• Peggy Noonan’s telling anecdote

    I know I should just stay away from the WSJ, but I can’t help myself. This time it’s a post by Peggy Noonan, “The High Cost of Obamacare“. I’m going to ignore her discussion of the rodeo clown incident and focus on her issue du jour with the Affordable Care Act:

    But back to health care. The piece I linked to, by Yuxing Zheng of the Oregonian, makes quick work of a complicated subject. A woman in Cornelius, Ore., takes care of her disabled 22-year-old daughter. The daughter has cerebral palsy, spina bifida and a condition called automonic dysreflexia. She requires 24-hour care. The mother provides it, receiving for this $1,400 a month. The mother fears—and is apparently right to fear—a provision of the Affordable Care Act that will, as Zheng reports, “largely prohibit guardians from serving as the paid caregiver of an adult child with developmental disabilities.” The mother is afraid this will mean foster care for her daughter, or a lengthy and costly process in which she herself will be forced to transfer legal guardianship to someone else. The provision, the paper says, will likely cause hardship for hundreds of Oregon families in which the guardian and the caregiver are the same person.

    Most of the time, I try to avoid anecdotes when making arguments for or against policy. Opinion writers don’t. But in this case I have to admire the chutzpah Noonan shows. She’s pulled up a mother who is getting paid – by the government – to care for her child. She gets paid $1400 a month to provide services to her daughter.

    Let me say that again. The government is paying this mother to care for her daughter.

    Do I have a problem with this? Absolutely not. I doubt many supporters of the ACA do. But CMS does. Why? They’re afraid of fraud:

    The new federal provision aims to resolve a conflict of interest that arises when the guardian who helps develop an individual service plan hires herself or himself as the paid caregiver, which could lead to financial fraud. Oregon has allowed guardians to be paid caregivers for more than 10 years under various federal waivers, and a state official says she can’t recall a case where that arrangement was problematic.

    CMS is more cautious than Oregon. They are enforcing federal guidelines about conflicts of interest. Now this will create legitimate problems for some families in Oregon, especially single parent families, who have been paid to serve as caregivers for their adult children with profound disabilities.  I sympathize with every single one of them. So do lawmakers in Oregon, who are actively trying to fix the regulations.

    But let’s take a breather. Let me propose a thought experiment for you. Can you imagine if, as part of the Affordable Care Act, President Obama had proposed a new program to pay parents to stay at home and care for their children? Can you imagine the outrage that type of welfare would have sparked? I bet Peggy Noonan would have had a coronary. But in this universe, suddenly she’s championing this program.

    Let me propose another. Can you imagine if President Obama had proposed to eliminate this fraud prevention provision, and then the media had uncovered someone who was abusing it to collect a paycheck and stay at home with their child? Can you imagine the outrage? I bet Peggy Noonan would have screamed that all of Obamacare should be scrapped over this abuse. But in this universe, fraud prevention is harming families.

    So be it. But it’s telling where Noonan got her anecdote. It wasn’t from among the 560,000 people in Oregon who were uninsured in 2011 and will likely benefit from the ACA. It wasn’t from the 237,000 people in Oregon who are expected to buy a guarantee- issue and community-rated policy (many with subsidies!) on the exchange. It wasn’t from the 222,700 people in Oregon who will be newly eligible for Medicaid under the expansion. It wasn’t even from the 14,300 people in Oregon who are currently eligible for Medicaid but not getting it for some reason.

    No,  Noonan tells a story that she picked from the 455 families in Oregon who are going to need a legislative fix in order to keep getting paid to be caregivers for their adult disabled children. I bet they get that fix. Do you think she’ll talk about that legislative triumph if it occurs?

    She ends with four specific points, which I feel compelled to answer:

    First, no mother or child should be put in this position by a government ostensibly trying to improve their lives.

    I agree. So will she support legislation to make it easier for parents to choose to dedicate more time to their children instead of working? Let’s wait and see.

    Second, everyone in America knows health care is a complicated and complex subject, that a national bill will have 10 million moving parts, and that when a government far away—that would be Washington, D.C.—decides to take greater control of the nation’s health care it will likely get many, maybe a majority, of the moving parts wrong.

    Again, the anecdote is telling. She didn’t choose from the majority, or even the many. She went after a specific minority where things might go wrong instead of talking about the many, many things that might go right.

    Third, because health-care legislation is so complex, it is almost impossible for people to understand it, to get their arms around what may be a given bill’s inadequacies and structural flaws. Stories of those inadequacies and flaws dribble out day by day, in stories like this one. They produce a large negative blur, and a feeling of public anxiety: What will we find out tomorrow?

    Is she serious? She’s bemoaning the dribble of bad news stories – like the one she is writing right now – and how they make people afraid! Again – you have to respect the chutzpah.

    Fourth, when a thousand things have to be changed about a law to make it workable, some politician is going to stand up and say: “This was a noble effort in the right direction but let’s do the right thing and simplify everything, with a transparent and understandable plan: single payer.”

    If a politician does, I think we’ll have pieces like Peggy Noonan’s to thank.


    • Wow, chutzpah indeed. You were probably far too kind.

    • I don’t get the part where she says she could be forced to change the legal guardian or put her child in foster care. Surely CMS means to hire a professional to administer care, not keep the same care and change the guardian, right?

    • A splendid example of the disingenuousness coming from the Right these days.

    • Moving on from Noonan, there is something to saty about the issue itself. Among younger LTSS users with physical or developmental disabilities, there is a growing trend to want to direct their own services, meaning that they choose who their aides are, or what particular services they want, rather than having the state or some agency assess them and choose the service providers and the schedule. It’s about maximizing autonomy.

      I believe that few states allow legally responsible relatives (i.e. first degree relatives, like spouses, parents) to be paid caregivers in the first place. Especially true in the red states.

      There is some sound reasoning behind the statute. The statute prohibits the same entity from conducting a functional status assessment (which would determine how much assistance the beneficiary needs) and being a paid provider. There is definitely some fraud (not just improperly documented services, but actual fraud) in Medicaid related to personal care: timesheets can be faked to inflate hours of care delivered, functional status assessment can be faked, beneficiaries falsifying service records and then pocketing the checks, etc. The Office of the Inspector General believes this is a growing concern (link below).


      I think that there has to be some way this concern can be addressed outside of requiring a complete separation of legal guardianship and paid family caregiver roles. Perhaps periodic review by a court or some other entity. However, with the growing trend towards self-direction, we may run into further conflicts as this paradigm clashes with the traditional LTSS paradigm.

      The statute can be found here:

    • A pregnant woman with a fetus diagnosed with Down’s Syndrome (or another likewise serious) has the choice to abort or to carry to term, meaning the child will need expensive attention.

      The sensible woman might abort; another might accept the burden of carrying to term. I gran her the option. What I don’t grant her is the option to assess me, directly or indirectly through Obamacare, any costs involved in taking care of a Down’s Syndrome child.

      Otherwise, I would be called upon to support the Roman Catholic Church, among others, to support injury to a child and its mother, and to support a diminished society. Sounds like a call to arms!

      • I’m sorry, but your post doesn’t really make any sense. What does Obamacare or the Roman Catholic Church have to do with this? At the present time lots of people in similar situations are being aided by the government under existing laws.

        It’s called having a society. Or a civilization if you prefer. Some people will always need government support. That’s the whole point of having one.

    • Over the past 13 years – in EVERY state – a GOP led Congress has been consistently slashing all funding to states and state programs that support families with disabled children. Those kids who need 24/7 attn, care or supervision. The parents were allowed to bring their kids there and leave ( mostly for a job, some for time out) them for 4-6 hrs. It was their ONLY respite.

      These are parents who essentially DON’T HAVE A LIFE / A REAL CAREER TO PURSUE / NORMAL SOCIAL ACTIVITIES OR OUTLETS….outside of caring for their child…almost every waking moment. And now, given the benevolent concern of DC leadership, these programs are 92% NONexistent.

      So help me understand…………….receiving $16,800 a year (taxable or not..?) for the ability to 24/7 provide human grace / care for your child or now adult, as you have been doing this since birth – single parent and/or 2 person household ( one is utterly exhausted by the time the working one gets home…) – which is AT AND below, the Federal Poverty Level – – should never be an option for parents due to CMS’s ASSUMED?? fraud of funds received……..and CMS actually KNOWS that all 48 state’s providers can provide these personal care services for UNDER $1400 a month ( do the math: 21 days @ $66 p/day = $8.25 an hour for professional services received…..RIGHT !!?!! – their daily Risk / Malpractice Insurance costs are higher than that).

      And CMS thinks FRAUD might be involved for a parent doing 14 hr shifts – translating their efforts into $3.28 p/hour for all their efforts Vs their REAL desire which is to go out and have a career that paid them a minimum of $40K a year, before tax’s….???

      Then should we also factor in the above scenario – yet its a lesbian couple instead – who now not only have to go through this gut wrenching. poverty train life….yet have to face ( depending on their state laws ) the stigma of NOT getting ANY “married couples” rights and being totally discriminated against by virtue of visitation / inheritance rights if one of them were to get sick or even die? And that child might be taken away as they cannot prove legal guardianship by virtue of (NO) marriage rights?? This all becomes a VERY sick-beyond-hope societal condition.

      And Peggy Noondog could not possibly discern this piece of Dickensian abusive humanity, in her entire Op-Ed??

    • Hillary Clinton once said that if Barack Obama could walk on water, the Republicans would complain that he couldn’t swim.

    • Barack Obama can walk on water, he just chooses not to flaunt his god like powers because of his incredible modesty. How dare Peggy Noonan point out a problem with Obamacare (and by no means the only or worst problem), Everything Obama does is perfect and criticism is a crime against the state. Those 16,000 new IRS agents will soon silence thought criminals like Noonan .

    • Here is another “thought experiment”: Obama didn’t write, or suggest anything in the ACA.

      Insurance Lobbyists wrote the entire bill. From stem to stern, this is the Good Ship “Insurance CEO.”

      So, who do you think it favors? Or rather, is entirely written to benefit?

    • So-the fact that Noonan highlighted a “minority” group (“only” 455 families) to point out just ONE problem of the ACA delegitimizes this entire cohort? from just ONE state? Isn’t this the entire basis of many leftist arguments like your own? Support the little guy as noone from the establishment ever stands up for them? Ah yes- now you’re a “Greater good” proponent who somehow has found every republican argument along those lines so offensive over the last 10 years precisely because it makes your EXACT argument here!!!

      There will no doubt be many more foibles to tell as ACA grows into an ever larger leviathan, gobbling up more resources and stories, likely with very different outcomes than intended by those who created it, or perceived by people (like you) who support it, but hey, as long as we can point to the majority who we assume are helped by it, F everyone else…It’s a win..

      Disgraceful post

      • The likelihood of a legislative fix is great. Tweaking is part of the legislative process.

        The coverage afforded by Obamacare is so substantial in the lives of many millions that circumstances needing addressing should and most likely will be done in Oregon, a progressive state.

        We can’t expect an intransigent Congress in Washington to bring that kind of common sense to the rollout of the healthcare law which has suffered more from noxious propaganda powered by hundreds of millions of dollars than from actual flaws in the law.

        Good read. Thx, Aaron.

    • As long as Noonan helps to support single payer she can write whatever else she wants. Sure Obamacare is a leviathan and he sold out the left to get it. But it will be better than what he had before for many people (nothing), and there is always fine-tuning involved in anything complex.

      Peggy’s piece is concern trolling at its finest. She doesn’t care about this woman and her daughter in Oregon. For her and Saint Ronnie, such a family should be on the street in some Dickensian horror story, not sucking up valuable resources from “hard-working” rich people. The last piece Peggy Noonan writes in her life will be a great day for me.