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You are here: Home / Anderson On Health Insurance / Migration, Medicaid and block grants

Migration, Medicaid and block grants

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Block grants that are fully funded transfer risks from the federal government which has the deepest and most comprehensive ability to cheaply eat risk due to its ability to borrow and its ability to spread risk across 330 million people to individual states that are severely constrained in their ability to borrow in a crisis.  The block grants in Cassidy-Graham are not fully funded so it is a cost shift as well as a risk shift to the states.  A new risk to state fiscal capacity in a CG world is happening now:

Hurricane Maria wrecked Puerto Rico:

There is talk about a potential large scale migration from Puerto Rico:

over the next several months, “the combination of the financial crisis, the health-care crisis and now these two natural disasters, it’s a recipe for a lot of people to feel that they’re hopeless and they need to come to the [mainland] United States,” said Rep. Nydia M. Velázquez (D-N.Y.), whose Brooklyn-area district has a significant Puerto Rican constituency. Velasquez, who is awaiting news about family members on the island, warned that if legislation addressing the economic problems isn’t coupled with federal hurricane relief , “we’re going to have an unprecedented number of people who will continue to leave the island.”

If Medicaid, Medicaid Expansion and Exchange funding is block granted based on 2014-2017 expenditures and a state receives a significant external population shock like a large migration from Puerto Rico, the number of people who need assistance paying for their healthcare will increase without a concurrent increase in resources.  According to Wikipedia, nine states had a higher proportion of residents with ties to Puerto Rico than the US national average.  These nine states have 72% of the Puerto Rican population in the states.   All nine of these states are net cash flow losers under Cassidy-Graham even without an immigration shock.

 

 

 

 

 

Reader Interactions

41Comments

  3. 3.

    Elizabelle

    Interesting. They will be arriving in time for the 2020 census. They could make a lot of difference on the political front.

    From the WaPost article David linked:

    In Congress, Puerto Rico is represented by Jenniffer González-Colón, a nonvoting member who caucuses with Republicans. Her aides couldn’t immediately say Thursday what she is doing to push for federal relief. In addition to Velázquez and Soto, several other Puerto Ricans serve in Congress: Reps. Luis Gutierrez (D-Ill.), Raúl R. Labrador (R-Idaho) and José E. Serrano (D-N.Y.).

    Caucuses with the Republicans? What the hell is up with that?

  4. 4.

    Mnemosyne

    I wouldn’t be surprised to see an influx from the US Virgin Islands as well, though migration to the mainland is (IIRC) somewhat less common.

  5. 5.

    Mnemosyne

    @Elizabelle:

    I may need to look up that IL representative who’s of Puerto Rican descent. We started having an influx of people moving to the Chicago suburbs when I was in junior high in the early 80s. I may know people he knows.

  6. 6.

    TenguPhule

    If Medicaid, Medicaid Expansion and Exchange funding is block granted based on 2014-2017 expenditures and a state receives a significant external population shock like a large migration from Puerto Rico, the number of people who need assistance paying for their healthcare will increase without a concurrent increase in resources.

    Feature, not a bug.

    Republicans can’t enjoy wealth unless those with darker skins are suffering because of it.

  9. 9.

    Duane

    In so many ways, GC is a disaster looking to happen. A runaway train speeding towards a burning landfill, while the schoolchildren watch.

  11. 11.

    Peale

    @Elizabelle: In the midst of the debt crisis in Puerto Rico, it came out that the wife of the former commissioner who caucused with the Democrats, had a business that profited from the sale of bonds and that his net worth had gone up considerably since becoming a congressman. Yeah, it seems that even in Puerto Rico, Democrats get punished by Democratic voters for a whiff of corruption that when done by Republicans, only serves to increase their margins of victory.

  12. 12.

    geg6

    @rikyrah:

    This.

    In regards to Puerto Rico, I’m FB friends with a former student who is originally from Puerto Rico but is currently working as a paralegal and attending law school in DC. She has been frantic the past few days because her whole family is on the island and she hadn’t heard anything at all about them. Finally, today they got in touch. They are all fine, a bit battered and a lot flooded, but alive and mostly well. They were wading to the opposite side of the island to see if her grandmother, who was also alive, could be persuaded to go back to San Juan with them so they could be all together. So relieved for her.

  13. 13.

    TenguPhule

    @Duane:

    A runaway train speeding towards a burning landfill, while the schoolchildren watch.

    But they’re watching from the inside.

  15. 15.

    Peale

    @Mnemosyne: Yeah, but that’s only a few ten thousands. The entire population of the USVI could move to Miami and no one would notice. Maybe there would be a Little St. Croix neighborhood named in Queens somewhere, but its not the same scale as PR. The population of USVI could probably fit into a college football stadium.

  18. 18.

    Elizabelle

    @Duane: And it’s Texas. The landfill and dangers and a school right near by? That train got to be in Texas.

    Between West, Texas and Houston (we don’t need no stinking zoning codes), I think municipal planning is going to get new respect in the Lone Star State. Object lessons in why we have it.

    FWIW, I wonder if the some of the Houstonians whose homes flooded have any recourses against the developers who were required to build drainage features and retention ponds, and did not. I have seen a lot of complaining that earlier suburbs were flooded because of the new development.

  19. 19.

    Elizabelle

    @geg6: To my knowledge, no. And I think a frontpager or others would be talking about it.

    Come out, come out, Betty in Dominica.

    I bet her electricity or internet is still out or too sketchy. I hope she’s OK.

  21. 21.

    tobie

    @rikyrah: Any reason for hating Gutierrez? I’ve always had a soft spot for his brash NY style. He reminds of an Anthony Weiner with a lot more smarts and discipline.

  23. 23.

    dnfree

    Excellent point. By the same token, states that experienced an outflow of residents presumably wouldn’t lose money, either.

  24. 24.

    randy khan

    There are many reasons block grants are problematic. This is only one of them, but it’s a doozy. (In the case of Graham-Cassidy, they’re also less than the money previously made available, so it’s a double whammy, particularly for Medicaid expansion states.)

    It’s hard to predict exactly what impact a Puerto Rican migration would have, but you’d have to expect it to be most significant in states with significant Puerto Rican populations already. According to Wiikipedia, 4 of the top 25 communities are in New York, with New York City at the top of the whole list. There are 3 in Pennsylvania, headed by #2 Philadelphia, 4 in New Jersey, 3 in Massachusetts, 5 in Connecticut, 3 in Florida, and 1 each in Illinois (Chicago, #3 on the list), Ohio, and Wisconsin. New York City has about 1/6 of the total, and New York State as a whole has about 23 percent, followed by Florida with about 18 percent. Probably Florida and Pennsylvania are the only states with existing large populations that could be tipped with a big migration, but it also could affect allocation of Congressional seats to states like New York, New Jersey, Massachusetts, and Pennsylvania that might otherwise lose seats after the next census.

  28. 28.

    Patricia Kayden

    Photos show extent of Hurricane Maria’s devastation in Puerto Rico. Such a beautiful island. I really hope they can rebound from all of their problems. Ditto the other Caribbean islands that have been damaged by the hurricanes we’ve seen lately.

  29. 29.

    Elizabelle

    Breaking news about a breaking dam. WaPost:

    70,000 in Puerto Rico urged to evacuate immediately as dam is in ‘imminent’ danger of failure

    SAN JUAN, PUERTO RICO — Tens of thousands of people in northwestern Puerto Rico were ordered to evacuate Friday afternoon after floodwaters from Hurricane Maria damaged the Guajataca Dam, which the National Weather Service said is in “imminent” danger of failing.

    The dam, built by the Army Corps of Engineers in 1929, suffered damage to its “structural integrity,” Gov. Ricardo Rosselló said in a news conference Friday. An estimated 70,000 people in the municipalities of Quebradillas, Isabela and part of San Sebastien could be affected if the dam collapses, he said. A failure would likely send a massive amount of water from an inland lake along the Guajataca River, which flows north through coastal communities toward the ocean.

  32. 32.

    dmsilev

    @debbie: Last I heard, the on-campus wingnut group which invited him hadn’t actually forked over the required deposit to rent out the venues that they were planning on using. That’s probably the real reason for the issues.

  37. 37.

    ? ?? Goku (aka The Hope of the Universe) ? ?

    @Mnemosyne:
    People like this scare me more than Milo:
    https://www.splcenter.org/fighting-hate/extremist-files/group/traditionalist-worker-party

    EXTREMIST GROUP INFO:
    Date Founded 2015
    Location Cincinnati, Ohio
    Ideology White Nationalist
    In Its Own Words

    “Now is not the time for unity. It’s not the time for love. It’s a time for disunity and for hate. It’s time to hate the migrant communities harboring this lethal threat. It’s time to hate the (((oligarchs))) who create those communities. And if there’s any hate in your heart remaining, invest it in the fools who are smiling and clapping along with the need for more ‘unity,’ ‘inclusion,’ and ‘love’ in the face of this existential threat to our nations, our peoples, and our future generations.”

    —Matthew Parrott on Traditional Youth Network, 2016, using the triple parentheses or “echoes” favored by anti-Semites to indicate Jews

    “When critical thinkers are shown what to look for, they become anti-semites in due time despite themselves, as Jewish subversion of the West is too pervasive and consistently hostile and destructive to remain objective about for long.”

    —Matthew Parrott, Traditionalist Youth Network, 2016

    “The plan of mass purging citizens would be insane to implement but perhaps one that might cross the mind of an economist or elite politician looking at the balance books and realizing that multicultural America is headed down the path of the Roman Empire.”

    —Matthew Heimbach, Traditionalist Youth Network, 2016

    “Statistically speaking, the myth of Blacks being targeted by law enforcement is untenable. In fact, if there’s a reckless disregard for human life and culture of violence to be found, it’s to be found in America’s Black community.”

    —Matthew Heimbach, Traditionalist Youth Network, 2016

    “Homosexuality is universally taboo because it’s dangerous, dysfunctional, and degenerate. It’s not a healthy part of a balanced civilization. Homosexuality’s like shingles, always lingering in the background but only flaring up into a real problem when a civilization’s somehow weakened or decrepit.”

    —Matthew Parrott, Traditionalist Youth Network, 2016

    Background

    In 2013, Matthew Heimbach — a young rising star in the white supremacist world who had led the White Student Union at Towson University in Maryland — joined with Matthew Parrott to found a white nationalist group they dubbed the Traditionalist Youth Network (TYN). Featuring a blog and a podcast, the group’s mission was “to provide resources and support to independent groups of high school and college students throughout North America who are learning about the Traditionalist School of thought” — a reference to an ideology that calls for a return to “traditional” values, including the central claim that nations should be racially and culturally homogenous. Heimbach and Parrot went on, in 2015, to create the Traditionalist Worker Party (TWP) as the political wing of the TYN.

    The TWP’s goal, according to a platform statement on its website, is this: “While we have candidates for political office and will run campaigns, that work is secondary to our first priority, which is local organizing and advocacy for real-life working families who share our identitarian and traditionalist vision.” (Identitarianism is a closely related ideology that emerged in recent years in Europe.) The group uses the slogan “Local solutions to the globalist problem,” a reference to the idea that globalization, the knitting together of nations and national economies throughout the developed world, is destroying racially homogenous communities and nations.

    The TWP/TYN is part and parcel of the American “Alternative Right,” an umbrella term for a racist ideology that scorns mainstream conservatism and argues that white people and white culture in America are under threat from the forces of political correctness and multiculturalism. It is also “traditionalist” and “identitarian.”

    The group’s version of “traditionalism” has its roots in the “radical traditionalism” espoused by mid-20th century Italian “philosopher” Julius Evola, a fascist thinker who believed that Jews were to blame for the modern materialism and democracy that he thought subverted the natural order of the world. The TWP website includes the group’s definition of traditionalism: “Traditionalism, properly applied, makes us as autonomous and self-governing as possible in relation to the modernist societies that we live in.” It defines traditions as “positive cultural interactions that have existed over a long period of time” and says “those traditions have existed for a long time, because they work. They have formed European-American mores.” The traditionalist ideology sees adherence to those “mores” as the best way to organize society, and argues that a traditionalist lifestyle can successfully supplant the state, since “the family is the natural enemy of the state.”

    “Identitarianism” refers to a movement that emerged in recent years in France that advocates for culturally and ethnically homogenous communities and blames liberals for selling out their country. Generation Identitaire, the youth wing of the anti-immigrant Bloc Identitaire movement in France, is known for its racist and xenophobic anti-Muslim stunts, like serving soups containing pork in Muslim neighborhoods. The ideology has its roots in the European New Right, or Nouvelle Droite, founded by French academic Alain de Benoist, who advocated against melting-pot societies and immigration while claiming to oppose biological racism.

    The TWP positions itself as being in favor of diversity — what it terms “ethnopluralism.” But what it means by that word is a diversity of nations around the globe that are each racially and culturally homogenous. In a section on its website defining the term, it says that “ethnopluralists argue that the liberal multiculturalism is false, as it promotes a melting pot which leads to the disappearance of ethnicities, cultures or races through miscegenation and therefore is in fact monoculturalism.” TWP is against racial intermarriage, no surprise given its platform statements.

    The “Folk” section of the TWP platform puts the group’s white nationalist views, and associated anti-immigrant vitriol, clearly on display. It says that communities should be able to determine their own “religious and ethnic character” without government interference, that American 14th Amendment birthright citizenship should be revoked, and that the borders should be secured with National Guard troops. One platform plank, “Stop Discrimination Against Whites,” claims that “our government is stacking the deck against White families,” and says that TWP “opposes all racial quotas in education, hiring, and government contracts.”

    Heimbach himself is an Orthodox Christian, and the TWP has a clear Christian bent (it claims to want to end “anti-Christian degeneracy”). This is a departure from European Identitarian ideology, which is less focused on Christianity. In the “Faith” section of its platform, the TWP calls for “religious freedom,” but this translates to advocating for discrimination in the name of religion: “If a business owner’s conscience compels him to serve one customer instead of another or refuse to sell a particular product, then the state should not interfere.” The “Family” section of the TWP’s platform also promotes a definition of marriage that is molded by “clergy and local tradition,” takes a strict anti-abortion stance, and advocates for “traditional” gender roles, with women staying home to care for children if possible. The TWP’s anti-gay stance has at times has led to conflict with others on the alt-right who want to include white gay people in the movement. When Heimbach wasn’t invited to the white nationalist National Policy Institute’s fall 2015 conference, it was rumored that it was because of his anti-gay views. (National Policy Institute leader Richard Spencer has waffled on the issue of LGBT inclusion to avoid alienating potential supporters on either side of that issue.)

    The TWP is blatantly anti-Semitic. In part of its “Folk” section, subtitled “Regulate Foreign Lobbies,” it airs the ancient “dual loyalty” claim about Jews: “The State of Israel has a large and powerful Jewish population in America, many of whom are more loyal to Israel than they are to America.” The theory that Jews are not fully loyal to the U.S. is a common anti-Semitic trope and is also demonstrably false. In an April 2012 poll by the Public Religion Research Institute, just 4% of Jews said a candidate’s stance on Israel determined their vote. By contrast, a 2015 poll by Bloomberg Politics found that 58% of born-again Christians said they would support Israel even when it went against American interests. So-called “Christian Zionists” support Israel because they believe it is a key player in the biblical End Times.

  38. 38.

    J R in WV

    Milo is a total piece of pig excrement. As a farmer (retired) I can tell you nothing is as bas a pig crap. Chicken crap is stronger, but it’s a pure ammonia thing. Pig excrement is just terrible, even in small doses.

    That is what this guy is, walking, talking pig crap.

    I saw his discussion about having sex with young guys. Despicable. He tried to talk around it, without really confessing, but failed utterly. What a loser.

  39. 39.

    J R in WV

    Obviously, Heimbach is also a walking, mumbling piece of pig excrement. Hadn’t run across him before, will keep my eyes peeled, we need to watch out for this kind of thing. So Un-American !!

  40. 40.

    Matt McIrvin

    I’m sure the people who only dislike illegal immigrants will be fine with a massive migration of native-born scrupulously-legal US citizens from Puerto Rico, right?

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