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Health

Moody’s: Refusing Medicaid Expansion Will ‘Put Pressure’ On State And Hospital Credit Ratings

Investor services and credit rating agency Moody’s has some news for GOP governors hesitant to expand their state Medicaid programs under Obamacare: either hospitals in states refusing the expansion, or the states themselves, will feel pressure on their credit ratings due to higher uncompensated care costs and cash-strapped budgets.

In a press release regarding a new Moody’s report on Medicaid expansion, the agency explains that refusing the expansion would by necessity force one of these institutions or the other to lose out — since the resulting increase in the ranks of uninsured, low-income Americans would put fiscal strains on safety net hospitals or the state at large. As Nicole Johnson, a Senior Vice President at Moody’s, explained, “States that opt out of Medicaid expansion will have to choose whether to compensate for the shortfalls with their own funds or leave hospitals to absorb the costs, which will increase rating pressure on the hospitals. States that choose to fund uncompensated care costs themselves could face budgetary strain.”

As the press release notes, refusing to expand Medicaid would significantly increase uncompensated care costs for hospitals that cater to low-income Americans because Obamacare institutes deep cuts to reimbursements made to these “disproportionate share hospitals,” or DSHs. This is because lawmakers originally expected the expansion to be mandatory for all states, thus lowering the need for DSH payments — but the Supreme Court ruled that provision to be optional, instead.

Moody’s has consistently argued that Obamacare is a good deal for hospitals and states. In fact, before the Supreme Court had issued its ruling on Obamacare, Moody’s released a statement saying that “the best possible outcome from the Supreme Court would be a full confirmation of the law” because that would be “credit neutral.” They also warned that possible hits to credit ratings would not just be limited to safety net hospitals, because, “With fewer people covered by healthcare insurance, for-profit hospitals will face increased bad-debt exposure and reduced reimbursement rates.”

Now, in their latest report, the agency asserts that the negative effects of refusing to expand Medicaid “will be greatest in states that opt out of Medicaid expansion, but have a relatively high proportion of uninsured residents.” That describes many states led by GOP governors, who have recently been coming to embrace the expansion after intense lobbying by advocates for the poor and hospital associations that are concerned about these very uncompensated care costs. But many of these GOP governors face an uphill battle against members of their own party when it comes to expanding Medicaid.

Alyssa

How to Fix the MPAA Rating System After the ‘Bully’ R-Rating Fiasco

After the MPAA refused to change the rating on Bully, a documentary about the impact of vicious anti-gay harassment on teenagers, from an R to a PG-13, Harvey Weinstein, whose company is releasing Bully, has suggested that it might be time for him to depart the MPAA. Weinstein is a showman par excellence, and I wouldn’t be surprised if he’s using the ratings system as a way of bringing attention to the movie. But he’s also correct that the ratings system isn’t working to truly get people the information they need to make decisions about what movies their children should see, and in setting standards for which content children absolutely shouldn’t be able to see without their parents present.

First, we need to move beyond the contradictory ideas that ratings simultaneously need to be responsive to community standards, and that they also should be consistent over time. It’s much more important that ratings be responsive to contemporary community standards, broadly defined, than it is that they be consistent from the onset of the ratings system until the present day. If we were still abiding by the standards of the 1947 People v. Wepplo decision that declared material obscene ” “if it has a substantial tendency to deprave or corrupt its readers by inciting lascivious thoughts or arousing lustful desire,” most American popular entertainment couldn’t be marketed or made at all.

More importantly, the American public as a whole isn’t actually served by holding on to certain old standards. A significant majority of Americans believe that gay couples should at least be able to get the legal protections of civil unions, and we’re edging towards a majority of Americans supporting equal marriage rights. It doesn’t serve the interests of that majority to treat depictions of sexual contact between gay couples differently than depictions of those same acts between straight couples—it serves a minority who are resistant to the consensus that the rest of the country has reached about the normalization of gay couples.

It also doesn’t particularly serve the public interest to have the only grounds for a movie to be moved from R to PG-13 even if the profanity it in would normally trigger an R rating is if “based on a special vote by a two-thirds majority, the Raters feel that most American parents would believe that a PG-13 rating is appropriate because of the context or manner in which the words are used or because the use of those words in the motion picture is inconspicuous.” That doesn’t leave any room for precisely what Bully is trying to accomplish: illustrate that certain language is the opposite of inconspicuous, that it’s pernicious, and damaging, and that it can take lives. One would hope that most American parents believe that it’s a worthy goal to communicate to their teenagers that harassing their peers to the point of suicide is horrendous and a message that doesn’t have to—and in fact shouldn’t—wait until children are of age.

We need a ratings system that more clearly breaks down the reasons parents might find a movie unsuitable for their children, and that provides some sort of context for tagging a movie with those elements. I’ve long thought it might make sense to have a universal ratings system that applies across popular media so parents don’t struggle with the different, and not particularly analogous, systems that are used to label music, movies, television, and video games. And while I don’t think it’s perfect, the television ratings system that appears before programming begins and breaks ratings down into discrete and clear elements seems to me to be the one that provides parents with most information. Parents expose their kids to different things at different rates—I might let my kids hear mild curse words before I let them see Darth Vader cut Luke’s hand off—and they should be given information consistent with that. It’s very, very difficult to reconcile efficiency in label with the goal of providing as much context as possible to parents, but we need more than a single tiny box with several letters in it to truly serve the needs of communities and individual families.

Linda Holmes raises a vital point about Bully that illustrates the difficulty of getting a ratings system right. In theory, it would be good for every student to see a movie about the worst consequences of bullying and harassment with an adult who can help talk through its lessons, be that teacher or parent. But there are also students who may be struggling dreadfully with these issues who might not be safe seeing the movie with a parent or teacher because those people are among their tormenters. We live in a day and age when teachers can use the platforms they have to make life harder for gay students, and when gay teenagers have disturbingly high homelessness rates because their parents are not always supportive. When the ratings system is based around parental decision-making rather than an impossible-to-reach standard of audience wellbeing, it’s going to flounder in cases this one.

Economy

Cantor Cites S&P In Anti-Tax Screed, Ignores S&P’s Blasting Of Republican Tax Policy

When the credit rating agency Standard & Poors downgraded the U.S. from AAA to AA+, it pointed to both the use of the nation’s debt ceiling as a political football and the GOP’s complete intransigence on taxes as justification for the drop. As National Journal put it the day that S&P handed down its decision, “It’s hard to read the S&P analysis as anything other than a blast at Republicans.”

Since then, Republicans have desperately tried to spin the downgrade in order to pin the blame for it on President Obama. Rep. Michele Bachmann (R-MN), for instance, said that S&P “essentially proved me right,” even though she was one of the premier “default deniers,” whose very existence S&P said contributed to the downgrade. Last week, as Political Correction’s Alan Pyke noted, Speaker John Boehner (R-OH) and House Majority Leader Eric Cantor (R-VA) quoted S&P in a USA Today op-ed “to support their claim that the downgrade was ‘a clarion call to get America’s fiscal house in order’ rather than the penalty for their party’s shameless politicization of the debt ceiling.”

Cantor is back at it in a Washington Post op-ed today, first pointing to S&P to criticize the Obama administration, and then blasting the administration for proposing new revenues:

Since taking office, [Obama] has added trillions to the debt, ignored the recommendations of his own fiscal commission and put forth a budget that failed to address the drivers of our debt. Then we had to drag him to the table to make even the modest spending cuts that Standard & Poor’s says don’t go far enough. [...]

But the politics of division have reared up, fueled by efforts to incite class warfare. For example, though he often talks about millionaires, billionaires and corporate jet owners paying their “fair share,” behind closed doors the president admits to wanting to raise taxes on individuals making $200,000 per year and families and small businesses earning $250,000 per year.

Why does the president insist on higher taxes? Behind the rhetoric lies a desire to permanently increase the size of government — a philosophy that most Americans, who already think the government is trying to do too much — do not agree with. For the past few years, investors, families and businesses small and large have felt the threat of higher taxes, increased regulations and government expansion.

Of course, even a cursory look at the S&P report reveals that the agency agrees with Obama and the Democrats when it comes to taxation. “The majority of Republicans in Congress continue to resist any measure that would raise revenues,” the report says, noting with dismay that “new revenues have dropped down on the menu of policy options.”

Cantor has already acknowledged S&P’s warning regarding taxes, but has urged his GOP colleagues to ignore it. Evidently his part in this bit of theater is repeatedly citing S&P while continuing to advocate the policies that led S&P’s to issue its downgrade in the first place.

On a separate note, President Obama’s pledge to let the Bush tax cuts expire for those households making more than $250,000 annually was one of his highest profile campaign promises, which he has repeatedly cited over the last two and a half years. How does this qualify as a position that he only admits “behind closed doors”?

Economy

Grassley Calls S&P Downgrade A ‘Wake-Up Call’ To ‘Reduce Deficit Spending,’ Then Admits He Hasn’t Read The Report

ThinkProgress filed this report from the Iowa State Fair in Des Moines, IA.

After one of the three credit ratings agencies, S&P, downgraded the United States’ creditworthiness from AAA to AA+ in large part because of extreme GOP intransigence on raising revenue, Republicans were quick to try to deflect blame onto the Democrats. GOP presidential candidate Mitt Romney singled out the White House, saying “Standard & Poor’s rating downgrade is a deeply troubling indicator of our country’s decline under President Obama.”

Sen. Chuck Grassley (R-IA) piled on the following day, calling S&P’s move a “wake-up call for Congress and the President to take meaningful action to reduce deficit spending and the resulting debt.”

ThinkProgress spoke with Grassley at the Iowa State Fair on Thursday to get his further thoughts on S&P’s criticism of Republican stubbornness. However, before we were able to ask the Iowa senator about S&P’s recommendations regarding our nation’s fiscal dilemma, Grassley made a startling revelation: he has not even read the report.

KEYES: Did you get a chance to read the S&P report?

GRASSLEY: It’s a wakeup call…

KEYES: Did you read the report they released on it?

GRASSLEY: No, I did not, because it came out as I was leaving. I was out here, you know, so I don’t have a copy of the report.

The report is five pages long. It was released a full week ago. And despite Grassley’s assertion that he was “out here [in Iowa] so I don’t have a copy of the report,” it’s available free on the Internet for anyone to read, Iowans included.

Still, Grassley didn’t let the fact that he hadn’t read the report stop him from making broad generalizations about what our plan of action needs to be going forward.

With the revelation that Grassley, the Ranking Member of the Senate Judiciary Committee, didn’t even read S&P’s short report explaining why it decided to downgrade the United States’ creditworthiness before commenting on it, one has to ask: how many other members of Congress haven’t read the report?

Economy

The Downgrade Trifecta: S&P Slams Third GOP Debt Stance For Jeopardizing U.S. Credit

Since the Standard & Poor’s (S&P) agency lopped one “A” off the U.S.’s AAA credit for the first time, Republican politicians and pundits have been quick to blast the White House for the downgrade. Labeling it “Obama’s downgrade,” GOP lawmakers like Rep. Michele Bachmann (MN) blamed Obama’s “failed economic policies” as the root cause. House Speaker John Boehner (R-OH) insisted that he “warned the President that his plan didn’t cut spending enough but he didn’t listen.” House Budget Committee Chairman Paul Ryan (R-WI) even viewed the downgrade as “a vindication of [the GOP's] actions.”

S&P, however, takes the exact opposite view. In fact, the credit agency cited almost every stance the GOP took during the debt ceiling debacle as a reason for the downgrade.

Tax Increases: During debt negotiations, Republicans obstinately refused to even consider tax increases as part of the deal. On the day S&P announced the downgrade, the agency repeatedly slammed “the majority of Republicans in Congress” for continuing “to resist any measure that would raise revenues,” which, it complained, seems to be a priority that has “dropped down on the menu of policy options.” Contrary to GOP delusion, S&P indicated that it would improve the U.S.’s credit rating if “the 2001 and 2003 tax cuts for high earners lapse from 2013 onwards, as the Administration is advocating.”

Balanced Budget Amendment: Though considered one of “the worst ideas in Washington,” Republicans are continuing their efforts to pass a balanced budget constitutional amendment (BBA) and even suggested that the downgrade would not have happened, or would be reversed, if a BBA were passed. S&P head John Chambers, however, publicly denounced the idea and indicated that a BBA would hurt, not help, the U.S’s creditworthiness. “We think that fiscal rules like these just diminish the flexibility of the government to respond,” he said, adding that S&P would question a BBA’s “credibility.”

Default Denial: Despite a deluge of warnings from numerous economists and experts, several Republican “default deniers” simply did not believe that failing to raise the debt ceiling would result in negative economic consequences. “The case has not been made that this is an absolute necessity,” said Rep. Bill Huizenga (R-MI). “I don’t think it’s going to have an adverse on the economy” or “be disruptive to the economy per se,” said now-supercommittee member Sen. Pat Toomey (R-PA). Yesterday, S&P senior director Joydeep Mukherji noted that this level of skepticism about “the serious consequences of a credit default” was yet another reason for the downgrade. “That a country even has such voices, albeit a minority, is something notable,” he said. “This kind of rhetoric is not common amongst AAA sovereigns.”

That the downgrade is a result of this Tea Party trifecta has forced many Republicans to do what they do often: ignore the facts. Responding to S&P’s default denial charge, Rep. Tom McClintock (R-CA) insisted that “no one said [default] would be acceptable.” And, as is her fashion, Bachmann completely disregarded the facts last night in the Iowa GOP debate. “Standard & Poor’s essentially proved me right,” she said.

Economy

Bachmann Claims ‘S&P Essentially Proved Me Right’ — S&P Really Disagrees

Last night, during both the GOP presidential primary debate and a post-debate interview with Fox News’ Sean Hannity, Rep. Michele Bachmann (R-MN) claimed that S&P’s downgrade of the United States creditworthiness vindicated her position that the debt ceiling should not have been raised. “Standard & Poor’s essentially proved me right,” she told Hannity, after telling the debate audience that the S&P downgrade came about because the agency said “we don’t have an ability to repay our debt”:

We just heard from Standard & Poor’s, when they dropped our credit rating and what they said is we don’t have an ability to repay our debt. That’s what the final word was from them. I was proved right in my position. We should not have raised the debt ceiling.

Watch it:

After this performance, it’s blatantly clear that Bachmann has no idea what S&P said, because just about every word out of her mouth regarding the agency’s decision was incorrect. For starters, S&P never said “we don’t have an ability to pay our debt.” After all, the agency still rates the U.S. as AA+, meaning it has a “very strong capacity to meet financial commitments.” One S&P analyst characterized the difference between AA+ and AAA as just “degrees of excellence.”

Furthermore, the reasons that S&P issued the downgrade — as it clearly laid out in its release on the subject — were the use of the debt ceiling as a political football and GOP intransigence on taxes. As National Journal put it, “It’s hard to read the S&P analysis as anything other than a blast at Republicans.”

A Standard & Poor’s director added one more justification to the mix yesterday, saying “that one reason the United States lost its triple-A credit rating was that several lawmakers expressed skepticism about the serious consequences of a credit default”:

Without specifically mentioning Republicans, S&P senior director Joydeep Mukherji said the stability and effectiveness of American political institutions were undermined by the fact that “people in the political arena were even talking about a potential default,” Mukherji said.

“That a country even has such voices, albeit a minority, is something notable,” he added. “This kind of rhetoric is not common amongst AAA sovereigns.”

Of course, one of those people expressing skepticism about the severe consequences of not raising the debt ceiling was none other than Michele Bachmann.

Economy

Romney Repeatedly Dodges Questions About Raising Taxes To Boost Massachusetts’ Credit Rating

ThinkProgress filed this report from the Iowa State Fair in Des Moines, Iowa

When Standard & Poor’s announced its downgrade of the United States’ credit rating last week, former Massachusetts Gov. Mitt Romney’s (R) presidential campaign seized the opportunity to remind voters that while he was governor, S&P raised his state’s credit rating.

“When I was governor, S&P rewarded Massachusetts with a credit rating upgrade for our sound fiscal management and the underlying strength of our economy,” Romney said in a statement. “That didn’t happen by accident. The president’s failure to put the nation’s fiscal and economic house in order has caused a massive loss of confidence that resulted in an embarrassing downgrade.”

What Romney failed to mention, however, was that his administration persuaded S&P to boost that rating by providing evidence that Romney had increased government revenues by about $1 billion, as Politico’s Ben Smith reported Wednesday.

At the Iowa State Fair today, multiple reporters attempted to ask him about the report after he finished his speech to voters. Romney, however, refused to answer any questions, ignoring S&P-related questions from both ThinkProgress and CNN. At one point, Romney stopped to explain that he would only take questions at pre-scheduled media availabilities, the last of which was held before Politico’s report was published Wednesday:

ROMNEY: If you’d like to answer questions, I’ll be happy to answer at one of my press availabilities.

Watch it:

Romney reiterated that he would not raise taxes if he was elected president. But by dodging the questions, Romney refused to address the fact that taxes did increase on his watch, and that Massachusetts earned its upgrade by taking the balanced approach to spending and revenues Republicans — including Romney — now oppose.

Economy

Boehner Claims S&P Downgrade Happened Because Democrats Blocked The GOP’s Attempt To Eliminate Medicare

Ever since the credit rating agency S&P downgraded U.S. credit to AA+ on Friday night, Republicans have desperately trying to pin the blame on President Obama, even though, as National Journal put it, “it’s hard to read the S&P analysis as anything other than a blast at Republicans.” S&P called out the GOP for using the debt ceiling as a political football and for its flat refusal to consider new revenue as part of any plan to reduce long-term deficits.

Earlier this week Rep. Allen West (R-FL) claimed that the S&P downgrade “has nothing to do with increasing revenues,” while some Republicans have said that passing a Balanced Budget Amendment would have prevented the downgrade, both of which S&P disagreed with. House Speaker John Boehner (R-OH) yesterday jumped into the same pool, saying that the downgrade could have been avoided if only Democrats had embraced the House Republican budget and its plan to eliminate Medicare:

House Speaker John Boehner (R-Ohio) blamed President Obama and the Democrats Tuesday for the recent downgrading of the U.S. credit rating, saying that if Democrats had joined with Republicans in passing the GOP budget, which the House passed in April, “it’s unlikely anyone would be talking about the United States being downgraded today.” [...]

“S&P said in its own report Friday that entitlement reform is the key to long-term financial stability. We passed a budget through the House in April that includes entitlement reform, and cuts more than $6 trillion. The Democrat-controlled Senate and President Obama have prevented most of those reforms from happening. And that’s why we have a downgrade,” Boehner said in an excerpt of his prepared remarks obtained by The Hill. [...]

“The President and the Democratic leadership in Washington are trying to blame the tea party, because they know this downgrade is on [the Democrats]. When we took the bold step of proposing entitlement reforms, they reacted not by embracing them and joining us, but by demonizing those proposals for political gain,” Boehner said.

While the S&P release announcing the downgrade does say that containing costs in Medicare is key to long-term fiscal sustainability, it also explicitly says that the fact that “new revenues have dropped down on the menu of policy options” was a justification for the downgrade. Nowhere does it say that wholesale voucherizing of Medicare is in any way a preferable policy.

S&P also noted that “compared with previous projections, our revised base case scenario now assumes that the 2001 and 2003 tax cuts, due to expire by the end of 2012, remain in place. We have changed our assumption on this because the majority of Republicans in Congress continue to resist any measure that would raise revenues, a position we believe Congress reinforced by passing the act.” But for Boehner, the downgrade is not reason for reexamining the GOP’s intransigence on taxes, but occasion for doubling down on its plan to end Medicare and throw seniors into the individual health insurance market.

Economy

Allen West Claims S&P Downgrade ‘Has Nothing To Do With Increasing Revenues’ — S&P Disagrees

Tea Party Rep. Allen West (R-FL) blamed Standard & Poor’s downgrade of U.S. debt squarely on Democrats, saying this morning on Fox and Friends that “they are the ones that are totally to blame.” West added that the downgrade “has nothing to do with increasing revenues by tax hikes,” saying only spending mattered. Watch it:

This is likely news to S&P, as they said revenues had everything to do with their decision. If West had bothered to read and accurately present the rating agency’s explanation for its move, he would see they repeatedly expressed concern about the lack of revenues in the debt ceiling deal and Republicans’ stated refusal to raise revenues in the future. For example:

We have changed our assumption on this because the majority of Republicans in Congress continue to resist any measure that would raise revenues, a position we believe Congress reinforced by passing the act.

West went on to feign some outrage against Sen. John Kerry (D-MA), calling his comments labeling S&P’s move the “Tea Party downgrade” as “the most insidious thing I’ve ever heard.” West has apparently led a very pleasant life if that’s the most insidious thing he’s ever heard — though his dishonesty might be worse.

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