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The GOP Pulled Off the Medicaid Bandaid. Next Up? Medicare Amputations.

In this post we’re going to look at the grow­ing right wing “Health Care Com­pact” move­ment that would trans­fer Medicare from a fed­er­al­ly run pro­gram to a state-run enter­prise inca­pable of deal­ing with eco­nom­ic shocks (which isn’t very use­ful for a safe­ty-net pro­gram). We’ll also take a look at what we can expect should the “Health Care Com­pact” come into force by review­ing Kansas’ recent Med­ic­aid pri­va­ti­za­tion schemes and the FBI inves­ti­ga­tions that have fol­lowed. And final­ly, we’ll look at the ori­gins of the Health Care Com­pact. Hint: it’s the kind of plan that gets hatched when some­one like Ted Cruz catch­es nul­li­fi­ca­tion fever [1].

When “God’s Sen­a­tor” [2], Sam Brown­back, became “God’s Gov­er­nor” of Kansas back in 2010 it was clear some pret­ty big changes were on the way for Kansas. After all, when a GOP mem­ber of Opus Dei [3] is your new gov­er­nor, some form of aus­ter­i­ty for the mass­es is prob­a­bly in the cards [4]. And sure enough, fol­low­ing the 2012 intra-GOP “mod­er­ate” purge [5], aus­ter­i­ty for Kansas has arrived in full force [6]. As once might expect [7], this includes the self-inflict­ed aus­ter­i­ty that comes with refus­ing to accept the Oba­macare Med­ic­aid expan­sion. Just think of it as self-fla­gel­la­tion [8] for Kansas. Utter­ly point­less, yet still painful and dam­ag­ing, self-fla­gel­la­tion [9]:

Hos­pi­tal offi­cials say refusal to expand Med­ic­aid will hurt their bot­tom lines
Mon­ey need­ed to off­set oth­er cuts com­ing because of Oba­macare

By Jim McLean
KHI News Ser­vice
Jan. 13, 2014

PARSONS — For Jodi Schmidt and oth­er hos­pi­tal admin­is­tra­tors across Kansas, Med­ic­aid expan­sion is a crit­i­cal busi­ness issue not a polit­i­cal one.

Schmidt is chief exec­u­tive of Labette Health, a 99-bed region­al med­ical cen­ter that serves Par­sons and sev­er­al sur­round­ing com­mu­ni­ties in south­east Kansas. She said the mon­ey being lost because of the deci­sion by Gov. Sam Brown­back and leg­is­la­tors to not par­tic­i­pate in the first year of expan­sion could mean the dif­fer­ence between the hos­pi­tal fin­ish­ing the year in the black or with a deficit.

“What­ev­er your pol­i­tics, the real­i­ty on the ground for hos­pi­tals is that Med­ic­aid expan­sion is crit­i­cal­ly impor­tant for us,” Schmidt said.

Expan­sion could pro­vide cov­er­age to an esti­mat­ed 85,000 Kansans who make too much to qual­i­fy for the state’s exist­ing Med­ic­aid pro­gram — called Kan­Care — but too lit­tle to be eli­gi­ble for fed­er­al tax cred­its to help them pur­chase pri­vate cov­er­age on the Healthcare.gov exchange.

A study done last year for the Kansas Hos­pi­tal Asso­ci­a­tion [10] esti­mat­ed that expand­ing eli­gi­bil­i­ty to the lev­el called for in the Afford­able Care Act would increase fed­er­al Med­ic­aid spend­ing in the state by $3 bil­lion between this year and 2020. The fed­er­al gov­ern­ment has pledged to pay the full cost of cov­er­ing the expan­sion pop­u­la­tion for three years and no less than 90 per­cent there­after.

Expan­sion would pro­vide Labette Health and oth­er hos­pi­tals in the association’s south­east dis­trict an addi­tion­al $2.7 mil­lion a year to share.

The mon­ey is need­ed, Schmidt said, to par­tial­ly off­set antic­i­pat­ed Medicare cuts and loom­ing reduc­tions in fed­er­al pay­ments that help hos­pi­tals off­set the cost of car­ing for the unin­sured.

“We could be see­ing an addi­tion­al $1.7 or $1.8 mil­lion in reduced reim­burse­ment next year,” Schmidt said. “And so this lack of Med­ic­aid expan­sion is just one more hit and there is only so much indi­vid­ual hos­pi­tals can bear.”

Forty miles up U.S. High­way 59 from Par­sons the sto­ry is much the same in Chanute. There, Den­nis Franks, the CEO of the 25-bed Neosho Memo­r­i­al Region­al Med­ical Cen­ter, said the hos­pi­tal needs the mon­ey that would come with Med­ic­aid expan­sion to off­set cuts in oth­er reim­burse­ments.

“When you live on the mar­gin every dol­lar counts,” Franks said. “So, when I’m tak­ing $700,000 to $1 mil­lion a year out of my bud­get that means there are ser­vices I can no longer pro­vide. What am I going to do to make sure that I keep my doors open and do the things for this com­mu­ni­ty that I need to do?”

Via Christi Region­al Med­ical Cen­ter in Wichi­ta may be the Kansas hos­pi­tal most affect­ed by the state’s reluc­tance to par­tic­i­pate in the Med­ic­aid expan­sion. Last year, it received near­ly $13 mil­lion in so-called dis­pro­por­tion­ate share pay­ments to help off­set some of the costs of car­ing for the unin­sured. Start­ing next year, those pay­ments will be steadi­ly reduced along with Medicare reim­burse­ment rates.

Note that Wichi­ta also hap­pens to be the head­quar­ters of Koch Indus­tries, so this is the Kochs’ back­yard that’s shoot­ing itself in the foot while refus­ing insur­ance.


That prospect has put Via Christi at the fore­front of an effort being mount­ed by the hos­pi­tal asso­ci­a­tion to work out a Med­ic­aid expan­sion com­pro­mise with the Brown­back admin­is­tra­tion and Repub­li­can leg­isla­tive lead­ers.

“We’ve made some progress with the pub­lic and with some leg­is­la­tors in mak­ing the case for Med­ic­aid expan­sion,” said Bruce Witt, direc­tor of leg­isla­tive affairs at Via Christi. “We’re at the point now where pol­i­tics has kind of come into play and that’s where the real chal­lenge lies.”

Put sim­ply, the chal­lenge is get­ting Brown­back and leg­is­la­tors to decou­ple the expan­sion issue from Oba­macare, which remains anath­e­ma to the Repub­li­can Party’s base and unpop­u­lar with most Kansans, assum­ing the polls are accu­rate.

The hos­pi­tal asso­ci­a­tion has hired for­mer U.S. Health and Human Ser­vices Sec­re­tary Mike Leav­itt [11], a Repub­li­can who served in the Bush admin­is­tra­tion, to try to per­suade Kansas Repub­li­can lead­ers to move for­ward with expan­sion using a pri­vate-sec­tor approach sim­i­lar to those being devel­oped or imple­ment­ed in Arkansas, Iowa, Penn­syl­va­nia and a hand­ful of oth­er states.

Witt said he is hope­ful progress can be made if expan­sion advo­cates with Leavitt’s help can “engage the busi­ness com­mu­ni­ty.”

“The Kansas Cham­ber, for exam­ple, has, at least, expressed a will­ing­ness to con­tin­ue dis­cus­sions about Med­ic­aid expan­sion, par­tic­u­lar­ly if it’s tak­ing a more Kansas-based, pri­vate-mar­ket solu­tion,” Witt said.

Mike O’Neal, chief exec­u­tive of the Kansas Cham­ber, con­firmed the busi­ness orga­ni­za­tion is will­ing to par­tic­i­pate in such talks.

“I can’t pre­dict at the end of the day whether that dis­cus­sion will bear fruit in a way that the peo­ple who want the expan­sion are going to be sat­is­fied,” O’Neal said. “But the dis­cus­sion of an issue this impor­tant is healthy and it should take place.”

Also note that the Kansas Cham­ber of Com­merce, like vir­tu­al­ly all US cham­bers of com­merce [12], is a heav­i­ly Koch-finance orga­ni­za­tion [13].


Both O’Neal and Sen­ate Pres­i­dent Susan Wagle, a Wichi­ta Repub­li­can, have said they expect the messy roll­out of the ACA will make the expan­sion dis­cus­sion [14] more dif­fi­cult. But both said they would be open to Kansas pur­su­ing a plan like the one Penn­syl­va­nia offi­cials are seek­ing fed­er­al approval to imple­ment.

I’m intrigued by the Penn­syl­va­nia plan [15] because it has a work com­po­nent to it,” O’Neal said. “They are actu­al­ly try­ing to change the pro­file of the Med­ic­aid pop­u­la­tion and incen­tivize some that are in that pop­u­la­tion to get into a work sit­u­a­tion.”

Approx­i­mate­ly 45 per­cent of unin­sured Kansans in the Med­ic­aid eli­gi­bil­i­ty gap are employed, accord­ing to the Kansas Health Insti­tute, a non­par­ti­san research and pol­i­cy orga­ni­za­tion that includes the edi­to­ri­al­ly inde­pen­dent KHI News Ser­vice.

Yes, the pro­posed Med­ic­aid expan­sion plan for Penn­syl­va­nia that has the Kansas GOP and Cham­ber of Com­merce so intrigued was to make Penn­syl­va­nia the only first state to impose of work-search require­ment (even though 45% of unin­sured Kansans in the “gap” are already employed). So the swelling ranks of the long-term unem­ployed (that rarely ever find work again in the US econ­o­my [16]) get keep swelling but at least they might have health­care cov­er­age as long as they con­tin­ue look­ing for non-exis­tent jobs. Penn­syl­va­ni­a’s gov­er­nor has since watered down his work-require­ment pro­pos­al while he awaits for fed­er­al approval [17] so it remains to be seen if that will come into effect. But it’s a rul­ing states still suf­fer­ing from Oba­macare Derange­ment Syn­drome are going to be watch­ing close­ly and, as such, we should all prob­a­bly watch how that devel­ops too.

So might Med­ic­aid expan­sion in some form still hap­pen in Kansas this year of Penn­syl­va­nia’} plan gets approved? Nope! Not chance. Not, after God’s Gov­er­nor signed a bill that strips the gov­er­nor of the pow­er to expand Med­ic­aid in 2014 (even if he los­es reelec­tion in Novem­ber) [18].

The GOP’s Death Sen­tence For Amer­i­ca Health Care Com­pact
But that does­n’t mean no changes are on the way for Kansas and a col­lec­tion of oth­er states that also have gov­er­nors suf­fer­ing from Bad-Samar­i­tani­tis: A mul­ti-state “com­pact” is already in the works and Kanas just joined it: Kansas, along with eight oth­er states that have refused to expand Med­ic­aid, wants to cre­ate a “Health Care com­pact” that will allow these states to com­plete­ly take over the man­age­ment of Med­ic­aid AND Medicare. So the states that are refus­ing to take on the respon­si­bi­ly of ensur­ing their res­i­dents’ basic needs are met, want a lot more respon­si­bilty over those basic needs [19]:

Brown­back signs con­tro­ver­sial health care com­pact bill
Goal is to give mem­ber states con­trol over Medicare and Med­ic­aid

By Dave Ran­ney
KHI News Ser­vice
April 23, 2014

TOPEKA — Gov. Sam Brown­back has signed into law a bill that might make it pos­si­ble for Kansas to join a com­pact of states that want the pow­er to run Medicare and Med­ic­aid with­in their bor­ders.

The new law also cre­ates the pos­si­bil­i­ty that the com­pact states could cir­cum­vent sev­er­al key pro­vi­sions in the Afford­able Care Act, also known as Oba­macare.

“The Health Care Com­pact will allow states to restore and pro­tect Medicare for gen­er­a­tions to come,” Brown­back said in a pre­pared state­ment today announc­ing that he had signed the mea­sure. The actu­al sign­ing was Tues­day.

The com­pact couldn’t come into being with­out approval by Con­gress, which is con­sid­ered unlike­ly as long as Democ­rats con­trol at least one of its cham­bers. Democ­rats cur­rent­ly con­trol the Sen­ate, and Repub­li­cans are push­ing hard in this year’s elec­tions to regain the major­i­ty. The GOP already con­trols the U.S. House.

Kansas Insur­ance Com­mis­sion­er Sandy Praeger and AARP Kansas had ear­li­er urged the gov­er­nor not to sign House Bill 2553, call­ing the ini­tia­tive friv­o­lous and mis­guid­ed.

‘Real­ly twist­ing things’

In a state­ment released today, the gov­er­nor accused Oba­macare of “cut­ting $700 bil­lion out of Medicare,” a claim being used by Repub­li­cans across the nation as they con­tin­ue to fight the law and cam­paign for elec­tion. Poli­ti­fact, a fact-check­ing project of the Tam­pa Bay Times, has labeled the claim a half-truth.

Accord­ing to Poli­ti­fact [20], the law doesn’t actu­al­ly cut Medicare spend­ing but is expect­ed to reduce future growth in the program’s costs most­ly by reduc­ing Medicare Advan­tage, “a small sub­set of Medicare plans that are run by pri­vate insur­ers.”

“The gov­er­nor is real­ly twist­ing things,” said Dave Wil­son, a past vol­un­teer pres­i­dent of AARP Kansas.

Wil­son also said he doubt­ed Brownback’s assur­ances that he would oppose any reduc­tion in Medicare ben­e­fits, if the com­pact were enact­ed and state offi­cials gained con­trol over Medicare, which cur­rent­ly is admin­is­tered sole­ly by the fed­er­al gov­ern­ment.

“That’s what he says and that’s what leg­is­la­tors who sup­port this say,” Wil­son said. “But the real­i­ty is they can’t do it now, but with this bill they could do it and that could have a tremen­dous impact on seniors, on the dis­abled and on vet­er­ans.”

Fed­er­al offi­icals run the Medicare pro­gram, which pro­vides health cov­er­age for seniors. But Med­ic­aid, which serves poor chil­dren, the frail elder­ly and the dis­abled, is a shared state-fed­er­al pro­gram with the fed­er­al gov­ern­ment pay­ing the major­i­ty of its cost (about 60 per­cent) and impos­ing var­i­ous basic require­ments on the states.

But Med­ic­aid also gives states sig­nif­i­cant lat­i­tude in the ways they man­age the pro­gram, includ­ing the deter­mi­na­tion of eli­gi­bil­i­ty stan­dards. For exam­ple, Kansas oper­ates its Kan­Care pro­gram with a waiv­er exempt­ing it from many of the stan­dard Med­ic­aid rules. And Kansas also is allowed to keep thou­sands of peo­ple out of Med­ic­aid who would qual­i­fy for the pro­gram in oth­er states.

One of nine

Kansas is one of nine states that have enact­ed laws express­ing the desire to join the so-called “health care com­pact.” The oth­ers are Alaba­ma, Geor­gia, Indi­ana, Mis­souri, Okla­homa, South Car­oli­na, Texas and Utah.

“All nine states that are now in this com­pact are states that have turned their backs on Med­ic­aid expan­sion,” Praeger said. “On the one hand you’re say­ing you want to bring those fed­er­al (Medicare) dol­lars back to Kansas, but on the oth­er hand you’re say­ing we’re not going to take those (Med­ic­aid) fed­er­al dol­lars.”

It’s unclear whether Kansas seniors will sup­port the governor’s deci­sion to sign the bill, she said.

“If it ain’t broke don’t fix it,” Praeger said. “And the Medicare pro­gram, while it needs to rein in costs, is a reli­able source of health care ser­vices for our senior pop­u­la­tion, and I would not want to be putting those folks at risk.”

Amer­i­cans for Pros­per­i­ty, a polit­i­cal action group tied to the bil­lion­aire broth­ers Charles and David Koch, has spent mil­lions of dol­lars fight­ing Oba­macare.

“Health care deci­sions should be made by Kansas offi­cials, not the fed­er­al gov­ern­ment,” said Jeff Glen­den­ing, state direc­tor of Amer­i­cans for Pros­per­i­ty-Kansas. “With Con­gres­sion­al approval, the Health Care Com­pact will trans­fer con­trol of fed­er­al health care fund­ing from Wash­ing­ton, D.C., to Kansas. It sup­ports the state’s abil­i­ty to con­trol its own health care sys­tem.”

Glen­den­ing said the com­pact wouldn’t require the states to take over Medicare or Med­ic­aid but would allow them the option.

“Under the com­pact, we can set stan­dards and reim­burse­ment rates rather than hand­ing those impor­tant deci­sions over to the fed­er­al gov­ern­ment,” he said.

‘Path out of Oba­macare’

The Lib­er­tar­i­an Par­ty of Kansas also endorsed the new law.

“We believe in gov­ern­ment at its most local lev­el,” said Al Ter­welp, chair­man of the state par­ty. “So we sup­port the com­pact idea in gen­er­al, hav­ing the state of Kansas be in as much con­trol over health care issues as pos­si­ble.

In the Leg­is­la­ture, the bill’s pri­ma­ry spon­sors were Rep. Brett Hildabrand and Sen. Mary Pilch­er-Cook, both Repub­li­cans from Shawnee and oppo­nents of Oba­macare.

“By sign­ing the health care com­pact, the gov­er­nor has agreed Kansas needs to pro­tect Medicare for seniors, while also pro­vid­ing a path for Kansas cit­i­zens and busi­ness­es out of Oba­macare, giv­ing Kansans more eco­nom­ic sta­bil­i­ty, free­dom and choic­es for their health care needs,” Pilch­er-Cook wrote in an email to KHI News Ser­vice.


Uh oh! Kansas’ seniors (and Alaba­ma’s, Geor­gia’s, Indi­ana’s, Mis­souri’s, Okla­homa’s, South Car­oli­na’s, Tex­as­’s and Utah’s seniors) might be in for quite the rude awak­en­ing, because the GOP’s “solu­tion” to Oba­macare appears to be the sub­ver­sion of Medicare. Well, ok, that only hap­pens if the GOP takes con­trol of the Sen­ate in 2014, but since that is a very real pos­si­bil­i­ty....Uh Oh! [21]

What Might God’s Gov­er­nor do to Medicare? Let’s See...
Of course, if you take Brown­back at his word, Kansans should­n’t be con­cerned about an ero­sion of Medicare because, while Brown­back and these eight oth­er states real­ly want to take over con­trol of Medicare, Brown­back have no plans on cut­ting the pro­grams. Of course, if there’s reces­sion in the future it does­n’t sound like Kansas will have a choice in cut­ting back Medicare, but we should prob­a­bly ignore that for Sam’s sake. No, there should be no con­cern that the par­ty that has made the demo­niza­tion of the poor an ide­o­log­i­cal neces­si­ty (because oth­er­wise “the mar­ket” can’t be the answer to all of life’s prob­lems [22]) might have secret plans in mind for gut­ting pro­grams for the poor once they have the pow­er to do so.

Then again, if you take Brown­back at his word, you’re prob­a­bly some­what naive [23]. Or maybe you’re a loy­al­ist lob­by­ist work­ing on pri­va­tiz­ing Med­ic­aid [24]:

Sat­ur­day, April 26, 2014
Sources: FBI exam­ines lob­by­ing by Brown­back loy­al­ists

Par­al­lel Strate­gies lob­by­ist David Kensinger, left, and part­ner Riley Scott, right, hud­dle in the Capi­tol dur­ing the 2014 leg­isla­tive ses­sion with clients Mary Sloan and Ben Jones, who are with the Coali­tion Against the Death Penal­ty. The FBI is look­ing into Par­al­lel Strate­gies.

By Tim Car­pen­ter

The Fed­er­al Bureau of Inves­ti­ga­tion is explor­ing whether con­fi­dantes of Gov. Sam Brown­back oper­at­ed influ­ence-ped­dling oper­a­tions in Kansas piv­ot­ing on per­son­al access to the Repub­li­can gov­er­nor and top admin­is­tra­tion offi­cials.

The Tope­ka Cap­i­tal-Jour­nal learned the months-long inquiry involves Par­al­lel Strate­gies, a rapid­ly expand­ing Tope­ka con­sult­ing and lob­by­ing firm cre­at­ed in 2013 by a trio of vet­er­an Brown­back employ­ees who left gov­ern­ment ser­vice to work in an envi­ron­ment where cozi­ness with for­mer col­leagues could pay div­i­dends.

Of con­cern to the FBI were behind-the-scenes finan­cial arrange­ments relat­ed to Brown­back­’s pri­va­ti­za­tion of the state’s $3 bil­lion Med­ic­aid pro­gram. The gov­er­nor’s brand­ing of Kan­Care hand­ed to three for-prof­it insur­ance com­pa­nies exclu­sive con­tracts to pro­vide Med­ic­aid ser­vices to 380,000 of Kansas’ dis­abled and poor.

Own­ers of Par­al­lel Strate­gies, who also main­tain sep­a­rate indi­vid­ual lob­by­ing firms, declined requests to dis­cuss for this sto­ry emer­gence of their influ­en­tial joint fran­chise, which includes on its client list the gov­er­nor him­self.

Par­al­lel Strate­gies was found­ed by David Kensinger, Brown­back­’s for­mer chief of staff and cam­paign man­ag­er and cur­rent direc­tor of the gov­er­nor’s polit­i­cal orga­ni­za­tion Road Map Solu­tions; George Stafford, a long­time fundrais­er, employ­ee and advis­er to Brown­back; and Riley Scott, a senior staff mem­ber to Brown­back while he was in the U.S. Sen­ate and son-in-law of Kansas Sen­ate Pres­i­dent Susan Wagle, R‑Wichita.

“Thanks for reach­ing out,” Scott said, “but I’m not inter­est­ed.”

The FBI also has looked into activ­i­ties of indi­vid­ual leg­is­la­tors and lob­by­ists unaf­fil­i­at­ed with Par­al­lel Strate­gies.

Kan­Care, launched in Jan­u­ary 2013 and expand­ed in Feb­ru­ary, is arguably the most far-reach­ing reform of Brown­back­’s first term.

Kensinger was the gov­er­nor’s chief of staff dur­ing for­ma­tive con­struc­tion of Kan­Care, but quit two months before con­tracts were signed with Ameri­Group Kansas, Unit­ed Health­care of the Mid­west and Sun­flower State Health Plan, a sub­sidiary of Cen­tene. These con­trac­tors now employ as lob­by­ists one of Kensinger’s part­ners at Par­al­lel Strate­gies, Kensinger’s for­mer lob­by­ing part­ner and a one-time Brown­back deputy Cab­i­net sec­re­tary.

Ques­tions cen­ter on whether Brown­back rep­re­sen­ta­tives pressed com­pa­nies or orga­ni­za­tions to hire spe­cif­ic lob­by­ing firms or whether enti­ties that showed inad­e­quate def­er­ence were tar­get­ed for polit­i­cal or finan­cial pun­ish­ment.

Make a note of this because it’s a key ele­ment of what the FBI appears to be focus­ing on: Brown­back­’s chief of staff dur­ing the “Kan­Care” over­haul, David Kensinger, quit two months before the con­tracts where signed relat­ed to the pri­va­ti­za­tion of Kansas’ Med­ic­aid pro­gram (the one Brown­back does­n’t want to expand). And the three orga­ni­za­tions that got that con­tract now employ, as lob­by­ists, three part­ners from Kensinger’s firm Par­al­lel Strate­gies.

So that’s what the FBI is inves­ti­gat­ing. Well that and the K‑Street-style [25] form of ret­ri­bu­tion-based pol­i­tics that Brown­back brought to Kansas. More on that below.


Eileen Haw­ley, spokes­woman for Brown­back, said she was unaware of an inves­ti­ga­tion by law enforce­ment involv­ing State­house insid­ers. She assert­ed Brown­back wouldn’t engage in uneth­i­cal behav­ior as the state’s top elect­ed offi­cial.

“He’s real­ly one of the most hon­or­able and eth­i­cal peo­ple I’ve met,” Haw­ley said. “I have a hard time believ­ing any of these things were occur­ring in the gov­er­nor’s office.”

It is unclear how far the fed­er­al inves­ti­ga­tion has pro­gressed or whether evi­dence will mate­ri­al­ize to war­rant pro­ceed­ing to court.

Joel Seal­er, spe­cial agent with the FBI in Kansas City, Mo., said the agen­cy’s long-stand­ing pol­i­cy was to decline pub­lic com­ment on top­ics of inquiries and tar­gets of probes.

“Can I com­ment? No,” Seal­er said. “I can nei­ther con­firm nor deny any type of inves­ti­ga­tion.”

K Street in Kansas

The elec­tion of Brown­back in 2010 trig­gered realign­ment of Topeka’s polit­i­cal appa­ra­tus fol­low­ing eight years under Demo­c­ra­t­ic Govs. Kath­leen Sebe­lius and Mark Parkin­son. Elec­tion night suc­cess­es by con­ser­v­a­tive Repub­li­cans, accord­ing to one for­mer Kansas GOP offi­cial, fueled an oper­a­tional phi­los­o­phy best cap­tured by the phrase “to the vic­tor belong the spoils.

In 2012, Brown­back­’s red-state over­haul entered an advanced phase when he took a promi­nent role in a series of con­test­ed Repub­li­can Sen­ate pri­ma­ry races. In a maneu­ver rare by Kansas stan­dards, Brown­back embraced a slate of GOP chal­lengers and worked against incum­bent Repub­li­cans opposed to pieces of the gov­er­nor’s agen­da. Ten Repub­li­cans seek­ing re-elec­tion were oust­ed.

“They’re ruth­less,” said Steve Mor­ris, a for­mer Sen­ate pres­i­dent who lost re-elec­tion to a GOP can­di­date backed by the Brown­back machin­ery. “I served with (Govs.) Joan Finney, Bill Graves, Kath­leen Sebe­lius and Mark Parkin­son. None of them, to my knowl­edge, did that.”

With­in days of the August pri­ma­ry, high-rank­ing mem­bers of the Brown­back admin­is­tra­tion began inform­ing polit­i­cal advo­cates that cam­paign con­tri­bu­tions to mod­er­ates or Democ­rats would no longer be tol­er­at­ed.

This mes­sage of finan­cial loy­al­ty was deliv­ered in advance of a Sep­tem­ber fundrais­er in Tope­ka head­lined by Brown­back. With the House already con­trolled by con­ser­v­a­tives, the objec­tive was to raise suf­fi­cient cash to elect 14 GOP can­di­dates capa­ble of bring­ing the Sen­ate in line with the admin­is­tra­tion’s ideals. Lob­by­ing firms were urged to demon­strate ded­i­ca­tion to the cause by donat­ing $500 to $1,000 to each high­light­ed gen­er­al elec­tion cam­paign.

Polit­i­cal evo­lu­tion in Tope­ka has been described dur­ing inter­views with more than two dozen Repub­li­can, inde­pen­dent or Demo­c­ra­t­ic lob­by­ists and polit­i­cal fig­ures — most con­duct­ed on con­di­tion of anonymi­ty due to their anx­i­ety about pos­si­ble ret­ri­bu­tion from allies of Brown­back — as anal­o­gous to the infa­mous K Street in Wash­ing­ton, D.C.

This road-to-rich­es boule­vard in the U.S. cap­i­tal was a hub of activ­i­ty among for­mer gov­ern­ment employ­ees eager to exploit revolv­ing-door access and Repub­li­cans in gov­ern­ment who made it known they were in charge and expect­ed future polit­i­cal invest­ment to mir­ror that real­i­ty.

It’s worth recall­ing that Brown­back was pret­ty famil­iar with how K‑Street oper­at­ed dur­ing his time in DC [26], so this attempt to recre­ate that kind of sit­u­a­tion in Kansas is, to some extent, a “do what you love” form of lead­er­ship.


“That is the sin­is­ter part of the Brown­back folks,” said Rep. Jim Ward, a Wichi­ta Demo­c­rat. “They pun­ish. They can make it very cold for you. I think that’s bad for democ­ra­cy. At some point, it’s going to blow up.”


Kan­Care links

As it relates to Kan­Care, the three Med­ic­aid con­trac­tors rein­forced their lob­by­ing oper­a­tions by hir­ing indi­vid­u­als who are no strangers to Brown­back.

Scott, a part­ner in Par­al­lel Strate­gies, was added in Jan­u­ary by Unit­ed Health­care. Gary Haul­mark, a for­mer deputy Cab­i­net sec­re­tary in the Brown­back admin­is­tra­tion, resigned from state gov­ern­ment in 2013 to rep­re­sent Ameri­group. Sun­flower employs Hick­am, who ran a lob­by­ing firm with Kensinger from 2004 to 2010.

“I believe it is wrong for peo­ple as close­ly con­nect­ed to the seat of pow­er to be in a posi­tion of lob­by­ing for pay,” said for­mer Sen. Dick Kelsey, a Repub­li­can who rep­re­sent­ed a dis­trict south of Wichi­ta. “I still have a prob­lem with the pay-to-play con­cept.”

Kelsey said Brown­back offi­cials had a polit­i­cal inter­est in tamp­ing down com­plaints about Kan­Care until after the Novem­ber elec­tion. There is an aggres­sive behind-the-scene cam­paign to min­i­mize pub­lic crit­i­cism about deny­ing access to treat­ments, plac­ing admin­is­tra­tive hur­dles on providers deliv­er­ing care, and to delay­ing pay­ment of con­trac­tors.

At the same time, Kelsey said, the man­aged care orga­ni­za­tions want to please the admin­is­tra­tion by hir­ing Brown­back asso­ciates. It is a sym­bi­ot­ic rela­tion­ship, Kelsey said, that has­n’t best served inter­ests of clients.


Sen. Lau­ra Kel­ly, D‑Topeka, said enough uncer­tain­ty about the direc­tion of Kan­Care exist­ed to war­rant a sig­nif­i­cant inquiry by the Leg­is­la­ture. She said pro­duc­ing an accu­rate assess­ment would require assur­ances that indi­vid­u­als and orga­ni­za­tions com­ing for­ward wouldn’t be sub­ject to retal­i­a­tion for speak­ing out.

Kel­ly, who serves with Crum on the Kan­Care over­sight com­mit­tee, said the mod­el for the Leg­is­la­ture could be the inquiry of the Kansas Bio­science Author­i­ty led in 2011 and 2012 by Wichi­ta Sen. Wagle, who since then was elect­ed Sen­ate pres­i­dent. The KBA, a state-financed eco­nom­ic devel­op­ment enti­ty work­ing to expand agri­cul­ture, ani­mal health and human health inno­va­tion, was the sub­ject of a leg­isla­tive review and a foren­sic audit that cost near­ly $1 mil­lion.

“If the sit­u­a­tion at the Bio­science Author­i­ty war­rant­ed an inves­ti­ga­tion, this sit­u­a­tion does, too,” Kel­ly said.

Price of dis­sent

Indi­vid­u­als who have expressed crit­i­cism about Kan­Care said they were tar­get­ed by Repub­li­cans rep­re­sent­ing the leg­isla­tive or exec­u­tive branch­es of state gov­ern­ment.

Rocky Nichols, exec­u­tive direc­tor of the Dis­abil­i­ty Rights Cen­ter of Kansas, a non­prof­it legal advo­ca­cy orga­ni­za­tion, was pub­licly rebuked in March by Angela de Rocha, spokes­woman for the state’s aging and dis­abil­i­ty ser­vices agency. The Dis­abil­i­ty Rights Cen­ter has for years crit­i­cized as inad­e­quate the fund­ing direct­ed at dis­abled Kansans.

De Rocha said the Dis­abil­i­ty Rights Cen­ter hap­haz­ard­ly added peo­ple to dis­abil­i­ty ser­vice wait­ing lists in the past “with­out much atten­tion to accu­ra­cy or detail in order to pro­vide a soap­box” use­ful for Nichols to “score cheap polit­i­cal points.”

In response, Nichols said the Dis­abil­i­ty Rights Cen­ter has no role in adding peo­ple to the wait­ing list. Nichols said the out­burst by de Rocha indi­cat­ed a will­ing­ness to attach unsa­vory motives to the work of an orga­ni­za­tion attempt­ing to advance pub­lic pol­i­cy under the Kan­Care ban­ner. Oth­er non­prof­it groups have expe­ri­enced a sim­i­lar back­lash for speak­ing out, he said.

“We have heard from sev­er­al advo­cates and providers that if you advo­cate and tell the truth — if the truth is unflat­ter­ing to state gov­ern­ment — often there’s some form of blow­back,” Nichols said.


Yikes! K‑Street for Kansas and the pri­va­ti­za­tion of Med­ic­aid [27]? That does­n’t sound very senior-friend­ly. And this all hap­pened with­out the Health Care Com­pact.

Ted Cruz’s Prin­ci­pled Death Sen­tence For Amer­i­ca Health Care Com­pact
But what exact­ly is this “Health Care Com­pact” that appears to open the door for some rather aggres­sive pri­va­ti­za­tions of Medicare too. Well, it’s an idea that’s been con­sid­ered by a grow­ing num­ber of states in recent years as part of the nation­al out­break of Oba­macare Derange­ment Syn­drome [28]:

Updat­ed: 11:14 a.m. Fri­day, April 11, 2014 | Post­ed: 7:00 a.m. Fri­day, April 11, 2014
Ohio con­sid­ers leg­is­la­tion to con­trol its health care

By Michael D. Pit­man

Staff Writer

Ohio is one of 21 states that have intro­duced leg­is­la­tion to con­trol its health care, which includes con­trol­ling fed­er­al dol­lars and changes that could affect health care in the state.

Leg­is­la­tion would allow states to join a fed­er­al­ly cre­at­ed health care com­pact that would trans­fer the author­i­ty and respon­si­bil­i­ty to make health care deci­sions from fed­er­al con­trol to the mem­ber states. So far, only North Dako­ta has failed to pass leg­is­la­tion through its state­house to join, and three states — Ari­zona, Min­neso­ta and Mon­tana — have had their gov­er­nors veto leg­is­la­tion. There are eight states with leg­is­la­tion approved by their gov­er­nors, and Ohio is one of eight states with leg­is­la­tion still pend­ing.

Recall that those eight states that have approved the leg­is­la­tion now includes Kansas, so it’s nine states so far.


Repub­li­can Reps. Ter­ry Boose, of Nor­walk, and Wes Rether­ford, of Hamil­ton, intro­duced House Bill 227 this past June, which would allow Ohio to be a mem­ber of the health care com­pact. The bill passed out of the State and Local Gov­ern­ment Com­mit­tee on April 2 by way of a 10–8 vote. The vote was down par­ty lines, though Repub­li­can Bob Hack­ett, of Lon­don, vot­ed with the Democ­rats. Com­mit­tee mem­ber Rep. Matt Lundy, D‑Elyria, said this bill is not right for Ohio.

“The pro­pos­al is so extreme and has such a neg­a­tive impact on the health of our cit­i­zens that even Ari­zona Gov. Jan Brew­er vetoed (a sim­i­lar bill),” said Lundy. Arizona’s state leg­is­la­ture passed its ver­sion of the health care com­pact bill in 2011, but it was vetoed by the con­tro­ver­sial gov­er­nor who became crit­i­cized in the nation­al media for sign­ing Ari­zona Sen­ate Bill 1070, known as the “show me your papers” law. The U.S. Supreme Court in June 2012 struck down key pro­vi­sions of SB 1070 but upheld a pro­vi­sion that allows police to check a person’s immi­gra­tion sta­tus in cer­tain cir­cum­stances.

The gov­er­nors in Mon­tana and Min­neso­ta exer­cised pock­et vetoes by nev­er sign­ing the bills that passed each of their respec­tive state’s leg­is­la­tures.

Mered­ith Tuck­er, Ohio Demo­c­ra­t­ic Par­ty com­mu­ni­ca­tions direc­tor, called the bill a “par­ti­san stunt.”

“It’s sad that Ohio Repub­li­cans con­tin­ue these par­ti­san stunts when there are so many impor­tant issues fac­ing strug­gling Ohio fam­i­lies,” she said.

U.S. Rep. James Lank­ford, R‑Oklahoma, intro­duced House Joint Res­o­lu­tion 110 in Feb­ru­ary and has gar­nered sup­port from 11 Repub­li­can con­gress­men, includ­ing Urbana Rep. Jim Jor­dan, who have signed on as co-spon­sors. The Okla­homa Repub­li­can said this res­o­lu­tion is “a break­through gov­er­nance reform that allows states to clean up the health care mess cre­at­ed by the fed­er­al gov­ern­ment.”

“Those mem­ber states are then free to imple­ment their own health care sys­tems with­out inter­fer­ence from fed­er­al bureau­crats, using fed­er­al health care funds already col­lect­ed and spent in their state,” Lank­ford said.

Because of their dis­plea­sure with the Afford­able Care Act, com­mon­ly referred to as Oba­macare, Rether­ford said he and sev­er­al Ohio leg­is­la­tors felt it nec­es­sary to work to join the health care com­pact efforts. And besides that, he said health care is “an issue that should be tak­en care at the state lev­el.”

“Wash­ing­ton, D.C., often has a one-size-fits-all approach but what works for Cal­i­for­nia often doesn’t work for Ohio,” said Rether­ford.

Ohio’s bill is like­ly to be pre­sent­ed for a vote after the May 6 pri­ma­ry elec­tion, Rether­ford said.


As the House Repub­li­cans con­tin­ue efforts to repeal the Afford­able Care Act, the health care com­pact res­o­lu­tion could be part of the efforts.

“The president’s health care law con­tin­ues to wreak hav­oc on fam­i­lies, local small busi­ness­es and our econ­o­my,” said Speak­er of the House John Boehn­er. “The truth is you can’t fix this law — it needs to be torn out by its roots. Repub­li­can lead­er­ship will con­tin­ue our work to replace this fun­da­men­tal­ly flawed law with patient-cen­tered solu­tions focused on low­er­ing health care costs and pro­tect­ing jobs.”


Lank­ford, who oppos­es the Afford­able Care Act, said the com­pact does not con­flict with efforts by state attor­neys gen­er­al, state leg­is­la­tors or mem­bers of Con­gress to repeal or mod­i­fy the health care law.

“While we wait for this pres­i­dent and Sen­ate Democ­rats to move beyond their intran­si­gent sup­port of this unwork­able law, Con­gress can give inter­est­ed states a way to solve their state’s health-care prob­lems them­selves,” Lank­ford said. “States that like their Oba­macare can keep their Oba­macare. The health care com­pact sim­ply gives a state like Okla­homa the option to cre­ate a cus­tomized sys­tem that bet­ter meets the needs of Okla­homa fam­i­lies.”

As we can see in Ohio, the “Health Care Com­pact” appears to large­ly be part of the broad­er effort to gut Oba­macare. Yes, if Oba­macare can’t be reversed at a fed­er­al lev­el, the Com­pact will allow states to sim­ply ignore the law and ALSO take con­trol of Medicare and Med­ic­aid (for a thor­ough gut­ting).

And if this strat­e­gy leaves states with sub­stan­tial­ly less rev­enue for those pro­grams in the future that’s fine too accord­ing to the GOP. Yep! And it’s been fine since at least 2011 because there are prin­ci­ples behind the ini­tia­tive that the GOP is try­ing to uphold. They’re Ted Cruz’s “Ten­ther” prin­ci­ples, and nul­li­fi­ca­tion of health care is just one ele­ment of a much larg­er strug­gle to nul­li­fy progress [29]:

Kaiser Health News
Some States Seek­ing Health Care Com­pact

By Guy Gugliot­ta

Sep 18, 2011

This sto­ry was pro­duced in col­lab­o­ra­tion with The Wash­ing­ton Post

State gov­er­nors and leg­is­la­tors opposed to the fed­er­al health-care law are eye­ing a nov­el approach to escape its pro­vi­sions: join­ing an “inter­state com­pact” that would replace fed­er­al pro­grams — includ­ing Medicare and Med­ic­aid — with block grants to the states.

To date, leg­is­la­tion has been draft­ed or intro­duced in 14 states and brought to the floor by law­mak­ers in at least nine. Three Repub­li­can gov­er­nors — in Geor­gia, Okla­homa and Texas — have signed the com­pact into law, while Mis­souri Gov. Jay Nixon (D) let the com­pact become law with­out sign­ing it. Sup­port­ers say they hope to get 40 states to put it on the leg­isla­tive cal­en­dar in 2012.

If a sig­nif­i­cant num­ber of states pass the com­pact, sup­port­ers plan to sub­mit it to Con­gress for approval in the same way that the body approves inter­state com­pacts reg­u­lat­ing com­merce, trans­porta­tion, and resource con­ser­va­tion and devel­op­ment.


States have nev­er sought a com­pact to shield them from a whole area of fed­er­al law, let alone been grant­ed per­mis­sion to form one. Some state offi­cials, includ­ing Repub­li­cans such as Ari­zona Gov. Jan Brew­er who vetoed the com­pact, are wor­ried that it would usurp their author­i­ty. Many oth­ers point out that join­ing a com­pact would dis­qual­i­fy their states from receiv­ing auto­mat­ic fed­er­al fund­ing increas­es dur­ing hard times and pre­vent them from get­ting their fair share of the avail­able pool of mon­ey.

Still, even if its prospects are more dubi­ous than oth­er meth­ods of get­ting rid of last year’s Patient Pro­tec­tion and Afford­able Care Act — con­gres­sion­al repeal, judi­cial chal­lenge or a Repub­li­can pres­i­den­tial vic­to­ry in 2012 — the com­pact has become a pop­u­lar way for con­ser­v­a­tives to high­light their oppo­si­tion.

And com­pacts might receive even more atten­tion now that Texas Gov. Rick Per­ry signed his state’s law July 18, just three weeks before he announced his can­di­da­cy for the Repub­li­can pres­i­den­tial nom­i­na­tion. The pri­ma­cy of states’ rights over fed­er­al pow­ers is a tenet of tea par­ty Repub­li­cans whose sup­port is key for can­di­dates dur­ing the pri­ma­ry sea­son.

For the orig­i­nal drafters, health care is only the first com­pact in a longer list that would include mea­sures giv­ing states broad pow­ers to con­trol bank­ing, edu­ca­tion and ener­gy. “Our view is that a good pol­i­cy made under bad gov­er­nance will morph into bad pol­i­cy,” said Hous­ton busi­ness­man Leo Lin­beck III, a key finan­cial backer of the com­pact ini­tia­tive. “Progress does­n’t mean cen­tral­iz­ing pow­er. Progress push­es deci­sion-mak­ing pow­er back to the peo­ple.”

Note that Leo Lin­beck III comes from a fam­i­ly with deep pock­ets and a long his­to­ry of sup­port­ing far-right caus­es [30].


Sup­port­ers Look To The Tenth Amend­ment

The health-care com­pact grew out of dis­cus­sions and research con­duct­ed a year ago at the Cen­ter for Tenth Amend­ment Stud­ies at the Austin-based Texas Pub­lic Pol­i­cy Foun­da­tion [31], a con­ser­v­a­tive pol­i­cy group. The 10th Amend­ment to the Con­sti­tu­tion leaves to the states all pow­ers not con­ferred upon the fed­er­al gov­ern­ment.

“Found­ing Fathers like James Madi­son sold the Con­sti­tu­tion to the indi­vid­ual states by pre­dict­ing that the accu­mu­la­tion of fed­er­al pow­er would nev­er hap­pen because the states were too strong,” said Mario Loy­ola, direc­tor of the Tenth Amend­ment Cen­ter. “The fed­er­al gov­ern­ment now reg­u­lates vir­tu­al­ly all of the things the framers said it would nev­er reg­u­late.”

Look­ing around for tools to reverse this trend, Loy­ola, a for­mer coun­sel for the U.S. Sen­ate’s Repub­li­can Pol­i­cy Com­mit­tee, and for­mer Texas Solic­i­tor Gen­er­al Ted Cruz, now a can­di­date for the U.S. Sen­ate, hit upon the inter­state com­pact, which Loy­ola said “held the promise of reestab­lish­ing a bound­ary between state and fed­er­al author­i­ty through a con­sen­su­al agree­ment with Con­gress.”

Again, note that Ted Cruz was one of the orig­i­na­tors of the Com­pact. Ted Cruz [32].


The his­to­ry of com­pacts goes back to the colo­nial peri­od, and more than 200 are cur­rent­ly in force. Many coor­di­nate activ­i­ties between con­tigu­ous states, such as the Port Author­i­ty of New York and New Jer­sey. Oth­ers, such as the Dri­ver License Com­pact and the Wildlife Vio­la­tors Com­pact, offer rec­i­p­ro­cal recog­ni­tion of laws and licens­es in mem­ber states.

The Health Care Com­pact, how­ev­er, is the first one that attempts to shield states from a whole area of fed­er­al law. It is four pages long and would replace the cur­rent fed­er­al health-care sys­tem with block grants to the states. The ini­tial grants would be pro-rat­ed on the basis of 2010 fed­er­al fund­ing lev­els. There­after, allo­ca­tions would rise to reflect infla­tion and state pop­u­la­tion increas­es. The com­pact would not apply to mil­i­tary per­son­nel, vet­er­ans or Native Amer­i­cans.

With this tem­plate in hand, the bil­l’s adher­ents formed the Health Care Com­pact Alliance late last year. Eric O’Keefe, chair­man and chief exec­u­tive of the con­ser­v­a­tive Sam Adams Alliance, is the Com­pact Alliance chair­man, and Lin­beck serves as vice chair­man. O’Keefe said the Alliance has so far spent “not much more” than $1 mil­lion.

Late in 2010, O’Keefe won sup­port for the com­pact from lead­ers of the Tea Par­ty Patri­ots, one of the main tea par­ty groups that have emerged across the coun­try. Lin­beck said “our big push” will come in ear­ly 2012, when he and O’Keefe are hop­ing that 25 to 40 leg­is­la­tures may take up the bill. O’Keefe said he would pre­fer to have at least 15 states pass the com­pact before it is sent to Con­gress.

In its ear­ly days, crit­ics denounced the mea­sure as a reprise of the 19th cen­tu­ry doc­trine of “nul­li­fi­ca­tion,” hold­ing that any state could ignore a fed­er­al law it did not like. Lin­beck point­ed out, how­ev­er, that the Health Care Com­pact is not nul­li­fi­ca­tion, since it requires con­gres­sion­al con­sent.

Recall that “nul­li­fi­ca­tion” of fed­er­al law has been one of the GOP’s pri­ma­ry meta-themes in recent years [33], so while this Health Care Com­pact may have sound­ed pret­ty “out there” back in 2011 when this was first pro­posed, times have changed [34] (some­what [35]) for the GOP! Some­times [36] it even includes nul­li­fy­ing local laws. That’s how much the GOP loves nul­li­fi­ca­tion these days (hint: that’s because it’s most­ly about nul­li­fy­ing oppo­si­tion to the oli­garchs [37]).


Draw­backs For States

Sign­ing on has draw­backs for states. The com­pact can­not be amend­ed unless all par­tic­i­pat­ing states agree to the amend­ment and resub­mit the bill to their leg­is­la­tures. For elect­ed offi­cials who want to put their stamp on their state’s laws, this can be a hard pill to swal­low.

Also, if states were under­fund­ed in 2010 at the fed­er­al lev­el, they would be stuck there under the com­pact. “We have 3 mil­lion peo­ple in Medicare and anoth­er 4 mil­lion on Med­ic­aid and CHIP (the Children’s Health Insur­ance Pro­gram),” said Anne Dunkel­berg, asso­ciate direc­tor of the Austin-based Cen­ter for Pub­lic Pol­i­cy Pri­or­i­ties, a think tank focus­ing on low- and mod­er­ate-income Tex­ans. “Just now [in Texas] we’re $600 below the nation­al aver­age per per­son for Med­ic­aid.”

And, Dunkel­berg added, adher­ence to the com­pact would elim­i­nate the guar­an­tee of a fed­er­al match to state Med­ic­aid spend­ing, make a state inel­i­gi­ble for one-time enti­tle­ments such as the 2009 stim­u­lus and cause states to lose access to auto­mat­ic increas­es when enroll­ment goes up dur­ing a reces­sion.

Did you see that last part? The Com­pact would cause states “to lose access to auto­mat­ic increas­es when enroll­ment goes up dur­ing a reces­sion” (see [38] the fixed nature of the “Fund­ing” sec­tion of the Com­pact). And if it turns out that this was a hor­ri­ble idea, good luck amend­ing it since you’d need all the mem­bers to approve! That’s just part of the anti-Oba­macare fun on dis­play with this Health­care Com­pact idea and with Kansas sign­ing on as the ninth state that idea could poten­tial­ly become a real­i­ty, espe­cial­ly if the GOP takes con­trol of the Sen­ate this year.

So, putting aside Gov­er­nor Brown­back­’s recent FBI inves­ti­ga­tions into Kansas’ Med­ic­aid pri­va­ti­za­tion schemes, isn’t it some­what fas­ci­nat­ing that we haven’t seen more of a uni­fied strat­e­gy from the GOP in pro­mot­ing the Com­pact on the nation­al cam­paign trail? It’s an elec­tion year and oppo­si­tion to Oba­macare is still a cen­tral com­po­nent of the GOP’s nation­al elec­toral strat­e­gy. Plus, it’s very much in keep­ing with the “States Rights” theme the GOP has been push­ing ever since Oba­ma first took office. So why isn’t the Com­pact a big­ger “theme” this year? Is it just bad tim­ing [39]?

Or could it be that the GOP’s lacks faith in the elec­torate? Don’t for­get, the Health Care Com­pact pro­pos­al that Sam Brown­back just signed requires Kansans to believe that peo­ple like Brown­back won’t stab them in the back while gut­ting their Medicare. Is that a real­is­tic hope? After all, oppo­si­tion to Oba­macare is rel­a­tive­ly easy. You just have to say “I don’t like this or that about the pro­gram”, and peo­ple you’ll find plen­ty of peo­ple to agree with you. But, as many have point­ed out, the GOP has­n’t real­ly put forth any alter­na­tives to Oba­macare so far and that’s where the elec­torate’s faith in the GOP gets tests. And yet, there IS a GOP alter­na­tive to Oba­macare: The Health Care Com­pact! It was even the brain­child of the GOP’s id [40]!

So why aren’t we hear­ing “Com­pact” this and “Com­pact” that all over the cam­paign trail? Could it be that even the con­fused Kansans and oth­ers [41] that have been sup­port­ing the GOP all these years — even when it’s clear­ly not in their best inter­ests [42] — are start­ing to real­ize that the par­ty that’s wag­ing a war on Food Stamps [43] might also be inter­est­ed in slash­ing Medicare giv­en the oppor­tu­ni­ty? Slash­ing Medicare and Med­ic­aid expen­di­tures is part of the Paul Ryan bud­get plan [44] so why would­n’t it be part of the Com­pact too even if its advo­cates say oth­er­wise?

Could the GOP be los­ing the “don’t wor­ry, we won’t hurt you” cred­i­bil­i­ty it needs to “sell” its plans to gut Medicare with­out alarm­ing seniors? Cham­pi­oning the Health Care Com­pact on the cam­paign trail sure would raise some alarm­ing ques­tions in the vot­ing booth for seniors. Could that explain the lack of enthu­si­asm for mak­ing this a nation­al par­ty plat­form? For exam­ple, if politi­cians and the oli­garchs that fund them are try­ing to grab [45] green eggs and ham [46] and health­care from those with the least, and then these same politi­cians start cam­paign­ing about send­ing Medicare pow­ers back to the very same states with gov­er­nors that are try­ing to gut Med­ic­aid, does­n’t that raise the ques­tion of what else their hearts desire? Maybe that’s a ques­tion the GOP would rather not have to answer [47].