ER, outside the health insurance system and run up costs in the long-run,” he says.

Trish Riley, director of Baldacci's Office of Health Policy and Finance, told The Portland Press Herald that if Dirigo is eliminated, the state will either have to cut 6,700 people off Medicaid, or the general fund would have to come up with the roughly $6 million.

In other words, Maine Republicans have found a way to simultaneously cut off health coverage for thousands of struggling families, increase the cost of everyone else’s health care, and waste millions of Maine taxpayers’ dollars – all in a single proposal.

If these are the kind of “ideas” Maine Republicans are bringing to the table, then progressive organizers had better dust off the state’s unique People’s Veto provision, because there are going to be a lot of crazy new laws to repeal between now and 2012.

There’s a leadership race brewing in the Texas House, with incumbent Speaker Joe Strauss facing revolt by right-wing allies of former Speaker Tom Craddick. And one contender, Warren Chisum of Pampa, is already basing his campaign on his opposition to one of the most important health care reforms in American History.

No, not that one - Chisum is actually proposing that Texas pull out of Medicaid and the State Children’s Health Insurance Program. And the idea is so extreme that even some of Chisum’s initial allies are already thinking twice:

State Rep. John Zerwas, R-Simonton, an anesthesiologist who authored the bill commissioning the Medicaid study, said early indications are that dropping out of the program would have a tremendous ripple effect monetarily. He is not ready to discount the idea, he said, but he worries about who would carry the burden of care without Medicaid’s “financial mechanism.”

“Because of the substantial amount of matching money that comes from the federal government, there’s an economic impact that comes from that,” Zerwas said. “If we start to look at what that impact is, we have to consider whether it’s feasible to not participate.”

Indeed. In addition to taking away health care from 3.6 million Texans, ending the Lone Star State’s involvement in Medicaid would forfeit at least $24 billion in annual federal funding for the program.

Which means even if all of those people are able to find and pay for health care on their own (they’re not), and even if the GOP’s utopian fantasy that private insurance is more efficient than Medicare or Medicaid turns out to be true (it isn’t – Medicaid is more efficient), pulling out of Medicaid and CHIP will suck at least a quarter of a trillion dollars out of the Texas economy over the course of ten years.

The reality is, some portion of those 3.6 million Texans will find insurance, but at a significantly higher cost than Medicaid would have spent to provide care. The vast majority of those 3.6 million will simply do without, because they cannot afford insurance. And when their un-detected and un-treated medical problems become so severe that the emergency room is the only option, the people of Texas will foot the bill.

That bill will be on top of the quarter-trillion-dollar guaranteed loss.

But this is health care we’re talking about, and an important question went unasked in the Texas Tribune article: How many of those 3.6 million Texans (including nearly half a million blind and disabled individuals, another quarter million pregnant mothers and newborns, and over 2.3 million children) will lose their lives because they’ll lack adequate health care?

And how many dollars saved will each of those lives be worth to the GOP?

Thanks to the 2/3 Democratic majority in the Connecticut Legislature, Democrats in 2009 overrode the governor’s veto of a bill to create “SustiNet,” designed to be the nation’s first true public option health insurance plan. But with the Connecticut Legislature and governorship up for election in 2010, many analysts believe that this year’s voters hold the fate of SustiNet in their hands.

And the choice couldn’t be clearer – if you live in Connecticut and believe in building a public option, you need to get out and vote for Democrats. The American Prospect’s Joanne Kenen explained the situation:

Though approved in concept by the state Legislature, SustiNet at this point is only a concept. It has a board, a cadre of volunteer analysts, and task forces as well as support from foundations, advocates, and Democratic legislators. But the commission must go back to the Legislature next year for final approval -- and funding -- in an environment that is fiscally challenging and politically uncertain. The race to succeed Gov. Jodi Rell, a moderate Republican who is not seeking re-election, is competitive, and the Legislature, which passed the SustiNet bill and then overrode Rell's veto, could have a different composition post-November. For political or economic reasons, SustiNet could be delayed or scaled down. But state Rep. Chris Donovan, the speaker of the Connecticut House, says the idea has broad public support. The message he has been relaying around the state, he says, is, "Better plan, costs less. Like that beer commercial: tastes great, less filling."

We hope you caught that – even a self-proclaimed “moderate” Republican vetoed the plan last year, despite broad public support (that seems to be happening a lot lately). Which means the best way to guarantee that SustiNet stays on track is to maintain the Democrats’ veto-proof majority in the legislature.

It would take a disastrous election cycle to break State House Democrats’ 114-37 advantage, but State Senate Democrats currently sit right at the 2/3 mark with a 24-12 edge. Just like the federal health care reform bill, not a single Republican State Senator voted to pass SustiNet.

And make no mistake, if SustiNet goes online in 2012 as planned, it will be a groundbreaking achievement for health care reform:

[SustiNet Board Co-Chair Kevin] Lembo and other advocates note that SustiNet is not just a coverage mechanism. It was conceived, too, as a catalyst for delivery-system reform, aiming to improve quality while restraining costs. Various task forces are working on creating or expanding medical homes and chronic -- disease management, electronic medical records, incentives for evidence-based medicine, and public-health initiatives on obesity and tobacco. Addressing racial and socioeconomic health disparities is also an explicit goal. Lembo said the public option could end up covering about 1 million people out of Connecticut's 3.5 million, meaning it could have a big ripple effect on health-care delivery and public health throughout the state.

If the experience of Massachusetts, Hawaii, and Oregon are any guide, it could also become a model for other states to follow – and possibly the federal government as well.