“You want a drink?”
Jabe raised his head from the counter and flinched, seeing Charlie’s chubby round face so close to his.
“Get away from me,” Jabe said. “Like waking into a bad dream.”
“All I asked is if you wanted a drink,” Charlie said. He stood up and adjusted a strap on his overalls. Jabe fingered the twenty dollar bill in his pocket. He pulled the wadded green bill out and spread it on the table.
“Need a pint of Grandad,” he muttered and moved a shock of hair from his eye. Charlie stepped over to the table and snatched up the money with a suspicious eye toward Jabe.
“It’s good,” the boy said quickly.
Charlie shrugged his shoulders then plodded through a swinging door to the back room. He reappeared moments later with a fifth in his hand. “This is all I got, Jabe. You think your daddy would mind?”
“How much more is it?”
“Three or four bucks. You need anything else?”
“Nothing I want to pay for. I was wondering, though, um, you know that insulation you been using in your house. You done using it?”
Charlie snatched a rag off a hook at the end of the liquor shelves and wiped his hands. “I still got a few more feet to lay yet. Check the dumpster in a couple of days. I won’t try to keep people’s hands off it, Jabe, so I’d keep a watch for it if I were you.”
Jabe nodded. He lifted the whiskey bottle, enjoyed the heft of it in his hands, and allowed himself a moment to admire the rich caramel colour in the daylight. He laughed a bit as he slid the bottle into the inside pocket of his coat.
“People going to think I’m some kind of drunk,” Jabe said. “Daddy’s going to be glad to see this. He’ll be able to make a real hot toddy before he goes to bed tonight.”
“How is the old man?” Charlie asked.
“Older,” Jabe replied. He began to push his feet against the floor feeling the way the boards sagged. A slick of hair dangled just above Jabe’s eye, making a shadow in his vision. He tried brushing it aside, but it fell back until, finally, Jabe gave up. “You’ll never believe what he’s thinking about doing.”
“I don’t know. Work here a few weekends and you hear some strange ideas.”
“Well, you know how he gets when he’s thinking about doing something,” Jabe scratched his nose and sneezed. “Well, about noon today he comes in to the house all excited. Says he’s going to have us raise cattle.”
“Doesn’t sound like a bad idea to me, Jabe. Reckon if there’s anyone who can make a go of something like that, it’d be your daddy.”
“He’s crazy, Charlie. It’ll go just the same way as all the other things we done. He just… He don’t see the way things are.”
“He doesn’t, huh,” Charlie said.
“The difference between him and me is I’m more practical. I got common sense. Daddy’s got it too, sometimes, but then all of a sudden — boom. Off he goes on some crazy project. I tell you, if it weren’t for me keeping his feet on the ground.” Jabe shrugged.
Charlie rolled the twenty around his index finger and smiled. “Yeah, well, you tell him we miss him down here.” He rang up the sale and counted out Jabe’s change.
“By the way, Charlie, you know where I could get my hands on some barbed wire?”
“Barbed wire?”
“Fences for the cattle, Charlie.”
Charlie grabbed a plastic cup from beneath the bar, went to the spigot and poured himself a beer. “You tried up at the Carpenter’s house?”
“I need better than that. I was hoping to get some that was like … almost new.”
“You want to scrounge new barbed wire?”
Jabe thought about the barbed wire, about his dad’s idea to raise cattle. “No. It’s just my dad, you know. He wants it for the cattle. Wouldn’t do me no good. About that insulation — Ms. Multhous needs something to keep in the heat this winter. She’s going to need it bad.”
“I’ll do what I can, Jabe.”
Jabe nodded. “Appreciate it.”

Jabe kicked at large rocks as he scuffled across Charlie’s empty gravel parking lot. He looked across Buckner’s Creek, taking in the soft smell of rotted pumpkin from Otter Manley’s garden on the hill. Otter’s old trailer seemed to be leaning to the left toward the steep embankment. Place was going to end up in pieces all over Lumberton Station road if he didn’t do anything about it.
There had been a rain last night. Jabe wondered if old Otter had managed to stay dry. He’d tried to fix Otter’s roof a couple of times, but he’d told Otter to consider moving. Baling wire was the only thing standing between him and disaster. Stubborn old man.
Why do old folks always have to be so damn stubborn? Otter was just like his old man and this cattle farming business.
“It’s six Black Angus, Jabe. Five cows and a bull the man wants to sell. All we got to have is the land Jabe. He done told me. I’m telling you, son, we can make this go.”
We can make this go. His dad’s words played over and over in Jabe’s mind as he watched the swirling clouds of brown rainwater flow swiftly down the culvert, depositing bits of foil cigarette wrapping and wadded wax cups into the tall grass. Sunlight glinted off a bottle top, catching Jabe’s attention as it bobbed in the ripples and spun off hollow reeds. The current carried the cap along with effort as heavy droplets spattered its top, trying to force it down to the mud bottom.
Jabe lost sight of it at the Milner Creek bridge where the culvert cracked and split into several thin branches, like roots, leading downhill into the wide expanse of creek water below. He walked to the middle of the bridge and stopped to look over the concrete railing at the pile of driftwood and tree limbs which clogged the creek’s passage beneath the bridge. He stared down at the water for a long time, the bottle tucked tightly beneath his arm. He became aware of how painful it was, digging in his side.
Caught between the branches and the limbs, Jabe spied a rusted tin can spinning within a thick creme froth, caught in the continuous push of the current but blocked by the branches. He began scraping his tongue between his teeth, generating enough to spit. But the glob missed the can by several yards as it plopped in the water and dissolved.
Jabe was at the top of Mexico Road when an idea came to him. He removed the bottle from his jacket and looked at it in the full light. He was sorely tempted. While he thought about it, he picked at a corner of the label, wadding it, and popping it in his mouth to chew. He liked how the paper softened into a hard cottony ball and stuck in his teeth. Maybe later, he thought, and stuffed the bottle back in his coat.
Down along the ridge, under cover of the trees, Jabe slowed his pace. He was in no hurry to get home. Dotted in places beyond the embankment the rusted hulls of washing machines, box springs, and old refrigerators had become part of the landscape. They all seemed to somehow to fit among the oak and maple trunks. Just a few feet from him, Jabe noticed movement inside the round hole of an old front loading dryer, a corner of which was partially buried in the ground. Rooted.
A possum emerged from the hole, its sharp white snout and black pinhole eyes moving carefully back and forth, searching for a way out. He watched as the animal braced its forepaws against the rough, burnt orange metal and slid to the ground with a thump. A totally useless damn critter, Jabe thought, and they’re taking over the woods.
The possum snatched its head toward the voice and backed away as it noticed Jabe watching it. Back against the metal appliance, it bared its jagged teeth before shooting away into the forest. Jabe watched the leaves fly up behind the possum, noting how they cracked like they were on fire.
Ms. Multhous was standing outside her home, a chrome International camper, wielding a rake in one hand and a garden spade in the other. Jabe waved listlessly as he walked toward the trailer, jamming his hands in his jean pockets.
“I near froze last night, Jabe. The cold months ain’t but a little way off. Have you found anything yet?”
Jabe shook his head. “No ma’am, I haven’t. I been looking but there’s not a thing I seen thrown away yet.”
“Well fiddle,” she said as she laid the rake against the side of the house and sat down on the wrought iron step to her front door. The garden spade dangled in her hand as she thought. “Where have you been to see?”
“All over,” Jabe said with a shrug. “But it ain’t all bad news. I been talking to Charlie and he says there might be some in his dumpster later on. But he’s not going to hold it for me.”
“You told him who it was for, didn’t you?”
“Yes ma’am. But you know how it is. He don’t even know how much is going to be left when he gets done using it.” Jabe began to scuffle his feet against the ground, grinding it through the sandy dirt.
“Oh Jabe, sit a spell why don’t you. You won’t be late gettin’ home to your pa.”
Jabe felt a twinge in his gut, like a mousetrap closing, when she mentioned his old man. “I don’t know about that, Ms. Multhous. He said he got some work for me to do. He’s got this idea, y’know.”
Ms. Multhous patted the ground below her. “Hard. Even after that rainy spell we had last night. Still hard as brick. It’s going to be bad winter this year, Jabe, you wait and see. Kerosene is getting so high these days.” Ms Multhous turned and pointed the spade at Jabe. “You mark my word, Jabe Avery. It’s getting so a body can’t survive no more,” she said and jammed the point into the black peat around her flowers.
“Well things ain’t what they used to be, you know. Course old Mexico here never did have much.”
“Oh that’s not true, Jabe. Why when Laitie was alive, oh you just never seen the like of this old road. We had a farm stretched as far as the eye could see. You won’t believe me, Jabe. That’s just your way. But there was a time we had everything here…”
Jabe’s eyes glazed over as Ms. Multhous launched into her speech, the same one he heard time and again when he talked with her. It sounded pretty, all the roadside stores and the farms, all carefully groomed and orderly. She said that from the hillside, the fields all looked like quilt patches leading into Lumberton Station. Jabe tried to imagine what it all was like, the place that she described. There may have been a time once, he thought, but all he saw now was a clothesline across the road, five rabbits and two grey squirrels skinned, dangling upside down, bound to the line by their hind feet.
“Jabe,” he heard Ms. Multhous say softly. “You just wouldn’t believe it.”
“I guess not, ma’am.”
With a sigh, Jabe looked over at the bend. “I better be getting on, Ms. Multhous.”
“Don’t run off too soon now, Jabe.”
“I know, ma’am. But I don’t want to keep Dad waiting too long.”
“Oh, that reminds me. Now you wait one second.”
Ms. Multhous disappeared into the trailer and he heard the sounds of pans clatter and the low gasp of a freezer being opened and shut. Ms. Multhous appeared at the door carrying a sealed Cool Whip bowl and offered it to Jabe. “I meant to give you these last week. I know how your daddy likes squirrel brains, so I saved a few shells for him. I’d take them myself, but I ain’t as able as I used to be.”
Jabe opened the container and looked at the collection of skulls. “They fresh?”
“Why of course,” Ms. Multhous snapped. “You go on now. It won’t do to keep your pa waiting.”
As Jabe plodded around the bend deeper into Mexico Road he just barely heard Ms. Multhous call out to him. He turned and looked at her, so small in the distance, so far away. “Don’t forget that insulation,” he heard her say and he waved back.
Several miles from Ms. Multhous’ trailer, the brittle asphalt road gave up and disintegrated into small bits of gravel and broken glass. Jabe found a pair of jeans lying crumpled in a ditch at the side of the road. He held the pants up to his waist and wondered why people threw away such nice things — a perfectly good pair of pants. The zipper was bent and the top button was gone, but the belt line seemed about right. He tied the legs together and slung them around his neck then gathered his other items and continued on, noticing shadows beginning to meld together into a uniform bluish-gray.
At the end of a curve, Jabe left the dirt road to follow a path carved by water runoff up the hill. Sharp corners of exposed rock provided quick steps up the jagged pathway. It was a good shortcut. One he needed about now.
Just over a rise at the top of the hill, Jabe could see a thin column of smoke coming out from behind a maple grove. He could smell the fumes, the heady mixture of kerosene and leaves. He walked to the back door and pulled on the latch.
The heat in the kitchen took Jabe’s breath away. His dad was standing at the counter watching an iron skillet boil on a pot-bellied stove. The stove top was a very dim red. His daddy was standing over it, smiling.
“Surprise! Didn’t think the old man still had it in him to cook nothing, did you? Where have you been?”
“Charlie’s. You know, you didn’t have to start dinner. I’m on time.”
His dad stepped toward the pot, leaned in to smell it. “I don’t have to wait on you. I was cooking for myself long before you came along. This looks like it’s ready.”
“Dad!” Jabe yelled, but it was too late. His father lifted the pan off the stove, then dropped it, spilling the vegetable stew in the floor.
“Gad damn!” he hollered, his hand pressed tightly between his legs. Jabe ran to his father and knelt down to inspect the hand. The palm was chalk white save for one long red streak across the wrist. Jabe led his father to the kitchen stool in the corner and told him to stay there and wait while he filled a bucket with cold water. When he returned, Jabe also brought a pie pan which he had filled with kerosene.
“This coal oil will take the pain out. Leave it in there for a few minutes and then stick it in the bucket,” Jabe said.
His father began running his hand through the kerosene. “I think it’s going to blister.”
“You’re lucky. You might have lost that hand if you burned it too bad. Don’t know why you couldn’t wait for me anyhow. It isn’t even dark out yet.”
“Don’t you talk down to me, son,” Jabe’s father warned.
Jabe took out a dustpan and began scooping the vegetables and dropping them in a bucket for the chickens. His father watched from the stool, his face no longer drawn tightly as he swished his hand around in the cold water.
“See, I told you,” Jabe said, noticing how his father had calmed. “Feels better, don’t it.”
“Feels tight. Going to be sore in the morning. Why are you throwing away all my dinner?”
“Because it’s all ruined. Don’t worry, I’ll fix you something.”
“I ain’t worried. You get that fence like I told you?”
Jabe shook his head as he wrapped paper around his hands and stooped to pick up the skillet. “I went over to Charlie’s and looked around there, but he didn’t have none.”
“I didn’t tell you to scrounge it.”
“Don’t worry. There wasn’t any.” Jabe stepped quickly out the back door with the slop bucket, kicking at the chickens to get them away until he reached the compost heap near the window. He threw the whole mess down, bucket and all, then crossed his arms. He knew his dad was waiting, expected a big fight. He felt in his pocket for the whiskey bottle and was surprised to find it was gone. In all the commotion, he’d forgotten and set it out. Perfect. Now his dad would know what part of the money went for. He took a deep breath, then pushed open the kitchen door.
There was no reply. His father was no longer in the kitchen.
“Dad?” he whispered.
He entered the living room and saw his dad leaning against the front door, looking outside. The bottle was in his hand.
“Did you even try?”
Jabe struck a kitchen match and began lighting oil lamps. He refused to answer. There was no reason to fight about it. He just hadn’t gone. That was all. He heard his father sit in his rocking chair near the front door, heard him rattle through the container Ms. Multhous had sent.
“I can make you a little something to go with them squirrels, Dad” Jabe said.
His father stared out the front window.
“Make us some toddies, Jabe. Maybe I’ll eat something later.”
“I seen another damn possum today. Looks like it lives down the road from Ms. Multhous in one of those old machines down there,” Jabe said, holding a mug of hot toddy in both hands.
“Any young one’s with it?” Jabe’s dad asked tranquilly and sipped his drink. “Young possum ain’t bad, y’know.”
Jabe snickered. His father noticed and stopped rocking in his chair. “Tell me something, Jabe? You remember anything about what I said this morning?”
“Yeah. You was talking about raising cows.”
“That’s right. And I told you we needed fences, too. When I told you about that, did you see anything?”
Jabe ran his finger around the lip of his mug. “See?”
Jabe’s father looked down at the plastic bowl. It was empty.
“Nothing, son. Don’t worry about it.”

Jabe sat quietly in his chair listening to his father breathing evenly and calmly as he slumped in the rocker. Jabe had set his dad’s legs up on a stack of pillows and cautiously removed the half empty ceramic cup from the windowsill.
He yawned and stretched, looking about the room while smacking his lips. He took one more deep swallow straight from the bottle, screwed the cap back on and took it and the mug to the kitchen. Just as he pulled the cold room door open, he heard a scratching sound on the floor. He paused and listened. There came a sharp crinkling sound like leaves being crushed underfoot, but they weren’t coming from inside of the cabin. He walked to the back door and squatted down, slowly opening the door and stepping outside.
In the purple blackness he could see a figure crawling through the compost heap.
“Hey,” he spoke and saw the figure snatch up quickly, its eyes glowing flatly like two small pin heads. It bared its white teeth and hissed.
“Go on,” Jabe said, but the possum held its ground, opening its mouth wider and thrusting its head threateningly. Jabe and the possum held each other’s stare for a long while. Finally, Jabe turned and went back in the house. From the back window he watched the animal continue to paw the rubbish.
Jabe turned to the kerosene lamp, cupped his hand at the top of the glass and blew the light out.

Medicaid seen like wave of the Undead

By Josh Shepherd
Amid the advance planning that Kentucky’s employers are doing to comply with health insurance mandates going into effect on January 2014, there is only one big question mark remaining. Will Kentucky adopt Medicaid expansion? As of the end of February, the Kentucky Cabinet for Health and Family Services said Medicaid expansion is still on the table, but there has been no decision yet.
The Medicaid decision is one of the few facets of the Patient Protection and Affordable Care Act’s (ACA) health insurance mandates for which there is no hard deadline. When experts comment on the various strategies open to employers to comply with health insurance mandates before the January 2014 deadline, there is a lot of speculation, but little in the way of a concrete vision about what is going to happen.
Despite the ACA’s intention to provide medical coverage for 100 percent of the nation’s populace, states have been given some leeway to address how they want to work with Medicaid, a program expected to fill the hole for the nation’s uninsured.
Many states, including Kentucky, are wrestling with the question of how they want to extend Medicaid benefits and whether, in the long run, the program can sustain the influx of individuals and families whose incomes are at 133 percent of the federal poverty level. Jose Fernandez, Ph.D., assistant professor of Economics at the University of Louisville, is particularly interested in the answer to that question. According to projections from a number of sources, the extension could increase Kentucky’s Medicaid population by approximately 30 percent, said Dr. Fernandez.
Betsy Johnson, a partner in the law firm of Stites and Harbison and the former Commissioner of the Medicaid program in Kentucky, put an actual number to it. Under expansion, Kentucky could see well over 420,000 new Medicaid recipients.
But the expansion should not be all that alarming, Johnson argued. For the first two years, the federal government will subsidize 100 percent of the program’s cost. That subsidy is written into the Act, Johnson said. But the ACA also states that those subsidies will be reduced incrementally over the course of this decade. Even though subsidies will disappear by 2018, “I think Kentucky is leaning toward Medicaid expansion,” Johnson said.
Janet Craig, also a partner with Stites and Harbison, noted that many red states that opposed the ACA have said they are seriously considering adopting Medicaid expansion. “That includes Florida, where the expected Medicaid population increase would be larger than Kentucky,” Craig said.
Being able to afford the increased Medicaid population is just one issue. “If the objective is to provide everyone health care coverage, the expansion of Medicaid accomplishes that almost overnight. The fed is covering that cost, but eventually those credits go away and the state will still have to find ways to fund it,” Dr. Fernandez said.
But aside from the funding issue, Medicaid expansion has another potentially interesting side effect, particularly with some of Kentucky’s large group employers. For purposes of implementing the state’s Health Exchange program, discussed later in this article, Kentucky’s defines “large employers” as those companies with 51 or more employees. When the insurance mandates go into effect, those large employers must have in place a qualified and affordable health insurance benefit for their employees or they can face some stiff penalties. The health insurance package they offer must, at minimum, provide coverage for the 10 Essential Health Benefits as required by the ACA. The large employer must also provide a match on the cost of premiums such that the employee’s share of the premium does not exceed 9.5 percent of their household income.
However, for many of Kentucky’s largest employers, the wages they pay their employees would actually qualify them for the Medicaid expansion. “In Kentucky, if you are a company like, for example, Wal-Mart, then the majority of your full-time employees are minimum wage earners. They can offer a qualified health insurance benefit, but that benefit requires the employee to pay a portion of the premium as well as co-pays and deductibles. In that situation, it makes more sense from the employee’s perspective to enroll in Medicaid.
For minimum wage workers, the Medicaid option requires no out-of-pocket expenses, no co-pays or deductibles. Why wouldn’t a savvy low wage worker take advantage of that circumstance? Plus, the employer is not concerned about a penalty because they are meeting their obligation under the ACA. The employee has to be the person to opt out of the plan. But I don’t know if there are any controls to prevent that or even if it should be,” Dr. Fernandez said.
The penalty to large employers that offer no qualified health insurance by the deadline is $2,000 times the number of full-time equivalent employees. Those employers that offer a qualified plan but at premiums their employees cannot afford, the penalty is $3000 times the number of employees. For those companies that provide a qualified health care plan with affordable premiums and matches, then there is no penalty.
According to Dr. Fernandez, “Come 2014, the world will not change much for big firms that are already offering good health insurance packages. For others, the impact is going to depend a lot on what they have been doing in the past.”
In contrast to Dr. Fernandez point of view, though, Janet Craig said that the greatest amount of anxiety over the ACA is coming from large firms. Craig has made numerous presentations to business groups and associations about the ACA in order that they can better prepare to meet the requirements and deadlines on time.
“There are still a lot of concerns about additional costs for insurance plans in health care reform and they’re worried about the penalties,” Craig said. Many of the firms that she has addressed have enough employees to fall into the definition of large employer, but to keep health insurance costs low, they have joined with other businesses and, through their professional associations, leveraged purchasing power for their health insurance. Federal law, however, does not view an association as a large employer. So that option is likely to go away in 2014, Craig said.
Furthermore, the ACA also has penalties against so-called “Cadillac Plans” or high cost employer-sponsored health plans that provide higher coverage and higher premiums. “The ACA has a provision to levy a 40 percent excise tax on companies who provide health care plans whose premiums exceed $10,200 for individuals or $27,500 for families. These “Cadillac Plans” which provide higher coverage have been widely criticized because, it’s argued, these plans encourage overuse of medical care,” Craig said.
There are some potential end runs for large employers. For very large employers, there has been speculation that the penalty costs would wind up being less than the expense of providing health insurance, Craig said. There have also been questions about how FTEs are being calculated to determine whether a company qualifies as a large group or small group employer.
“Hiring only part-time people is not an escape from the mandates,” Craig said. “There is a formula that companies can apply if they have questions about that.” There are still some extant grey areas. There was not much information offered about requirements on companies that rely on temporary or seasonal employees. This is an area where individuals could slip through the system’s cracks, said Dr. Fernandez. But this is less of an issue when it comes to small group employers and their access to Kentucky’s Health Exchange program.
Kentucky is one of 16 states that are in the process of implementing its own Health Benefit Exchange program. The program is actually meant to help individuals meet the health insurance mandate. But Kentucky has taken the extra step of making this Exchange program available to small group employers. The idea about providing small group employers with the Exchange option is basically the same as companies purchasing health plans through an association.
The Exchange is designed to give small businesses the same buying power as larger employers. The process of developing and implementing the Health Exchange is already well on its way, said Carrie Banahan, Executive Director of the Kentucky Health Benefit Exchange. “We are on target to begin providing services by the October 2013 deadline. That is when we are scheduled to begin operations.”
Kentucky’s Health Benefit Exchange (HBE) program has been two years into development and this March, its progress will be reviewed by the federal Department of Health and Human Services.
In 2014, business with 2 – 50 employees can elect to provide health insurance coverage to their employees through the Exchange. By 2016, employers of 51-100 employees will have an option to use the exchange. Though a decision has not been made at this point, by 2017 Kentucky could exercise an option to invite large group employers to purchase health plans through the Exchange.
Banahan explained that the Exchange is really nothing more than a marketplace for basic health insurance plans. The benchmark plan upon which insurance companies must base their offerings is the Anthem PPO. Already, Banahan said, several qualified health plans have been submitted for the Exchange and all of the Kentucky-based insurance providers have submitted products, including Humana, United Healthcare, and Anthem among others.
The plans will be available at different “metal” levels: Bronze (which provides 60 percent coverage of costs), Silver (70 percent cost coverage), Gold (80 percent coverage), or Platinum (90 percent.) Small group employers who participate in the Exchange may review these plans and select one to make available to their employees, or they can even provide a mix of levels from which their employees can select.
The Exchange will also provide an on-line portal for purchasers to compare plans on an easy to understand “Apples-to-Apples” basis. They can compare prices, services, and ratings. The major incentive to small businesses to purchase their health insurance through the Exchange is a 50 percent federal tax credit. That credit is only available through the Exchange.
“This is probably one of the best things to come out of the ACA’S insurance mandates,” commented Janet Craig. “Small group employers are currently exempt from the penalties, but they still have to make their employees aware of plans available through the Exchange.”
The incentives to small businesses make participation in the Exchange particularly attractive. There have been critics who say that the ACA’s insurance mandates on business could result in job losses. Dr. Fernandez acknowledges that such a possibility exists. But there is another view that the efforts to make health care affordable for small employers and independent minded individuals could, theoretically, be more amenable to entrepreneurs.
Bottom line costs for running a business has always been an inhibitor to small businesses. It is not unreasonable to speculate that one of the long-term effects of the ACA is to provide a dis-incentive for large companies to add to their employee base through vertical integration. Rather, they might consider contracting out with smaller companies for supplies and services to keep their employee base small.
“There is nothing in the legislation that I can see having a detrimental effect on business entrepreneurship, whether in Kentucky or anywhere else. In fact, it may be to a company’s advantage to stay small and take advantage of what the Exchange can provide,” Dr. Fernandez said.