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Since 1965, Medicaid has stood the test of time as the nations principal public health insurance program for the low-income population. Since its inception, the program has ballooned primarily through a series of program expansions in the 1980s and again after the enactment of the Affordable Care Act in 2010 so that today the program accounts for nearly 20 percent of State budgets and covers more than 1 in 5 Americans. While Medicare has implemented program reforms (payment reforms such as the inpatient and outpatient prospective payment systems; Medicare Advantage; Medicare Part D; delivery system reform through the Innovation Center), Medicaid has been slower to innovate. However, innovation does not need to come at the expense of coverage for millions of Americans, nor should it. Instead, as thoughtful Republicans rightfully think through ways in which to bring the Medicaid programs into the 21st century, a little out-of-the-box thinking may be the cure.

Under current practice, Federal funding for the state-administered Medicaid program is generally reserved for traditional health care services. So while Medicaid will gladly pay tens of thousands of dollars for an eligible childs admission to the hospital for an asthma attack, Medicaid will not pay the $100 needed for a portable air conditioner so that the parents of that child can leave the window closed at night in the summertime (thereby preventing that asthma attack.) Both of these services the hospital admission and the air conditioner provide clear benefits for the well-being of this child. Yet, one costs thousands and is readily covered, while the other saves thousands and is not covered by the program.

As Medicaid moves into the 21st century, we need rethink what is health care, particularly for those most in need. If paying for a driver to take a special needs individual to a job keeps that individual healthier (both physically and mentally), who is to say that this is not a health care service? If a young mother would benefit from a voluntary home visiting program to receive guidance to help them become a better parent, does this not improve the well-being of both the child and the mother?

The good news is that this idea is catching on. A recent amendment to Medicaids managed care rules permits a state to adopt and even direct payment models intended to recognize value or outcomes over volume of services. And states across the country are piloting pay for success models, wherein private sector funding steps in to pay for interventions designed to improve lives and save money, offering these investors a return on their investment. But government intervention (or at least clarity) is needed here. As Republicans begin to rethink the Medicaid program, they should also rethink what is health care and clarify that Federal dollars are available for evidence-based practices which promote the well-being of the individual and long-term cost savings.

Ruth Ann Norton serves as President & CEO of the Green & Healthy Homes Initiative (GHHI), a national nonprofit founded in 1986 dedicated to the elimination of childhood lead poisoning and the creation of healthy, safe and energy efficient housing for Americas children.

Ross Margulies is an attorney at Foley Hoag LLP where he advises a wide range of health care clients on regulatory and administrative processes and reimbursement matters.

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As Republicans Rethink Medicaid, Rethink What Is 'Health Care' - HuffPost

Perhaps no great surprise here: The number of Fairfax residents voting absentee in the Democratic statewide primary is outpacing those in the Republican, according to county election officials.

As of June 1, a total of 1,348 Democratic ballots have been cast in Fairfax County, compared to 514 Republican, county elections officials said.

Virginians will go to the polls on June 13 to select both the Democratic and Republican nominees for governor and lieutenant governor. (Incumbent Attorney General Mark Herring, a Democrat, is seeking re-election and does not have intra-party opposition; Republican John Adams was unopposed for the GOP nomination.)

The Democratic primary ballot will feature Tom Perriello and Ralph Northam for governor and Justin Fairfax, Gene Rossi and Susan Platt for lieutenant governor. The Republican ballot will feature Ed Gillespie, Corey Stewart and Frank Wagner for governor and Bryce Reeves, Glenn Davis Jr. and Jill Vogel for lieutenant governor. The winners move on to the Nov. 7 general election.

Under Virginia law, voters do not register by political party, so any registered voter can cast a ballot in the Democratic or Republican primary, but not both. Voters will cast ballots at their regular polling places; for those who qualify, in-person absentee voting will take place through June 10, while mail-in absentee voting also is available.

(For complete information, see the Web site at http://www.fairfaxcounty.gov/elections/. Information is available in English, Spanish, Vietnamese and Korean.)

Some localities across Virginia also will see primaries for House of Delegates seats, but there are no intra-party challenges in the Sun Gazette coverage area.

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In Fairfax, Democrats outpace Republicans in absentee voting - Inside NoVA

Rep. Scott W. Taylor, a Republican from Virginia Beach, just became the second House Republican among 238 to support a federal ban on LGBT discrimination, reflecting a shift in public opinion on the issue in Virginia and the nation.

The Human Rights Campaign announced last week that Taylor was the newest co-sponsor of the Equality Act, which, if passed, would add sexual orientation and gender identity to existing federal civil rights statutes.

The other Republican co-sponsor, Rep. Ileana Ros-Lehtinen (Fla.), is not seeking reelection next year.

Among Democrats in Congress, the opposite disparity exists, with almost all members supporting the legislation, except moderates Joe Manchin III (W.Va.) and Joe Donnelly (Ind.) in the Senate and Marcia L. Fudge (Ohio) and Daniel Lipinski (Ill.) in the House.

David Stacy, a lobbyist for the Human Rights Campaign, which advocates for gay rights, said Taylor, a 37-year-old freshman House member and former Navy SEAL, is a natural fit for the legislation.

It didnt take a big sales job because he understood right away that this was the right thing to do, Stacy said. It was broadly supported across the state and in his district.

Taylor, a foreign policy hawk who supports President Trump, represents a district that relies on tourism and has marketed itself as an ideal vacation spot for the gay, lesbian, bisexual and transgender community.

As a delegate in the state General Assembly, Taylor was a primary supporter of a bill introduced by Del. Marcus B. Simon (D-Fairfax), who represents a liberal Northern Virginia district, that would have banned LGBT discrimination in housing.

Once in the U.S. House, Taylor introduced a similar bill, which has 12 co-sponsors six Republicans and six Democrats.

I think this is the right thing to do, Taylor said when the bill was introduced this spring. We havent polled it, so I have no idea if its a net negative or a net positive in the district.

His district is also home to many active-duty and retired military personnel, who, polls show, tend to be open-minded on social issues.

For Taylor, supporting LGBT rights is a political winner, Stacy said.

But the Equality Act is unlikely to go to a floor vote in the GOP-controlled House because Republican leadership would be reluctant to force lawmakers vulnerable to challenges from the right to go on record on an issue that animates social conservatives.

That helps explain why Rep. Barbara Comstock (R-Va.), who represents a Northern Virginia district that favored Hillary Clinton by 10 points last year, has a zero rating from the Human Rights Campaign.

But Mark J. Rozell, dean of the Schar School of Policy and Government at George Mason University, said the mere introduction of LGBT rights bills is indicative of how much social attitudes have changed in the past decade.

When he wrote the 1996 book Second Coming: The New Christian Right in Virginia Politics, Rozell said, it wasnt even conceivable that we would have a conversation like this right now.

Its the older generation holding on more strongly to the traditional social views, he said. For the younger generation, they dont even understand why this is an issue.

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Two House Republicans favor a ban on LGBT discrimination. One is from Virginia. - Washington Post

Sen. John McCain recently reflected on the first five months of GOP rule in Washington, ticking off the partys greatest congressional achievements to date.

Theres the confirmation of Supreme Court justice Neil Gorsuch. Theres also the dozen Obama-era regulations that have been repealed. Im overjoyed. Sure. Thats what we promised, McCain said with a tight smile. Im really happy.

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Then he paused.

I was being sarcastic The fact is Im disappointed, the famously gruff Arizona Republican fumed in an interview late last month, calling his partys governing plans a train wreck set to hit Congress in September.

Everything piles up, we go to the edge of the cliff, shut down the government, then we have an omnibus or a continuing resolution where we can vote yes or no. No amendments, no improvements, nothing, McCain added.

Concerns are rising in Washington that Congress may be headed toward the economic and political disaster of a debt default and a government shutdown later this year. And the chamber most likely to get Congress out of the jam the Senate is failing to live up to its moniker as the worlds greatest deliberative body.

Rather than a honeymoon with a new presidency and Republicans firmly in the majority, the Senate has become a grinding churn of nomination votes constantly delayed by Democrats, and partisan warfare with little bipartisan cooperation other than averting an April government shutdown.

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Theres no budget, no funding levels for the fall and little talk between the two parties on how to avoid a shutdown and debt default in late summer or early fall, worrying senators in both parties.

No meeting, no anything and no plan. I look at September and its just: How are we going to get that done? said an exasperated Sen. Patty Murray of Washington state, the No. 3 Senate Democrat.

When are we going to do the appropriations? Were not talking about that, moaned Sen. David Perdue (R-Ga.). Its gonna go to a [continuing resolution] or an omnibus. We get an up-or-down vote on the whole thing, which is what Im yelling about.

Instead of focusing on a bipartisan spending deal to avert the blunt impending budget cuts of sequestration and lift the debt ceiling, the GOP Congress has been cranking away at a partisan agenda of tax cutting, repealing Obamacare and rolling back Obama-era regulations. Republicans arent yet close on health care and have barely started on taxes, though GOP leaders insist that a vote on an Obamacare repeal measure will occur before August.

They wont, however, guarantee that it will succeed.

Im very frustrated ... were going to do all these things by Sept. 30? Give me a break. Were going to cut taxes, pass health care, set aside sequestration? said Sen. Lindsey Graham (R-S.C.). We should have an agenda. We know were not going to pass a budget with sequestration caps. Im not.

The hawkish South Carolina senator said he hopes to start bipartisan talks on a spending deal when Congress returns this week, and Republican leaders are hoping to get the Senate back attuned to legislating after a fallow five months of the new Congress.

There have been zero amendment votes on regular legislation, with only a non-binding budget vote-a-rama in January to satisfy enthusiasts of the chambers often wide-ranging amendment process. Its the fewest such votes in a new Congress since 1981, a stark contrast to 69 amendment votes taken to date just two years ago, according to legislative statistics.

And while the Senate has passed more than 30 bills, most have been passed by unanimous consent, a procedure reserved for only the least controversial matters. The bulk of the Senates legislating has been a rollback of President Barack Obamas legislation, with Gorsuchs confirmation the crown jewel of the Senate agenda.

South Dakota Sen. John Thune, the third-ranking Senate Republican, called the progress so far in the Senate obviously sort of a mixed bag. He noted the Obama-era regulations rolled back by the Senate and the confirmation of Gorsuch, but added that on big-ticket bills, the Senate had to wait on the House.

So now, were in the throes of trying to figure out health care reform, Thune said. I think well get onto eventually the tax reform but we have to do a budget to do that, and weve got to start the appropriations process.

Still, Republicans generally blame Democrats for not allowing more to get done.

Weve done an awful lot, but the Democrats have stopped almost everything else. Anything, complained Utah Sen. Orrin Hatch, the chairman of the Senate Finance Committee.

Senate Minority Leader Chuck Schumer (D-N.Y.) was happy to shift the blame back on Republicans: When the Republicans are willing to work with us, we get things done. When theyre not willing to work with us, we dont get things done.

Democrats signaled earlier this year that they had little appetite to drag out debate for lower-profile nominations from President Donald Trump, yet theyve forced the Senate to go through the procedural grinder for relatively obscure nominees such as John Sullivan for deputy secretary of state and Rachel Brand for associate attorney general.

Democrats have forced procedural votes on 26 nominations so far this year a rapid pace that, according to the Pew Research Center, already surpasses nearly every single Congress since 1949, when the procedural maneuver first began being used on nominations. During the 113th Congress from 2013 to 2014, then-Majority Leader Harry Reid (D-Nev.) was forced to tee up procedural votes on 150 nominations overall.

Maybe they could stop using the filibuster on everything that moves, said Don Stewart, a spokesman for Senate Majority Leader Mitch McConnell (R-Ky.). It doesnt have to be this way. Democrats have a choice in their behavior they choose to attempt dysfunction. Despite that, legislation is moving.

Party leaders say that the dearth of bipartisan legislation will end soon, with consideration in June of a veterans bill as well as possibly new Iran and Russia sanctions and extending user fees for the Food and Drug Administration one of a number of looming deadlines that hit at the end of September.

Hopefully when we come back from recess, said Senate Majority Whip John Cornyn of Texas of when the bipartisan legislating will begin. The leader has asked the committee chairmen to process bills that we can pick up and hopefully have bipartisan support.

The debt limit is likely to require lifting before the August recess, a significant escalation of the looming default deadline, according to Republican sources. And rank-and-file Republicans are eager to make progress on major legislation such as tax reform and are even lobbying others to cancel the lengthy August recess to get going on key GOP priorities.

How can I go home and work the state in August when were still sitting here with that yet to be done? Perdue said. My argument is, there are four or five weeks. Take three of those weeks and lets work tax to the ground.

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Senate Republicans fear 'train wreck' in September - Politico

Defending his decision to pull out of the Paris climate-change agreement, President Trump said he was elected to represent Pittsburgh, not Paris. However, his conception of Pittsburgh as a heavy-industry steel town is badly out of date. CBS News reports:

The one-time industrial center is now a thriving city focused on health care, tech and clean energy. In fact, Pittsburgh now has more jobs tied to clean energy than to steel. Mayor Bill Peduto has taken to news programs and Twitter to denounce Mr. Trumps decision.

As the Mayor of Pittsburgh, I can assure you that we will follow the guidelines of the Paris Agreement for our people, our economy & future, Peduto wrote. . . . More than 13,000 peoplenow work in renewable energy and related areas in Pittsburgh, according to a report from the Keystone Energy Efficiency Alliance and Environmental Entrepreneurs.

Pittsburgh plans to transition to100 percent renewable-energy sources by 2035.

Trump and his populist puppeteer Stephen K. Bannon seem to think Republicans will cheer climate-change denial. Again, their conception of America is badly out of date. Last October, the Houston Chronicle reported:

The UT Energy poll of 2,043 Americans by the University of Texas at Austins Energy Institute found that 89 percent of self-identified Democrats and 62 percent of self-identified Republicans accept the overwhelming scientific consensus about global warming. In 2012, only 45 percent of Republican accepted climate change science as fact.

Thats in direct contrast with Republican leaders, both nationally and in Texas, who still question whether humans burning fossil fuels for the last 250 years has contributed to a warming planet and rising sea levels.

Oh, and the University of Texas at Austin is one of the worlds premier schools for climate science. (Texass U.S. senators should drop by and learn something UT has some great professors at the top of the field.) Major energy companies including ExxonMobil and ConocoPhillipswanted the United States to stay in the Paris agreement.Again, the right-wing pols seem oblivious to the 21st-century economy, current public opinion and the state of scientific knowledge.

In the minds of Trump and his allies, coal jobs are coming back. Nope. Industry experts say coal mining jobs will continue to be lost, not because of blocked access to coal, but because power plant owners are turning to natural gas. At least six plants that relied on coal have closed or announced they will close since Trumps victory in November, including the main plant at the Navajo Generating Station in Arizona, the largest in the West. Another 40 are projected to close during the presidents four-year term.

Likewise, Trumps fetish with manufacturing jobs suggests he hasnt gotten out much since the 1970s. (Despite the presidents promise to bring jobs back to the United States, technology has caused massive upheaval in the manufacturing industry. Labor-intensive manufacturing is rapidly disappearing from communities like Erie and economists say traditional factory jobs are not coming back.) Hes pushing for jobs in a sector of the economy that employees a declining segment of the workforce:

Economists say that automation is by far the biggest factor behind the decline in manufacturing jobs across the country. Technological advances mean that fewer factory workers are required to maintain the same level of output.

Since 2001, roughly one-in-three manufacturing jobs have been lost in Erie, but manufacturing output has remained relatively steady. Manufacturing represented 28 percent of Eries GDP in 2001. In 2015, it was 26 percent.

This pattern holds true across the country, according to Mark Muro, the director of policy at the Metropolitan Policy Program at the Brookings Institute. Today, it only takes six workers to generate $1 million in manufacturing output, says Muro. The same level of output would have required 25 workers in 1980.

Republicans are paying a price for cocooning themselves in the Fox News fact-free bubble and vilifying cities where some of the most dynamic parts of the economy are based. While they accuse elites of being out of touch, the GOP climate-change deniers and non-college-educated voters especially those who reside in poorer, rural and small-town America are increasingly oblivious to the world outside their ideological bubble. Rather than level with voters, their GOP representatives cater to their ignorance and mislead them about the state of science and of our economy.

The more out of touch these voters become, the more they come to resent and distrust people who tell them facts contrary to their isolated world view. (Dont call us ignorant!) They elect people equally clueless, or willing to feign cluelessness. Even educated right-wing pundits resort to ad hominem attacks on Hollywood stars, meaningless buzzwords (a raw deal!) and flat-out untruths about the Paris deal rather than addressing the facts. The If you cant convince them, join them attitude seems to have infected conservative outlets terrified of losing readers/listeners.

So, the gap between those participating in the 21st-century economy and those hiding from it gets wider and wider; the politics of the latter group gets less and less grounded in reality. The result is counterproductive policy decisions and tribal politics with Trump leading the race to the bottom.

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Rip Van Winkle Republicans - The Washington Post - Washington Post (blog)