Writings and observations

This is from a report by the Oregon Health Care Association, about a Portland State University study which shows needs of Oregon seniors have risen while Medicaid reimbursement rates decreased in community-based care settings.

The number of Oregon seniors who depend on Medicaid has risen considerably since 2008, but the Legislature’s funding of reimbursement rates for services has declined in the same time period, according to a new report by Portland State University’s Institute on Aging.

The report – “Oregon Community-Based Care: Resident and Community Characteristics” – offers a unique look at Oregon’s long-term care landscape, and includes data from 243 community-based care (residential care and assisted living communities) providers across the state. Findings indicate the proportion of Oregon seniors who depend on Medicaid to afford care has risen by ten percent since 2008, but Medicaid reimbursement rates have decreased by three percent when adjusted for inflation.

“The findings from this study fill an important gap in our understanding of Oregon’s senior population, staff and caregivers, and community-based care settings as a whole,” said Paula Carder, PhD, Associate Professor, Portland State University Institute on Aging. “The demand for community-based care is expected to increase as our population ages, and we hope this report will be used to inform policy decisions that ultimately improve the lives of aging Oregonians.”

The report indicated that nearly half (47%) of all residents in community-based care settings have some form of dementia, including Alzheimer’s disease. This staggering figure represents a five percent increase from 2008 in the number of seniors with dementia living in community-based care settings, and points to higher overall acuity rates and service needs among Oregon seniors. According to a 2010 report by the Alzheimer’s Association, the number of Oregonians with Alzheimer’s disease is expected to double by 2025.

In March, the Oregon Health Care Association released data that shows more than 31,000 low-income seniors in Oregon depend on Medicaid reimbursements to afford care each month, but Medicaid rates have not kept pace with rising costs. In state after state, studies demonstrate that investments in long term care for low-income seniors ultimately improve health outcomes by allowing providers to offer better quality care. A 2011 study showed that states that increased Medicaid reimbursements the most improved quality outcomes for low-income seniors in long term care settings.

Commissioned by the Department of Human Services (DHS), the report was a collaboration between DHS, Portland State University Institute on Aging, the Oregon Health Care Association, SEIU, and LeadingAge Oregon.

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Reading

Leonard Pitts has a strong blast at social conservatism out today that ought to generate some discussion. (He makes the point that he’s not talking here about small-government, fiscal or foreign policy conservatism.) By way of description, he notes, “Always, social conservatism defined “them” as something faceless and frightening against which the rest of “us” must struggle with everything we had, or else be overrun. It is an ideology that has contributed virtually nothing of value to the life of the nation – unless you count mindless panic as a good thing.” And he points out polling showing that for the first time since such polling has been done, as many Americans now call themselves social liberals as social conservatives – when the polling was first done, in the 90s, the sc side outnumbers the lc side about two to one. He wrote, “Gallup’s numbers suggest more Americans are seeing through this con job, this appeal to their basest selves. They suggest the GOP, held in willing thrall to this dead-end thinking for years, may now have a chance to break free.” The polling has been pretty clear on this for a while, and the next few elections may tell quite a story.

About the Washington state second special session: What we have here is a failure to compromise. No new facts are needed; a little bit of give is. The call of a third would be cause for serious complaint.

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First Take

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As the seemingly endless chatter about how “sovereign” Idaho is continues, and another anniversary of statehood approaches, let’s look back on how it looked leading up to the moment of statehood.

You could say that Territorial Delegate Fred T. Dubois’ wire back to Boise, upon approval, to “Turn the Eagle loose!”, was more emblematic of his emotions than of what he had experienced along the way.

Idaho territory had already gone through, and narrowly evaded, a number of proposals to break it up and combine it with other jurisdictions. Idaho activists wanted to establish some legitimacy for their request, so they called for a constitutional convention to write a state constitution – which met, and drafted the constitution (albeit amended) Idaho still has. The convention had no legal authority to meet,not only because – unlike the four previous states to be admitted – Congress had not approved any such convention but also because the territorial legislature hadn’t done so either.

The convention did take care to say, in the third section of the first article, that “The state of Idaho is an inseparable part of the American Union, and the Constitution of the United States is the supreme law of the land.”

The legitimacy of the convention was only a minor problem in Congress, where a resolution approving statehood had to pass both the House and Senate. Democrats, though in the minority, were not eager to admit Idaho, since that would mean yet another Republican state (as everyone knew Idaho would be), especially after recently admitting the Republican Dakotas, Montana and Washington (as it was then).

The Idaho bills – more than one of them – reached consideration point early in 1890, at a critical juncture. Congress’ action was sure to turn on a case before the U.S. Supreme Court, Davis v. Beason. Samuel Davis was a Mormon who had voted after taking the “test oath” – a territorial law requirement that the voter not adhere to certain principles of the Church of Jesus Christ of Latter Day Saints – and was charged and convicted of perjury. Davis’ case before the Supreme Court was based on the idea that the test oath was unconstitutional.

Dubois, the Idaho territorial delegation who spearheaded the statehood effort, wrote to an ally in Idaho that “If their decision is adverse, of course we are done . . . I shall not ask for statehood unless we can keep the Mormons out of our politics.”

When the Supreme Court ruled against Davis, in favor of the Test Oath, the bills began to move through Congress, but amid raucous debate, a lot of it having to do with Mormons. Then a fierce debate erupted over “free silver” (a coinage question that would become much more intense in the coming decade). After anti-climactic floor votes, the admission bill was signed by President Benjamin Harrison on July 3.

Conditions were attached. For example, 3.5 million acres of the new state specifically were set aside to be used as an education endowment, and the use of them was closely regulated. The subject of how to use those Idaho lands has been back in Congress from time to time, notably in 1998 when then-Representative Mike Crapo proposed a loosening of the rules.

If it’s an immaculate sovereign conception anyone is looking for, Idaho’s isn’t it.

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Idaho Idaho column Stapilus

I wondered what the acronym for BASE, as in BASE jumping, was. Turns out it refers to the places from which you would be able to jump: a building, antenna, span, or Earth. It is highly dangerous, without doubt, far more than skyjumping. Twin Falls, with its high Perrine Bridge to the immediate north, has become a favored spot, and people have died. Local officials have become concerned, as they should be, and have been trying to get a handle on the situation. Today, however, front-page news reports around Idaho highlight a BASE community (if that’s what it is) that seems to be looking toward spreading out, moving to more widespread and less regulated locations. Is that better than having them do their thing in one place? No easy answers here.

Traditionally, the line not crossed by most political people who were on the pro-life side of the abortion was to call for bans on abortion in the case of rape and incest. There’s political reason for that; while many of the time-related decisions about abortion deeply split the American public, abortion in the case of rape and incest does not, in a meaningful way: About 70% favor allowing it in those cases. In Wisconsin, likely presidential candidate Governor Scott Walker has said he will sign a bill banning abortion in the 20th week – which in itself will be controversial but likely not overwhelmingly so – even in cases of rape or incest, which may be another matter. (A 20-week bill recently passed by the U.S. House did include those exceptions.) For decades now the pro-choice public (as opposed to the activists) have been the proverbial frog in the pot of water brought to a slow boil, never quite hitting the peice of legislation or administrative action that rouses them to action. Might this one be it, when signed into law by a presidential candidate? Keep a close look.

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Larry Kenck, who has been Idaho state Democratic chair for about three years, is departing for health reasons. Personable but also fair quick with sharp responses to Republicans, he’s been a sound enough leader for the Idaho Democrats, but if he’s found a way to make a dent in the overwhelming Republican machine in the state, it isn’t visible yet. Not that it seems to have impinged his efforts, but – will the party go for a Boise-based chair next time?

What, Gandhi less than a saint? A contributor even now, more than 60 years after his death, to the enduring bitterness and conflict between India and Pakistan? An insightful piece in Foreign Policy today gets too exactly that, in compelling fashion. India’s population, while majority Hindu, long has included a large minority of Muslims, but in the runup to independence Gandhi and the pro-indepedence Congress group he fostered was dominated by Hindus, and he countenanced a number of anti-Muslim efforts and rulings. Muslims feared that with independence (even once Pakistan was broken off from India) that Hindus would overwhelm the new country’s power structure, and Muslims would be sidelined at best. Gandhi spoke repeatedly in favor of religious pluralism, but his approach to the independence movement was heavily grounded in Hinduism, and he made no secret of it. Critics (including no less than Leo Tolstoy) blasted Gandhi back in the day for mixing religion into the pro-independence movements. A piece well worth reading.

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First Take